The Heidi Hypothesis

The surface and the depths

2012-01-31T12:32:00.000-08:00

On a superficial level the question I've been exploring here and in my book is: Is natural good? There are some people who tend to believe that what is natural is healthy, and there are just as many of their opposites who are inclined to believe whatever carries any mark of its natural origin is dangerous. For some the fish lifted moments ago from a lake is more wholesome than anything you could buy in a grocery store. For others, it is suspect, uncontrolled and unsanctioned by food-safety authorities. Getting beyond the gut reaction and sorting out the facts is fascinating to me and I think people who read the book will find it entertaining, I only call this stuff superficial because I think there's a deeper, more important level.
To start out, the question as I've just framed it (Is natural good?) presupposes a yes or no answer. But nature is wholesome, nurturing, and abundant at the same time that it is deadly. And the deeper problem has to do with that frame of mind that crosses its arms and says: "Well, which is it? It has to be one or the other." The people drawn to this binary distinction are the most extreme. They are the folks that take a wheelbarrow-load of herbs every day so that they will never die and they are also the people who demand surgery early and often in the vain hope that technical intervention will allow them to live, if not forever, at least until the next surgery can be arranged. These extremes--though at opposite poles when it comes to what they believe in--are strikingly similar in how they go about their lives.
The more I've studied this, the less I care about the what. What's better the all-natural approach or the technological approach? Eh, sometimes one, sometimes the other, the best methods tend to ignore that division. I mean, where do you draw the dividing line between natural and technological anyway? But I do think there's something important to say about the how.
At both extremes you can find a narrowness of focus that molds the world to the theory, rather than vice versa. You see a willingness to consider evidence only when it fits comfortably within theory. There's a tendency to divide the world into binary oppositions, to see the world in black and white. And both react to contradictory evidence, not with wonder and curiosity, but with suspicion and dismissive annoyance. The only reason my book is possible is because the tendency to dismiss (rather than consider, adjust, and embrace) is so extreme: No one else has taken these arguments seriously enough to give them the attention they deserve, to get past all the craziness and see where important kernels of truth lie in the critique of technological progress.
Interestingly, when I describe these extremes (the all-natural versus the technological), most people replace the word "technology" with the word "science," as if science were clearly aligned with one extreme viewpoint. In fact nothing could be further from the truth. Science is on the side of curiosity and wonder, not dogma. The scientific method teaches us to adjust our theories to fit the evidence, rather than the other way around. That said, there have been times where science has behaved badly, where researchers have put there heads down and refused to see outside their own vision of how the world works. As Thomas Kuhn pointed out, when scientists have worked with a theory long enough, they tend to develop a mental crust that keeps thoughts running in the old predictable channels, and leads them to attack what they don't understand. But as soon as this happens, as soon as people are defending against evidence rather than embracing it, I'd say they are no longer doing science.
I'd like to do more than play judge and determine the winners and losers on the natural-technological spectrum. I'd like this inquiry to point out that the extremists both these camps are on one side of a more important spectrum. That's a spectrum between certainty and curiosity. Between orthodoxy and skepticism. Between dogma and science. Between those who sneer and those who feel awe. In every case, I'd argue for the latter.

2012-01-12T12:28:00.000-08:00

Cholesterol (orange) buried within the transparent protein, including interaction with a lipid in the membrane (cyan). Credit: Grace Brannigan and Jerome Henin, University of Pennsylvania

In a good article on the confusion over cholesterol, Johan Lehrer gets at tendency to assume that when we have a lot of detailed information about something we understand it. We have wheelbarrows of data on cholesterol, but have almost no idea how its related to heart disease. Lerher writes:

“The cholesterol pathway is one of the best-understood biological feedback systems in the human body. Since 1913, when Russian pathologist Nikolai Anichkov first experimentally linked cholesterol to the buildup of plaque in arteries, scientists have mapped out the metabolism and transport of these compounds in exquisite detail. They’ve documented the interactions of nearly every molecule, the way hydroxymethylglutaryl-coenzyme A reductase catalyzes the production of mevalonate, which gets phosphorylated and condensed before undergoing a sequence of electron shifts until it becomes lanosterol and then, after another 19 chemical reactions, finally morphs into cholesterol. Furthermore, [the cholesterol drug] torcetrapib had already undergone a small clinical trial, which showed that the drug could increase HDL and decrease LDL… The success of the drug seemed like a sure thing.
And then, just two days later, on December 2, 2006, Pfizer issued a stunning announcement: The torcetrapib Phase III clinical trial was being terminated. Although the compound was supposed to prevent heart disease, it was actually triggering higher rates of chest pain and heart failure and a 60 percent increase in overall mortality. The drug appeared to be killing people.”

Good scientists know that sometimes it's necessary to step back from the data and look at the big picture. One post-doc friend, when his mentor quizzed him on what we don't know about molecular biology answered (I think correctly) - "All the little things. No wait, all the big things!" The nice thing about looking at the big things is that it forces you to look at the really big things. As T.S. Eliot put it in the opening of “Choruses from the Rock:”

Endless invention, endless experiment,
Brings knowledge of motion, but not of stillness;
Knowledge of speech, but not of silence;
Knowledge of words, and ignorance of the Word.
All our knowledge brings us nearer to our ignorance,
All our ignorance brings us nearer to death,
But nearness to death no nearer to GOD.
Where is the Life we have lost in living?
Where is the wisdom we have lost in knowledge?
Where is the knowledge we have lost in information?

Of course, sometimes there is a roundabout path to wisdom through information: Siddhartha Mukherjee, in the Emperor of All Maladies, notes that a successful understanding of certain forms of cancer was generated accidentally from the findings of researchers diligently beavering off in the wrong direction. Perhaps an understanding of cholesterol will rise out of the data in a similar way.

Lunar eclipse of 2011 with infant

2011-12-10T08:45:00.000-08:00

photo by matthewwu88

December 10, 2011 - Bernal Heights

Josephine woke up at 6 am this morning and was snuffling snotily. She still hasn’t gotten over her cold. I remembered that there was supposed to be an eclipse that morning and I grabbed my computer to see what time it was. Beth looked at my laptop with appalled dismay as if it was a goat or something I was hauling into bed.

“What are you doing?

I shouldn’t torment her when she’s in this fuzzy sleep state, but I can’t help myself.

“I just thought I’d watch some videos from the internet.”

“Oh. Um. Nate? As long as you are up, would you take the baby?”

“Of course I’ll take her, I was just checking to see what time the eclipse was.”

“Oh.”

Somewhat later:

“Do you think you can make sure she doesn’t get cold?”

“Unfortunately no.”

“She’s just a baby! She has trouble staying warm.”

“I’ll find a nice warm dog to slice open like a Tonton.”

“What?”

“A little hypothermia never hurt anyone.”

“Do you think you can zip your jacket around her in the carrier?” (This is what we do almost every day when we go out – it’s a big parka and Beth borrows it because it can fit over Jo).

“No can do. The jacket is way to small this morning.”

“Thank you so much for taking her.”

So we trundled up the hill. I thought it was a solar eclipse so I’m hoofing to the top to get the view to the east. But on Prospect Street, I turned my head and there it was over Twin Peaks, the swollen harvest moon, dusky in the earth’s shadow. I stood there a while, confused. I suppose Beth wasn’t the only one who was hazy. My mind was stubbornly fixed on the idea that the moon was blocking the sun. And the sun rose in the east right? Right. And I was looking, what, west? Yeah, west, the Pacific Ocean lay just beyond that ridge. So what was going on?

