November 2009 Archives

The World In Overshoot

What should we do when the world is in overshoot? An article in the latest issue of the New York Review of Books looks at depletion of natural resources in a world of ever increasing demand.

John Terborgh reviews "Paradise Found: Nature in America at the Time of Discovery", by Steve Nicholls. Nicholls is an entomologist and wildlife film producer who became alarmed at the progressive devastation of nature he saw in his perennial travels across America. Says Terborgh, "The World Is in Overshoot" communicates its message

"...on two levels, emotional and philosophical. The emotion is a restrained outrage at the wanton and often savage slaughter of wildlife -- cod, salmon, seabirds, curlew, beaver, bison, passenger pigeons, sea turtles, oysters, seals, walrus, and on and on. One feels it viscerally. And that drives home the philosophical point that all the excess and destruction were ensured by the cast of mind of the European colonists, the conviction that God created the wealth of nature expressly for man's benefit."

The current plight of Grand Banks cod fisheries illustrates the problem that many species face. John Calbot discovered the Grand Banks in 1497. Today the adult cod population of the Grand Banks is 3% of what it was then, an outcome that Thomas Huxley certainly didn't predict. In 1883 Huxley wrote about the fish he called "Darwin's bulldog":

"I still believe the cod fishery...and probably all the great fisheries are inexhaustible; that is to say nothing we do seriously affects the number of fish"

We've held this perception of nature for hundreds of years, it's almost part of being human, harvesting the endless bounty of nature. Garrett Hardin popularized the "Tragedy of the Commons" concept in 1968, but the Grand Banks pillage had started long before that and would not be stopped by increased awareness of scarcity. For over five hundred years the Grand Banks were fished by Europeans and Americans. Technology improved over the centuries and catches increased with each improvement, hand lines to long lines to gill nets to larger nets; wind to steam to factory ships; the "inexhaustible" bounty grew more precarious. At one point the Canadian government imposed a moratorium on cod at tremendous cost to the fishing economy, but for many reasons, now, 17 years after the moratorium the codfish has yet to recover.

The NY Review of Books author talks about the alterations in Grand Bank's species like snow crabs, shrimp, lobster, skate and dogfish, which make up the damaged ecosystem that can't support cod populations. Another damaged ecosystem is the "political tragedy of the 'commons'", says Terborgh. The fisherman naturally maximize their gains, but the politicians contribute to the tragedy by failing to pass effective regulations:

"The reluctance of official bodies to protect natural resources manifests a failure of political systems, particularly of modern democracy."

Nature, Idealized

The article is accompanied by an Albert Bierstadt painting, "Among the Sierra Nevada". The painting is an interesting choice for the article. Bierstadt made trips to Western United States in the latter 19th century, then composed over 500 paintings, many of them depicting idealized western landscapes dominated by lush forests, plentiful wildlife, and majestic mountains, all bathed in surreal golden light. This particular painting was painted while Bierstadt was in Europe, nine years after the artist visited the Sierra Nevada in California, Critics say the mountains look more like the Alps than the Sierra Nevada, as Bierstadt

"painted the West as Americans hoped it would be, which made his paintings vastly popular and reinforced the perception of the West as either Europe or sublime Eden."¹

Other critics say his paintings resemble not Europe, but Arcadia. Either way, Bierstadt paints a west to seduce potential travelers, free of unwelcoming animals (and indians), free of hostile mountain passes. His paintings were labeled blatant propaganda by some critics, encouraging people to go West. According to more extreme views, his art contributed to the destruction of the wilderness.

Terborgh, however, notes, not about Bierstadt:

"The diminution of nature is a price to be paid by a society obsessively dedicated to unending economic growth. To lay the blame on the past obscures the lesson for our own time."

Terborgh rightly points out the weakness in pinning resource depletion on past actions. Past failures don't absolve us of the pressing need to act today. The pairing of the painting with the essay - perhaps inadvertently - also points out that sometimes we give in to temptations to paint the past more idyllically than it was. Other artists depict the west much more harshly then Bierstadt's commercial aims ever allowed him to. Terborgh writes of Paradise Found.. that Nicholls-

"turned to writing to lay out a sweeping panorama of what North America has lost in the centuries since the first explorers wrote back to their European sponsors of an exuberant nature so bountiful we can no longer imagine it."

Nature was bountiful, but some depictions, like Bierstadt's, were over-imagined. Overplaying the beauty and tranquility of nature served economic interests (encouraging settlers) long ago. Do we as easily overestimate economic security and but overlook nature today? Same bias, different outcome? Does short term gain obscure the long term value of the environment, to our long term detriment?

-------------------------------

¹ Gordon Hendricks, Albert Bierstadt: Painter of the American West (New York, 1974), 51058, 149-50; Anderson and Ferber, Albert Bierstadt, 74-77, in Hyde, A., Cultural Filters: The Significance of Perception in the History of the American West, The Western Historical Quarterly, Vol 24, No. 3 (Aug., 1993), pp 351-374.

Photo courtesy of WikiCommons: here.

Acronym Required sometimes writes about the environment, and we critiqued a proposal that applied the Tragedy of the Commons parable to antibiotics here.

The past couple of weeks have been filled with stories about scientists' public dust-ups, intriguing to all, especially non-scientists. Why are they so interesting? Maybe such sordid tales offer something beyond dry research results sexed-up by editors desperate to grab readers weaned on YouTube? Maybe the stories make scientists seem not quite so pocket-protector laden and boring? (We're not boring, really!) But since we all know people who slow down to gawk at accidents, others who link lavishly to tales of disease, distress, death, and dismal demises, perhaps those people are just as enamored, in the same schadenfreude way, to science bickering and wave-making?

• Ice Floes and Climate Woes: Antarctica is losing ice from the eastern side as well as the west, according to a study in Nature Geoscience, an event that could significantly increase sea levels. But that's not the news everyone's focusing on these days. What interests them are the emails exchanged between a few scientists, stolen from a server at East Anglia University in England and broadcast on the internet.

