Monthly Archives: October 2016

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Hide and Seek

I guess the hunt is never over. Just when you think you’re winning, a sleeper cell surfaces, one you hadn’t even suspected, and closets itself somewhere you’d never think to look –an endless game of hide and seek. A Samsara of possibilities.

An yet, what would be the thrill of exploration if you knew all of the findings beforehand? We all need quests -adventures that uncover the hitherto unexpected, don’t you think? It’s what gets us out of bed in the morning. Me, anyway.

Questions and answers, for example… Let me play the devil’s advocate for a moment. We tend to assume that answers are the result of questions –we ask a question and then search for a correct -or at least appropriate– answer. But are we actually falling into a post hoc fallacy? ‘Post hoc, ergo propter hoc’ –because something occurred right after, or seems to be a response, we assume the initial thing caused the second. That’s just one way to look at it, of course. What if we assume there are answers lying around everywhere, and that the game is to find the appropriate question –the one that fits? A kind of ante hoc approach, I suppose, in which the answers come first.

Okay, try this. Answer: There are significant numbers of bacteria living under, and protected by, the fingernails. Question: Why doesn’t persistent scrubbing eliminate bacteria on the hands? I know this approach is merely a capricious inversion, but sometimes transpositions help us gain an interesting, if not useful, perspective. An article from BBC brought it to mind: http://www.bbc.com/future/story/20160622-what-lives-under-your-fingernails

I’m a surgeon, and early in my career it occurred to me that the water I was using at the scrub sink before an operation was itself not sterile. After a fastidious and lengthy hand and arm scrub with whatever cleansing soap was in vogue, I would then rinse off the soap with what amounted to tap water… And then, yes, I would observe ‘operating room technique’ and don sterile gloves for the procedure, but, apart from perhaps reducing the amount of whatever had been on my hands, what had all that scrubbing accomplished? Was it just a theoretical conjecture that it actually made a difference? A sop to sterile tradition? And if I were required to wear sterile gloves anyway why not just, I don’t know, use the same soap I used in the shower? It would certainly be cheaper. Questions! Questions swirling around hunting desperately for answers…

Had we posed the answer first, though… (Can you pose an answer?) Maybe the answer: ‘there are significant numbers of bacteria in the subungual compartment’ is a perfect fit for the question: why ‘is this hand region […] relatively inaccessible to antimicrobial agents during normal hand-washing procedures’?

Think about it for moment. Isn’t this the classic conundrum of basic science –science that is done for its own sake, science that has no existing practical applications? It consists of a whole platoon of answers to questions that have not yet been framed –or at least questions that were not anticipated at the time, or maybe just not the questions that were asked. A classic example of an answer (observation) looking for the right question was that of the findings of Penzias and Wilson –two physicists working on a new type of antenna at Bell Labs in New Jersey. In the early 1960ies they found a source of noise (the answer) in the atmosphere that they couldn’t explain. Finally, after eliminating other questions, they realized it was the cosmic microwave background (CMB) left over from the Big Bang. They received the 1978 Nobel Prize in physics for finding the proper question: ‘Is there any evidence of the Big Bang still around?’

And how about another answer: DNA is a large double helical molecule containing patterns of paired nucleotides and is found in cell nuclei for some reason. Question: why is it there? Or even: Could it be related to reproduction? Or heredity…?

Okay, I know this is a bit of a cart-before-the-horse stretch, but I think it does make us less complacent and maybe more appreciative of raw data. Details. Complexity. I’m not suggesting that Inductive logic is somehow flawed –it’s one of the fundamental tenets of the Scientific Method which posits using observation (answers) to derive general principles (more answers).

It’s not that confusing, really –it’s actually how things work in Science. The questions often arise because of the observations –after them, in other words- and so require experiments (questions) to see if the observations were indeed the answers…

So, isn’t the world a wonderful place? I ask that question -just one of many- after observing all the answers lying around unquestioned –unbothered, really- on the grass and among the flowers growing outside my window, all the unchallenged clouds in the sky above, and all the sunlight glinting off my polished floor.

I wonder, sometimes, whether the King James translation of the apostle Paul’s letter to the Corinthians was unwittingly prescient: ‘For now we see through a glass, darkly.’ And only when we recognize the importance of the observation, are we encouraged to ask why is that?

 

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Earthing Unearthed

Sometimes I feel disconnected. It’s almost as if I have been traveling on a highway all my life, largely unaware of the myriad roads that emanate from it. Unaware of the different coloured horizons that have been hiding out there all along. Or is skulking sometimes a better descriptor? Every so often I come across a concept so… bizarre, that I wonder how it even survived long enough to acquire a name. ‘Earthing’ caught my attention immediately.

