Map of life expectancy at birth from Global Education Project.

Friday, May 30, 2008


I'll do drugs and rock and roll later. So, as it turns out, no doubt much to your surprise, the whole subject of sex is very interesting. I would say, after a bit of rooting around in the wilds of biology, that the origin of sex is actually as big a puzzle as the origin of life, if not an even greater one. Creationists, in fact, are all over it - in their view, sex could not possibly have evolved, so there you go.

Biologists no only wonder about where sex came from, they wonder almost as much about why it has stuck around. However, I must say that even though I'm not a specialist in the subject, I don't find that puzzling at all. Maybe having a bit of distance makes it seem clearer. Understanding why sexual reproduction is so strongly maintained, and is so nearly ubiquitous among the eukaryotes and particularly the metazoa, is actually very helpful in thinking about how it got started, so let me begin with the easier question.

It seems, at first, that sexual reproduction is a big disadvantage. First of all, you have to find a mate, which requires luck and effort. Second, your own genes get diluted, so if evolution is about gene selection, that would seem a big strike against sexual reproduction. You have to invest in making gametes which has some energy cost, and the process of fusing gametes to make a zygote can fail - it often does, in fact - reducing your rate of reproduction. Sexual selection pressure can drive evolution in odd directions, such as making big showy tails that attract predators and slow you down, or investing a lot in unproductive behaviors. (Tell me about it.) And the close physical contact required for mating creates one more way for pathogens to get around. So why bother with the whole thing?

Imagine two lineages of similar creatures, one reproducing sexually, the other reproducing asexually. Both have to live with pathogens and parasites, most of which are asexually reproducing prokaryotes that have very fast generational turnover. The asexually reproducing lineage has almost no genetic diversity. Occasionally a random mutation will arise, which will probably kill the organism, though once in a while a mutation will be tolerable or even favorable and the mutated lineage will persist. Nevertheless, a mutation in one lineage can never get combined with a mutation in another; 100% of the animals are reproductively isolated. They don't mate and they don't mix their genes. If a pathogen evolves that can evade their immune systems, they're wiped out, extinct, so long, sayonara, good bye.

The sexually reproducing species, however, is genetically diverse. Harmless or favorable mutations that arise over time will eventually spread, in all possible mixtures, through the progeny. Some that might even be harmful if expressed survive because they are autosomal recessive. When the new pathogen comes along, it is likely that some of the individuals in the population will just happen to be resistant to it. They and their offspring will survive and go on to rebuild the population.

It gets even better than that because all that mixing and matching of genes creates all sorts of combinations that might just happen to be better than any one mutation by itself. A mutation that is harmful in the asexual lineage might just turn out to be favorable if paired with some other mutation, but the opportunity will only come along if there is sexual reproduction. In a nutshell, the sexually reproducing species can evolve faster, and create much more innovation. Hence it is no surprise that all complex, multicellular organisms reproduce sexually. If they didn't, they never would have developed such complexity, and that's why asexually reproducing organisms are all microscopic, one-celled creatures. Some multicellular organisms, notably plants, can also reproduce asexually, which is handy for producing lots of new individuals fast and covering a hillside with daffodils or whatever; but also having sexual reproduction gives them all the advantages noted above as well.

Now, as for how the whole thing got started, that's a tough one. Lots of speculation actually centers around infections and parasitism -- two organisms getting their genes all mixed up together and then having to sort them out and mix them up again every generation. Maybe that Y chromosome is all that's left of a parasite.

Anyway, I'm not going there because I don't know where I tread. But I do know that evolution is inventive, but also conservative. It can only work with what it's got, which is why we don't have three arms even though it might be useful, or an eye in back to see what's gaining on us. So we're a social species, with very complex social structures and behaviors, and there just happen to be two different kinds of us, since we reproduce sexually. Now, evolution does drive a certain amount of sexual dimorphism simply because of the reproductive function. Men and women have different parts because they have to. The equation of investment in offspring also differs between men and women, and there's nursing as well. But it would be surprising if other kinds of sexual differences, in capacities or behavior, that one way or another enhanced the success of the species didn't also emerge.

It was fashionable back in the 1970s and '80s to believe that the differences in gender roles were all socially determined, and that human societies were possible in which the only differences between men and women were the direct consequences of gestating and suckling. Now I think it's becoming clear that much about gender roles is indeed socially determined and is highly mutable, but some things are not. There are differences between male and female brains and behavioral proclivities -- statistical averages, not absolutes -- and proclivities for different patterns of mating behavior, attachment to children, etc. For a while, it wasn't really possible to study these matters, and trying to sort out what is culture and what is wiring was not even permitted. But now people are working on it, and I do believe this will help us to know ourselves better.

From here, it gets to be pretty tricky. Sensitivities, and dudgeon, are high.

And don't get me wrong: It's important to study these issues in part because we might just like the answers after all:

"The so-called gender gap in math skills seems to be at least partially correlated to environmental factors," says economist and study researcher Paola Sapienza, PhD of Northwestern University's Kellogg School of Management. "The gap doesn't exist in countries in which men and women have access to similar resources and opportunities."

Google Bomb

If you go down to the bottom of the side bar, you'll spot a few new links. Don't worry about it, just trying to help interested voters find solid information.

Thursday, May 29, 2008

Another Open Door Crashed Through

Gary Schwitzer in PLoS Medicine:

  • The daily delivery of news stories about new treatments, tests, products, and procedures may have a profound—and perhaps harmful—impact on health care consumers.
  • A US Web site project, (, modeled after similar efforts in Australia and Canada, evaluates and grades health news coverage, notifying journalists of their grades.
  • After almost two years and 500 stories, the project has found that journalists usually fail to discuss costs, the quality of the evidence, the existence of alternative options, and the absolute magnitude of potential benefits and harms.

Most health "journalists" base their stories on press releases from researchers, drug companies, and medical device manufacturers. They are caught up in the heroic mythology of medicine, and get all breathless and excited about dramatic breakthroughs and world changing advances. The fact is that medicine advances incrementally, and the vast majority of what happens on the cutting edge offers a little bit of benefit, and a lot of side effects and risks, for a lot of cost. True breakthroughs that offer a big ratio of benefit to risk at reasonable cost don't happen very often, and they generally can be seen only in hindsight, as the result of the accumulation of a lot of pieces of knowledge and technique.

The polio vaccine, which suddenly and cheaply eliminated a great scourge, provided an enduring template for how the culture views medical research. That was more than 50 years ago and I can't think offhand of anything comparable that has happened since then. (Correct me if I'm wrong. Vaccines for measles, mumps and so on are nice, but those diseases didn't compare to polio in their impact.) But reporters are still seeing its ghost.

Wednesday, May 28, 2008

We interrupt this blog for a brief rant

I'm still going to do the bit about sex (and I know every tummy is aflutter with anticipation), but I thought I'd throw up this excerpt from a bit of correspondence I sent to an economics commentator -- one who I believe will be sympathetic to it.

Economists love to claim that they are the most "scientific" of the social sciences, that sociologists and anthropologists are all soft and mushy and value laden, while economics is hard science like physics or chemistry. The principle basis for this claim, as far as I can tell, is a fondness for using mathematics -- which, by the way, sociologists do at least as much, although economists don't seem to know that.

Unfortunately, garbage in, garbage out. The process of economics is:

1) State a number of postulates, every one of which happens to be false, i.e., never holds in reality.*

2) Build an elaborate theory based on said falsehoods, mentioning in passing that oh, by the way, we'll go back in deal with the fundamental falsity of the whole thing later.

3) Forget what you said about the falsity of the postulates and start believing in the theory as a description of reality. And so now you've managed to bamboozle yourself.

4) When the theory manifestly fails to predict or explain, add epicycles, or better yet, just ignore your errors and carry on as though nothing happened. Oh, and by the way, go from the purported "is" of your theory to a wholly unjustified "ought." Even if the theory were correct, it does not show that markets produce just or moral outcomes -- but economists like to pretend that it does just because, well, just because.