Eventually I figured it out. Josephine was looking around, wide eyed, her tiny lips pursed in a little ‘Oh,’ but she does that whenever we go outside. A woman had stepped out of her front door to look and we said good morning. I walked up the steps.

At the top of the hill a man heard Jo cooing from within my jacket (I’d zipped it up over her head), and his face was immediately transformed by a smile. “Oh there’s a little shnorkums!” The combination of a common focal point (the moon) and cuteness (the baby) was social magic. When I unzipped my parka a young couple nearby broke their embrace. “I was wondering if there was a baby in there,” the woman said. “So cute! Do you want some tea?” The man lifted a samovar and she poured me a cup. “First lunar eclipse?” quipped another neighbor.

Josephine exercised her vocal chords, making long strings of vowels which started like a gurgling cry of distress but evolved to a more meditative tone, as if she were saying, “This! … oorrr, that may-be…” She lifted her eyebrows, her forehead wrinkling.

Another woman with a rambunctious puppy approached and asked if Josephine could see the moon.

“I have no idea,” I said. “I think her sight is pretty good by now. And she seemed to be howling. Which is, I don’t know, sort of associated with moons?”

But of course the sea of San Francisco lights below us, the bouncing black puppy, the cool morning wind on her cheeks, the sunrise—smearing up the opposite sky—all these things would doubtless be just as miraculous to Josephine as this massive eclipse. That’s the nice thing about babies and eclipses—the world under their strange light can be reenchanted with wonder.

The problem with inexpensive remedies

2011-11-16T15:27:00.000-08:00

About three months ago my daughter was born, and aside from sometimes looking like ET, and sometimes like Paul Giamatti with a hangover, she was perfect in every respect. Then we noticed that she had some little white patches in her mouth, which I assumed were just fatty milk residue but then had to admit were thrush. Yeasty thrush infection in the perfect baby mouth! Imagine my outrage. It got worse and worse until finally we called the doctor who gave us the Rx for Nystatin, an antifungal. It was this awful, sticky yellow stuff that had a disorienting viscosity and would always drip right when the baby had turned her head. So it got everywhere, and we were supposed to give it every couple of hours, and I felt like I was ruining my daughters palate by making her first significant exposure to a new taste this horrible sugary stuff. Also, it totally didn't work. We fed her the stuff for over a month, carefully spreading it all around. It seemed to fertilize the thrush.

So like any good, meddling, slightly neurotic parents we look in our infinite library of parenting books and read about another thrush remedy called Gentian violet. We ask the pediatrician about it. "There's a blast from the past," he says. "That'll work." The wife buys some (for $2!) at Walgreens. We stick it in the baby's mouth. Baby now has a purple mouth. The next morning all those white patches are gone save one pin point on the lip. We hit her again with the purple magic. Done.
Then, of course I start getting up on my high horse about the superiority of herbs and blindness that makes us default to prescription drugs even if they don't really work. Next I look up Gentian violet and learn that it's not derived from the purple gentian tulip as I had thought but instead, from coal tar. It's also known as Tris(4-(dimethylamino)phenyl)methylium chloride and in large quantities it's linked to cancer. Oops.
So then we go back to the doctor and tell the story and he gets all worked up about it. The stuff has been used forever, he says, it's perfectly safe, it's got a track record better than aspirin. Everything causes cancer in high enough doses. The reason he's upset is that research only gets done if there's profit in it. And no one is going to pay for a clinical trial of chemical that sells for $2 a bottle (enough for about 300 thrush-mouthed babies). True.
So I'm pretty glad we are no longer buying Nystatin and the baby is once more perfect. But funny how my biases shifted on me when I went from thinking natural herb to chemical. Why should the herb be any safer?
By the way, if you are a parent stumbling on this after trolling the internet at 3 am you should also hear the following addendum. You've no doubt already read that gentian (or crystal violet) stains. I knocked the bottle over, off the top of the toilet and it went everywhere: Down the wall, in the toilet, all over the floor, on my feet... If you are as clumsy as me, break out the rubbing alcohol. That will lift it off non-porous surfaces amazingly well. Still, budget two hours and half a roll of toilet paper.

Why don't we have more midwives?

2011-10-03T15:39:00.000-07:00

Last summer I made a trip to Kentucky to see what I could learn about an all-but-forgotten part of our medical history. The land on either side of the road grew steeper and greener, and by the time I reached Hyden, Kentucky, I felt I was at the bottom of a well with walls of beech wood and kudzu. This was true Appalachia, where dwellings clung to the rare plot of level ground, a doublewide up on a hillside ledge, a Dairy Queen in the bend of a river, a crook between hills provided enough resting place for the town of Hyden a handful of brick buildings clustered around a crossroads. The house I was looking for was tucked back in the forest, a manorial building of black logs and white chinking that stood above the Middle Fork of the Kentucky River. Hollyhocks were blooming in the yard. It was Mary Breckinridge’s house, and home of the Frontier Nursing Service.

When Breckinridge came here in 1923, the U.S. maternal mortality rate was 870 per 100,000. And in these deep hollows, where people were cut off from medical treatment, women were even more likely to die in childbirth. Breckinridge changed that. In under a decade it would be safer to give birth in her corner of eastern Kentucky than in the best hospitals in New York. It was as pure an experiment as you could ask for—there were no rich women flying in to deliver, no hospitals to catch the most dangerous cases—just a group of midwives making improvements. What’s more, the data were sterling: Breckinridge, a woman of great chutzpah, knew the world would doubt statistics generated by midwives in the mountains, so she recruited Dr. Louis Israel Dublin, vice president and statistician at the Metropolitan Life Insurance Company (now MetLife), to do the numbers.

The results, published in 1932, were astounding. The women the Frontier Nurses serves, who were desperately poor and usually gave birth at home, were ten times less likely to die in childbirth than the average American. The nation would not reach the standard of care in this corner of Appalachia until the 1950s, after the widespread acceptance of antiseptic and the discovery of antibiotics.

Breckenridge did not quite know what to make of these numbers. “The question that will arise in every thoughtful mind is why there should be this discrepancy between the Kentucky mountain woman and her city sister,” she wrote. “Doubtless there is too much deliberate obstetrical interference in city hospitals but not so much, I am convinced, as people might think.” Then, in what seems like an uncharacteristic lapse of reasoning, she went on to lay out a theory that drew on eugenics: Rather than praising her own work, she credited the racial homogeneity and sturdy birth canals of the population she served. These explanations are no longer scientifically relevant, but even if the racial hypothesis had held up, it did not explain the radical improvement that had occurred among this population.

A better explanation had to do with the fact that the Frontier Nursing Service midwives were highly trained and able to devote time and passion to their charges, making dozens of house calls per pregnancy. Most importantly, they weren't tempted to use those technological interventions into birth that Breckenridge had mentioned, which often did more harm than good.

This low-tech armamentarium of time and attention was highly effective. When Louis Isreal Dublin made his accounting in 1931, eastern Kentucky was suffering from a year-long drought and famine, and tuberculosis was running rampant. And yet maternal health was improving. Dublin concluded that, if this style of maternity care were became a model for the nation it would save a million lives within fifteen years:

“If such a service were available to the women of the country generally, there would be a saving of 10,000 mothers’ lives a year in the United States, there would be 30,000 less [sic] stillbirths and 30,000 more children alive at the end of the first month of life,” Dublin wrote.

