Such Sweet Sorrow

I kind of figured sugar would sneak back. It always does! Just when you think it should be terminally ashamed of the stuff it’s done, it shows up as somebody else and fools everybody. I mean, forget trying to pretend that you don’t recognize it in a crowd, that you can’t see under its mask. Sugar is, well, sugar, eh? No matter how it tries to sweet-talk its way around you, it is what it does. Period.

But what is that? Apart from fuelling our atavistic requirements for easily assimilable energy, and therefore surviving early Darwinian whittling, I’ve often wondered if there’s more to sugar than meets the tongue. It has too large a presence in our world to be confined to pleasure alone. Almost every organism seems drawn to it. Should this be telling us something?

Every once in a while my overweening, but naïve hunches are rewarded with information that addresses much the same issues but in ways I hadn’t considered: http://www.bbc.com/future/story/20180328-how-sugar-could-help-heal-wounds?

Moses Murandu is a man who grew up in the rural Easter Highlands of Zimbabwe, and later moved to England to work in its National Health System. ‘A senior lecturer in adult nursing at the University of Wolverhampton, Murandu completed an initial pilot study focussed on sugar’s applications in wound healing and won an award from the Journal of Wound Care in March 2018 for his work. […] To treat a wound with sugar, all you do, Murandu says, is pour the sugar on the wound and apply a bandage on top. The granules soak up any moisture that allows bacteria to thrive. Without the bacteria, the wound heals more quickly.

‘In some parts of the world, this procedure could be key because people cannot afford antibiotics. But there is interest in the UK, too, since once a wound is infected, it sometimes won’t respond to antibiotics. […] And a growing collection of case studies from around the world has supported Murandu’s findings, including examples of successful sugar treatments on wounds containing bacteria resistant to antibiotics.’

Well, it’s safe to say that I don’t know how much sugars will contribute to our health and well-being, but they do serve as a reminder that western science is not the sole guardian of knowledge. Or wisdom. Answers are not rare -they are lying around everywhere just waiting for the right questions to discover them. The right curiosity. And we run a risk dismissing traditional enlightenment -folk wisdom- out of hand.

The problem, as I see it, is one of attribution. The credibility we assign each source should be determined by the results of testing its hypothesis, finding the appropriate question to interrogate whatever is proposed as an answer. Finding the key that fits the lock… And the thesis investigated does not have to be of mind-bending importance; science is not the exclusive purview of people in white coats. Nor those of a certain age…

I recently happened upon a Tim Horton’s café in close approximation to a message from my stomach that it needed both a coffee and a bagel. Not being in the mood to argue, I decided to accede, although my loyalties normally lie with Starbucks. I had been wrestling with the question of habit on my walk –my strange unwillingness to explore new ground, consider new sources. Tim’s could be the answer waiting for the question.

Science, if it be considered from the inductive perspective, I reasoned, required the inference of laws from particular instances -answers from the right questions. In other words, Propose, Test, and then validate or refute. It isn’t enough to simply assume…

I had chosen a busy time unfortunately, and I was lucky to find a single table in a corner by the window. It was squeezed between a group of elderly women crowded around a larger table busy consuming their donuts and politely slurping their coffees, and a small table like mine occupied by a harried looking mother trying to bottle-feed a squirming, unhappy baby in her arms and a young boy busily kicking the legs of his chair.

The elders were surprisingly quiet, but not the little boy, so my ears naturally focussed on him.

“Why can’t we go, Mommy?” he kept asking.

I could tell his mother had almost reached the end of her tether, and she stared at him crossly, determined not to interrupt the feeding. “Because I’m still feeding Janny, Tim,” she replied, tensely. “She’s really hungry.”

The boy tilted his head curiously. “She’s squiggling around; she’s not even sucking…”

At that point the baby began to cry even louder-scream, actually- so the mother put the bottle on the table and positioned the baby on her shoulder to burp it.

But Tim still looked puzzled. “But she doesn’t like the bottle, Mommy,” he said, as if his mother should have noticed by now.

His mother shrugged, almost in tears. “I know, Timmy, but you were hungry too, remember? That’s why we came in here instead of going back to the car.”

Tim sat back in his chair for a moment to process the problem. “Well, why don’t you let Janny suck your breasts?” he said, in the rather loud voice of a four year old.

