The tangled webs we weave…

Some of the more fascinating observations in medicine have to do with perception and interpretation. How patients and doctors cognitively process experiences can have rather huge implications toward the type of health choices they make. For example, some doctors can become easily convinced he or she might possess some innate healing power simply by talking and touching patients (fallacy of charisma). This can lead to other even less reality based practices. In the same way, a patient can perceive an improvement in their malady as associated with some other event (That fever went away when I drank that green pea soup- therefore green pea soup cures fevers…).

All humans innately create pattern associations as a natural matter of survival and this quality has deep evolutionary roots beyond the hominid line. That Homo sapiens have become so successful as a species is a tribute to the exquisite effectiveness these pattern associations have had in creating such social tools as language and culture.

In essence, humans are the children of non biological pressures (i.e., technology and social interaction) as much as they are of the biological ones (i.e., environmental pressures including climate change). One of the theories for our particular brand of intelligence and consciousness describes the inter play of pressures between ever more demanding technological advances and progressively more complex brain structure.

Whatever the case may be, the point here is that there has been a historically tenuous balance between the reality of the world around us and the “imagined” world we see in our heads. As time progresses, it seems humanity has been slowly tipping this balance in favor of realistic perceptions of reality over imagined ones.

That is, as information about the natural world accumulates and comes together in a larger “jigsaw” of associated pieces, humanity is being more careful of how it interprets perception. On the other hand, a tremendous chasm is growing between those who understand these realities and those who don’t.

So it is today in medicine. Whether we are doctors or patients, we tend to create a mishmash of imagined and real interpretations of disease and treatments. By understanding this and seeking out palpable realities- those put together through the laborious and careful work of so many- we can “keep our feet on the ground” and reduce the confusion between hope and false hope, effective healing and false healing. Even when there is little hope, authentic acknowledgement, companionship, and bonding will go much farther than anything our imaginations can muster.

Animal forensics

Veterinarians play a key role in recognizing and addressing animal abuse

Until recently, national awareness of the seriousness of animal abuse has been abysmal. This has been reflected by the relatively scant legal protections for animals as well as the often comical punishments for convicted felons of animal abuse where a finger slap has been all the law could muster.

Veterinary training in forensics and animal abuse has been equally meager and is due to many factors. Among the most salient reasons for this historically low emphasis in detecting animal cruelty and pursuing investigative animal forensics include two important factors.

First, society as a whole is only just now coming to grips with the serious link between animal cruelty and domestic violence. The veterinary and legal communities have been hampered by the relatively light punishments against perpetrators as well as the fear of potential legal retribution by accused abusers against medical examiners.

This is changing as animal cruelty laws now carry a felony sentence in 41 states and many of them- but not all- includes immunity clauses that protect veterinarians from civil and criminal liability when reporting animal abuse. Indeed, this will become increasingly important as veterinarians are now being required to report suspicions of animal abuse to the proper authorities.

Second, veterinarians form client bonds essentially from a “feel good” point of view, where the human/animal bond is held in a positive light that anybody can partake of. It is not hard to understand then that suspicion of abuse is typically rather low on the differential list of many veterinarians. This makes it more difficult to correlate signs of abuse to the owners, especially when dealing with varying levels of possible neglect.

In general, veterinary doctors are mostly focused on preserving health, and therefore when faced with possible abuse Dr Melinda Merck , one of the few veterinary forensics specialists in the world, notes that “it requires thinking outside the box…Anytime you have injuries that don’t match the history, then you have to think cruelty… Forensic investigation for cruelty is just expanding your possibilities to some horrific possibilities’.” This is indeed a tough scenario for the veterinarian to swallow as it adds a “policing” quality to the sacred veterinary/client relationship and wears very uncomfortably for many veterinarians.

The times are quickly changing though, and as society becomes aware of the human/animal link in abuse patterns and violence, veterinarians are expanding their roles and involvement in the science of forensics.

The special training that is required to recognize the signs of active animal abuse and post mortem forensic abuse is now becoming a burgeoning specialty in veterinary medicine. Skilled professionals such as Dr Merck are sharing their profound skills and experience in animal forensic medicine to the veterinary medical community as demand for forensic information continues to expand.