Today, the Frontier Nursing Service now runs a school, which sends some 200 nurse midwives to work in underserved areas around the country. The midwives work at the margins, where more technological care is unavailable. Dublin’s vision had never come to fruition. Rather than remaking obstetric practice in its image, the place of midwifery in the medical hierarchy hadn’t changed much since 1925.

(This is a condensed excerpt from my book - I figured I'd post for midwives week.)

Reading Journal: Mountain Gloom and Mountain Glory

2011-06-01T14:57:00.000-07:00

The reason this book is interesting to me is that it gets at the argument that wilderness areas are worth saving when they are sublime. When people are in those high places, the argument goes, they are able to make contact with something profound and this contact is healing in the broadest sense - it improves lives, improves souls, improves us as humans. See Heidi.

But then there is the obvious counterargument that goes: wait a second, beauty is in the eye of the beholder. Yosemite may be sublime for you, but maybe an open-pit mine is sublime for me. It would be useful to know if we can move beyond or dismiss either argument. And next, it would be nice to know with some more specificity what we are really talking about with this feeling of the mountain high.

Marjorie Hope Nicolson's starting point in this book is to provide a counterexample: It proves that the mountain high is not some universal, timeless, recognition of the sacred in mountains. In England, from the middle ages up until the 18th century, mountains were dismissed with "violent disparagement" as the ugliest of natural objects. But once the Romantic period begins, language regarding mountains becomes exalting, ecstatic, lyrical. On it's surface it seems like this would be enough to dismiss John Muir's arguments about the sacredness of Hetch Hetchy. But remember this is the starting point (page one of the preface), and Nicholson delves deeper. What she really wants to know is, "Why did mountain attitudes change so spectacularly in England?"

"During the first seventeen centuries of the Christian era, "Mountain Gloom" so clouded human eyes that never for a moment did poets see mountains in the full radiance to which our eyes have become accustomed. Within a century--indeed within 50 years--all this was changed. The "Mountain Glory" dawned, then shone full splendor. Why?" (3)

What happened was the Enlightenment. As scientific discoveries began to upset the assumptions of the Christian world it produced "one of the most profound revolutions in thought that has ever occurred." No longer did people have a fixed place in the universe in the great chain for being from earthworm up through peasant, squire, king, to God. No longer could they look at the stars and see fixed lights moving in perfect symmetry on spheres. Instead there was a chaotic abundance, each moving in its own path. Jon Donne was so disturbed he wrote a sort of pre-Yeats Second Coming poem, and George Herbert simply tried his best to ignore these changes. The Romantics, on the other hand, were the ones who, rather than resist these findings, discovered a way to bring them into their idea of a God-driven universe. Henry More for instance:

Nature's careless pencill dipt in light
With sprinkled starres hath spattered the Night

Here, for the first time, was an English Christian finding God in the infinite disorder of nature. More was first appalled ("An infinitie of worlds! A thing monstrous if assented to") (133), and then enthralled by the implications of astronomy. He decided that this not only made sense, but was inevitable, and he was "Roused up by a new Philosophick furie." Rather than looking for God in simple perfection, More began finding Him in richness, diversity, variety, abundance. If something natural seemed evil it was only because of man's limited point of view. You can see the roots of modern day bio-spiritualism here.

The discovery of the sublime in nature came not from some literary tradition, but from science, argues Nicholson:

"Awe, compounded of mingled terror and exultation, once reserved for God, passed over in the seventeenth century first to an expanded cosmos, then from macrocosm to the greatest objects in the geocosm--mountains, ocean, desert. ... Scientifically minded Platonists, reading their ideas of infinity into a God of Plentitude, then reading them out again, transferred from God to Space to Nature conceptions of majesty, grandeur, vastness in which both admiration and awe were combined." (143)

(Richard Holmes makes the same point more intimately by telling the stories of Romantic artist/scientists in The Age of Wonder).

So what does this mean practically? Is Muir's claim that Hetch Hetchy is a cathedral shattered because it wouldn't have been a cathedral in 1500? Certainly it shatters the claim that we can know with absolute certainty which places are sacred in a religious sense. There's no more space for orthodoxy. But just because a feeling is subjective doesn't mean that it is not real. There are measurable effects on the body to being surrounded with (subjective) natural beauty. Lowered heart rates. Increased scores on tests. Faster healing. All these very real reactions are influenced, not just by the absolute quality of the place, but the meaning that culture and science have imbued in its scenery.

Is pain always indicative of injury?

2011-05-27T17:49:00.000-07:00

My wife and I are in a childbirth class with a group of about 30 adults, and recently the question of pain came up. One student (apparently a scientist) argued that all pain was indicative of injury—the normal pain of childbirth, even emotional pain and grief involves small tissue damage in the brain. Fascinating! Who knew?

But as I thought about it that night, I found that there was something in the argument that didn’t sit right with me. The next morning I realized what it was: It’s one thing to point out that pain is linked to some kind of cellular rending as a clinical fact, but to claim that all pain is by definition injury is to step out of the magisterium of science and onto my turf—because at that point we are talking about the meanings of words.

The word injury carries with it a strong connotation of wrongness. It comes from the Latin injuria (in = not jus or jur = right, eg justice, jurisprudence). There are some types of pain that don’t feel wrong at all—in fact, they can feel very right. Exercise is one example. I think of the line from Chariots of Fire, when Eric Liddell responds to his sister’s demands that he give up his shot at the Olympics by saying. “God made me for a purpose, but He also made me fast. And when I run, I feel His pleasure.” I wouldn’t call it God, but I certainly have felt an overwhelming sense of rightness in my own running as I push up against the barriers of pain. Injury is an imprecise, misleading word if it describes something that feels right. (NB this is subjective. Running a 60-second 400 meters will be injurious for one person and sublime for another).

So what is the right word to describe pain of childbirth, a pain that is usually chosen (and there is bound to be pain in the process, even with an epidural), wanted at some level? Damage (damnum – a loss, eg damn) and harm (old Norse for sorrow) have connotations similar to injury. There are other, less uncomplimentary words, to describe the breaking down of one thing to deliver something new: Tilling, the act of plowing under one kind of life to produce another comes from the German zielen (to strive) and seems appropriate in nuance, but too poetical for practical use. There is deconstruction, change, transformation, all of which are adequate. Transformational pain seems more on point than injury. All transformations involve some destruction (tree to table, table to ash, ash to tree), but the word does not connote loss or gain.

Perhaps this is too obvious to see, but it would also make sense to call desired pain labor. All labor, whether intellectual, manual, or uterine, is painful in varying degrees. But it is also productive of something desired. Labor does rend cells, but in the long run it usually makes them stronger. The word in Latin is the same (labor) and it means toil and trouble—though trouble in this Latin sense simply implies changing things up (from turbidus – turbid, trouble the waters).

These days labor is frequently used in a negative context: laboring fruitlessly, belaboring the point, laboring under a false assumption. It tends to imply the Luddite banging his head against the wall, too stupid or unskilled to utilize the wings of technology. But I think labor deserves more respect. Now that machinery allows us to satisfy our desires with such airy ease it’s possible to see how unsatisfying such labor-free gratification can be. That which comes easily tends to pass me by almost unnoticed (how many cookies have I eaten?). The things I truly value are those that trouble me, which demand attention—and respect—which force me to sweat, to prove my worth, to become a slightly better person before yielding themselves. In those pursuits I accept (sometimes grimly, sometimes joyfully) the pain, and I think it would be wrong to call it injury.