It doesn't matter how fancy your math is, if the entities being differentiated and integrated aren't real, you're just playing with yourself.

Economics, as currently practiced, uses a ptolemaic universe. You are still waiting for your Copernicus. In the meantime, the reason the ptolemaic worldview persists so stubbornly is because it is extremely useful as an apologia for inequality, privilege, and the rapaciousness of powerful interests. That's why corporations endow highly paid chairs in economics, that's why economists have the ear of presidents and members of congress, and make policy, and that's why the corporate media channel their nonsense.

You are now saying, in essence, that reporters ought to know that economists are full of crap and stop believing them. I agree with you but this is a fairly radical statement coming from someone with a Ph.D. in the subject. And as I say, I think it's asking a lot of reporters to recognize that such a deep seated, near consensus illusion is wrong.

*I'm sure I don't need to enumerate them for you, but you know what I mean. There is no such thing as a transaction with no externalities, no such thing as perfect information, no such thing as no transaction costs, no such thing as rational choice or utility maximization, no such thing as perfect competition, and markets always fail to produce essential collective goods. Econometrics either ignores an enormous percentage of costs or treats them as profits, the essentiality of legal regimes and regulation to determining who has bargaining power is largely ignored, and on and on. When pressed, economists deal with some of these fundamental failures by adding epicycles, but as I say, it would be far more scientific to recognize that the theory is wrong in the first place, and to start by studying reality instead of just making shit up. That way, you might eventually get to a theory that is actually, you know, useful.

Tuesday, May 27, 2008

The downside of education

I'm working with a colleague to analyze some focus groups he conducted in which people talk about their communication with their physicians. I'm working mostly with the ones that were conducted in Spanish, but that's largely beside the point for this post. I'll give you my English translation of the material. We had two groups consisting of people who had a college education, and two groups consisting of people with limited formal education. The moderator asked them to explain what the term "depression" means to them. Here are typical reponses from the smarty-pants people with ejumukashin:

It is a mental state caused by stress or a traumatic event. It is a state of hopelessness.

It’s a very complicated term, you have to know a bit [lit. the dregs] of psychology in order to understand what is happening to you. At first I thought that depression had a biological component but now I know that it has a social component.

To sleep many hours, not to want to get up, to use a lot of drugs, not to respond to the stimuli of daily life.

It is an electro-chemical change in the levels of the neurotransmitter.

The levels of serotonin are lacking, serotonin levels that the brain does not produce.

And here's the sort of thing the unschooled rabble had to say:

Well for me it's that -- it's like I dont have the spirit to do anything, except to be seated, that nobody talk to me, that they don't say anything to me, to be thrown there in an armchair, and that nobody say anything to me.

Okay, often depression makes a person not want to get up out of bed, uh, it lowers the self esteem as though one were nothing. As though nobody likes one, uh, he/she doesn't want to eat, doesn't even want to bathe. I know people, including me at times I have gotten a very strong depression, such that I don't want to get out.

Depression is truly as they say, that one does not wish to go out, but to me I get it with leaving the house, because if I am at home I feel that I, that I am, that I drown. It pleases me to be accompanied, conversing with someone or to go out, you know. Because then if I stay at home I feel that it’s as though the walls are pressing in on me.

Well, it’s when a person has problems and stays quiet, doesn’t talk with anybody, every moment he feels worse and there are times that the physicians—one goes to the doctor and the medications don’t work, as happened to me once. I – they gave me the medicine but I didn’t benefit, I stopped going to the appointments and everything because the medicine didn’t do anything for me. And they if they give medicines to one and one adapts to those medicines. It drives one crazier. Because I saw when I was at the appointments now an old woman said, well she was an older lady but not so old, and she said, “Oh, I want my medicines because I can’t sleep without those medicines,” then what it does is that the people adapt to those medicines, you can’t quit them. One has to try to control oneself.

It’s good to go out to walk and converse with people. You are outside! You are conversing. Now I don’t go out much but we always used to go out, with her … one subject after another, we’d go there and . .. we always had a lot of friends around, you know? And so I don’t get depressed much.

I don't know about you, but I'd much rather have this discussion with the uneducated people. They respond with their lived experience, and the experience of their families and friends. The educated respondents give dictionary definitions and etiological theories, cold abstractions, and keep their distance from it all. I don't learn anything from them.

Monday, May 26, 2008

The Big Three

No, I'm not talking about Paul Pierce, Kevin Garnett and Ray Allen. These are three great mysteries that trouble the Enlightenment project -- the quest to understand the universe from the human perspective. These enduring mysteries are among the reasons so many people still cling to irrational beliefs and mysticism. In ascending order of philosophical profundity (in my personal ranking) they are:

The origin of life: This does not in fact present a philosophical challenge to scientific inquiry. It's just a puzzle. We can certainly solve it, in principle, using hard core positivist logic and standard tools of scientific inquiry. The bad news, potentially, is that it happened an awfully long time ago and we just might not ever get a definitive answer. There is a philosophical nugget in there, specifically that there are probably limits to knowledge, there just might be questions that seem very important to us that will always be questions. That may be annoying, or disappointing, but it's not a fundamental challenge to humanism.

Some people, however, feel otherwise, just intuitively. That life could originate without some sentient agent making it happen just seems improbable, or maybe just unsatisfying. Creationists often point to the origin of life as the weakest link in the story of evolution, and perhaps it is. But the fact is we do have a few plausible ideas about how it could have happened, even though we haven't been able to assemble all the pieces of a plausible model. Remember, it only has to happen once -- over millions of years, in the vast volume of the oceans, a single entity that reproduces, but imperfectly, has to occur. And we're off.

Why this universe? There are actually a few pieces of this problem, but they add up to one big one, which is essentially metaphysics. (Some people will say that number 3 -- wait for it -- is also part of metaphysics, and classically it has been, but in the modern formulation of inquiry I would say they are clearly separable.) Why is there anything at all? Why is there this universe instead of some other? And where did it come from, how did it originate? Physicists are busy describing the universe and elucidating its history, but these why and how questions are so far entirely elusive. One thing we have learned is that the facts do not correspond to the beliefs of any religion, so just making stuff up or depending on old fables written in forgotten languages doesn't work.

We know that the universe is bigger and older than the fables say, and that it will endure much further into the future, but it does seem to be temporally finite. We cannot say whether space is finite or not. That is not to say that something may not have existed before the beginning of this universe, from which it arose, and it also may well be that the universe we can observe is embedded in something larger in space as well as time. We just don't know.

As for the three questions within this question:

Why is there anything? Some people don't think that's a big problem. Why should existence be surprising? Of course something exists. Others think non-existence ought to be the default condition and existence requires an explanation. Anyway, religion is no help. If the universe exists because God so ordained, why does God exist?

Why this universe and not some other? One answer which seems plausible though speculative, is that there are many universes, perhaps infinitely many. We just happen to be in this one. In principle, it seems to me, it might be possible to demonstrate that somehow. Of course, by definition, if we could get access to another universe, it would no longer be another universe, but part or our own.

There are two other kinds of explanations. One is that there is something arbitrary about the universe. It just happens to be this way. If you're puzzled about why it just happens to be hospitable to us, that's easy: we're here in the first place because it is. If we were not possible, there might or might not be some other kind of entity contemplating the universe that actually did exist. Cosmologists are generally not happy with this answer because a universe that works essentially like ours, but has tiny differences in basic constants, would vanish in a flash or have no structure. This universe seems highly improbable.

Another kind of explanation is that there are fundamental constraints of logic, some sort of discoverable deep structure, that requires the universe to be as it is. This strikes me as circular.

Where did it come from?This is really no different from part 2, I think. If we could understand why it is as it is, we would probably understand how it began as well.

As before, religion is no help with any of this. If God decreed it all, where did God come from? And why does God want this and not something else? In other words, that's just listing the same questions, again, using a different vocabulary.