  Fox News and the usual suspects are gleeful of course, oiling up for a long campaign of undermining science and swaying wishy-washy people. Everyone else spectates, eagerly leaning into the ropes. The Financial Times avidly quoted 'both sides', first the "free-market think tank" CEI spokesperson who called the emails "global warming house of cards", then the scientist whose email revealed that he wanted to "beat the crap out of" a certain scientist, a phrase that one person sincerely explained as "a common pleasantry" among high-calibre scientists. Optimistic climate deniers are talking "smoking guns" and ClimateGate. But as Real Climate: put it in one of their posts:

  "if cherry-picked out-of-context phrases from stolen personal emails is the only response to the weight of the scientific evidence for the human influence on climate change, then there probably isn't much to it."

  "Probably" is understatement. Somehow the media constantly gets away with quoting 'both sides' without signaling to readers the truer story: One side has hundreds of studies - the scientists; whereas the other side is lobbying for some corporation, or out of desperate laziness. The science is depressingly convincing on climate change. But obviously people don't all embrace change, and to that end, the deniers have proven time and time again that hammering away with their fraudulent message will keep people consuming petroleum products.

  My take is that if you unearthed the email trove of any group - government, academic or corporate - you'd find some nasty, flaming emails, but not everyone sees it the way I do of course. Some scientists are calling for increased transparency.

• Personal Genomics, What Risk? Researchers from the J. Craig Venter Institute and Scripps Translational Science Institute compared the results of two personal genomics companies for five individuals and found discrepancies in the disease risk predictions. The two companies, 23andMe and Navigenics DTC, responded to the paper in a recent issue of Nature. The two companies agreed with the criticism on some points and offered explanation on other points -- for instance about the differences between population risk and individual risks, and the importance of doctors' communication about genetic risks to patients.

  In other personal genomics news, Iceland's deCode Genetics went out of business, leaving it ambiguous, although we're assured that the genetic information will be protected, where their vast genetic data bank will end up.

• Curly-haired Science Populizers Spar: Steven Pinker popularizes cognitive science and evolutionary psychology. Malcolm Gladwell popularizes sociology and social psychology. They both have Canadian roots and very curly hair. Now they're sparring. Pinker critiqued Gladwell's, "What the Dog Saw" in a recent issue of "New York Times. Like any good manager or professor, Pinker offers four paragraphs of compliments before he breaks out the sharp red pen. Gladwell is a "minor genius", Pinker writes, but "unwittingly demonstrates the hazards of statistical reasoning and who occasionally blunders into spectacular failures", and "frequently holds forth about statistics and psychology, and his lack of technical grounding in these subjects can be jarring."

  Pinker says that Gladwell provides "misleading definitions", and furthermore, he mistakenly calls an eigenvalue an "igon value." The criticism may seem idiosyncratic to the lay person, but subject area experts see things differently. They're more likely to believe that imprecise definitions and simplification lead to public confusion. What's interesting is that such criticism comes from Pinker, who, being a popularizer like Gladwell, must certainly recognize the necessity of selectively choosing what to include in rhetorical writing for huge non-science audiences.

  Gladwell responds that Pinker "is unhappy with my spelling (rightly!) and with the fact that I have not joined him on the lonely ice floe of IQ fundamentalism." Clever defense and countercharge - in other words, "Igon value" was a typo not a misunderstanding, intimates Gladwell; and Pinker is more or less an intellectual pariah. Gladwell also denigrates Pinkers' sources for being bloggers or online denizens: "our differences owe less to what can be found in the scientific literature than they do to what can be found on Google." Ouch, ouch and ouch.

• Fantastic FOXP2 - The Speech Gene? David Shenk provides his blog at The Atlantic as a forum for a scientist and a New York Times journalist to spar about the journalist's presentation of science. Shenk posts a letter from University of Iowa neuroscientist and Behavioral Neuroscience Editor-in-Chief Mark Blumberg, to Nicholas Wade's about his New York Times story, "Speech gene shows its bossy nature." Blumberg takes Wade to task for calling FOXP2 the "speech gene".

  "the distinct possibility that the mutation influenced a myriad of other brain and body functions that, in turn, affected speech. Indeed, given all that we know about how genes work - as well as our sad history with grandiose claims about single-gene effects on behavior - wouldn't it be wise for all of us to be more cautious when communicating these findings to the public?

  In turn, Wade writes:

  "The role of this article was to update readers on a new finding, not to review the history of ideas about FOXP2. So there's no space to go into the argument about the gene's precise involvement with speech and language, much of which we have covered in earlier articles."

  Of all our notes, and all the other dust-ups in play in the news recently, I really enjoyed this presentation by Shenk because it gets to the heart of challenges with science communication and the work that scientists and writers must do to get science across to non-scientist audiences without generalizing or leading readers astray. Definitely worth reading.

• Do Names Portend Profession? Yes, we're joking. But if you're into astrology and anti-vaccination, if you think global warming is a giant hoax, you may steer clear of certain girls' given names. "Isabella", for instance, is a pretty name, second in popularity for girls in 2008, but, like Arabelle, Anabelle, Belinda, Elizabeth, Isabel, Isabella, Mirabel, Rosabel, Sybil or Mabel, it comes with troublesome nicknames, like "Bella"" or "Belle", which can also stand alone. Bella is the wan female protagonist of new popular movie, "The Twilight Saga: New Moon". Bella loses her mind (according to reviews) when her vampire boyfriend goes missing. OK there may be worse things then your daughter mooning around for months over her missing vampire boyfriend...but what are they again?