Bacteria are controlling your mind

2011-03-28T12:23:00.000-07:00

More evidence that we are "superorganisms" of many creatures working together and against each other. Bruce German predicted this years ago. The study is pretty basic - they aren't showing that bacteria are responsible for Mozart's musical genius - but it provides proof of concept. There's a good plain-language write up here.

This is cool

2011-03-04T17:37:00.000-08:00

The plant above is called La Llareta. It's a bush with millions of tiny, tightly-packed leaves. It's in Chile's Atacama desert, and it's more than 2,000 years old. Rachel Sussman is photographing the oldest living things in the world. It's interesting to see the type of things that have had the fortitude, or adaptability, or luck to survive from one epoch into a very different time.

Reading Journal: Politics of Nature

2011-02-25T15:16:00.000-08:00

Update: Coincidentally there's an article in this Sunday's NYT Magazine on these issues. Latour is quoted about how his formulation against facts has emboldened attacks on climate change evidence.

I have had this on my shelf for a long time. Every once and a while I take it down and work my way through a little more. Philosophy is always hard, and French philosophers in translation have scared me ever since some traumatic experiences alone in my college dorm room with no one to protect me from Jean Baudrillard. With Latour, unlike Baudrillard, I didn't get the sense that he was being deliberately difficult. But he still makes up an awful lot of words (or gives them special meaning which are different from their commonly understood meaning). Anyway - I've slogged through this enough that I think I can summarize in plain English. Though I'm sure I'm losing some of the nuance in translation. So here’s what (I think) Latour is saying in Politics of Nature:

Latour uses Plato’s metaphor of the cave to describe the current state of the way we think about nature: We are the prisoners endlessly debating the projections on the wall, but certain people (those who claim to have science on their side) are assumed to have gone out of the cave and seen the real world (nature), and so they are given the power to cut off the argument and say, this is the way things actually are. So nature in this formulation, or natural law, achieves a sort of transcendent divinity. We worship it. If the laws of nature say we should sacrifice our son Isaac, well, we’d better do it because nature’s dice are loaded (as Emerson put it).

But he says, there is no cave - and no "out there." There is, in other words, no such thing as nature. Which means that nature can't (or shouldn't) be brought in to trump the debate.

Latour’s not a relativist – he thinks there is an objective reality, and that the sciences give us better and better pictures of that reality. However – The sciences will never give a perfect picture. We will probably never be able to predict the future. It’s easy for hubris to grow—but in point of fact the sciences still only give a little direction in the majority of decisions we make. The looming problem of our times is that people try to cut off political debate by declaring that their perspective is simply uncontestable reality, proven by science (even if “proven by science” is something a good scientist would never say). Science can help people make decisions, but because it's always incomplete, and always made in the real world by real people (with their own assumptions, and desires, and incentives) it's not really providing access to natural laws that transcend politics. This means that if I accept Latour, I can never pound your fist on the table and say: "We don't need to discuss this - climate change (eg) is a fact and it's a fact that we must raise the gas tax or we are all going to suffer. That's not a political issue - we've sent our best scientists out into nature and we know that it it true. So no matter what you're political orientation you are now bound by a higher law - the transcendent law of nature - to vote with me."

The solution – First of all, come out of the cave: Recognize that we all have access to (and are part of) nature, and that people claiming that you should trust them without a careful consideration of all arguments are cult leaders (not scientists).

We need: Fewer appeals to science as a justification for a position, and more authentic science. Fewer indisputable facts, more collective experimentation.

So how do you make society work if it’s not guided by nature's law? (It’s no more difficult than making a society work even if it’s not guided by religion). Scientists are certainly involved, as are moralists and politicians and economists. The first step is to recognize when there is some new issue troubling the water: It might be the discovery of a new disease, or it could be a group who say there is terrible timber management around their homes (maybe they think the clear cutting with seed trees is not working). The next step is to figure out everything that might be affected by this. Let’s stay with the second example – that might be the people that live in the area, the logging companies, the people who use the timber (home builders, craftsmen), those who consume the timbers, all the species that occupy the forest, or who might if a different strategy of management were adopted, the people downstream in the watershed, the species in those streams, the people whose weather patterns are changed by moisture evaporation from the trees, the people who breath the oxygen they create… and there are probably others. From all these parties we see what they can tell us about what they want. Some of this may be incomplete (we might not know what the fish wants, or to even include a fungus that no one has named yet). But we assemble as much information as possible (each party defining the problem in their own terms). Then we’d create a hierarchy—we’d figure out which party’s needs were the most important to our republic (maybe we don’t care so much about the bacteria that would like the entire forest to be coated in tar-like ooze)—we figure out what parties can live together and what compromises can be made. This would be a knockdown fight, but that’s the nature of politics—we eventually decide that it’s okay for some to die (Latour likes the example of 8,000 people dying from traffic accidents per year in France. Being able to travel quickly ranks higher in the hierarchy than those lives.) Finally, once you have that hierarchy you institutionalize it: You act on it. The next day, parties that are not content with their position on the totem pole come back again and make the case that their problem is hurting the republic – and if there is a big enough disturbance the process starts over. Instead of the laws of nature cutting off debate and creating simple solutions, there is tons of debate and the solutions get increasingly complicated.

A.O. Scott on "Safe"

2011-01-24T17:28:00.000-08:00

A review of the great - and oh-so-close-to-home - Todd Haynes movie.

"Are these dangers really out there in the world, or are they just in our heads? Neither answer is likely to make us feel better, or make us feel safe."

Paleo Diet

2011-01-24T09:28:00.000-08:00

Banksy's Caveman, photographed by Lord Jim

On Wed, Dec 22, 2010 at 7:12 PM, -- I got this email from a friend. She -- wrote:
Hey Nate, I keep hearing about this damn "Paleo" diet, and it reminds me of your investigation into whether what's "natural" is "good." Seemingly intelligent people claim that humans are in fact best suited to a diet consisting only of what a caveman would have eaten. It seems absurd to me -- I mean, we've physically evolved since that time (pinkie toes have gotten smaller in response to wearing shoes), so how could eating grains that we've cultivated for 10,000 years be bad for us? Not to mention that these same people drive cars, work in buildings, etc.

My response: I'm inclined to agree (with significant caveats).

We know that humans have evolved a lot since the agricultural revolution. Besides the toes (which I hadn't heard about), there have been some digestive changes. I, and most other descendants of the snarling pillaging northern European types, have a mutation that allows us to continue producing lactase into adulthood. Dairy is a really important part of my diet despite the fact that there are a lot of people who believe it's wrong, just wrong, to be drinking mammary fluid as an adult. (If you google around a bit you'll find lots or rants by people who are clearly replacing their milk with something more powerful...) But these people do have some right to complain, something like 70 percent of the world is lactose intolerant (see China) and yet government guidelines have been recommending a nice glass of milk a day forever.

Okay - I could take that tangent pretty far - but the point is we've changed: People with ancestors from around the fertile crescent have more amylase in their saliva (helps break down starches). And all humans have a long small intestine and short hind gut compared to the great apes, which is consistent with a shift to higher quality foods (less leaves, more grains and meats - or maybe just more cooking).

So, go ahead and thumb your nose at your paleo diet friends and dig into a sandwich. Or actually, wait - because here come the caveats. Katherine Milton, who has spent years in the jungle studying what monkeys eat (sometimes living with indigenous people) makes some of the same points you did, but also notes that it's pretty clear that our Western diseases, or diseases of affluence (heart disease, obesity, diabetes, colon cancer) are related in some way to diet. As the unstinted flowering of the diet-book tree suggests, we really don't understand what's causing these afflictions. And when people do go on the paleo diet their blood sugar drops, they lose weight, and reverse their diabetes (type 2). In other words: Mock it all you want, it looks like it works. There's a lot of science behind this and a big clinical trial going on at UCSF looking at diabetics on the diet.