What and why is consciousness? This, to me, is the most philosophically challenging problem for science because it seems not to be susceptible to positivist inquiry. The philosophy of science requires that phenomena be mutually observable, that they happen "out there" where we all can see and verify them. But the only consciousness any of us can observe is our own. We can't even know, according to positivist principles, that any other entity is in fact conscious. Maybe I am the only conscious being in the universe. Maybe you think you are.

Neuroscientists have made steady progress in linking reported conscious experiences to observable phenomena in the brain. Quite likely this is possible absolutely, down to the finest-grained possible description of conscious experience. But even if the ghost and the machine can be shown to correspond completely, point by point, would that explain consciousness? To say that consciousness is an illusion is to beg the question. Consciousness is experience. To dismiss experience as illusion is nonsensical and explains nothing.

Consciousness, by its very nature, seems somehow to exist outside of the material universe, to be some other kind of stuff. It is this feeling that gives rise to the conviction some people have of a soul, an immaterial substance that persists after death. I must point out, however, that is far from an inevitable conclusion. Buddha Gautama concluded that the self is an illusion, arising from the temporary confluence of matter that makes the material body and dissolving with it.

Scientists would like to believe that all questions are ultimately susceptible to inquiry. That remains to be seen. However, I do insist that making up arbitrary answers, and believing in them on faith, is not a solution to these problems. Living with mystery may be hard for some people, but ultimately, it is even more rewarding.

Friday, May 23, 2008

Cancer's War on Us

Cancer is frightening, but it's also damn interesting. It's a very stark reminder of what we are, as metazoans, and that's something quite astonishing.

There are two major inventions that make us metazoa fundamentally different from all the other life forms except the plants and fungi (which are actually closely related to the metazoa). They can't really be separated, but I'm going to say that the most fundamental is the transfer of the reproductive capacity from the level of the cell, to the level of the organism. The second is the organism itself -- a colony of cells with identical genomes but which have many different patters of gene expression and hence constitute various tissues with differing functions, organized (and note the etymological link) into a complex structure.

In the other kingdoms of life, individual cells reproduce by division. Bacteria may form structures called biofilms. (Think of the slime that may adhere to the bottom of a sink strainer that hasn't been cleaned for a while.) These may even have some structure, and cells in different locations may even behave differently, but biofilms cannot reproduce themselves. Only the individual cells within them reproduce, and whether they end up forming a biofilm depends on whether they happen to encounter the right conditions.

Our cells, in contrast, have given up their individual rights. They reproduce only under rigidly constrained circumstances. If they suffer DNA damage, or happen to be in the wrong place at the wrong time, they even kill themselves. Evolution has favored these behaviors because they produce the best chance of the cell's DNA being passed on to another organism, or more precisely, that an identical copy of half of its DNA will be passed on, although this may occur multiple times. This may seem a sacrifice not worth making, but it is well worth it because it is only through sexual reproduction, relegated to specialized germ cells, that metazoan evolution can occur.

Cancer means that this system has broken down, that a cell and its progeny no longer obey the rules. What is remarkable is not that it happens, but that it doesn't happen more often. It only takes a single cell out of the trillion or so that make up you to become sociopathic, and you have cancer. On the other hand, with intelligent design, it would never happen.

The origin and evolution of the sexes is at the core of the evolution of complex organisms. I've been thinking about this a bit lately just because it's so damn fascinating. I'll be away from your Intertubes for a couple of days now but I'll have more to say about it on my return.

Thursday, May 22, 2008

Technical difficulties

Haloscan is messed up and it's making comments disappear. Believe me, I did not delete them. There were quite a few comments on previous posts which have vanished into cyberlimbo. I'll try to recover them. Meanwhile, please keep commenting and I trust everything will be fixed shortly.

War on Cancer

It seems the bad news Senator Kennedy got this week has caused a lot of focus on cancer in general. Before I add to that particular chatter, let me say a word or two about Ted Kennedy. I worked for Ralph Nader just after I graduated from college, and back then Kennedy was already a force in the Senate. He was also already overweight, in perpetual need of a haircut, and not exactly abstemious, and he stayed that way until just a few years ago. In 1994, when Mitt Romney ran against him for reelection and it looked like it might be close, a friend of mine said, "Well, I voted for the bloated, alcoholic murderer, and I'm sure glad I did." Yes, he didn't always display the greatest maturity, self discipline or courage in his personal life, but he knew that his privileges and his sinecure in the Senate were not earned, and that they conferred an obligation to everyone less fortunate, and particularly the most vulnerable. He spent his life as a drum major for justice.

So, cancer. Kennedy was instrumental in providing funding for the National Cancer Institute, and in particular in launching the National Cancer Institute's major effort to defeat cancer during the 1980s through 2000. However, during the Bush years NIH has undergone a steady decline in real resources. This is what Sen. Kennedy said on March 11, at a hearing of his Committee on Health, Education and Labor:

We cannot close our eyes to the consequences of continued failure to capitalize on the progress we have made in medicine in recent years. Thanks to thoughtful research and scholarship by a consortium of universities that includes many of our nation’s leading centers of innovation, we have before us a chilling statement of where our current budget policies for NIH will lead.

The report’s conclusions are a call to action for Congress and the nation. President Faust of Harvard, one of the authors of the report, will present the findings in more detail, but even a brief review of some of the major conclusions should shock those who hear them.

Due to inadequate funding, the success rate for grant applications has dropped from 32 percent in 1999 to 24 percent today. For young researchers, the situation is even more dire. Their success rate in applying for their first independent research grants has dropped from 29 percent in 1999 to 12 percent today. That means a young researcher has just one chance in eight of getting a grant.

As a result, the age at which a researcher gets his or her first independent research grant has risen from 39 years old in 1990 to 43 years old today. Many young scientists conclude that it’s not worth the wait, and pursue other career options. Even those scientists who do get funded are forced to spend more time writing grants and less time doing research at the bench. Many turn to industry jobs where they can benefit from funding security, despite losing the freedom to pursue academic research.

Tell me about it. Don't worry, I now have funding -- or at least I think so, I'll know for sure next week. But believe me, it's been a long hard struggle. NIH now says it's funding less than 20% of applications, but I am pretty sure it's a lot worse than that. I have colleagues who have gotten percentile scores of 13 or less, and ended up not funded at all, or with drastic budget cuts. And since NIH only scores half of all applications, a percentile score of 13 means you are in the top 6 or 7 percent of applications.

Now, this is not necessarily a factor of what we ought to be spending on biomedical and other health related research. The reason this happens is because the massive expansion of the NIH budget before 2000 created a whole lot of laboratories and a cohort of young researchers who are now seeking their own grants, only to run up against a cash cow that is slowly drying up. The demand for research dollars is driven by the supply of researchers, not necessarily the public interest. I don't know what the right amount of money is to be spending on biomedical research, but it definitely has a bigger payoff than occupying Iraq or eliminating the estate tax.

Progress in the so-called War on Cancer has been incremental and frustrating. We've learned a lot about the basic science of cancer, but the clinical payoff has mostly been in the form of expensive treatments with fairly limited benefits, with certain notable exceptions. We've certainly driven down the death rate from breast, colon, cervical and prostate cancer, through screening and good old fashioned slicing and dicing, but the magic bullet remains elusive. Sen. Kennedy stands to gain a few months of life from recent advances, probably no more than that.

Sure, we could get bigger bangs for the buck by fighting tobacco addiction around the world, and other basic public health measures. But that's not where the competition for the dollars lies. It's not as if money taken away from NIH is going to buy mosquito nets and condoms for Africans. And I have always said, along with the founders of Faber College, "Knowledge is Good." I trust that next year, Sen. Kennedy will be around to see NIH funding set back on a reasonable path of growth.

Wednesday, May 21, 2008


I essentially agree with Mr. G that Provigil doesn't really increase intelligence, it's actually a lot like the amphetamines that students take during exam week -- it creates a temporary state of hyperarousal which allows for intense concentration. But what if there was a treatment that could be given to children which would, in fact, cause them to have permanently enhanced mental capabilities?