  "Belle" of course, was the nom de plume of the anonymous British scientist, named after the movie, not the name "Isabelle", who blogged about her second life as a prostitute. News of the scientist blogger outed as "Belle de Jour" elicited delighted and scurrilous musings online and in real life. Online, BoingBoing posed a "takeaway debate", asking: "Is this good or bad for scientists/science bloggers?" In real life one scientist acquaintance told me that he'd read that women with Asperger's syndrome were often "loose" because they could compartmentalize (we didn't check his source). He then continued, thinking aloud, that "of course they might be scientists too", and his eyes lit up at his connection and all the potential relationships he would have previously discounted. So in that case, to BoingBoing's question, it might be good for scientists.

  But "good or bad" is not necessarily the only takeaway, as British columnists tell us. Rowan Pelling wrote: "Interviewers have been asking me breathily what I thought of Belle when I met her, as if my eyes must have been out on stalks at the idea of a PhD student turning tricks." Actually, it wasn't her "trade", but the excellent "quality of her writing", that "shocked" Pelling.

  To be honest, the parts of Belle de Jour that I read I found about as captivating as reading a Martha Stewart description on how to stuff pillows with barley husks, so clearly I'm not the best judge of this sort of thing. But columnists babbled on and there seemed to be no debate about her "writing" prowess. Clive James of the BBC gushed:

  "And what a female...she was Ernest Hemingway...a woman of outstanding beauty and brilliance...student of informatics, epidemiology and forensic science...a student of military strategy...the thinking man's dream girl...There is nothing this woman can't do, and you can tell by the history of her blogging...She knows everything. She even knows what informatics is. I looked it up, and basically it means information theory.

  Yikes. Chill, pal. Perhaps they edited my Scribner Classics Hemingway edition, but I don't recall Hemingway writing such doozies (albeit rare) as Belle's 'my pussy makes men cry'. So now then, (and speaking of names, we won't even go into the name "Brook[e]), back to BoingBoing, what's the takeaway for scientists? Actually, I would debate, not much with this flash in the pan story.

  But here's my takeaway from Brooke Magnanti. Magnanti works for the Bristol Initiative for Research of Child Health and studies toxicology, most recently on organophosphate chloropyrifos (CPF) used in pesticides. An abstract in Toxicology Letters by Magnanti et al, (Volume 189, Supplement 1, 13 September 2009, Pages S268-S269) suggests the EU policies on CPFs be changed to the more restrictive one of the US which limits indoor use. I find this interesting. Many people, myself included, tend to think of US policies for environmental hazards as laxer than EU policies -- but be careful about generalizations. Acronym Required wrote about US and EU policies, and the EU's REACH protocol here and here and here, and here. I know, science, far less interesting, sigh.

The turkey is no phoenix, but nevertheless we've dug through the archives for Thanksgiving posts. From 2007 in "Thanksgiving - All Things Ottoman:

"...As most people know, the domesticated turkey that Americans eat for Thanksgiving descends from the wild turkey, Meleagris gallopavo, native to America. The Spaniards fancied the turkey when they invaded Mexico where turkey was indigenous, and then introduced the bird to Europe when they returned in the early 1500's. However, during the expansion of the Ottoman Empire, turkeys were thought by northern Europeans to be a product of Turkey.

Europeans also for a time called turkeys "India fowl", then confused the turkey with "Guinea fowl" and gave turkeys the same Latin genus name: "Maleagris". The species name that they settled on, "gallopavo" combines the Latin for rooster and for peacock. From these confusing origins turkeys have long struggled with their identity. First they were put in their own family, Meleagrididae; but now scientists consider turkeys to be part of the pheasant family, Phasianidae, in the subfamily Mealeagidinae...."

And 2005:

"The history of Thanksgiving is somewhat murky, but the first harvest festival in North America was probably in Newfoundland. The American colonists most likely had a somewhat more modest festival than our cranberry laden myths would have it. Tryptophan in turkey doesn't cause post meal sleepiness..."

Thanksgiving is one of our favorite holidays. Hope all our readers who celebrate Thanksgiving enjoyed it, and those who didn't didn't go hungry, had work, and took a moment to enjoy something...

For most of history, people were bent on dominating and conquering nature, clearing land, killing predators, and domesticating the wild. Now humans are determined to prevent some species from going extinct, from trees to frogs to large cats. Here are some recent ones:

• Headlining, With Great Fanfare, Some Crocodile Fossils: The open-access journal ZooKeys published a monograph describing crocodile fossil finds from the Cretaceous period, including what the scientists describe as three new species. "My African crocs appeared to have had both upright, agile legs for bounding overland and a versatile tail for paddling in water", said Paul Serono, the National Geographic explorer in residence (emphasis added). (via Science in "Slideshow: Ancient Crocs With a Dog-Like Walk")

• Darwin's Mockingbirds: Scientists are analyzing DNA they've extracted from the footpads of mockingbirds brought back by Darwin. They hope to use the information to select species of mockingbirds most like the original ones, and reintroduce these species to the island of Floreana.

• Amazon Deforestation Slows? Brazil reported a record low for Amazon deforestation, the lowest it has been in 21 years. Only 7,000 sq km was destroyed between July 2008 and August 2009. However some organizations tempered any enthusiasm over Brazil's claims. Greenpeace said in a press release that its would be happy when " in 11 years time, the Amazon was being destroyed at a rate of a little less than three cities the size of Sao Paulo a year". Some people suggest the recent reduction is related to the economic recession. We previously wrote about deforestation here, here, and here.

• Modeling Deforestation and Degradation -- REDD: The journal Nature describes a deforestation modeling project aimed at "reducing emissions from deforestation and forest degradation" (REDD). Emissions from deforestation and degradation account for about one-fifth of the world's total emissions, however deforestation goals weren't included in the Kyoto Protocol because there was no reliable system for estimating CO2 emissions reduction. Scientists think that REDD is one of the cheapest ways of reducing overall emissions. If models were robust, richer countries could use the forecasts to reduce CO2 emissions, and to compensate poorer countries for minimizing biomass loss, more economical than reducing industrial emissions.