So how do we resolve this contradiction? Clearly we have evolved for a more modern diet - but going back to eat like a caveman is healthier? I think it's not that the paleo diet per se is healthier - but that just about anything is healthier. Here's Milton from another paper: "Information on diets and health of recent and contemporary traditional peoples, both hunter-gatherers and small-scale agriculturalists who also eat wild foods, show that all such societies are largely free of the diseases of affluence, whether the daily diet is made up primarily of wild animal foods, wild plant foods, or a single cultivated starchy carbohydrate supplemented with wild plant and animal foods." You have people who live on potatoes, people who depend on corn and beans, people up north who eat heroic amounts of saturated fat and cholesterol and almost zero veggies, you've got the Masai in Africa whose staple is cows milk sweetened with blood (incidentally there was a separate mutation for lactase in Africa). None of them get heart disease or diabetes on these diets with the anything near the frequency that we do (even if you just look at the cohorts over 60). Basically humans can eat anything - there's just one culture in the world that's hit upon a truly unhealthy diet - and that's us.

Except - it may not be unhealthy for everyone. There are probably a lot of other factors besides these enzyme mutations that make people different and some of us are probably perfectly well adapted to a sedentary lifestyle and a processed-foods diet.

Nate

Cool opportunity for Bay Area amateur naturalists

2011-01-13T21:14:00.000-08:00

Academy of Sciences & Farallones Marine Sanctuary Seeking Naturalists

2011 Rocky Shore Naturalist Training Course

WHO: The California Academy of Sciences and Gulf of the Farallones National Marine Sanctuary

WHAT: Training as Rocky Shore Naturalists

WHERE: California Academy of Sciences, and Farallones sanctuary offices, San Francisco

WHEN: Saturday January 29th at 1PM, first of three field trips to Duxbury Reef
Classes February 2^nd from 6:30-9:00PM and February 2nd- March 23^rd from 6:30-9:00PM

Volunteers will be trained in invertebrate zoology, natural history, tidepool etiquette and stewardship, intertidal research and monitoring. Naturalists will work at Duxbury Reef in Bolinas as roving interpreters for visitors and conduct monitoring. Volunteers can also work at the California Coast exhibit and Discovery Tidepool at the Academy of Sciences. We meet on Wednesday evenings from 6:30-9 PM at the California Academy of Sciences/Golden Gate Park, or at Sanctuary offices in the Presidio.

Volunteers must commit to working at least once a month for a year. Volunteers must also complete a two-hour Academy volunteer orientation. Visit the Rocky Shore Partnership blog at: http://www.calacademy.org/blogs/rockyshore/ Enrollment is limited. Contact: Rebecca Johnson, rockyshore@calacademy.org; phone 415/ 379-5252.

Awesome things Bruce German says

2010-12-04T02:17:00.000-08:00

As you may be able to tell from my previous post, I just got back from a day trip to Bruce German's land of wonders and curiosities (also occasionally known as UC Davis).
This is not your average food chemist. He has a razor scooter in his office. Also there is some evidence that he is still Canadian at heart: There's a wooden mountie holding up his iPhone charger and a big illustration of a hockey goalie above his desk. He studies lipids - namely the lipids in milk and writes papers about pretty incomprehensible things like the milk fat globule membrane (MFGM) and cis-9, trans-11 conjugated linoleic acid, and yet when he talks about this stuff he consistently blows my mind. The following is mostly just notes to myself. Very rough...

"I'd throw diet-book writers in jail. Every one works, but the last thing in the world that you should do is a diet with food restriction."
Weight loss is usually fifty percent muscle and bone deterioration. Then when you eat again, unless you are exercising every single muscle fat comes back faster. And we don't know if you lose smooth muscle.
"If you are traveling you'd want to be eating to turn up the immune system, you could even eat food that is specialized to the microbes in the place you are going ahead of time to build up defenses - versus normally the last thing in the world you want to do is turn up your immune system because then you end up with these autoimmune overreactions to pollen or whatever."
On a new model for teaching kids about nutrition: "We are not telling them what to do, just empowering them to know themselves."
"Milk educates infants as to smells - it instills food preferences."
"I have a set of pre-assumptions that I'm not even aware of and its dictating what I'm thinking. We need these young minds when they're not stuck."
"The industrial authoritarian model of nutrition is in diametric opposition with human evolution. If you look at humans what's most astonishing is not what they've gained but what they've lost" (which leads on a long example - we lost the big crushing jaw muscles but that mutation allowed our heads to get bigger, we literally became less of meat-heads, and allowed the expansion of the brain - this might have happened when we were learning to cook? Perhaps those early campfires were the Promethean flames. I had forgotten that Prometheus had a brother, Epimetheus. Zeus gave them clay to make humans and animals, plus a lot of cool features like claws and prehensile tales, armored shells, poisonous venom, and of course big crushing jaws. Epimetheus really go into designing creatures to go with these features and realized too late that he had used them all up before Prometheus had finished molding the humans. So Prometheus feels sorry for us and steals us fire - you know the rest. So, we may not have cool attachments, but we can cook. The mouse can tell when it is deficient in calcium, and sniff it out - we can starve to death next to a nutrient that would save us - we've lost that instinctive eating - but we have gained freedom, while the panda is enslaved by bamboo.
"We are at the the platinum level of freedom and we are all supposed to eat the same way, and we are doing this for fear of heart diseases that only goofball white men in middle America are getting?"
I suggested that instead of nutrient deficiency diseases we were getting nutrient ultra-sufficiency diseases - he thinks that's not it:
"It may end up really being imbalance diseases. If you look back through history at the extremes of nutrition, usually when there was an abundance of food there was more movement, people built cities. And when food is short, I've gone to villages where food is in short supply and around noon the kids all just sit down. They are almost catatonic. But they are conserving energy because they are low on calories. But here we have a situation where kids are eating a lot, and its discouraging movement. It's a total aberration. So I think it may have to do with an imbalance, the wrong combination of nutrients. You know when I was a kid my mom wasn't standing at the door saying get out there, she was standing at the door saying get in here and do your homework."

Re the hooded seal and fat: "There's got to be a trigger that says okay open up the gates, out you go."
Just overdose everyone with essential nutrients - flood out variety with excess.
HAMLET - points to structure importance elegant change (old milk)
Freesland-Campina Dairy co-op Andre Workman