Dr Merck and others are developing the beginnings of standardized forensic procedures for animals that parallels that of humans. This will facilitate the recognition of what constitutes abuse of domestic animals and promises to guide the veterinary profession through what can often be very emotionally stressful and confusing experiences.

The ultimate goal is to better protect the defenseless, be they children, the aged, or- in this case- the animals, from some of the sadder and more sadistic elements of our society.

Complementary/alternative medicine and relative harm

A recent comment thread on a skeptical list touched on the concept of complementary and alternative medicine (CAM) and relative harm. This commentator noted that the low incidence of harm from the practice of CAM paled in comparison to the horrors of other human activities such as alcoholism, poor diets, religious dogma, and smoking. The general conclusion being that efforts should therefore be more focused on these problems rather than the more “benign” CAM medical practices.

While these types of comparisons may seem to make sense- most of us want to address humanities problems in some way- we need to look a little deeper before we let the CAM modalities run amok over the medical landscape.

Implying that CAM modalities are comparatively benign and can thus be allowed as a legitimate choice in medicine begs the question; because they are benign; then they are benign. In addition, there is a bit of over-reporting of the facts in claiming that CAM is, when compared with major social ills, an insignificant harm. Although not the major point, if one wants to go there, history is replete with examples to the contrary.

The crucial issue here is that critical thinking has allowed for solid and palpable progress in many areas of human endeavor. The progress in modern medicine is due in large part to utilizing this skill to derive effective modalities from the realm of science- a discipline that has given us the closest picture of the true nature of things we have as of yet.

This was my response to the “CAM is benign ploy”:

“If you take into account the significant harm non-science based medical practices have wrought throughout history using combinations of ineffective and often harmful therapies, the importance of minimizing the bubbling cauldron of ignorance in medicine today becomes ever more urgent- even if these therapies “appear” harmless compared to demonstrably effective medicine.

Without the self critical, self correcting methodology of science, modern medicine stands to become another recent socio-cultural phenomenon- a postmodern paper tiger. Conflagrating consumer “choice” in medicine together with the gory details of humanities frailties, socio economic missteps, religiosity, and often schizophrenic behavior misses an important point. That is, where critical thinking has flourished; it has been possible to better navigate reality as it is.

Freedom of choice brings with it a huge responsibility; especially regarding others. Add to this the fact that freedom of choice in medicine is further tempered with society’s demanding expectation (for the most part) that it provide the most effective practice possible- no matter what a person “believes”.

To date science provides the clearest roads to this end. Unlike religion, politics, or cultural roots, science reflects universal realities (i.e., you breath oxygen, are structurally bipedal, and communicate using a complex recursive language). In kind, scientific medicine strives to derive knowledge and treatments based on these truths. Not a religion or cultural dogma, it can flex, bend, and change- based on expanding scientific understanding.

If medicines imposed science based limitations are removed, society will again be open to a plethora of competing false realities among which the placebo- that ghostly deception- reins supreme. Indeed, this type of medical “anarchy” silences the all important need for honest discourse. Instead of a place where human touch, emotional acknowledgment, and real communication can truly thrive- even under the harsh light of reality- a thick fog of magic, dogma, and ideological suggestion would smother any effective medical progress, and turn even simple human behavior against itself.”

In search of science in medicine

Teasing out the facts

The importance of being able to understand real patterns and realtionships among biological processes has become glaringly critical in light of the innumerable contradicting, supporting, and partially supporting pieces of data available for study in relation to medical outcomes. The lack of more than just a superficial comprehension, even in the medical community, of epidemiology and statistical analysis leaves a huge vacuum when attempting to separate the real from the perceived. Without a working knowledge of disciplines like these, how can we discern what works from what does not?

We are constantly exposed to a “conclusive study” that seems to support the latest theme or idea du jour imaginable. A parade of sometimes knowledgeable doctors, PhDs’, Institutes, and organizations are often hopelessly entangled in an incredibly complicated web of meaning. To make matters worse, many of these official terms (i.e., “Doctor”, “Center”, and “Institute”) have been compromised and do not necessarily represent any type of unbiased source of information. It is very easy under these circumstances to see how even "studied" people can be led astray. It is more important than ever that individuals have the education and the mechanisms necessary to be able to differentiate for example, a quality study from a poorly designed one. Unfortunately, too many people have minimal competence in the nuances of endpoints, meta analysis, cohort studies, quality ratings, and many other analytical skills that enables one to place these findings into proper perspective. Indeed, not to belie the point, even well educated scientifically oriented professionals can find it hard to wade through this quagmire.