Notice I didn't say, "make them more intelligent," because we already know that there isn't a single quality that's synonymous with intelligence. There are various capacities that don't necessarily go together. I would guess that John Coltrane had a reasonably high IQ but I really don't care. And Daniel Goleman's book Emotional Intelligence was very helpful to me in explicating the very different realms of intellectual and social competence.

Nevertheless, while success in school has something to do with diligence and motivation an hard work, we all know that some children have mental capabilities that make success in school come easily to them, and that others just don't do very well even if they try hard. Unless they happen to come from a wealthy and powerful family, or have some rare talent such as athletic ability or whatever it is that Jennifer Lopez does, their options in life will be very limited. So any parent would want the IQ booster for their child. And let's face it. We live in a complex society, and we have a need for people who can understand complicated ideas and do intellectually demanding work.

So why is Dr. Bashir a pariah? First of all, as with all enhancement issues, it's unclear where the line is between enhancement and achieving one's potential. We know that IQ (which is just one number that tells us little or nothing about many important capabilities, but it is used a lot in research) tends to be higher in children whose mothers are well nourished, don't smoke or drink too much alcohol, are breast fed, who subsequently have good nutritional status, who are not lead poisoned, who are raised in rich and intellectually stimulating environments, who have good teachers, and so on. I don't see how anybody can object to any of that but most children in the world today lack one or more of these advantages. Even so, what would be wrong with also giving children the magic pill, especially if we stipulate that we have fixed these other deficits for most or all children?

Granted the Law of Unintended Consequences, and that there might be many downsides we cannot foresee to a world full of Lisa Simpsons (of both sexes) and hardly any Barts, are there problems we can foresee? Is there something wrong with this picture?

Yes folks, it really is that simple

Mark Penn spills the beans to Sparky on the rationale for the Clinton campaign.

Tuesday, May 20, 2008

Why death?

But first, a brief digression to note that Her Majesty's Parliament has approved research using cells created by transfer of nuclei from human somatic cells into non-human ova. The media report, as usual, is scientifically inaccurate, calling these "animal-human embryos." They aren't really. As I have discussed previously, the nuclear DNA is 100% human. Only the mitochondria are from other mammals.

The mitochondria -- descendants of ancient archaea that became endosymbionts in eukaryotic cells some billion years ago -- reproduce exclusively asexually, cannot exchange genes with counterparts of other lineages, and live exclusively in the comparatively homogeneous environment of the eukaryotic cell. Hence, while they experience some genetic drift, they do not really evolve. Rabbit mitochondria are very similar to human mitochondria, and it isn't clear that these cells are any different from human cells in any practical way. Nevertheless, as the AP report tells us, "opponents warn that an easing of laws on creating the embryos could lead to the genetic engineering of human beings." As I said before, I really don't see how this is a meaningful step in that direction. This technique is not envisioned for reproductive purposes, but for stem cell research. Conceivably it could be used to produce therapeutic stem cells some day. But it does not contribute to modification of human nuclear DNA, which is what genetic enhancement is all about.

As Kathleen points out in a comment on the previous post, there are enormous practical difficulties with trying to genetically modify humans. The organism is incomprehensibly complex, and pulling on the wrong thread could unravel the whole cloth. Changing genes to try to give someone greater intelligence or some other capability could have unforeseen ill effects; and how could we ever ethically do the experiments to find out? This is a valid observation, certainly, for the present. But we are already doing experiments with animals, to create livestock with commercial advantages; and we are also very close to genetically modifying human embryos in order to correct some of those rare, but real, genetic disorders caused by an identifiable single abnormal gene, such as cystic fibrosis and sickle cell anemia. As this sort of research proceeds, along with research into patterns of genes associated with various characteristics, I would not rule out that we'll learn enough that somebody, somewhere, some day will decide to try enhancing a human genome. But I agree it is not an imminent problem.

So anyway (whoof), let's talk about a non-genetic treatment to delay the aging process, such as a pill. Why do we get old and die in the first place? Because evolution compels it. Evolution is not, as we are often mistaught, driven by "survival of the fittest." This is quite obvious because no organism survives. Natural selection does not concern survival, but reproduction. Genes are preserved that are associated with more successful reproduction, and not just for a single generation but into the future, generation after generation. That requires not only reproduction, but continual evolution, because the environment changes and new challenges arise as other organisms evolve and the earth also changes.

Shorter generations advantageous because they allow an organism to evolve faster, although there is a balance for complex organisms that require time to develop. It may also be advantageous to reproduce multiple times, and then there are mammals and some other creatures that benefit from sticking around to invest in their offspring. So there are factors that may favor a longer lifespan as well. Nevertheless, sooner or later, you have to get out of the way, because you are competing with your offspring for limited resources. In order for them to succeed, and for their offspring to succeed in turn, you must die. You are programmed to do so because evolution has produced that result.

Presumably our lifespan is more or less optimal, from an evolutionary standpoint, for the way our ancestors lived some time ago. That doesn't create any ethical imperative for us to honor it today. We can live longer if we want to, but is that wise? Suppose we could take a pill that would enable us to live to be 120, without necessarily experiencing degenerative diseases, disability, or severe mental decline. What would be the implications for our children and grandchildren? What would our own superannuated lives be like? I don't expect we could draw Social Security for 50 years, we'd have to keep working. And, obviously, this would cost money. Presumably the pills would be patented for the first 15 years or so, and cost thousands of dollars a year. Some people would have access to them, but most would not.

So how would that scenario play out? I doubt that many people who had the chance to take the magic pill would turn it down, but what would be the social consequences? Think about it.

Monday, May 19, 2008

Able to leap tall paradoxes in a single bound . . .

As the comments on the Sunday post demonstrate, there are a whole mess of issues tangled up in this human enhancement problem. People come at it from various directions, although we mostly wind up in the same knot.

So, my first proposal is that it's counterproductive to treat this as a single, general problem. The most prevalent attempt to generalize is a conservative take -- one that we hear not only from religious thinkers but also from a certain strain of environmentalists who have what I would call a quasi-religious or mystical view of nature. This is the claim that there is some entity called "human nature" which has a kind of sacrality. If we set out to make a new kind of human being, or a post-human, we will either be offending God, or destroying ourselves, however you want to look at it.

The liberal view of human nature, in contrast, is as always more reality based. That is, human nature is what we make of it. For as long as we have been capable of the requisite self-reflection, planning, and cultural development, we have been transforming our nature. The invention of writing, for example, produced a revolution in human nature. Literate people are very different from people in pre-literate societies. Command of fire, clothing, agriculture, all of the basics, created new kinds of creatures. Nowadays it is commonplace to change human nature -- it's what we do through education, military basic training, football camp. Cro Magnons couldn't fly, couldn't play saxophones, couldn't make a perspective drawing, and couldn't run a four minute mile. Does that make us no longer human?

Even so, it's fair to ask whether any particular enhancement is for better or for worse. There is even a respectable argument to be made over whether we are in fact better off than our hunter-gatherer ancestors. Disclosure alert: that was the precise subject of my master's thesis and I came down firmly on the side of ambivalence. But if we aren't, it isn't because we have offended God -- who according to all the religions I know about came along through one or another incarnation or prophet no more than 3,000 years ago at the outside, to endorse a social order and human nature that was very far removed from Eden.

We have to look at each of these questions separately, and on their merits. An extended life span is a different issue from enhanced mental capabilities, or physical strength, or whole new functional elements such as wings or X-ray vision. So, I'll take on the longevity thing first, with the next post.

Sunday, May 18, 2008

Basic Knowledge

I haven't ranted very much lately about the democratization of science, and mea culpa. So the theme for today is that we can't have a more democratic scientific institution if most people lack the basic knowledge they need to participate.

This is the story of my professional life, actually. My day job is with a community based public health agency, and my academic half is concerned with people's control -- or usually lack thereof -- over their own health and health care. (As I often say, I am a community-academic partnership.) My work concerns all sorts of issues -- mental health, addiction, environmental justice, diabetes, heart disease, you name it -- but HIV is a particularly big piece of it, in part because it has paradigmatic qualities that make it particularly instructive for many of the principal concerns of medical sociology.