Things you find in a milk lab

2010-12-03T23:45:00.000-08:00

The place where milk is broken down and examined piece by piece looks a lot like your high-school chemistry lab probably did, only more so - more pipes and cables swooping up past hanging fluorescent lights, more battered and mysterious machines crowding the faux-wood lab bench, more cool things that steam or blaze and could be induced to go boom, along with stern, though tattered, instructions forbidding blazing and booming pasted to the walls.
One in a red font that crams exclamation marks into every letter reads: "Danger invisible laser radiation Avoid eye contact or skin exposure to direct or scattered radiation." A freezer is marked, "Biohazard," and someone has taped two blue napkins to it with the words, "Do not open" inked fiercely in red on each. A digital display on the door shows the interior temperature to be -30 degrees Celsius. Above the lab bench hangs a professionally carved wooden sign, the sort that on country houses display the surname of the inhabitants, which some wit has designed to say, "Spectrometry for the masses."
There are two blackboards on the wall covered in acronyms I don't understand with arrows pointing from one to the next. There is another freezer without frightening signs, and this one contains hundreds of test tubes and beakers and vials with frozen milk scabbed to the glass.
On the benches slim patches of workspace are scattered: a pair of blue cryo gloves (like oven mits), several blue pipettes, a plastic purple honeycomb half full of disposable pipette tips, a toaster-sized machine called the Mini Vortexer with a dial that goes from one to ten--it is turned to ten, and another machine for enzymatic cleaving. On the floor at the far end of the bench is a torpedo-like tank of helium, painted maroon. Next to it are two silver tanks of liquid nitrogen. A graduate student, her hair pulled back in tight braids opens the valve one one of these and then rests her elbow on top of the tank and watches as hissing ice clouds form around the hose leading to the big white mass spec machine which dominates a quarter of the room and looks as if it might have been stolen from the engine room of a steamship. This is one of the machined designed by Carlito Lebrilla, the man German calls "a wizard." This machine is essentially a scale, a scale so precise that it can divine the atomic composition of milk molecules simply by weighing them. "It's like weighing a battleship to see if there is a fly on the deck," German says, shaking his head in wonder.

Ioannidis profile in the Atlantic

2010-10-18T06:10:00.000-07:00

Medical scientists are facing the fact that they have an evidence problem, according to this profile.
But some wonder if they should admit that publicly:

Already feeling that they’re fighting to keep patients from turning to alternative medical treatments such as homeopathy, or misdiagnosing themselves on the Internet, or simply neglecting medical treatment altogether, many researchers and physicians aren’t eager to provide even more reason to be skeptical of what doctors do—not to mention how public disenchantment with medicine could affect research funding.

John Ioannidis, the subject of David Freedman's story (check out his very interesting blog here), says hiding uncertainty is the wrong approach.

We could solve much of the wrongness problem, Ioannidis says, if the world simply stopped expecting scientists to be right. That’s because being wrong in science is fine, and even necessary—as long as scientists recognize that they blew it, report their mistake openly instead of disguising it as a success, and then move on to the next thing, until they come up with the very occasional genuine breakthrough. But as long as careers remain contingent on producing a stream of research that’s dressed up to seem more right than it is, scientists will keep delivering exactly that.
“Science is a noble endeavor, but it’s also a low-yield endeavor,” he says. “I’m not sure that more than a very small percentage of medical research is ever likely to lead to major improvements in clinical outcomes and quality of life. We should be very comfortable with that fact.”

I'm reading Bruno Latour's "Politics of Nature" right now, and he pins a lot of what's wrong in this world in our desire for science to deliver the answers relevantly and on time. We (mistakenly) think of the world as divided into two parts: nature and civilization. In civilization we talk a lot, we have opinions, we debate, we struggle over politics. Nature (according to this view of the world) has no talking, it's silent but it contains the truth. The trick then, is to send someone out into nature and bring back the truth to put an end to all the arguments. We call this person "a scientist."
The problem with this is that 1. Even scientists have trouble finding the truth (see above) and 2. They aren't above politics (see above again).
A more healthy system, according to Latour, would be to recognize that civilization is in nature and inextricable from it, and that science is not exempt from politics. He's not denying the existence of objective truth, but instead of saying X-Files style that "The truth is out there" he's saying "The truth is right here" but that we have to be honest about how little of it we can see - which means accepting that politics and debates about who's vision of the world is more correct are an essential part of governing. We can't hope for science to trump politics. Doing so get's us into a lot of trouble.

hat tip to Faith Gibson for sending the story to me...

A.O. Scott on Walkabout

2010-10-17T10:08:00.000-07:00

That Tony Scott is a good writer. Nothing particularly fancy, just admirable, the way he's able to notice and then put into words. Which I suppose is the basic skill required of a writer.

Here are a couple quotes from his review of "Walkabout"
"The price of living in the modern world is a feeling that we have fallen out of touch with the natural world. We long for an innocence that may have never existed but still exerts a significant hold on our imaginations."

Perhaps that dream of innocence isn't from an earlier time in human history, but in individual history - childhood. Or both. Perhaps in childhood we access a way of life closer to that in which our minds evolved.

Here's the video in full:

"Unmediated perception as if we were seeing the world for the very first time"

"Innocence is always lost but the memory or maybe the dream of our time in it is always with us."

A visit to The Farm

2010-06-22T21:36:00.000-07:00


The Farm Midwifery Clinic

I like to pretend I'm a rolling stone from time to time, but it sure does feel good to roll back to the piece of earth that's come to fit my contours over the years. I'm back in San Francisco after more than a week traveling in Kentucky and Tennessee. My most significant excursion was a trip down to The Farm, a hippie commune that's managed to persist in fine fettle since 1971. They don't do a lot of farming at The Farm, unless you count growing forests, and deer, and meadows full of ground-nesting birds. What they really focus on down at The Farm is growing people, and officiating the front end of this process is a coven of midwives. These are the women I went to meet - they offer a radically different mode of maternity care. It's a form of medicine that would shock and dismay hospital administrators around the country. It's low tech, often taking place in the woman's own home, far away from the transfusions and pain medications and operating rooms that hospitals rely on to save lives when something goes awry. In theory, this midwifery center should be producing a higher than average number of catastrophes. But that hasn't happened. In the 40 years they've been catching babies, the midwives have accumulated a significant corpus of data (about 3,000 births) and the results are fascinating. The birth safety record is far, far better than the national average.
But is this a comparison of apple and apples? There's a certain amount of self selection that happens - ie it's only fairly bourgeois, health-conscious women who would even think to seek out a midwife. (There's a similar cause and effect mix up with multivitamins: People who take them are healthier, but only because unhealthy people usually don't take 'em). And that's probably affecting things at the farm a little bit: There are women who have flown in from as far away as Tokyo, and Cairo, to give birth there. Those mommas have got to be A. Far more committed to going the extra mile for health in every way, and B. Rich enough to pay for quality care and live without a lot of stress. But when I got to The Farm and started talking to people it became clear that there were two counterbalancing factors. First, some of the people traveling to The Farm are attracted because the midwives there are some of the only people in America who can reliably do higher-risk births (like breech babies, twins, and birth after a cesarean) vaginally - so they attract a more difficult population. Second, about one third of the babies born there come from the (economically depressed) surrounding area - a lot of these are Amish women who wear their long dresses through the entire birth.
Ina May Gaskin, the head midwife, says that about a third of the births are Farm babies, a third are from the surrounding areas, and a third travel in from farther away. I understand that the midwives are organizing their data for a report - I hope they include information about the demographics of their patients to allow this kind of parsing. But regardless of demographics, the statistics are impressive. They seem to indicate that, for a healthy middle-class woman, this can be a superior form of care. There's another impressive indicator: The Farm Midwifery Clinic is still in business - which (I think) means that they've never been sued. If this form of natural birth really was causing more cases of baby brain damage - or any sort of catastrophe - I think you'd see some lawsuits over the course of 3,000 births.
I'll be writing more about my visit - hopefully before all the mosquito-bites I got there fade away. But for now I've got to catch up on the work I left when I went on the road - while enjoying the feeling of air that's not 90 degrees and 80 percent humidity.

If I eat this it will put me in a junk mood

2010-05-09T20:00:00.000-07:00

In honor of mother's day:
You wouldn't give your mama artificial love-
So why would you feast on artificial grub?
Full video below (if everything is working right...)