  A REDD project by Applied Systems Analysis (IIASA) uses three existing land-use models to predict future losses. Project scientists say this model is a better predictor of deforestation than estimates based on historical analysis. The model predicts higher rates of deforestation in Central African countries of the Congo Basin than historical based predictions do, because economic activity in Africa is accelerating. Therefore compensation would be relatively greater in Africa using REDD, whereas Brazil, where deforestation has been going on for years, would fare better using a historical model. However as with any model, REDD is naturally only as good as the data going in, and doesn't factor in illegal logging.

• Geo-Wiki: In order to improve deforestation models, another tool, Geo-wiki asks volunteers to help refine land cover maps by filling in knowledge about their local areas (via Nature).

• 

  17,000 Species, Leagues Under The Sea As the rainforests disappear, scientists involved with the Census of Marine Life released a preliminary report on a bounty of life in the sea below the reach of sunlight, including this copedpod on the left, which I'm most enamored with.

• Scientists Make Mistakes about Skates: Species of skate may be fished to extinction because of species identification mistakes, according to research reported in Aquatic Conservation. Since the 1920's scientists thought two species of skates -- which are cartiligenous fish like rays and sharks -- were only one species. The two distinct species, the flapper skate, Dipturus intermedia and the blue skate, Dipturus flossada were grouped together and known as the common skate: Dipturus batis. The French researchers say that both species may be more endangered then previously assumed because of the taxonomic labeling mistake.

  The researchers also point out that official fisheries statistics done by French ports grouped five distinct species under only two species names. The ports survey used the counts to calculare skate decline, but more precipitous declines of some of the five species were masked in the survey. The scientists warn that similar fishing surveys may gloss over species loss in "Taxonomic Confusion and Market Mislabelling of Threatened Skates: Important Consequences for Their Conservation Status". Igle et al, Aquatic Conserv: Mar. Freshw. Ecosyst. (2009). DOI: 10.1002/aqc.1083

• Carp Invade Great Lakes: Some carp are endangered. Jullien's Golden Carp Probarbus jullieni, found in South East Asia, especially in the Mekong, is considered a threatened species. The so called naked, or scale-less carp, Gymnocypris przewalskii, is found between freshwater rivers and the saltwater Lake Qinghai in China and is also endangered. Others species of carp are not endangered, rather they endanger.

  Scientists now think that two species of "Asian Carp" have invaded the Great Lakes. The bighead carp Hypophthalmichthys nobilis and silver carp Hypophthalmichthys molitrix threaten the $7 billion dollar fishing business of the Great Lakes. These fish grow up to up to 100 pounds and eat 20% of their body weight in plankton and will wipe out native fish. The silver carp not only endangers fish, it can apparently can endanger boaters who sometimes protect themselves from injury by wearing hockey helmets on carp infested waters.

  The bighead and silver carp were imported by catfish farmer's in the 1970's to remove algae. When the fish began to take over the ecosystem, federal and state governments spent ~$10 million on electrical barriers to keep the carp out of the lakes. Based on DNA samples recently collected by scientists in the water on the lake side of the fence, the carp have crossed the fence. The Army Corps of Engineers told the New York Times that "all options are on the table" to control the fish.

• Pelican Decimated by DDT Off the Endangered Species List: The brown pelican is one of four species to be removed from the endangered species list. The US Department of Fish and Wildlife has removed bird, Pelecanus occidentalis since populations have increased. DDT decimated the species in the 1970's, but since the chemical has been less in use, the bird has had the opportunity to breed and thrive. (Hat tip to Nature News and its alliteration addled "Big Billed Bird Bounces Back".)

• Climate Change Negotiations - Like Watching Clothes Dry? In last weekend's Financial Times, Matthew Engel compared the US reluctance to combat climate change with Americans' civic battles over punitive hanging and hanging clothes on clotheslines. Turns out that when Engel moved to the US from Australia he brought his Hills Hoist with him, which provided him unique cultural insight. (The internet explains that a Hills Hoist is a rotary clothesline developed in Australia which can be mechanically raised, lowered and spun. In addition to these features, the Australian government lists the contraption as a National Treasure, prized "because it could hold four nappies on each of the four outer wires.")

  Anyway, when Engel put up his Hills Hoist he realized that the US generally disparages clothes hanging. Although his neighbors were accommodating of his family's aired laundry, Engel tells the story of one Pennsylvania woman who's battling her community in defense of her right to hang clothes -- "if my husband has a right to have guns in the house, I have a right to hang laundry", she says. Engels observes the irony of US communities forbidding homeowners from hanging their clothes outside, given that clothes dryers account for six per cent of US consumer end-use electricity consumption.

  With similar cognitive dissonance, he says, the US claims that climate change action is an important priority, but backs away from any Copenhagen commitment (at the same time endorsing such a thing hopes alive). Attempting to explain the apparent clash of values, he thinks (and I'm just reporting) that although Americans define themselves with property rights and piousness, these values clash with puritan ethics and an "unshakeable faith in technology, lingering from the 1950s."

  Acronym Required previously wrote about cognitive dissonance in "Cars, Selling Cognitive Dissonance", "Sea Change or Littoral Disaster" and many others.

Maher Still Loco on Vaccinations:

As he has for years, Bill Maher continues to spread disinformation about vaccines. In countless news cycles Maher infuriates doctors, public health officials, and responsible citizens with his bizarre warnings about letting a government "stick a disease into your arm".

Challenged to get a word in edgewise between his fusillades about "mercury" and "diet" and natural "immunity", doctors and scientists nevertheless patiently correct his errors. They explain that a vaccine is not "a disease" but a disabled virus that looks to the immune system like a live virus or bacteria and therefore prevents infection by the actual deadly virus or bacteria¹ like polio, measles, diphtheria, or influenza.