Sociologists are interested in the "sick role" and how disease shapes identity, and HIV is a powerful shaper of identity, with particularly strong components of stigma, disability, community and empowerment vs. disempowerment. It's a chronic disease that people have to live with their whole lives. Its treatment is complex and requires intense, ongoing involvement with physicians and the medical institution. Treatment adherence is particularly challenging. People with HIV are a preoccupation of public health authorities, advocates and researchers because they are infectious, but in a way that is fully under their control; and because every person with HIV is a potential incubator of drug resistant virus. These related facts mean that each individual's treatment adherence, as well as their sexual and drug injecting behavior, is of concern to society in general and government agencies in particular.

So, people living with HIV have to navigate all these complexities, for the sake of their own health and autonomy, and for the sake of others. And, people who aren't HIV infected have a responsibility to understand the facts about the virus and engage the problem with both compassion and reason. Unfortunately, the average person has such limited knowledge of biology that it just isn't working very well.

Of course, once people are told that they are HIV infected, they try to learn what they need to know about their condition. But without basic knowledge of cellular biology, and evolution, many people just never really get it. I sat down once to write a basic explanation, in accessible English, of what a virus is, what a retrovirus is specifically, how HIV causes disease, how the antiretroviral drugs work, what drug resistance is and how it comes about. I thought I'd done a pretty good job, so I showed it to an HIV educator. "Oh, this is too technical," she said, "people won't follow this." But I had begun at the beginning, and explained everything, step by step, from cells to DNA and RNA and enzymes and evolution. That was just too much for people, apparently.

So instead, people are given vague and misleading metaphors, often military. HIV is the "enemy soldiers," the drugs are our soldiers, and we need to keep them in the field so the enemy can't advance. The virus "attacks" cells. And the virus is "intelligent," it can "learn" how to get around the drugs. One woman I interviewed personalizes her infection, she refers to HIV as "she." Somebody told her that viral load is a measure of how many baby viruses the mother virus is having.

Many HIV educators and advocates say we should respect these ideas, that they are somehow "indigenous to the community" and represent the points of view of the authentic people, that it's somehow insulting or elitist (yup) to tell people they are inaccurate. I think that's nonsense. People have been told these things by professionals acting as health care providers and HIV educators, who are just too lazy or don't have the time to tell the people the truth and work with them so they can understand it.

I'm not sure what to do about the general ignorance of biology, and that includes far too many high school biology teachers. But it's something we must fix.

Friday, May 16, 2008

Ist ein ubermensch!

Okay, so getting back to Dr. Bashir. Right now there is a rather heated debate going on in some quarters about whether it is ethical to use technology not merely to cure or ameliorate disease, but to enhance human abilities or other desirable characteristics, such as physical attractiveness or personality.

It doesn't take more than a moment's reflection to see that the question, taken at face value, is just silly. People have always looked for ways to make themselves more capable or more beautiful, and we accept it as a matter of course. Just to make this discussion manageable, let's consider athletics.

The big flap these days is obviously over performance enhancing drugs. Yes, they're against the rule -- or rather, some are but not others, as I'll show in a second -- but other than that, is there anything essentially different about steroids and other methods that athletes use all the time? Of course not. Athletes train at high altitude or, if that's inconvenient, in hyperbaric chambers. They consume carefully engineered diets and regimens of supplements. They use elaborate machinery to develop muscular strength, endurance, and flexibility, and to build patterned motions into their motor neurons. Baseball pitchers routinely undergo ulnar collateral ligament reconstruction, "Tommy John Surgery," which actually gives them a superior elbow, and often a faster fastball, than they had before. As for drugs, it's perfectly legal for athletes to take painkillers and anti-inflammatories, undergo, yes, steroid injections to reduce joint and tendon inflammation, and in most sports to consume caffeine and other herbal stimulants. Some people say, well, steroids present long term dangers to health but in fact, professional athletes typically suffer from osteoarthritis, post-concussion syndrome, and other ills after they retire. If the long-term effects on athletes' health really mattered to anyone, we would have to ban most professional sports.

Now consider medicine in general. There is a great deal of handwringing over the prospect that children who are healthy but just shorter than average are being given Human Growth Hormone, and over the possibility of "cosmetic psychopharmacology," in other words that people are taking antidepressants because they are unhappy with aspects of their personality, such as shyness or irritability, that were not considered diseases until the drug companies came along.

But let's consider some treatments that don't seem to bother anyone. When Social Security was established in the U.S., it wasn't very expensive. Most people didn't even make it to age 65, and few lived much past it. Nowadays it's a tragedy if somebody dies before age 70, and most of us fully expect to carry on well into our 80s, simply because of ongoing efforts to prevent and cure disease. That is beyond what used to be considered the normal human life span, of course, but I haven't heard anyone worrying about such a fundamental change in "human nature." Even so, it isn't good enough. Scientists are working on ways to slow or even halt the aging process, and they are already testing the compound resveratrol. If it turns out that it works, and let's us all live to be 120, believe me, there will be very few voices saying it's unethical to take it at all, and many more declaring that it's a human right to take it which needs to be extended to everybody.

What if there were a pill that would make children smarter? (Uh oh. It turns out there just might be one. The word hasn't really gotten around yet, but I'm waiting for the shit to hit the fan.) Assuming it had no dangerous long-term effects, parents would be clamoring for it. People would insist that it be added to school lunches, and I expect I'd be popping it every morning at my desk.*

So there seems to be an arbitrary quality about what sorts of technological "enhancements" do and do not offend people. If you think about it a bit more, it's hard to see how the extension of human intelligence represented by writing, and books, and now by the electronic digital computer, is fundamentally different from sci-fi concepts like getting computer chip implants that enhance memory or processing power. Technology, over time, has made us more capable, longer lived, healthier and yes, better looking. Cosmetic dentistry and wart removal are taken for granted. Face lifts and hair transplants are considered silly by some, but hardly objectionable for those who want them. So why object if parents don't want their children to be short? Why draw the line at some technologies and not others? What's the difference? To me, certainly, it is far from obvious.

So, here's the last step. Suppose we find out that resveratrol works, and everybody starts taking it. What's wrong, then, with inserting a gene into a human embryo so that the person will manufacture the chemical, and won't have to take the pill? The result is the same, only cheaper. And yes, she or he will pass the capability on to her offspring and we'll have a race of people who live to be 120. Why is that unethical, but accomplishing the same thing by taking a pill is not? The same goes for greater intelligence, or physical ability, or even temperament. If we can take pills so we won't be depressed or anxious, why not put happiness and equanimity in our genes. What's the difference?

You tell me.

* Of course intelligence is not a function of a single chemical. Success in school and at all intellectual work or pursuits depends on a combination of memory and information processing capabilities, an inquiring personality, concentration, diligence and hard work, all of which result from a genetic endowment unfolding in a particular environment, and which in turn may be enhanced or suppressed by good or incompetent teaching and mentorship. But a pill might still increase intellectual performance, ceteris paribus.

Thursday, May 15, 2008

Ants Taking Over Texas

That was the headline I saw on a fellow traveler's newspaper on the subway this morning. I can only say, it would probably be an improvement over the present administration down there. It got me to thinking I should weigh in here on politics. Lately I've been leaving it to others who specialize in that sort of thing, and I still need to deal with the Man and Superman thing, the rest of Stem Cell Century, and current public health news. However, this will be the most critical election for public health in my lifetime, so it requires attention.

I didn't post yesterday because I was too busy during working hours and too filled with bitter loathing for the malignant dwarf who has fraudulently occupied the office of president to put anything up in the evening. That the toxic slimeball would thrust itself back into the public discourse at this particular moment, to inject more narcissistic sewage, serves to remind us of why we have despaired for the American polity. The Republicans were actually able to build a cult of personality around a sociopath with the mentality of a three-year-old and all the charisma of a leech. The corporate media joyfully joined in the conspiracy, and the voters actually made two successive elections close enough for the conspirators to steal. Hitler and Stalin at least had a certain gravitas, but this clown couldn't be elected president of the fourth grade. Yet there he sits.