My favorite line:
This so called food aint meant for humans
If I eat this than my bowels won't be movin'

Word to Denis P. Burkitt.

A slight bone to pick with Freakonomics

2010-04-28T23:06:00.000-07:00

James McWilliams cited this piece, which I wrote for Conservation Magazine, in his Freakonomics blogpost today on the NYT website. McWilliams was making the point that environmentalists often turn each environmental disaster into a cautionary parable (about some form of human folly) long before it's clear that the disaster was caused by said folly.

"...when an environmental problem has been identified, no matter how complex the underlying ecological factors, it’s often packaged as a morality lesson highlighting the impact of a single, human-driven environmental sin."

I totally agree. But it seems unfair to limit this critique to environmental groups. Every think tank (liberal or conservative) seems to fire off a volley of facile conclusions when something happens that touches their issues. Food and medical companies are quick to trumpet any shred of junk science supporting their products. It's how people work: We to try to make meaning from the seemingly random events occurring around us, to make theories about how the world functions, and then look for evidence (for, and even against if we're smart) in everything that comes up. And, it's worth noting, it's exactly what McWilliams did in his blog post.

In building his case that environmentalists are at the pinnacle of shrill-alarmist mountain, McWilliams notes that the environmental movement has decreed that pesticides are responsible for the global pollinator crisis, despite evidence that there are other more likely causes and - in fact - that there is no global pollinator crisis. To prove that "the environmental movement" has blamed pesticides he cites a bunch of pull quotes. These turn out to be from either: A. measured thoughtful pieces that actually leap to no conclusions, or in his strongest case B. a random post on a lefty forum. There's nothing from the NRDC, or the Sierra Club, or any of the main organs of the actual movement. (Even PAN only raises the possibility of a causal relationship between bee death and pesticides cautiously.)

In fact, I've found that environmentalists tend to be more well informed, and more self policing than most. In my story, the scientists offering evidence that there really was no global pollinator crisis were self-proclaimed environmentalists. From my story - Jaboury Ghazoul was the bona fide treehugger who first questioned the reality of the crisis:

Ghazoul’s purpose was not to defend big agriculture but to protect the credibility of conservationists. Big-picture claims should be evaluated using big-picture data, he wrote, “lest we overplay our hand in demanding conservation action for the wrong reasons.”

So McWilliams is using the research generated by the cautious, self-policing impulse among environmentalists to prove his point that environmentalists are not cautious or self-policing enough. I actually really like McWilliams' work generally. He provides a reality check against conventional wisdom. But dude, if you are going to criticize people for making claims before checking their fact, it would be prudent to check your facts before making that particular claim.

Incidentally these scientists - Ghazoul, Aizen, Harder - are all deeply worried about the pollinator shortage in the U.S., and warned that industrial agriculture in the developing world was likely to cause similar problems:

The fact that yields have increased despite the disparity between bees and flowers could indicate that wild pollinators are supporting farmers. But Aizen and Harder warn that, as more land is devoted to luxury crops and as small, diverse fields are converted to vast, high-tech monocultures, farmers could wipe out native bees—effectively knocking down the prop holding them up. Furthermore, if farmers in Africa turn to the likes of Eric Olson to ship in domestic honeybees, it could compound the problem. “Don’t forget,” Harder told me, “honeybees are an invasive species in most places.” They don’t always contribute to the relationships that have evolved between local species over the eons. They take pollen from native plants but often don’t fertilize them as well as the local bees. This means fewer seeds, fewer native flowers, and fewer wild pollinators.

The newest trends in food processing

2010-04-11T22:53:00.000-07:00

The big new thing for the food industry in 2010? Not being big, or new - but instead being natural and old-feeling. Which is tough for the industry, because usually the way food businesses make money is offering something new. It's hard to persuade buyers to try your product if you are offering more of the same. And its even harder to grow your market (imagine this pitch: this year eat more! We need your help.) All this may account for the slightly rueful tenor of the FoodProcessing.com's write up of new trends for 2010. Witness:

At the risk of upsetting manufacturers of artificial preservatives, colorings and flavorings, Jane and Joe Sixpack simply cannot be more clear in their growing distaste for “chemicals” in their food. And yes, this trend is on track to grow.

That seems like it might be a positive indicator until we get to the next sentence:

Again, the Innova 2010 report positions the “natural” category as part of the simplicity trend. In the beverage category alone, the group noted “13 percent of global soft drinks launches in the first nine months of 2009 were positioned on a ‘natural’ platform, equivalent to nearly 1,000 products.”

Wait, all-natural sodas? We don't really need a lot more of those. Last time I checked sweet drinks were already the main source of calories in our diet. Instead of really offering whole grains and pastured meat, most of the food industry efforts seem to be a form of dress up. People are worried about high fructose corn syrup now, so manufacturers are offering all-natural sugar instead. (For a while there the euphemism was"dehydrated cane juice" but maybe that's starting to seem cynical to people). Don't like artificial sweeteners? Well now we can sell you natural sweeteners! Nevermind that the health questions surrounding stevia are more troubling than those lingering around sucralose. I know that Michael Pollan feels a little guilty for aiding in the sugar renaissance, though he never said sugar was good - he just pointed out that having HFCS in ever single thing you eat can't be good. But to end on a positive note - here's to those in the food industry who are overcoming the challenges and actually offering real food. It's tough - most producers have lost the skills to get truly simple foods to customers. The farmers are few and far between, and the product rots (pests tend to eat things that are healthy), but there's a huge upside: There's vacuum in the market and if you can find a way to genuinely satisfy that demand you'll be rewarded.

Overtesting: This is interesting

2010-03-28T22:16:00.000-07:00

From the NYT:

Growing awareness of the risks of scanning led F.D.A. scientists several years ago to begin demanding more and better information from manufacturers to prove that their devices actually were effective for such clinical applications as cancer screening and mapping blood flows in the brain.
But agency managers responded that suddenly changing the rules for the devices would be inappropriate and unfair to manufacturers, documents and interviews show.

The problem is that these CT scans expose you to a lot of radiation, so a lot of scientists say we shouldn't use them unless we are pretty sure there is something wrong. But the manufacturers want everyone to use them, early and often, and they'd like the government to pay for it: "hundreds of millions of dollars annually."

General Electric, one of the biggest makers of the devices, told F.D.A. managers that the company wanted CT scans approved for colon cancer screenings because Medicare officials and private insurers were “actively discussing whether to reimburse for use of CTC for screening asymptomatic individuals” and “to assist their customers in reimbursement for procedures,” internal agency documents show.

Great work Gardiner Harris!

Nice write up in "Antidote"

2010-03-28T20:34:00.000-07:00

William Heisel who blogs at Antidote, posted the first part of an interview with me here and started off with this lovely introduction. I'd like to think it's apposite, and that's the reason it seems so well put to me (although perhaps I just like it because Heisel is so charitable). Either way, it's always pleasant to have people say nice things about you, and I'm usually overwhelmed with self consciousness when I try to sell myself - so I'm going to push through and paste his description here:

Nathanael Johnson, a Bay Area radio reporter and freelance writer, has made a nice career examining the many ways Americans go overboard – from the food that we eat to the health treatments that we seek. He has written about the Orwellian world of pork farming and the radical raw milk movement for Harper's magazine. He has written about the surge in "functional beverages" for New York magazine. And he has written numerous features, including an insightful piece on excessive medical treatments, for his day job at KALW News.
In February, the Center for Investigative Reporting's California Watch published an investigation by Johnson that made the entire state — and large news outlets such as ABC World News with Diane Sawyer — sit up and take notice.
The mortality rate of California women who die from causes directly related to pregnancy has nearly tripled in the past decade, prompting doctors to worry about the dangers of obesity in expectant mothers and about medical complications of cesarean sections. For the past seven months, the state Department of Public Health declined to release a report outlining the trend.
This investigation had all the makings of a blockbuster. Innocent victims. Shocking trends. And the specter of government malfeasance. But it also had something else lacking in most investigations of this scope: a measured tone. Johnson made sure to underscore how few women actually die every year and, by contrast, how many healthy babies go home with healthy mothers.

