March 2005 Archives

Scary Superbugs

Methicillin Resistant Staphylococcus aureus (MRSA) has claimed a 2 day old healthy baby in an Ipswitch hospital in Great Britain. Staph aureus has been responsible for periodic lethal outbreaks in Canada, US and Britain over the past couple of decades. A number of Gram negative bacteria can infect deeper layers of tissue under the skin and cause necrotizing fasciitis -- in tabloid-speak "flesh eating bacteria"-- most commonly Group A streptococcus. Some Gram positive bacteria like Staph aureus can also cause this condition.

Antibiotic resistance is a global public health problem. Many individuals in the US are diligent about finishing their prescriptions. Hospitals and doctors are learning to prescribe antibiotics less, and working to promote hospital environments less conducive to bacterial proliferation.

In many developing countries however, the situation is much worse. Antibiotics are readily available as "over the counter" medicines, and are often overprescribed, especially in private clinics. They can be purchased without prescriptions for mere pennies, rupees, baht...TIt is not uncommon to meet people in developing countries who are mixing it up; taking steroids and antibiotics as well as traditional herbs or potions, in self-determined "power" cocktails. As well, there also individuals in the US who are also cavalier with antibiotics, perhaps because as a nation we take our health for granted.

People who play loose and fast with antibiotics, both in the US and in developing countries, are selfish and short-sighted about their decision. They believe that *not* following prescription guidelines affects only them; that the danger is to themselves. This is a popular misconception. Bacteria are natural inhabitants of our environment that evolve quickly to resist antibiotics. Bacteria are air and water borne (depending on the strain), not the individuals own private cultivation. The reason that antibiotic resistant bacterial infection is so prevalent in hospitals is because in this micro-environment, there are more bacteria, more potential hosts, and more antibiotics that bacteria have the opportunity to become resistant to. Similarly, with improved transportation, our world is a much more hospitable environment for the transfer of all existing microbial strains.

Therefore we are collectively responsible for our common health, and how we take medicine affects everyone's health, with is a common public good. Furthermore, research in antibiotic resistance is important to improving this specific public health threat.

NIH- A Realist Agenda

Research for biodefense is trumping research for public health, much to the dismay of the science community. The National Institute of Health (NIH) drives medical research and funding. The vast, powerful organization is comprised of 27 Institutes and Centers, about 17,000 employees, and a $28 billion budget (fiscal 2004). Primary goals include:

  • Our goal is to uncover new knowledge that will help prevent, detect, diagnose, and treat disease and disability, from the common cold to the rarest genetic disorder"
  • .
  • "Our investment in understanding such diseases as AIDS, diabetes, heart disease and cancer returns dividends in longer, healthier, and safer lives"
  • .

  • "We continue to make major inroads in fighting humanity's most enduring illnesses...."
  • .

And...with new found importance:

  • "...We are working to confront new threats to our health and safety, like bioterrorism."

In a letter to Elias A. Zerhouni, M.D., director of the NIH, published in the March 11th issue of Science, over 700 scientists(subscription) and institutions wrote to voice their concern about the repercussions of:

"[a} 2001-02 decision by the NIH National Institute for Allergy and Infectious Diseases (NIAID) to prioritize research of high biodefense, but low public-health significance."

"The number of grants awarded by NIAID that reference biodefense related microbes has increased by 1500% (from 33 in 1996-2000 to 497 in 2001 to January 2005...)." The increase in funding has largely favored research in tularemia, anthrax, plague, glanders, melioidosis, and brucellosis.

According to the authors, the new priorities compromise funding for bacteriology, mycology and virology research that is not biodefense related, and will have negative repercussions on public health.

Side Effects- Neat

Many people think that TV pharmaceutical ads need to serve up side effects straight up; not obscure them in "a swirling castanet show", as Bill Thomas, Republican representative from California recently put it.

The Wall Street Journal (WSJ) (subscription), reports today that a FDA study in 1992 showed that only 5% of patients understood very well, or at all, the possible risks and side effects of drugs, while 59% asked for the drugs by name. Doctors responded with the requested presciption about 57% of the time.

The article notes that Johnson and Johnson is market testing a new sort of drug ad. The ad shows a patient at a doctor's appointment, apparently gung ho about getting birth control pills. The doctor sits down with the patient and issues a cautionary "let's talk" followed by clear details of the risks of taking the pill, like blood clots and strokes.

The change in marketing tactic is no doubt brought on by strong persistent criticism of the direct to consumer industry, as well as recent Cox-2 inhibitor links to heart risks. Officials from the FDA are testifying in the Senate this week about the handling of public information regarding potential Vioxx dangers. The drug was pulled from the market last fall then released conditionally.