But the talk show host persists, as is his habit. Last month, Bill "I'm also not f-king my interns" Maher baffled amiable talk-show panelists Alec Baldwin, Chris Matthews and Maryland Governor Martin O'Malley by rehashing his concerns with vaccines. Yesterday, Maher continued his rant in a rambling column at The Huffington Post titled "A Conversation Worth Having". He noted he wanted to:

"clear up a few things about my beliefs concerning the flu shot, vaccines, and health in general...I will admit, I have gone off half cocked on this issue sometimes, and often only had time on my show to explain a fraction of what needed to be explained, and for that I am sorry...I agree with my critics who say there are far more qualified people than me"

Mea culpa? Unfortunately (and spoiler alert for the 2800 word article) no. I didn't say "anyone who gets a flu shot is an idiot", Maher said, "it was twittered...my bad". Then, "vaccination is a nuanced subject, and I've never said all vaccines in all situations are bad..." Nuanced?

Discerning Maher's Health Prescription -- "Sometimes It's OK to Fuck with Nature"

Maher writes "I'm not a germ theory denier" and claims "I do understand the theory of inoculation". With such pronouncements he exudes all the candor of an intelligent design proselytizer putting quotes around "the theory" of evolution. To a doctor who corrects him, Maher retorts snidely "Thanks, Doc, I thought there might be a little man inside the needle. Yes, I read Microbe Hunters when I was eight." Which is confusing since didn't he say: "the conversation is worth having?"

Cocksure and funny, Maher acts as though he's arguing the correct side of a clear line eight year old can see - you don't need to be a doctor or scientist. To one side of the line there are the OK vaccines, except, he hedges, vaccines are unproven. To the right, there are the not-OK vaccines that we should be debating, like flu vaccine. But actually, if you can't already tell, there is no line or margin, because Maher is arguing the same old run-of-the-mill anti-vaccine/medicine/science schtick you've already heard. He allows that "sometimes it's OK to fuck with nature" and prescribe medicine, but listen to enough Maher and you realize he maligns all medicine, all vaccines.

Casting Aside Science

Sure, at first you may be confused because he mixes recognizable words within gobbledygook. Do doctors ever ask patients what they eat, he asks rhetorically? No, he answers, "and a lot can be cured with diet and a healthier lifestyle" -- then Maher adds in parentheses -- "And a lot can't [be cured]. I also understand the role of genetics and generations of artificial selection". So mixing perhaps diet and exercise with pedigreed petunias and genetically altered crops?

Despite his clear understanding, lets review. The risk of some diseases, like diabetes Type II, can be reduced with healthier lifestyle. Some conditions, like obesity can be prevented with diet, and losing weight reduces the risks of morbidity and mortality associated with conditions like heart disease. True. But diet won't prevent crippling polio, or a flu pandemic or death of a pregnant woman, or stop a kid from succumbing to weeks of illness and a 105 degree influenza fever. And typical of Maher's machinations on science, medicine and disease, he jumps down the rabbit hole with "genetics and "generations of artificial selection". Scientists use artificial selection to breed products like corn by selecting for certain traits. Humans are not hothouse flowers, subjected to "generations of artificial selection".

How Does Maher Distinguish Himself From Dr. Beetroot?

In cajoling his audience to exercise skepticism and caution and arguing for "debate", a word that should tip anyone off to incoming falsehoods; Maher says:

"Someone needs to be representing the point of view that says the preferred way to handle flus is to have a strong immune system to begin with..."

Actually, we can think we recognize this "point of view". Take, for instance South Africa's former health minister, Dr. Manto Tshabalala-Msimang, (known derisively as Dr. Beetroot), who spent years telling South Africans to boost their immune systems against the AIDS virus with diet, beetroot and lemon.

In a familiar refrain, the South African Mbeki government insisted that Western drugs were too profit oriented and dangerous. As a result of this decision, hundreds of thousands of South Africans died from AIDS, and the dying isn't over, since infectious disease pandemics gather momentum over time. Newly elected President Zuma recently warned that the death rate from AIDS may overtake the birthrate in that country.

Is Maher's argument any different than that of Tshabalala-Msimang's? What de-marks greedy Western medicine from essential life-saving medicine? How does Maher, a board member of the "Reason Project", which is dedicated to scientific and secular knowledge, identify good medicine?

How is Maher's Position Different Than A Mennonite's?

Instead of agreeing with scientists and doctors, Maher chooses to listen to Barbara Loe Fisher who he finds "extremely credible":

"after devoting her life to studying this, she says that flu vaccines aren't proven and...points out that what we need, but do not yet have, are studies of vaccinated vs unvaccinated children."

Fisher is not a scientist or a doctor, and that's ok, anyone can educate themselves about vaccinations. Based on her experience parenting and in public relations, Fisher started a vaccination information center, appears on talk shows, testifies at events like the "Vaccine Policy Analysis Collaborative: A U.S. Government Experiment in Public Engagement", and gives lectures to naturopaths, chiropractors, and groups like "Body by God". Who's to say she can't do all that?

But given that Maher says she's devoted her life to studying vaccinations, you'd think she'd understand that vaccinating some children against polio, but not others, as she proposes in her hypothetical "study" would be medically unethical. It's medical ethics 101, a doctor would know this, as would most cogent adults. I'd think that Maher would also see the moral quagmire.

Furthermore, unfortunately, there's lots of evidence to prove that what Fisher and Maher say is the untested theory of vaccination is flat out false. As the NYT reported in 2003:

"The last two American polio outbreaks were in Amish and Mennonite communities in 1979 and in a Christian Science school in Connecticut in 1972. Measles killed 3 students of 125 infected in a Christian Science school in 1985, and a similar-size outbreak among the Amish in 1987 and 1988 killed 2 people. In 1991, 890 cases of rubella, leading to more than a dozen deformed children, hit Amish areas."