And now we're going to have a candidate who is smart, charming, incorruptible, visionary, eloquent; who truly comes from humble beginnings; who is truly a citizen of the world, yet with a life-long record of service to America and proven patriotism; who has inspired a whole new generation of young idealists; who has energized a long-oppressed community to a level of commitment and determination not seen for forty years, since they brought about a great transformation in American society; who has spoken directly and out of complex personal experience about the greatest wound in American society and culture, in a way that every other politician has avoided; whose money comes from millions of small donors, who is storming the ossified Democratic Party establishment and sweeping away the cynical and failing imagemakers and poll parsers in favor of honest discourse and frank confrontation with the hard realities of the day.

And we're afraid he has no chance.

I was a community organizer in my youth, a street organizer, knocking on doors and getting people to sit in at city offices and block streets over trash filled vacant lots and real estate speculators trashing neighborhoods. One of the places I worked was Fishtown, a poor white neighborhood in east Philadelphia on the Delware River. Fishtown was in rough shape, with lousy municipal services, deteriorating schools, unemployment, a bad drug problem, you name it. But the number one issue on most people's minds, as soon as they opened their mouths, was The Niggers. There were two things wrong with The Niggers: they don't like to work and they're all on welfare; and they're taking all the jobs. I usually got this in the same sentence. These people normally voted Democratic, but they liked Republican Mayor Frank Rizzo because he was sending the cops into the black neighborhoods to beat people up -- or, as Rizzo himself put it, Spacco il Capo.

So, the question is, today, are these same people going to vote for the colored guy in November? You know what? I think they just might, or anyway a lot of them will. Partly, it's just because they've gotten more used to the idea. Philadelphia has had two black mayors since then, and Fishtown's white ethnic residents have not been pushed into the river after all. They probably aren't any better off, but they're no worse off either. But more important, they aren't going to be voting for an abstraction, they'll be voting for a candidate, who I absolutely believe will find a way to speak to them.

The Obama presidency will represent a huge historic transformation for this country. The main reason we're so politically and socially backward is that the working class has been divided by race, a fissure that politicians and capitalist have exploited with almost perfect success since they used it to destroy the populist movement of the 1890s. The strategy broke down to some extent during the Great Depression, and again in the Civil Rights era, but it came back with a vengeance thanks to Nixon and Reagan and their clever use of racism. Now we have a chance to really put an end to it.

If we do, Attorney General Edwards will have a chance to put the bastards in jail. Now that will really be sweet.

Tuesday, May 13, 2008

Paging Dr. Bashir

For those of you who don't know, which I presume is all of you, Dr. Bashir was the genetically enhanced chief medical officer on Deep Space Nine. He was something of a sci-fi cliche: genetically enhancing human beings, in the future, is generally illegal and/or morally repugnant, and the genetically enhanced face discrimination, banishment, imprisonment or termination. Dr. Bashir had to keep his true nature a secret, although as I recall the commander ferreted it out in one episode. The way it works in the Star Trek universe is that his parents were criminals, but he merely faced ostracism and general hatred.

Anyway, today we are confronting mass hysteria over the news that some Top Docs (as the tabloids always call them) in New York inserted a gene into a human zygote. Various moral watchdog groups are viewing with alarm and slippery sloping and demanding public debate and whatnot, on the grounds that this is a step toward making a Dr. Bashir.

So let's take this in two pieces: Is it? And what if it were?

Part one: It isn't. The investigators inserted the gene into a genetically defective zygote that was incapable of normal development. Yes, they could have put it into a normal zygote but either way, the experiment was trivial. Their stated purpose was to demonstrate a way of tracing the ancestry of a clone of Human Embryonic Stem Cells, as a research tool. (Remember from an earlier episode that a clone doesn't necessarily mean an organism which is genetically identical to another, but as in this case, it can simply mean a line of cells of common descent.) This, in turn, is in pursuit of therapeutic uses of HESCs, not reproductive cloning.

I'm sure I don't have to tell you that if somebody is given organs or tissues created from HESCs, the genes of those replacement parts are not passed on to the recipients' offspring, if any.

Now, it is true that if someone were to insert genes into a zygote, and then allow that zygote to develop into a human being, those genes would be included in that person's germ cells, hence in his or her gametes, and could be passed on. But right now nobody is trying to do that, and this little experiment is of no importance in advancing such a project. Of course you can insert genes into a zygote, you can insert genes into any kind of human cell, big whoop.

However, right now, we don't know of any single genes which we could insert into a zygote and bring about any particular desired enhancement of the resulting person. Nor is it clear how such an experiment could be performed, because the whole problem is, you don't actually know what would happen. So it would never be approved. Maybe a mad scientist in a secret laboratory will try it some day, but that has been made no more likely by the experiment at issue. So get a grip, folks.

Part 2: Ahh, now this is a matter of considerable controversy among those who worry about weird stuff that might conceivably happen some day. It's a much more difficult ethical problem than it usually appears to people at first glance, no matter which side they take. Dr. Bashir was engineered to be super smart; he had to conceal his actual intellectual abilities to stay out of trouble. (Hey, so do you and I.) But people also worry about making 8 foot tall people for the NBA superstardom market, or maybe even giving people wings or X-ray vision or something.

Now this is worth talking about, in part because it connects seamlessly with some problems that are not fanciful at all, but are happening right now. So I will discuss it anon. Meanwhile, anybody care to weigh in?

Monday, May 12, 2008

Fool's Paradise

Now, following the Burmese cyclone, we have the Sichuan earthquake. I fear the death toll announced as of this post, 5,000 or so, will turn out to be far lower than the reality. People can't stop earthquakes any more than they can stop cyclones, but are these really "natural" disasters?

The only reason earthquakes are dangerous to humans is because of our built environment. People sitting out in the open will enjoy the ride, that's all. Even living in huts made of sticks and wattle, or teepees, people are perfectly safe from earthquakes. Earthquakes are catastrophes of civilization. They kill and injure us because they make our buildings fall down on top of us.

As I discussed regarding the Kashmiri earthquake two winters ago, the catastrophe was ultimately traceable to deforestation. Buildings in that region used to be wood framed, and would have been at little risk from even the most severe earthquake. But people cut down all the trees, and started to make unframed masonry structures. Then the earthquake came, and they died by the tens of thousands, and the rest were left homeless.

The region in China where the recent earthquake happened is prone to earthquakes and has had catastrophic tremors in living memory. But, as the report linked above indicates, schools, hospitals and factories have collapsed. Officials knew there would be an earthquake sooner or later, but they put up structures that were guaranteed to kill the people inside when that day came. We knew for 15 years or more that a major hurricane would drown New Orleans, but we didn't do anything about it. The Burmese government, such as it is, knew or certainly should have known that the mangrove forests protected the delta against the ocean, but they let them be cut down anyway to develop aquaculture. We know that a serious pandemic of one kind or another -- and it doesn't have to be H5N1 influenza -- will overload the health care system and leave people dying in the hallways and parking lots, but the only response so far is to come up with a list of who should be rescued first.

This is something basic about human nature. We just can't respond adequately to abstract dangers that we don't experience regularly but that somebody has worked out intellectually as being likely to happen. Making a low-cost proposal for that hospital or school building, and bringing it in under budget, is what got local Chinese officials good reviews and promotions. A bureaucrat who argued too strenuously to spend money on making the buildings earthquake proof would be exiled to Inner Mongolia. Americans don't want government telling them they can't build houses on barrier islands or taxing them to make preparations for something that hasn't happened since 1918. We just can't process dangers that have a huge magnitude but a low or unknown probability, or at least they can't compete with immediate and known rewards.

So how are we ever going to take on the problem of global climate change?

Friday, May 09, 2008

When will they ever learn?

(Above image is from Wikimedia commons.)