I feel I have to explain that I don’t go looking for these things, but in the spirit of full disclosure I will confess to being a one-time member of the Skeptics Society –one time, I suppose, because the time constraints of a busy medical practice required that I relinquish at least some of my addenda. Now, retired and awash in compensatory time, I dabble once again.

‘Earthing’, for those of you as naïve as myself, is the act of walking barefoot –not just on the beach or over the soft grass of a lawn, however. It is to soak up earth’s energy fields previously denied to you –blocked, in effect- by your shoes. These energy fields apparently supply free electrons replete with many health benefits. Shoes, as disruptors, ‘[…] allegedly cause inflammation and autoimmune diseases, circadian rhythm disruptions, hormonal disorders, cortisol disorders, heart rate variability problems, arthritis, herpes, hepatitis, insomnia, chronic pain, exhaustion, stress, anxiety, premature aging […].’ http://www.skeptic.com/reading_room/bogus-claims-grounding-bare-feet-to-earth/ Uhmm…

How could I have journeyed so far along the trail of years and not heard this coming up behind me? Call me old fashioned, if you will –or just ‘old’, perhaps- but I would still feel more comfortable if there were credible, corroborative and objective evidence to substantiate assertions before I even decide to consider them -let alone examine them seriously… Anybody can claim things, but as Carl Sagan once declared: ‘extraordinary claims, require extraordinary evidence’.

Now I have to say that just because something seems counterintuitive, I don’t think it should be simply dismissed out of hand. Paradigms do shift, after all. But they still require critical analysis; it is not enough to suggest that, as in the case of homeopathy, for example, any attempt to verify it destroys the field in which it exists. Nor are statements like, ‘It may be that our connection with the earth carries information, helping align us with the greater network of intelligence of our planet.’ either provable, or refutable –the famous philosopher of Science, Karl Popper’s belief that what distinguishes science from pseudoscience is its potential for refutation. For example, to say that all swans are white, only holds until a black one is found. The assertion –if properly attested by observations- is scientific in that the demonstration of even one black swan is able to refute it.

But, academic considerations aside, there is something troubling about ‘Earthing’ and its ilk. That something like this arose at all is, I suppose, a function of the random accretion of isolated and misunderstood bits and pieces of our complex modern world that are only describable in metaphor –as in, say, electrons are the carriers of electricity. True, as far as it goes, I guess, but misleading if taken as literal. Maybe some shoes –all shoes?- may block electrons… But so what?

Just try and understand the electric fields on the earth and in the atmosphere. As an example, a description from (shudder) Wikiversity: ‘The Earth is negatively charged, carrying 500,000 Coulombs (C) of electric charge (500 kC), and is at 300,000 volts (V), 300 kV, relative to the positively charged ionosphere. There is a constant flow of electricity, at around 1350 amperes (A) [approximately 1100 A], and resistance of the Earth’s atmosphere is around 220 Ohms. This gives a power output of around 400 megawatts (MW), which is ultimately regenerated by the power of the Sun that affects the ionosphere, as well as the troposphere, causing thunderstorms. The electrical energy stored in the Earth’s atmosphere is around 150 gigajoules (GJ). The Earth-ionosphere system acts as a giant capacitor, of capacity 1.8 Farads. The Earth’s surface carries around -1 nC of electric charge per square meter’. Do you see why most of us non-experts are dependant on metaphor? And why explanations such as this about ‘constant flow of electricity’ unaccompanied by suitable annotations may lead to some unfortunate and perhaps misguided applications?

On the other hand, I think that trying to dissuade gullible adherents requires some tact. Attempts to ridicule them by referring to the authors of a book on the subject: Earthing. The most important health discovery ever? and saying ‘None of the book’s authors is a physicist— it shows.’ is just ad hominem. Or suggesting that scientific credentials are not available: ‘The studies were not published in mainstream journals. They involved small numbers of subjects and usually failed to use any controls.’ While true -and to those of us with any acquaintance with how science works, compellingly obvious- it likely fails to convince those who mistrust the scientific paradigm and its lack of certainty to start with. And it may antagonize them to the point of utter rejection of any meaningful dialogue. It becomes another us-and-them standoff.

So, what to do? Tolerate or proselytize? Divide and conquer? Provoke and legislate…?