I could see his mother blush as soon as he said it, but Timmy had merely proposed a tentative hypothesis that could easily by tested to see if he had asked the right question, and his face was as innocent as a new nappy.

His mother leaned over the table with Janny so she could show Tim that they could talk quietly about it. “I would if we were sitting in the car…” she said, but he continued to stare at her, still puzzled. “And the car is still a long way away, Timmy.”

Tim leaned over the table like his mother. “Why can’t you breast her here?” he asked innocently.

She smiled and glanced around the room, embarrassed. “Some people don’t like to see mothers breast feed their babies in public.” She tried to whisper but Janny was really screaming now. She glanced at the washroom, no doubt wondering if she could feed her baby in there, but it must have been a small room, because there was already a line of needy hopefuls that had formed at the door

Tim smiled as if he knew how to solve the problem with his initial hypothesis, and he leaned towards me on his chair. “Hey mister,” he said in his best, grown-up voice, “Do you mind if Mommy breasts Janny in here?”

His mother was now beet red, and she glared at her little son and then attempted to smile at me. “I… I’m sorry…I…” But she was too embarrassed to continue.

“I don’t mind at all,” I said, trying to reassure her with a reciprocal smile. “You can use my jacket to cover yourself, if that would help…” I said, beginning to take off my jacket.

One of the elderly women at the next table leaned over and gave a thumbs-up to the frazzled mother. “We’ve all been there, dear,” she said and winked before she turned back to inspect her plate for donut remnants.

I handed the mother my jacket and the baby settled into the welcoming breast somewhere underneath. Propose, test, validate…

I added some extra sugar to my coffee, and settled back in my chair to celebrate the triumph of citizen science that even a child could perform. It’s just a matter of finding the right question, after all…

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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?

 

The Science of Answering

I suppose in this suspicious age, everything is open to scrutiny. But some things are examined at one’s own risk risk -like turning over a familiar log in the garden only to find unexpected and sinister-looking creatures lurking quietly beneath. This is fine, of course, but it can be hard to know what to do with the results of such investigations without some attributions -either positive, or more likely, negative. And, depending on our experience, a vacillation between the two.

Science by encouraging unbridled curiosity has often not been neutral in this. With some trusted and unsuspecting products that have been on the market for years, subsequent studies have occasionally determined similarities of structure, or function, with other, more bothersome effects. Aluminum in cookware was one famous example. Aluminum was found in some plaques in the brains of patients with Alzheimer’s disease so of course products containing aluminum went into a precipitous decline from which they never really recovered despite subsequent studies that failed to substantiate the risk. Or think of the autism scare after a since-repudiated 2004 article suggested that thimerosol, a synthetic form of organic mercury which has been used for many years as an antimicrobial agent and preservative in many vaccines, was the cause of autism spectrum disorder.

Once these doubts have been cast, suspicion often lingers that is hard to eliminate. Conspiracy theoreticians emerge from the shadows to sew their seeds, flaunting the seemingly obvious and intuitive conclusion that there must have been something that made the scientists find what they did. The fact that science actually encourages refutation -that nothing is ever known for certain and that they’re rather happy with that- escapes those who would rather believe there is a cover-up.

And now, there is another study –one among many- that suggests that even low amounts of parabens –preservatives used in, among many other things, the cosmetic industry- might increase the risks of breast cancer! Researchers from the University of California, Berkley have published a study in Environmental Health Perspectives that seems to demonstrate this: Environ Health Perspect; DOI:10.1289/ehp.1409200

‘Existing chemical safety tests measure the effects of a chemical on human cells in isolation. However, as these tests fail to consider that compounds might interact with other signalling molecules, the tests are insufficient, explained the researchers.

Using the naturally occurring growth factor in breast cells, heregulin, the researchers stimulated the HER2 receptors in breast cancer cells and exposed the cells to parabens. The chemical caused the oestrogen receptors to activate genes, which led to the proliferation of the cells. Moreover, the effect was significant: parabens in the HER2-activated cells stimulated breast cancer cell growth at concentrations 100 times lower than in cells lacking heregulin.’

Is nothing safe? It’s difficult to know what to do with information like this. Surely there is a middle ground between merely shrugging our shoulders and accepting that the world is a dangerous place, and railing against Science for trapping us here. Do we sometimes just use our indecision as a reason to worry? Change seems to spawn unintended consequences no matter how hard we try to anticipate them. As an enthusiastic user of modernity I suppose I am closer to the shrug camp, but I recognize that there are different world-views out there and I dare not gainsay them. Especially if they are first time patients who are a little wary of me to start with.