Since then, Africans who believed rumors that vaccinations are an attempt by Westerners to spread the HIV virus or sterilize Nigerians, started a polio epidemic. The Amish also suffered polio outbreaks. Mennonites, who don't believe in vaccination but do believe in travel caused outbreaks of measles in Minnesota, then South America. Like the Amish, Mennonites don't believe in vaccinations or insurance, but do believe that hospitals should cure them for a discount, once they get sick.

How is Maher's position different then that of a Mennonite? Can we have this conversation? How does Maher square his position on vaccines with his libertarian views, when people end up demanding hospital bailouts because they didn't take it upon themselves to prevent illness?

The Dredged Up "Under-reported Point of View" is Often Wrong, Concludes A Bright Person

The consequences of not vaccinating become graver and more frequent as more people refuse vaccinations. The value of vaccinations is not "debatable". Vaccinations have saved millions of lives, saved millions of dollars by keeping people out of hospitals, and boosted productivity of nations. But Maher ignores all this and calls for some cost benefit analysis, which is familiar anti-science denialism.

Maher appeals to all of those who eschew facts and take solace in unpopular views.

"I'm just trying to represent an under-reported medical point of view in this country, I'm not telling a specific pregnant lady what to do...[I]t's just that mainstream media rarely interviews doctors and scientists who present an alternative point of view..."

Pregnant women and kids are most susceptible to dying from H1N1 virus. Pregnant women have decreased lung capacity that increases the threat of pneumonia, and they have decreased immunity due to their pregnancy. The reason the media doesn't interview doctors and scientists with "alternative points of view" on the subject, is because doctors and scientists agree that vaccines save lives, and that pregnant woman and parents of children shouldn't die because they've been convinced by talk show hosts to doubt the CDC, the doctors, and the scientists.

Maher's is not selling an "under-reported medical point of view", as he claims, rather he's latched onto a non-medical, non-science point of view. Hmmm....why does he persist?

Bill Maher's Mainstream Media Profit Motives

Unbelievably, after flogging his point of view for years, Maher says he has no motive and expects no outcome: "[M]y audience is bright, they wouldn't refuse a flu shot because they heard me talk about it...." But his audience claps when he talks non-scientific hokum -- perhaps only because they're prompted? Either they're not thinking at all, or they're confused about science, or they're easily swayed by paranoid views, or they think they're at a gladiator show - in which case they will eventually be disappointed by the "debate." Can such folks be considered "bright" in the 21st century?

To the point, though, if Maher's especially non-bright, non-medical, non-scientific point of view weren't selling, weren't rewarded with clapping and viewers and advertising dollars, would he still be ranting on? Maher's anti-vaccination position has populist appeal that draws viewers and boosts ratings. His refutation of "mainstream media's profit motives" sells well. But lets be clear. HBO's Real Time, with millions of viewers each night, is mainstream media. What's not? Acronym Required, for instance, is not "mainstream media". So by his reasoning, you should listen up here. (No, actually I advocate you to do your own research and consult your own MD.)

And why pick on science? Scientists are a remarkably easy target, as we noted before when John McCain chronically made fun of science research. When Maher chose to accost religion, at least 50% of Americans are quite religious, and that's a lot of potential audience members to insult. Plus, religious people can get dangerous. Other Maher campaigns have also backfired, like when Maher's remarks about military recruiting spurred one Congressman to demand that Real Time be canceled.

Considering his options then, and the groups he's already alienated, scientists make a good target. They're pretty tame, therefore easy to pick on safely, and a select target for a large potential audience, since everyone's thinking of getting the flu vaccine. Maher can perhaps equivocate about good vs. bad vaccines and fool a lot of people. So Bill Maher and his mainstream media show try to expand his audience by maligning science to become more mainstream? So they forsake scientists, but also pregnant moms and kids in the process? Is this the conversation? More or less? Bravo, talk show host!

---------------------

Photo used via Creative Commons license.

¹ 11/19 Added "bacteria"

Acronym Required wrote on vaccinations previously, for instance in Vaccinations, Why the Worry? we wrote about the long history of rebellion against vaccinations. We also wrote about vaccinations here and in various posts and vaccines for specific illnesses.

Bill Maher's shenanigans have been will covered by scientists like Respectful Insolence here and here, by Pharyngula; by Aetiology here and here here and by many others.

• Progress on South Africa's New Stance on AIDS? Ten years ago, former South African president Thabo Mbeki told the National Council of Provinces that it would be "irresponsible" for the state to endorse antiretroviral drugs, noting a "large volume of scientific literature" attesting to the toxicity of ARV medicines. We've written about South Africa's HIV/AIDS denialism and obfuscation over years, when, despite international and national pressure on behalf of millions dying from AIDS, Mbeki's health policies never budged and the African National Congress (ANC) leadership failed.

  Now, President Jacob Zuma has eased concerns about his intentions for controlling the pandemic by articulating a new path for the country. He recently told the National Council of Provinces that he would fight the AIDS crisis, and warned that the "real danger that the number of deaths will soon overtake the number of births." Treatment Action Committee (TAC), hailed the new administration's stance.

  Acronym Required previously wrote about South Africa's new health minister and her stance on AIDS treatment in "New Minister of Health For South Africa. Change Afoot?"; and AIDS in South Africa in "Mbeki's AIDS Legacy and Ours", Public Health, AIDS, Mbeki, and the Media, "South Africa: Peddling Beetroot, Courting AIDS", ""Not in Paradise Anymore - AIDS in Africa - Reason for Optimism?", Zuma Dodges Corruption Charges", and others.

• When Opposition is de Rigeur: In 2004, after the publication of "Mountains Upon Mountains", Partners in Health founder Jim Yong Kim moved to the World Health Organization to lead the HIV-AIDS program, where he initiated the 3 by 5 HIV/AIDS treatment plan with a goal to treat 3 million people by 2005.

  From the time that antiretrovirals became available in the 1990's, people in Western countries like the US and countries like Brazil, that endorsed universal public health, increasingly had access to retrovirals, which made an AIDS diagnosis for those people more manageable and less often lethal.