Perhaps it’s my age, but I’ve seen many fads arise and then dissipate like waves on a beach, with any one of them having about as much individual significance. Think of alien abduction, recovered memory therapy, pet rocks… Each seems to have a brief super nova-like appearance, and is intriguing for a while, and then, when a new star is born, interest flags. Social media may extend the lifespan, perhaps, but novelty is usually trump for those attracted to the fringe belief realms. I’ve learned not to obsess on what I consider the irrational; I will attempt to educate, but not to the point of taking arms against a sea of trouble and by opposing, ending them –as Hamlet would have us decide. If they are not harmful, then they will, as certain as the tide, recede.

In the turmoil of this uncertain world I think we all try to find secure and novel refuge, and when the storm has passed, set out again. It’s what we do –Shakespeare again: ‘Wise men ne’er sit and wail their loss, but cheerily seek how to redress their harms.’

Earthing, with benign neglect, may itself be unearthed…

 

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Women are from Earth

Men are from Mars, Women are from Venus –remember that book? It was published in 1992, and although it was really talking about relationship issues between the sexes, it seems to hint at other, more physiological differences that underpin the disparity -differences that have sometimes been overlooked, or perhaps ignored, in many pharmaceutical drug studies. http://www.cbc.ca/news/health/sport-exercise-menstrual-cycle-1.3618140

The justifications seem reasonable at first glance. There are cyclic changes in women –alterations in the hormonal milieu that make it difficult to standardize conditions for studying the drug in question. For example, progesterone is only found in women after ovulation, and this might alter the metabolism or effect of the drug being studied. Or estrogen –the quintessential female hormone- might alter the effects of the study drug differently than the testosterone milieu of men. Might alter the risks. Indeed, the CBC article quotes Georgie Bruinvels, the lead author of a paper in the British Journal of Sports Medicine: “Evidence actually suggests that women are almost twice as likely to have an adverse reaction to a drug than a male counterpart,” she said. In fact, a U.S. accountability study found “80 per cent of drugs there are withdrawn from the market due to unacceptable side-effects on women.”

And then, of course, there is the risk of inadvertent exposure of an unexpected fetus to the study drug. So why take the chance? Well, for a start, except for pregnancy of course, the sexes share most of the same problems: heart disease, hypertension, diabetes, strokes, arthritis, pain… to name just a few. But if the drugs created to combat these conditions are only tested on men, the information obtained may not apply to women. At the very least, doses may have to be altered. For example, ‘In 2013, the U.S. Food and Drug Administration released a safety announcement about the sleep aid, zolpidem, also known as Ambien. It recommended the bedtime dose be lowered for men and women. It also warned that women are more susceptible to risks associated with the medication because they metabolize the drug at a slower rate than men.’

In Canada, there is an attempt to rectify the gender bias in studies: ‘[…] a policy of the Canadian Institutes of Health Research requires researchers to say how they are dealing with sex and gender when applying for research grants.’

But the issue of sex biased research applies not only to human studies, believe it or not. It can even apply to animal surrogates studied to provide drug data –laboratory mice: http://www.cbc.ca/news/technology/mouse-sex-studies-1.3545486 The same reason -hormonal cycles- is the reason given for choosing male mice as subjects, although the validity of this justification has been questioned. And the results of using male mice has had similar, if not more severe, repercussions: ‘A stomach drug called cisapride that was sold in the 1990s under the name Prepulsid was withdrawn by Health Canada in 2000 because it sometimes caused irregular heartbeat and sudden death “in women only”.’

Or, take Jeffrey Mogil, a neuroscientist and pain specialist at McGill University who ‘estimates that in pain research, 80 per cent of published studies use male mice or rats, even though 70 per cent of people with chronic pain are women.’ And further, ‘Published studies on male mice showed that blocking immune cells called glial cells could block pain. When Mogil repeated the studies on mice of both sexes, he found they worked in male mice, but not females.’

There has been an attempt to rectify this bias: ‘The Canadian Institutes of Health Research, the main federal funding agency for health and medical research, has been trying to address the sex bias in rodent research. Since 2010, researchers have been required to answer questions about whether they will account for sex in their studies.’

Given the need for drug data on both sexes before the resulting medication or therapy is safely released to the general public, what can be done? Well, in most well-designed studies, there are two groups: the group given the medication, and a ‘control’ group who is, as much as possible, identical to the studied group. The general idea is to decrease the number of variables to a minimum, so that the only difference in the study group is the drug.

So, to start with, the study could be partitioned according to the menstrual cycle in women –with the use of a simple blood test to check for progesterone if there is any doubt, or if the menstrual cycle is sufficiently irregular or unpredictable. Thus, after controlling for such things as weight, other medications, health, and past history (as one would do anyway to establish control groups) three arms to the study could be included to address the disparities: 1. Men –knowing that they would have minimal estrogen on board; 2. Women –a). pre-ovulatory (i.e. no progesterone in blood) and b). post-ovulatory women (progesterone in blood). Of course, given that there would also have to be matching controls, this would add extra costs –and probably time- to complete the study. But I would imagine these would be counterbalanced by the costs of developing a drug that might have to be withdrawn from the market for unexpected side effects -on women, say– not to mention any resulting law-suits or ethical considerations held against the company.