Apparently the highly profitable drug industry is ready to risk frankness. Direct to consumer (DTC) spending by the pharmaceutical industry increased 27% to last year to $4.44 billion. Of course it's hard to imagine how some companies will manage to fit all those side effects into those short spots.

Big Labels & Little Science

A recent World Changing post reacts to a CRN (Center for Responsible Technology) blog entry on the potential uses of nanotechnology. The World Changing essay warns against focusing on technology as the perennial silver bullet to societal ills, and is especially critical of "technophiles" who tout future technology in lieu of taking viable action today. As an example; why focus on nanotechnology to solve malaria problems when mosquito nets that are currently available can be used to help prevent this serious disease?

The point is well taken, and certainly it's nice to see people coming around to articulate this. But it seems to me that CRN's blog is a somewhat weak rhetorical launch pad for such an argument. So I could leave it at that, but the World Changing article and its juxtapositon to the CRN article motivate me to make a couple counterpoints. The WC article strongly distinguishes between two types of "technophiles", those who hue to a "technoprogressive" agenda, and the others;

"market libertarian technophiles who like to handwave about abstract indefinite futures in which injustice will somehow evaporate so as to help justify their own ugly indifference to injustice today".

With a flourish of typing and disdainful curl of the upper lip, the author categorically divides the sage "progressive", from the ignorant "market libertarian technophiles". It's a tempting idea, but I suggest we consider that "market libertarian technophiles" don't suffer from "ugly indifference to injustice". Perhaps they evolve their thinking via patterns something like this:

Budding scientists quickly learn that attaching social significance to grant proposals piques interest and justifies pleas for scarce and competitive funding. This optimism is carried to non-scientific venues, where fairly tedious, time-consuming, trial and error lab science -- arcane work, gets abstracted by scientists for public digestibility. At cocktail parties, for instance, when asked "What do you do?"; savvy scientists know that lines like "I'm working to cure cancer via nanotechnology" generate interest and nods of approval; whereas stating the unvarnished truth such as, "I toil year after year to develop dual-FRET and peptide-linked molecular beacons and magnetic nanoparticle probes for deep tissue imaging, but wait, there's more...", will cause audience eyes to glaze over and people to sashay away.

So before you know it, all the scientist's friends from other disciplines -- the humanities, political science and business, are talking about the weird little gadgets that their cool science friends make which will surely cure cancer. They're all excited technophiles now. Vanilla technophiles.

Then the business friends move to corporations where the home pages claim "we're curing cancer" and two clicks away assure bleating stockholders with; "we're raking in gobs of money". Their political friends get elected and quickly realize that they can only raise taxes for stadiums--never schools or health. They lobby for market liberalization so that "everyone has access to cancer cures", and are incidentally rewarded with campaign money from their business friends for saying so. Now all the business people and politicians are libertarians because according to their very realistic world view, capital for funding technology comes from corporations not taxes.

All the while people in humanities stay in school forever to teach upcoming generations about technology, democracy, and equal opportunity.

Libertarian politics may not look pretty, but there is a coarse reality to the notion that money encourages technology progress. As far as "ugly indifference" goes, if you follow my more or less realistic narrative, do progressives really look more idealistic then "market libertarian technophiles"? To put it bluntly, at the far end of one ideological spectrum, 'bombs should be banned', looks just as pie in the sky as the opposite "abstract indefinite futures" of libertarians.

Technology manages to be a fairly neutral investment vehicle, so perhaps progressive and libertarian "technophiles" both turn a blind eye to politics. Perhaps they listen too literally to innocent 'cocktail party" optimism. Perhaps naivete collectively tricks us all into denial and social inertia, tricks us into throwing all our bets at technology so we don't have to face the odious task of negotiating with those who we consider to be imperialists, facists, covetous or greedy humans, pirates, or terrorists. Perhaps techno-centrism is a evil evolutionary trick so that we selfishly focus on our own success, our own families and pensions.

Scientists (who generally don't refer to themselves as technophiles) aren't always in control of the societal outcome of their work. But it doesn't mean most don't think seriously about it, and lobby for the positive influence of their work. They have to, or else they wouldn't get funding.

Perhaps all technophiles should think even more about politics. Maybe all progressives who tout equality for the 80% of the worlds poorest should live in a populous, oppressed countries, rile up revolutions, then witness the destruction necessary before "equal access" is wrested from autocrats to see how impossible achieving democratic freedom is. Perhaps Adam Smith reveling market optimists should labor day in and day out at the very bottom rungs of a corporation for twenty years or so to figure out just how much "freedom" flourishes there then not be able to retire because they have no social security or their pension got wrested away in a fit of corporate bankruptcy debt restructuring.