  But there was huge opposition to treating large scale AIDS pandemics in places like sub-Saharan Africa. The various reasons people gave for not treating ranged from logistical (transport over inhospitable terrain), to patient non-compliance, to high rates of fraud, to fear of Western drugs. South Africa's example was publicized and shocking but not isolated. However, by 2004 drug prices had dropped and the tone of objectors had softened, if only slightly. Here's Kim in 2004, urging the world respond to the AIDS epidemic quickly "at its own pace", that is, at a pace comparable to the rapidly advancing viral pandemic. The 3 by 5 plan allowed 1 million people to be on treatment by 2005, and today, more than 4 million are being treated.

  "For the activists, you must hold all of our collective feet to the hottest possible fire because large organizations and the powerful have a way of finding reasons to not take action. If you don't continue to push us, we will falter."

  A good message. Jim Yong Kim is now the president of Dartmouth College.

• Problems in National Health: 17,000 kids in the U.S. Die each Year Because They Lack Insurance: John Hopkins Children's Center researchers studied data from more than 23 million children's hospitalizations in 37 states from 1988 to 2005. Compared with insured children, uninsured children faced a 60 percent increased risk of dying, the researchers found. The analysis attributed 16,787 of some 38,649 children's deaths nationwide during the period analyzed to lack of insurance.

• Polls, Spin, Memos, and the Public Option: We previously wrote about Frank Luntz, whose healthcare memo urged defeat of the public option via specific spin doctoring and tested rhetoric last July. Well, of course with Congress chewing over healthcare, Luntz has been at it again. Luntz purports to have talked to some Americans who told him they want still worse healthcare with no public option -- the "massively expensive" option he opines with false, if resonant authority. The new memo reiterates much of the old one and it contains all the same language aimed at preserving the healthcare status quo. When invited to talk shows, he says that his polling shows that Americans are "mad as hell". And Luntz isn't the only one lobbying against healthcare reform.

• Evidence Based Policy - Abstinence Funding Halted Decades After Proving Ineffective (Sometimes Time Wins): The Obama administration cut abstinence-only funding, after multiple studies showed that it doesn't work -- abstinence doesn't change sexual behavior, pregnancy, STD rates, or age of first sexual activity. Furthermore, studies showed that abstinence programs routinely dole out incorrect or incomplete information about condoms and contraception, causing confusion and misperceptions among the very vulnerable populations the programs claim to protect. (Abstinence-only doesn't work in HIV/AIDS programs either.)

  A recent Newsweek article focuses on the sudden funding decrease affecting those organizations which burgeoned during the last couple of decades because of the federal money. According to Newsweek's article, some U.S. programs like Kids Eagerly Endorsing Purity (K.E.E.P), in the South still manage to get lots of private funding, whereas other programs are at "in a race against time to keep these people in business."

Update January 24, 2010: In this post about the Tracy Kidder's book "Mountains Upon Mountains" and the MDR-TB story, we didn't talk about Haiti, where Paul Farmer began treating patients while in medical school at Harvard. There, Farmer met Ophelia Dahl, and together they started PIH with Jim Yong Kim. "Mountains Upon Mountains" tells the story of how they built the treatment facility in Haiti. The recent earthquake in Haiti is devastating and the work is not done for Haitians when the tragedy disappears from the headline news. There are many excellent agencies working in Haiti, but here's a link to the Partner's In Health page on Haiti. Remember Haiti -- even after the earthquake.

---------------------

I read Tracy Kidder's "Mountains Upon Mountains" last fall, as did many freshman college classes in the U.S. I'm not a college freshman, but I still found it a hopeful book, worth reading as antidote to ennui about the politics of healthcare or the environment, as a salve for cynicism about human nature or the media (perhaps by the end you won't need a goofy picture some fluffy, web-ubiquitous kitten), to remember where international public health was decades ago, or just because.

In Chapter 18, Kidder describes Partners in Health's (PIH) program in Peru to manage multi-drug resistance (MDR)tuberculosis (TB). By the late 1990's PIH's program, originally a trial, had decreased MDR-TB by 85%, curing the sickest patients.

The story is familiar now, perhaps legend, but still worth retelling. MDR-TB had been considered not worth treating in that patient population until PIH's persistence in Peru. Then (and now), the most successful treatment strategy was Directly Observed Treatment Short-Course (DOTS), which makes patients take first-line TB medicines under the eyes of doctor or healthcare worker, thus reducing non-compliance and risks of antibiotic resistance. While highly successful, DOTS didn't cure the MDR cases cropping up in Peru, where patients were dying regardless of medications they had or hadn't taken.

Paul Farmer and PIH's goal had always been to work towards health equity, to assure that people in poor parts of the world got comparable care to people in Boston. With MDR-TB, the PIH challenge became to convince global public health agencies, the TB community, and funders that these patients should be treated, at a time when the dominant public health paradigm dictated treating the greatest number of people with a limited pie of dollars. The PIH success in Peru helped their argument. But the expensive MDR program that PIH employed to cure patients still didn't make sense in public health circles because the cost of treating MDR-TB - to put it bluntly: didn't justify the lives saved.

PIH worked on the TB community, convincing them that the MDR protocol --"DOTS-plus"-- was technically feasible. Concurrently they worked on pharmaceutical companies and allied with NGOs to bring the drug prices down by as much as 90% on some drugs. They also worked with private funders to raise money, and by successfully coordinating these efforts, challenged the paradigm that precluded the poor from viable healthcare. As Jim Yong Kim put it, "The only time that I hear talk of shrinking resources among people like us, among academics, is when we talk about things that have to do with poor people."