And what about inadvertent pregnancy exposures to the drug? Oral contraceptives themselves may interfere with the study drug metabolism so either women on this type of contraception could be added to the study as yet another arm or, more feasibly, women using other reliable, non hormonal contraceptives could be enrolled, including women who have had a surgical sterilization procedure (e.g. tubal ligation).

All of these permutations and combinations may seem daunting, and yet surely the validity and applicability of the study results are what count in the end. As Mahatma Gandhi once said: ‘It is health that is real wealth, and not pieces of gold and silver.’ I just wish he’d said it louder.

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Statistics and Gender

Statistics, the collation, analysis and ultimately, the interpretation of data, have never been easy – at least for me. They have never reached the level of intuitive and, indeed, have barely climbed past manipulative in my head. And I readily admit to occasional cognitive dissonance even when they are used to support what I already believe. Or, rather, want to believe… I wonder if the sources from which I have accessed the numbers might be those that already pander to my own biases. In the cloud of assertions that cover me, everything is obscure and up for grabs.

I suppose it’s like that for us all, though –we hear what seems important to us and sift clumsily through the rest, filing most of it somewhere else, if at all. Especially if what has been measured is not crystal clear –or at least what has been reported is not. A classic example was that of a survey of shared parental leave in the UK. It was initially reported that only 1% of men were opting for this –much less than the rest of Europe. In fact, however, the figure reported was 1% of all men, not 1% of men who had just had a baby.

We have to examine what we read before we arrive at our conclusions; most of us don’t. Most of us have neither the interest, nor the tools to know if what is presented to us is reasonable, or at least free of bias – especially our own confirmation biases. A lot slips through the net.

A good example of this are the statistics on women and girls: http://www.bbc.com/news/magazine-36314061

‘There is a black hole in our knowledge of women and girls around the world. They are often missing from official statistics, and areas of their lives are ignored completely.’ For example, a record of their participation in the labour force in various countries. The data are often biased towards employment in the formal sector, which in those countries, is where men work. ‘Buvinic [an expert from the Center for Global Development, a think tank] argues that many women get missed out because they consider themselves primarily as housewives, when in reality they work on farms, do part-time jobs and seasonal work or run their own businesses.’

‘There are other problems too, Buvinic says. Not all countries collect statistics on other aspects of women’s lives, such as domestic violence or maternal mortality rates, and when they do collect this data they often do it in different ways, making international comparisons difficult.’ And, ‘There are many statistics that are collected without being broken down by sex, which makes it hard to tell when women are not being treated equally.’ For example, “Until recently, very few banks disaggregated their customer data by sex, leading to difficulties in understanding reasons behind the persistent gender gap in access to and use of financial services,” says Megan O’Donnell, one of Buvinic’s colleagues at the Center for Global Development.’

That I find all of this surprising speaks to my naïveté, I suppose, and yet I have my doubts that many of us would take the time from our busy lives to consider what this neglect might mean. David McNair – Director of Transparency at the One Campaign, a group that fights poverty- even uses the weighted ‘sexist’ epithet and summarizes the problem succinctly: “The reason why it is sexist is that women and girls are disproportionately left out of data collection. They are uncounted, therefore they don’t matter.”

Roughly half the population on the planet doesn’t matter? And it’s the half that has gestated and succoured that other half -the only half that is counted? Even if I try my best not to be an historical revisionist, it does not make sense to me.  Perhaps McNair, again, had the best explanation: “If you have robust data then you can be held to account for your decisions. There are people who have a vested interest in not having that information in the public domain.”

But I suppose we have to look for any encouraging little cracks in the imposing male edifice: ‘Recently the UN’s International Labour Organisation (or ILO) held a conference, where labour statisticians agreed how to start collecting data on unpaid and domestic work, for example time spent cleaning your house. Ten countries have volunteered to take part in a pilot to use this new framework to measure unpaid work.’

Whoa, ten countries have decided to put their toes in the water…? Or rather, their statisticians in the water? How brave. Maybe Macbeth was on to something when he said that ‘tomorrow creeps in this petty pace from day to day.’ It’s the end of his soliloquy that has me worried though: ‘It is a tale told by an idiot, full of sound and fury, signifying nothing.’

Oh, I hope not…