I've been pondering what lessons there may be in the recent disaster in Burma. (The people from that country who now live in Massachusetts seem to prefer Burma to Myanmar, so I'm going with it.) The "Reverend" John Hagee -- who John McCain has not been called up on to reject, eject, object, subject, deject, project or retroject -- says that God sent Katrina to destroy the Mississippi coast, Plaquemines Parish, and the Lower Ninth Ward of New Orleans because a homosexual parade was planned for a couple of weeks later in the French Quarter, which God was kind enough to spare. Mysterious are the ways of the Lord. I'm pretty certain that no homosexual parades were planned in Burma, however.

Since Burma is a Buddhist country, I expect the people are pondering the impermanence of all things and the wisdom of detachment. Fair enough, but are there any more practical lessons? As the map shows, you could not have designed a more destructive storm path. Nargis moved from west to east across the full width of the Irawaddy delta, at just the distance inland to draw the storm surge as far as possible up the river's many mouths. Hundreds of square miles are now under water. This was an extremely powerful storm, and it retained much of its power as it moved across the delta, now doubt because the land was so flat and the storm had enough water under it to continue to function as a tropical cyclone all the way to Thailand. So was the vast destruction caused by this storm just bad luck?

No, no more so than the destruction caused by Hurricane Katrina. I'll get out of the way quickly the likelihood that global climate change has made such powerful storms more frequent. We'll have to live with that for the foreseeable future. But there are three more points worth considering. In both the Irawaddy and Mississippi deltas, human intervention has destroyed the regions' natural defenses against cyclones. In Louisiana, the Mississipi has been forced into a narrow outlet channel, eliminating the natural process of silt deposition which for thousands of years had built the delta and the vast fringe of wetlands south of New Orleans. As this process was stopped in the 20th century, the wetlands started to erode and disappear, bringing the power of hurricanes and their accompanying storm surge that much closer to the city. In Burma, the mangrove forests which once fringed the delta have been destroyed to make way for aquaculture. Hence the storm surge moved unimpeded up the many mouths of the Irawaddy river.

Second, the Irawaddy delta was very sparsely populated until the British settled people there and developed rice farming in order to feed their south Asian colonies. It is perhaps only in hindsight that we can be so certain that it was foolish for so many people to live in such a vulnerable place, just as we can say about the Mississippi Gulf coast and the Lower Ninth Ward. But in both cases, the possibility of catastrophe was apparent and governments did not prepare adequately. Now that the question arises about whether the devastated areas ought to be repopulated, we have seen in the U.S. a controversy with far more passion than sense. (For the record, I think people need to be moved away from the coast as much as possible, and from areas of New Orleans which are near or below sea level. However, the interests of the affected communities have to be honored in the process. That means a new Lower Ninth Ward, on higher ground. I'm not sure what that might mean in Burma, but it's not for me to say.)

Finally, the atrocious response of the governments in both the U.S. and Burma is likely to be the most impactful legacy of both storms. It signaled the beginning of the end of the rule of the Republican conservative coalition in the U.S., and it may turn out to be the end for the Burmese junta. We can only hope so. If they survive this horror, it can only mean even worse years ahead for the Burmese people.

In broader terms, as a species, we need to find a sustainable coexistence with the rest of nature. Both of these disasters offer clear lessons about our failure to do so.

Wednesday, May 07, 2008

The Keystone Problem

Erratic posting lately is due to a trip to Brockton yesterday, and another day trip to Portsmouth today. Tomorrow I have to go to Lowell. These excursions all happen mostly over commuter roads, and I can tell you that in spite of the price of gasoline and reports that MBTA ridership is up a bit, the congestion is the same as ever. The state and federal governments just got done spending $16 billion to fix the whole mess by burying the interstate under the center of Boston and adding bridges, tunnels, and service roads all over creation but you already know what happened -- as soon as there was more pavement available, it filled right up. It still takes a half an hour to move a mile and a half from Sullivan Square to the exit to the Callahan Tunnel on I-93 South, all day, every day.

This happens because right now, people don't have much choice. A lot of them live in places that don't offer an easy trip in and out of town on mass transit. Others -- like me much of this week -- need to have their vehicles with them for business. And, if they all decided they couldn't afford the gasoline any more and tried piling into public transit, that wouldn't work either, because getting on an MBTA train is already to know what it's like to be trash in a compactor.

Well, we just won't be able to live this way any more. The Long Emergency has already started, but we've squandered the past couple of decades and it may already be too late. If President Obama is going to pull our asses out of the fire, this is where it will have to begin. Instead of spending that $16 billion on highways, we should have built a mass transit system for the 21st Century, which is what a few of us said back in 1984 but of course, nobody was listening. Now we're going to have to spend that money all over again, but we don't have it any more. And that's just the beginning of what we need to do.

It's a good sign, obviously, that Obama told the truth about his two opponents' disgusting race for the bottom on the gasoline tax, but he's got a lot more truth to tell us. I don't say he has to do it before November 4, but on November 5, he'd better start talking.

Tuesday, May 06, 2008

Local news, not of general interest

A friend who must remain as anonymous as a Michael Gordon informant sends this along. It seems the Environmental Protection Agency Midwest Regional Administrator has been canned for, you guessed it, trying to protect the environment. More specifically, her malfeasance in office consisted of trying to protect the environment in a way that annoyed a Fortune 500 Corporation.

Gade has been locked in a heated dispute with Dow about long-delayed plans to clean up dioxin-saturated soil and sediment that extends 50 miles beyond its Midland, Mich., plant into Saginaw Bay and Lake Huron. The company dumped the highly toxic and persistent chemical into local rivers for most of the last century.

Many local residents see Dow as a lifeline in region plagued by plant closings and layoffs. But all along the two wide streams that cut through this old industrial town, signs warn people to keep off dioxin-contaminated riverbanks and to avoid eating fish pulled from the fast-moving waters. Officials have taken the swings down in one riverside park to discourage kids from playing there. Men in rubber boots and thick gloves occasionally knock on doors, asking residents whether they can dig up a little soil in the yard.

Gade, appointed by President Bush as regional EPA administrator in September 2006, invoked emergency powers last summer to order the company to remove three hotspots of dioxin near its Midland headquarters.

Now, if she'd done something positive, like using her office to benefit the campaigns of Republican politicians, or to advance the cause of Christian dominion, she'd have good performance reviews. But this is just inexcusable.

The point of my post, however, is that this news has not made it out of Chicago. I haven't heard a peep about it anywhere in the national news media, or for that matter in the blogosphere. In the old days, this probably would have been worth some national attention, but now we just take this sort of thing for granted. With bowling scores and shots of bourbon to worry about, dioxin in the rivers is just too minor of a worry.

Monday, May 05, 2008

Tough luck

A couple of recent reports in the popular press on academic exercises offer considerable food for thought. First, I'll offer my own well-fed cogitations on this effort by a task force of physicians in various powerful positions to decide who gets triaged to the scrap heap in the event of an influenza pandemic or a comparable mass casualty event. Unfortunately, the issue of Chest in which this report appears hasn't made it onto my library's on-line subscription service yet, so I can only go by the news report. Hence I don't know the full composition of the task force. It includes representation from the military and the Department for the Impregnable Defense of the Glorious FatherlandHomeland Security, among other federal agencies, as well as medical societies and prominent academic physicians. I'm sure many will see this as vaguely sinister but I'll give them the benefit of the doubt as to motive.

I've railed against the pathological state of denial in this country often enough that I am obliged to welcome an exercise that seriously contemplates the possibility of bad stuff happening. The idea here is that the need for such resources as mechanical ventilators and intensive nursing care exceeds the supply. The task force members have created guidelines for who gets to breathe and who gets to drown in their own sputum. Those who get shitcanned include those with advanced dementia, people with severe trauma, people with serious chronic diseases such as heart disease and, oh yeah, everybody over age 85.

The news report doesn't spell it out, but my reading is that they have mixed a couple of criteria here, with life expectancy being the most important, but quality of life and the resources required to take care of the person also figuring in the formula. Now, you might just say that this is dirty work, but somebody has to do it. When the people are stacked up like firewood in the ED, you've got to choose somehow and you're better off having a plan.