It was a longer, tougher, more complicated and convoluted fight than my few sentences illustrate, or even that Kidder's skillful multi-chapter coverage details, but PIH's plan to treat MDR-TB patients more widely than in Peru worked. DOTS-plus was endorsed by public health, recognized as effective, and funded. Now people throughout the world increasingly get treated instead of being allowed to die. Their treatment decreases the spread of TB.

The challenges never end, of course, now there's the more lethal extensively drug resistant tuberculosis, XDR-TB. But, as the story shows, insistence and the persistence saves many lives.

Our Hypocritical Oaths:

When people complain about healthcare problems they tend to zero in on an isolated part of the system, like insurance. When they try to solve healthcare problems then focus on another part, like technology. They dredge up scapegoats to blame by accusing the poor or immigrants of driving up costs by depending on emergency rooms as primary care. The truth is, we all play a role in the gargantuan capitalist collective that is healthcare, and no matter how hard we try to be diligent consumers or responsible patients, we each enable a very unhealthy healthcare system.

On some level you may understand this. As you dangle your legs from the examining table clutching the corners of that little paper towel, you may recognize that you're sitting in a "care" facility that spends millions marketing to you about meeting your medical needs while unfailingly accommodating the needs of many other players -- the insurance company's stockholders, the investors in the shiny new medical complex, the medical fellow's future success, the administrators of various insurances, and the doctor's kids' educations.

Regardless of how smart and realistic and educated you may be, you aren't clever enough to avoid unnecessarily driving up health care costs, a fact you may well choose to ignore. Usually you can rationalize that the problems are not your fault. And since we all agree that it's not our fault, the dysfunctional system thrives and perpetuates itself.

But once and a while, a twinge of regret or guilt may creep over you. Perhaps it will happen after you wait five months to visit a certain specialist that everyone said is the best, only to realize that the ten words he deemed worthwhile his time to impart were less informative than what you read on -- except uttered by him they cost the insurance company and you $400 -- with the insurance discount. Maybe you should have known better.

Or perhaps someday you will look at what "you pay" on the bill compared to the five thousand dollars that insurance payed and momentarily feel as though you've scored a bargain at Ross Dress For Less -- even if you recognize that the insurance companies extraordinary profits came directly out of your pocket. Someday you'll be too busy to insist that the insurance company honor the preventative procedure contract; someday you'll acquiesce to doing some unnecessary high-cost procedure; someday you'll agree to do five more blood tests because you don't feel like getting your old records.

What the Teabaggers Deny

There's the everyday differences of opinion about how to diagnose and treat certain diseases and other issues, these drive up healthcare costs. Then there are the recognizable and seemingly avoidable mistakes that you participate in and recognize. Regardless of, or because of your expertise in economics or medicine or finance or business, someday you'll be slapped by undeniable buyers' remorse or the chagrin of being duped or overtreated. Someday you'll sit down on the examining table fully aware of the trade-offs and controversies of health economics, of third-party payers, of diagnostic options, and treatment controversies, only to recognize sometime after your "care", in an exasperating burst of awareness, that your time or money (if not your health) got wasted.

Before then, you may choose to be too overwhelmed with life's business to consider your participation in the sorry healthcare system. Or you may hear other people talk about some useless procedures they endured and think 'poor sap - wouldn't be me'. Such was the case with Dr. Jack Coulehan, who relayed in last month's "Health Affairs, that he "lost the smugness and condescension I often felt when listening to others' stories about being trapped by the system and manipulated into excessively complex and specialized medical situations", and ended up as "a poster boy for excessive medicine."

Coulehan, a primary care doctor, professor emeritus and public health fellow at NYU, described his exasperating experience in the emergency room one Easter Sunday. The doctor knew he had shingles, having diagnosed at least one hundred patients with the disease:

"but I decided to visit our hospital emergency room to confirm the diagnosis and get my prescriptions. My wife drove. I sat in the car with my eyes closed, wondering how it was possible for me to have turned into one of those elderly people who suffer from shingles."

The attending physician confirmed his self-diagnosis, but Coulehan relented to see two more specialists. He relays his confused thinking during an exchange with the attending physician:

Attending: "Maybe we should have an ophthalmologist and a neurologist take a look at you. What about it, just in case?"

Coulehan: "I don't know...I don't think so...well, OK...maybe it's a good idea." A tiny doubt crept into my mind. Could we be missing something? Might it be a tumor behind my eye? Or a weird form of glaucoma? I wondered whether she was being extra careful because I was a fellow physician. But, if so, why?

After one MRI, Coulehan observes:

"When the attending neurologist returned from his lunch he seemed absolutely delighted that I might have a blood clot in the sinus -- a finding, he said, consistent with the redness around my eye. "Did you have any recent dental work?" he asked, searching for an infection as a possible cause of venous blockage. (I hadn't.) I was gripped by molasses-like passivity. The reasonable part of my mind cried, "This is crazy! Get me out of here!" But a twiggy little nugget deep in my brain asked, "What if there is something serious wrong?"

Coulehan went through hours and hours of waiting and testing, testing and waiting, into the evening, noting that "Easter Sunday appeared to be a dead day in the ER, except for me and my shingles". By the end of the day, Coulehan finally got the medical prescriptions he had decided he needed at six in the morning while sitting on the beach with his wife. After two MRIs, a CT scan, and a $9000 bill, the doctor concluded: "I understand now how all those people could have been so gullible, so easily manipulated by the system. Now that I'm one of them, that is."

If you've already been chagrined after relenting to some test or procedure that's totally useless if not harmful, Coulehan's article will assure you that you're in good company. Which of course is comforting but also ironic. Since we're all making the same choices, more than a few of which are undeniably bad or unnecessary, many people feel no particular personal responsibility. In fact some people, like the teabaggers lining up in Washington DC like it's 3AM the day after Thanksgiving at Best Buy, fear that any change in the system will deny them their rights to those bargains advertised on their insurance receipts.

Coulehan's whole article is available at Health Affairs September/October 2009; 28(5): 1509-1514 (subscription).