Additionally, there is a deficient understanding of how the scientific method sifts information and knowledge, filtering innumerable pieces of information into a meaningful flow of integrated understanding .Science proceeds sometimes haltingly within a communal process, somewhat analagous to a filter funnel where information is sifted through several stages, and where the human endeavor of observation and interpretation, often replete with contradictory claims of truths about the world eventually yields a little trickle of fairly clear understanding. This can be an inexorably tedious and cumbersome process. Understanding how it works, and works so well can be a huge problem.

This problem stems in part from the weak science based education in the formative years of even highly educated people. Ursula Goodenough, professor of biology at Washington University in St. Louis relates that “science continues to be taught from K-12 to the college and university levels, in fragmented, incoherent bits and pieces rather than a coherent narrative, a history of nature.” She adds that “a primary concern is that students come to understand and appreciate both how science is done and some of what scientific inquiry has discovered.”

Another basic concern is that science education, both as articulated in the Standards and as practiced in American schools, basically fails to convey to students what Goodenough refers to as the scientific worldview: a narrative account, with supporting empirical evidence, of current understandings of the origins and evolution of the universe, the planet, and life (including humans), as brought to us from what are often called the historical sciences.”

In spite of these problems, it is critical that this education is done. Goodenough co-teaches a course at Washington University presenting a science worldview and has observed “students report that their interest in, and mastery of, scientific concepts is greatly enhanced when such larger contexts are provided. We’ve become convinced that a robust and mindful grasp of the scientific worldview generates a more abiding commitment to scientific inquiry, to environmental sustainability, and to societal responsibility.”

Another thought is that a significant amount of initial analytical observations and studies may be given unwarranted importance and significance due to misplaced criteria when determining the level of meaningful relationships. According to Colorado State University physicist Victor Stenger, the common level of significance when studies are published in the medical field is at about a p value of p=0.05. The p value has two important caveats to take into account. First, the p value is often misinterpreted to mean the “probability for the result being due to chance”. In reality, the p-value makes no statement that a reported observation is real. “It only makes a statement about the expected frequency that the effect would result from chance when the effect is not real”.

Second, p= 0.05 may be far too lenient a level of significance. It may be time to reconsider the traditional significance level from p= 0.05 to the much more stringent levels of physics researchers of p= 10^-4, especially with trials dealing with little scientific basis. This criterion, or something like it, could then be applied within the realm of medical research- especially in those cases that require extraordinary claims not consistent with our understanding of science (Some of the attributed powers of the placebo, the dualistic mind/body and quantum consciousness connections fall into this realm).

At any rate, the scientific medical community is faced with the looming challenge of teaching to a larger public- and to themselves- how the complex cogs of the scientific process reveals natures truths and how they are interpreted effectively and usefully within our human community. If we don't, we run the risk of being victims of our own success.

Malaria today

and homeopathic travesties

“Malaria now affects more people than ever before. It’s endemic to 106 nations, threatening half the world’s population.”

National Geographic Magazine has an excellent cover story discussing the scourge of malaria throughout human history including the present plight of so many. Unlike other diseases (polio, smallpox, plague…etc), malaria will affect nearly half a billion people, mostly in Africa, where there are strains resistant to most antimalarial drugs.

Michael Finkel describes in detail many of the complex issues regarding this disease, its control, and the often excruciating failures in combating and managing this ancient disease, including mismanaged population growth and socio-economic pressures that have exacerbated today’s sad state of affairs.

However, there are now promising campaigns designed to regain the upper hand. Zambia, for example, has implemented a national campaign utilizing a combination of pesticides, mosquito nets, and artemisinin^*-based combination therapies (ACT), and is looking to possible future novel vaccinations in a bid to do battle against this “archenemy”.

The article is a well put together description of malarial treatments appropriately emphasizing national pubic health strategies that hold the most promise for establishing a firm therapeutic beachhead. Unfortunately it fails to mention some of the more egregious approaches pretending to “treat” malaria, but succeeding only in misdirecting meager resources towards worthless therapies.