Jona did not trust me; I could tell by her eyes as soon as I introduced myself in the waiting room. While her face said hello, her eyes threatened me with silence if I so much as stepped on the boundary. The hand that shook mine was aggressively firm and it was all I could do to keep from wincing. I hate that. I’ve always felt that the first contact should be a greeting, not a contest. A sign of mutual respect, not a dare. I don’t feel at all competitive at that stage, but from her expression, I could see she felt it was a form of sport. I was surprised she let me lead her into my office.

When I was finally allowed to sit and open up my computer, I saw that her referral to me was for dyspareunia –code word for pain with sex. She sat on the other side of my desk with everything on guard: face, posture, fists… Everything dared me to ask her why she was here. So I didn’t. I just let her talk –debrief, as it were. Her eyes –at least the ones that she had trained to pin doctors to their chairs- were hovering around my face, waiting for me to provide the excuse for an attack.

“I know that Maria has listed my problems in the letter she Emailed, doctor, but before you start on me, I just want you to know that I refuse to take, insert, or inject any medications.” She proceeded to cross her arms tightly across her chest, as if something was trying to escape from under her blouse. “Maria wanted to put me on estrogens, but as you know, they can cause strokes, heart attacks and cancer. Sex isn’t worth that risk.” She glowered at me, still holding off the eye-attack until I said something. “Then, she suggested the low-dose variety that you merely put in your vagina… Merely?? It’s hardly a little thing to put an uninvited foreign body in there, doctor! She thinks my vaginal skin is too thin and that’s why it hurts.” She thought about it for a moment. “And how would she know? She couldn’t even get a speculum in there, so how could she say that? I’m 48, not 68 for God’s sake. I’m still having periods and tampons have never hurt.” She sighed theatrically and continued. “I’ve tried lubricants and stuff, but if you look at what they contain and then Google the contents, it’s like playing Russian roulette with your vagina. Some of them even print disclaimers and suggest medical consultation before using them. They can cause allergies, skin irritation, infections… Some are even carcinogens when you look up the pharmacology. And then there’s that article saying that the parabols might even cause breast cancer…”

‘Parabens,” I corrected her and then closed my mouth, smiled sympathetically and waited for permission to say something more. Anything.

“Whatever. My husband doesn’t understand, either. All he wants is something quick before he goes to sleep. Of course, he thinks I’m making up the pain stuff…”

The short pause, and a brief journey of her eyes to a picture on the wall gave me an opportunity to ask her something: “Do you talk to your husband?” I said, and waited for the eyes.

“He won’t even talk to me when we’re eating dinner…” She said slowly and looked down at her lap, caught off guard by the question, I think.

“How long has it been since you were able to talk?”

Jona withdrew her eyes and they disappeared into her face along with her anger. Then she shrugged, and a few words spilled out. “It’s been so long, I can hardly remember when…” She suddenly stopped talking and stared at me. “But why did you ask about him, doctor? Do you think our…?” she said in a whisper. “My GP never even asked…” Her expression changed from one of defence to one of curiosity. “Why did you wonder if I talked to my husband?” she repeated.

“Are you a Shakespeare lover?”

Her face tightened for a moment in puzzled irritation, but then she laughed. “Double, double boil and bubble; Fire burn and cauldron bubble,” she said, obviously pleased with herself. “The witches, in Macbeth, I believe.”

I nodded, then grinned. “Well, let me quote from the play-within-a-play in Hamlet –Gertrude answering Hamlet’s ‘Madam, how like you this play?’… ‘The lady doth protest too much, methinks.’ she answers…”

A little smile –the first real smile she’d shown me- blossomed like a flower on her lips. “Maria said you were good, doctor… You’re smarter than you look,” she said with mischief in her eyes this time, and her body relaxed into the chair. “What do you suggest I do?”

I readied my fingers over the keyboard and chuckled warmly. “I suggest we start by making sure there is nothing you need to worry about.” I thought of another memorable phrase, this one uttered by Hamlet himself: ‘There is nothing either good or bad, but thinking makes it so.’ But I didn’t say anything; she’d had enough Shakespeare for now I realized.