My first objection ought to be obvious. Who appointed these people God? It's fine to raise the issue but they seem to assume that it stops here. They've pronounced, we're done. In fact, acting on these guidelines would be illegal. You aren't allowed to discriminate in the provision of services -- and particularly publicly funded services such as health care -- on the basis of age or disability. Furthermore, there is a strong correlation between socioeconomic status and the likelihood of having poorly controlled diabetes or heart disease, for example -- among the markers for death in the task force report. That includes education, income, and oh, by the way, race. So these guidelines actually use the consequences of prior lack of access and inferior health care, among other factors, as reasons to deny care to people at the point where they need it the most, while moving the privileged people who enjoy better health thanks to your previous discrmiination to the front of the line.

And yet, and yet. Here you are, overwhelmed by a catastrophe, confronted with hundreds of desperately sick people, and you can't save them all. Doesn't it make sense to try to save the people who have the most life left, and the most left to live for, first?

Well, maybe so, but the 86 list isn't necessarily going to help you very much. You aren't going to have a list of all the people who need care, ordered from top to bottom on the basis of their shitcan score, so you can just work down until you run out of drugs or IV bottles or whatever it may be. Instead, the people are going to come in continually, in more or less random order. They will not be accompanied by detailed information about their cognitive or medical condition. You will not know in advance exactly how much of what resource each person will need -- whether they will need a ventilator, for example, or for how long. If you decide, "I'm not going to bother with this diabetic," and she dies, you may find out later that you did, in fact, have enough resources to take care of her, and they're still sitting on the shelf.

Conversely, in the case of pandemic influenza, it is likely to be the robust young people who are most severely sick and who need the most resources for their care. This was the experience in 1918. The explanation may be that it is an overactive immune response called a "cytokine storm" that caused death in that epidemic. (Here is an attempt to make that concept intelligble to lay people.) So it might well be that a much larger number of people could be saved by concentrating on the older folks.

So I would say this needs much more discussion, and probably legislation of some sort -- which would be almost impossible to pass.

Friday, May 02, 2008

Friday musings

I'll be disconnected from Your Intertubes for a couple of days, so nothing till Sunday at the earliest. Meanwhile, various recent events have brought into focus the role of religion in the political and social spheres.

I wear my atheism on my sleeve, which is supposedly obnoxious, although it's not only perfectly okay but widely encouraged and admired for religious people to do the same. So I pose this for your consideration.

Defenders of religion of late have taken to emphasizing the claim that religion is the source of morality. The Pope in particular is fond of saying that the great threat facing humanity is "moral relativism," from which only religion offers salvation. Evangelical preachers frequently make similar statements.

So let's take a look at the moral values given to us by religion. It is religion which persuades the members of the Fundamentalist Latter Day Saints to force 13 year old girls to have ritual sex with 50 year old men, and start bearing them children.

It is religion which causes Jeremiah Wright to say "God damn America," which is evidently deeply offensive.

It is religion which causes John Hagee to say that God destroyed most of New Orleans, Plaquemines Parish, and the Mississippi coast, killing more than 1,000 people and rendering a million or so people homeless, because some gay people were planning to have a parade a few miles or a hundred miles away. Evidently that is not considered offensive, but it certainly seems ridiculous.

It is religion which causes Pat Robertson to say that God made Mohammed Atta and his friends fly those airplanes into the World Trade Center, killing 2,800 or so bond traders and restaurant workers along with some firefighters and police officers, because there is homosexuality and abortion going on. Again, that's inoffensive but it makes me wonder why God didn't fly some airplanes into office buildings in Paris, London and Berlin. They have homosexuals too, you know.

I'm going to be a contrarian here and say that the principal risk of moral relativism comes from religion. Us atheists are in far greater agreement about morality than are religious people. Atheists never put people on the rack or burned them at the stake because they didn't say the correct mumbo jumbo. I've never heard of an atheist suicide bomber or a war between positivists and critical theorists. So Your Holiness, if you're truly worried about moral relativism, come on over to our side.

Thursday, May 01, 2008

From The Prescription Project

Always happy to throw them a link.

Go here to sign the petition.

Drug marketing is out of control. Help send a message to Congress.

Support the Physician Payments Sunshine Act, which will require drug companies to publicly report their gifts and payments to doctors.

Drug companies spend at least $25 billion each year marketing to doctors. We pay for that with every drug we buy. And studies prove that marketing causes doctors to prescribe higher-cost drugs. Some new drugs also have safety risks (like Vioxx). By increasing transparency, the Sunshine Act will help protect patients and counter the skyrocketing costs of drugs.

Sign this petition today to ask your members of Congress to support these bills.

'Nuff said. Although personally, I don't think reporting these gifts is sufficient -- they should be banned. As in, you can't do it. And, if that's not possible, doctors should be forbidden to accept them by both medical association codes of ethics, and state licensure requirements. And you should ask your doctor if she or he accepts anything of value from drug companies. If the answer is "yes," go elsewhere.


Ana points out that you don't have to be African American to believe in myths about HIV. True enough, but I have been involved in public health work related to HIV for more than 15 years now, and I have never encountered the belief that HIV was created in a secret government laboratory among white people. What I have encountered, however, is the belief, indeed the passionate insistence, that HIV is not the cause of AIDS. This is in some respects essentially the opposite belief -- that the conspiracy has to do with so-called antiretroviral drugs, and suppression of the true causes of the disease, while HIV is actually harmless, or in some versions, does not even exist.

One of the most prominent perpetrators of this claim is Peter Duesberg, an organic chemist at UC Berkeley. Because he holds a tenured position at a prominent research university, HIV denialists have made him their champion. He has no stature within the relevant scientific community and is almost universally regarded as a crank motivated by envy and resentment. You don't have to take my word for it, these people have put together everything you need to know. However, to his supporters, he is the new Galileo, who was also despised for his radical theories. (In case you have any doubts, Avert lays out the proof that HIV is the cause of AIDS in detailed, systematic, and accessible fashion.)

Now, the interesting questions here are why these denialists movements arise, and how we can tell them apart from legitimate scientific dissent. After all, there was a time during which Stanley B. Prusiner was widely ridiculed for his claim that prions -- abnormally folded proteins -- could be agents of infectious disease, specifically Creutzfeldt-Jakob Disease. Prusiner ultimately won the Nobel Prize for his discovery. Could Duesberg be another Prusiner, and why am I so sure he isn't?

First of all, Prusiner was not entirely isolated. The prion hypothesis had been raised earlier. It was a challenge to accepted dogma, and so the initial resistance was not surprising. It is appropriate and healthy for scientists to question new hypotheses and throw up resistance to their acceptance. Claims that step outside of existing frameworks have a high burden of proof. Now, HIV was not entirely a radical idea -- retroviruses were known, as were viruses which cannot be eradicated by the immune system, and viruses which take a long time to produce disease. However, it is certainly novel in preferentially attacking cells of the immune system, and is generally unlike other known viruses that infect humans.

So there was nothing wrong with Duesberg initially raising objections. The problem is that every objection he has raised has been refuted, and yet he continues to insist on his premise, either coming up with new objections, new ever more stringent standards of proof, and ultimately simply ignoring the truth. This is the same way creationism works, and global warming denial. Rather than pursuing the evidence where it leads, the denialists start with the conclusion and reason backward from there. For a time it may be possible to identify gaps in the chain of evidence and reasoning that lead to evolution, or global climate change, or HIV, but ultimately these theories have withstood the test. The evidence is incontrovertible, but the denialists cannot see it.

The essence of the problem is that their stake is not in the truth, but in some other benefit they gain from their belief. The consolations of faith, the opportunity to make billions by burning fossil fuel, or in Duesberg's case the conviction that one is the intellecutal superior of all the other scientists. For his champions, there is the opportunity to con Harper's Magazine into buying your article, or otherwise make money off of snake oil. The cost, however, is people's lives.