Ultimately science is as political as anything else, but we all need to know science in a realistic way and engage in technology discussions that both forward science and encourage understanding and participation. Perhaps we need to reassess our habit of encapsulating science for short, entertainment seeking attention spans. Maybe not. Whatever we do we need true science understanding on juries to vouch for DNA results, on school boards to vouch for evolution, and on presidential advisory panels to assess embryonic stem cell culture. I think it's unlikely that we could check everyone at the door first to make sure that their definition of "progress" appeals to our political sensibilities before allowing them to participate.

Above all, we need technophiles and scientists from all political persuasions who tolerate both people who lean towards free market optimism and those who lean towards social welfare optimism. We need people from all side willing to listen to the reasoning of each other.

Ethics- The NIH and FDA

The NYT commissioned the Center for Science in the Public Interest (CSPI) to look at the backgrounds of the 32 scientists on the FDA's advisory panel for the safety of Celebrex, Bextra and Vioxx in light of evidence of cardiac risks to patients.

The NYT reports:

"The center found that at least 10 of the 32 panel members had consulted for or received research support from Pfizer, which makes Celebrex and Bextra; Merck, which makes Vioxx; or Novartis, which is seeking approval for a similar drug. Had the votes of those 10 scientists been excluded, the panel would have favored withdrawing Bextra from the market and blocking the return of Vioxx. Only Celebrex would have been deemed safe to use."

On one hand, many argue that it's next to impossible to find "experts" that have not been engaged in drug company consulting. On the other, people argue that these dual roles for medical researchers endanger unbiased medical science that is truly in the public interest.

In a related story, "Some Scientists Say New Ethics Rules May Damage NIH" (March 3, 2005), WSJ reports of new ethics rules announced by the NIH that forbid any of the 18,000 NIH employees from consulting for drug companies, and prohibits 6,000 NIH employees from holding stock in pharmaceutical or biotechnology companies. The new rules have produced conflict within the NIH with rumors that rules will dissuade many prestigious scientists from pursuing positions there.

Required: Degree, Experience, References, Appropriate Finger Lengths...

One question that perpetually fascinates scientists is: nature or nurture? As employers making decisions about who to hire and for what skills, Larry Summers got our attention recently when he spoke at an academic conference about women in the workforce. Summers opened up a can of worms with his suggestion that math skills were sex based, moreover, that males had superior skills.

Many commentators use these occasions to chime in with authoritative sounding opinions, whipped up rational barely veiling bias. The media busily tries to disentangle truth from fiction, but in the end author's usually wind a story around their own opinion.

Scientific research in this area can look just as suspect. We recently came across work from Allison Bailey and Peter Hurd at the University of Alberta published in Biological Psychology. They say that the ratio of finger length in men varies according to how much testosterone they are exposed to in utero. Men with smaller index fingers relative to their ring fingers, according to their research, display a statistically relevant tendency towards aggressive behavior. The theory doesn't apply to women.

The authors point out that their finding should not be grounds for any normative action. But does that sort of cautionary endnote really to convince people? Or will the media go on and on suggesting that violent tendencies can can be attributed to and predicted by finger lengths?

Many people including MDs remain convinced like Summers that genetics responsible for complex behavior, a dangerous assumption which can be used for nefarious purposes. Self-labeled "organizationally challenged" Lisa Belkin jokes on 2/27/05 in the NYT article titled "Chaos and The Cubicle", that desk tidiness is hardwired.

Although Belkin doesn't mention it genetic studies have connected neatness with the presence of certain certain genes. Belkin quotes a production specialty consultant who notes: My H.R. clients have flat-out told me: 'I'd promote someone with a tidy office over someone with a messy office any day.'" Which begs the question, could the preference for neat office workers be met with genetic screening?

If behavior traits were genetically determined, should they used to promoted or demote people? To steer people towards different career paths? Should people be disallowed from certain jobs for carrying them? Could those who show traits for alcoholism be dissuaded from restaurant jobs and public transport driving jobs? Should those with compromised longevity traits be placed in jobs bound for programming perhaps?

Larry Summers tried to evade being labeled sexist by defending his suggestion that women were intellectually inferior to men at math as a "hypothesis". He has many supporters who chime in, saying -- why steer away from what "could be true"? Wrong, wrong, wrong. This research has been done already. More likely Summers' is convinced that now is a politically opportune time to share his true colors. He feels so confident in fact, that he shares this at a meeting of academics focused on diversity in the workplace.

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