One salient example is the SHEAF Trust, an organization with the following goals:

“The Sheaf Trust aims are:

Professional training in naturopathy/homeopathy

Healthcare in Africa using complementary and traditional remedies

Training local people in the use of homeopathy, for emergencies and acute situations

The education of local people in basic nursing skills, nutrition and home-based care”

Le Canard discusses the travesty of homeopathic malarial treatments and the dangerous implications they bring in a continent that is in desperate need of real and effective therapies. His subsequent post discusses iatrogenic medicine in a proper context and describes the concept of a more dangerous homeopathic iatrogenesis- a dangerous modality lacking any reality base, tools, or self correcting mechanisms that lead ever better and more effective treatments. In fact these critical components seem anathema to homeopathy (and CAM) in general.

As the true battle against malaria takes form, we need to keep present those, who through ignorance or self interest, strive to stifle and diminish the honest and open scientific discourse that promises to save so many lives.

* In fact, artemisinin derived from the sweet wormwood is one of the success stories of historical herbal medicine. It has been incorporated into the modern armamentarium because it works, like so many other plant based active ingredients.

64th Skeptics' Circle

Ignore the hackers and apply to the New Truth University (NTU) because... the truth is out there....

Of memes and consciousness

A theory of memeplex and self

According to Susan Blackmore, the world is full of memes ; replicating elements of information that exist in a myriad of forms and whose sole purpose is simply to be. They can persist as single entities, but often conglomerate and coalesce with other “similar” memes propagating synergistically through time. They can be basic entities such as an idea, saying, and fad or can organize into whole societal systems such as religious faiths and government structures.

The conceptual origin of the meme has roots in Richard Dawkins 1976 book, “The Selfish Gene” where he introduces the gene (a particular version of the gene still debated today) as the primordial replicator. Here the replication of information is the sum total goal and in the larger scheme these replications occurred sometimes with variations and pressures that essentially come to describe a kind of universal evolution. That is, anything that had the capacity to persist; to replicate, acted like the Dawkins gene concept and opened the door to evolutionary pressures.

In essence, this is what Blackmore calls the meme constructing an intriguing theory that argues our very “self”; the “I” in me, are basically a vast group of collaborating memes; a memeplex or “selfplex” if you will, that ultimately creates the illusion of self. Blackmore notes “Related memes tent to form mutually supportive meme-complexes such as religions, political ideologies, scientific theories, and new Age dogmas. Some of these may be hugely hugely beneficial to human society, but others are pernicious because they infect people and demand their resources in spite of being false.” She adds “The most powerful and insidious of all memeplexes is, I shall argue, your own self.”

According to this theory, the selfplex is the origin of the illusion of human consciousness and free will. These are illusions, myths of the memes within the context of the human mind- a human meme machine capable of allowing the flowering of ever more complex memes to succeed by replicating.

The brain works in such a way that a series of regions, mechanisms, and interactions create an experience of self. There is no central depository, or neural eminence that is the self. The package of memes work “together” using the human brains unique ability to imitate and speak (language) to create a flourishing environment that produces an effect- human consciousness. Blackmore goes on to say that “The implications of consciousness are this. The whole problem of consciousness stems from making a distinction between the world that is perceived and the self who is perceiving it, but if this self is just a myth, then this distinction must be false” She later adds “Our consciousness is the way it is because of the success of the memes that make up the selfplex.” With the ever more interactive and complex growth of human society comes more complicated meme interactions and further opportunity for them to replicate and persist.

This is an interesting concept and may carry the seeds for an ultimate understanding of the self . Even one of the interesting arguments against this theory discussed by Mary Midgley seems to perhaps misunderstand its intent and describe a false impression that there is a distinction between her idea of reductionalism and qualitative concepts such as the study of behavior.

Overall the meme theory will need to fit into the realm that describes a sense of self. According to Rita Carter (Exploring Consciousness) these are “first, a boundary in space- an elastic one which may incorporate things and people beyond our body, but one that is firm enough to provide a point of view and thus “ownership: “ of our individual slice of consciousness. Second, a sense of agency, such that our acts seem to be signatures of some entity distinct from mere physical processes, and finally a sense of unity and continuity that allows us to create an autobiography.”

It seems that this intriguing concept of the selfplex might hold promising gems in the continuing effort to expand our knowledge of how consciousness emerges and could provide another toe hold in the deepening quest to understand the “self”.