Nice huh? Thanks Bill!

People waking up to the problem

2010-03-12T11:08:00.000-08:00

Amnesty International finally released it's report on maternal mortality in the US, calling the situation "scandalous," and "disgraceful."

Jennifer Block has a great piece timed with the release in Time Magazine.

And Gary Schwitzer summed it up with "A week of news on overtesting, overtreatment..."

Worshipping the power of tests to stave off death

2010-03-11T10:59:00.000-08:00

Richard Ablin had an incendiary op-ed in the New York Times yesterday. He's the discoverer of prostate specific antigen and he writes: "I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster. The medical community must confront reality and stop the inappropriate use of P.S.A. screening. Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatments."

I've reported on prostate cancer before and noted the excellent This American Life episode in which researchers who have recommended curtailing the use of the PSA test talk about all the death threats had hate filled responses they got. So why is this such a big deal?

I think that people get so riled up about this because they've invested all their belief in this technological solutions. Get your cancer screenings early and often - in America this is the rock of scientific certainty upon which we build our faith. And it's not just faith that medicine will can save us, but that there is order to the universe - that we have control - that people don't just die meaninglessly. And when you take that away, when you say, "You know, this test really may do more harm than good," then you aren't just taking away a treatment, you are attacking a belief system.

Superstition - if we take Stevie Wonder's definition - is when you believe in things you don't understand. And most of us "believe in" medical technology without understanding it at all. If we lose that faith, we have nothing with which to face the empty vastness. Sure, we should be looking for better ways to cure cancer, but perhaps more importantly, we should be looking for better ways to face the unintelligible caprices and terrors of existence. These are problems we will never be able to solve, so the question is, how do we cope with the furies that will always and have always caused misery?

Our predicament is similar to that of the Protestants who colonized America. The Puritans had rejected as superstition faith in holy water and crucifixes—the pagan shields against unknown evil that had leaked over into Catholicism. The Puritans believed the New World seethed with devils, but they’d given up their occult defenses: the icons, saints, sacramental confession and the rest. Historian Keith Thomas thinks this is why Protestants executed witches, while Catholics, for the most part, did not. Today, instead of burning witches, we order tests. Medical technology has become our version of the occult. And it’s not particularly well suited to this role. Medical surveillance is costly, and every hospital visit carries risk. As a result, health-care costs have spiraled out of control, while patients have gotten sicker.

The solution, is a return of the witch doctor. The modern witch doctor would be a person with some medical skill, but more importantly, a person who can spend time with patients and listen long enough to understand what is really troubling them. The aid of a wise and experienced healer (even if their technique offers no actual physical benefit) is useful on two levels: First, we know that the meaning a patient affixes to a treatment has a powerful physical affect on healing. And second, a person’s attitude about their sickness is often more determinative of their quality of life than the cure.

Death in birth follow up

2010-02-09T16:59:00.000-08:00

California Watch asked me to write a follow-up article about some of the families I talked to for this piece. Their stories had been squeezed out under the restrictions of newspaper writing. You can read about them here. In writing it, I passed a draft by "Steve" to make sure I didn't reveal anything that would hurt his family (it's usually frowned upon to show a source the story - but this was a small piece, purely about the emotions). He called me in response and left a message that reduced me to tears right there at the keyboard. He gave me permission to post it and you can hear it on the California Watch site.
I think this news is finally hitting home. The piece ran on the front page of half a dozen major California newspapers, and on public radio's California Report. KCBS, the talk show Forum, and KALW asked me about it. Dozens of other outlets and scores of blogs reported on the story.

More women dying in childbirth

2010-02-02T20:12:00.000-08:00

According to a report that the state has been sitting on for more than 6 months it's getting more and more dangerous to give birth. If the statistics are strictly interpreted, it means that my wife has a better chance of dying than my mother did. I hope to publish more about this, fleshing out all the nuances and giving it the attention it deserves in the first chapter of my book, but for now, here's the breaking news.

What happens when an economist understands ecology?

2010-01-12T22:28:00.000-08:00

Dick Norgaard, being well versed in both economics and ecology, is one of those rare people who straddles the fault-lines of the disciplines. This means that - instead of believing that economic theory is immovable truth, or that the findings of the natural sciences are immutable - he can see how gracelessly these great tectonic plates rend at each other. From his vantage point, the faith that the invisible hand will solve our problems, and the belief that scientific progress is inexorably leading us to a bright future, look like especially primitive forms of superstition. If you want to know more, you might read this profile that Patrick Joseph had me write. Or look at his book, parts of which I found revelatory.

(Patrick Joseph is one of those editors who is not only intelligent but also civil, kind even, who must be blessed and treasured.)

The adventures of yeastman: Part 2

2010-01-10T21:26:00.000-08:00

Here's what you do if you want to make bread like this, bread with just enough spring against your teeth as you bite into it, just enough tension before it tears. Bread that is soft and elastic, which upon leaving the oven smells the way I imagine heaven should smell, if heaven were a small farm-house early on a December morning when you have awoken to find the kitchen already warm and the first snowfall of the season smoothing the earth's hard angles into curves. Here's what you do: You meet Laizu outside the bakery a little before 3:30 am. I was there before her, having hauled myself out of bed after a few hours of sleep and walking up through the sleeping houses. She pulled up moments later and shook her head at me as she got out of the car. "You really are interested in baking," she said. "you're early."

We went inside. The little bakery was warm from the two massive ovens, one on top of the other. Laizu opened up a plastic binder and showed me the recipes:
White bread:
Starter
4 cups water
4 pounds 7 oz. flour
4 tablespoons of salt

Wheat breat
Starter
4 cups water
5 oz. wheat flour
6 oz. rye flour
3 pounds 12 oz. white flour
quarter cup salt

"There are somethings that are not written down, that are just for the baker to know," she said. For instance - those 4 cups of water? They must be cold. We poured the starter, which had been sitting overnight into a bowl and Laizu clucked with satisfaction when she saw the web of filaments that formed and stretched as she pushed out the last bits with a spatula. Then the dry ingredients (only kosher salt - finer salt overwhelms the taste). Then the hook-like arm goes on the industrial mixer and it kneads the dough slowly for 15 minutes (then fast for 5). "So what do I do if I don't have a mixer," I asked. Laizu threw up her hands. "Oh then you must knead it by hand. That I don't know how to do." I should mention that Laizu is a reluctant baker. "I never liked it," she says. "I refused to learn. I didn't want to get up so early." The woman who had owned the bakery, had passed away she said, and this woman always told Laizu she should pay attention and learn. "She always said, 'you should learn now, or you will regret it when I'm gone," Laizu said. And she was right. But to my eyes Laizu is still a goddess in the bakery, a creator of miracles. As we talked she was slipping scones into the oven, rolling out a quiche crust, turning leftover bread into a rich pudding with eggs, cream and raspberries...
Meanwhile the mass of flour and water in the mixer has turned into a cohesive whole, clinging to the arm as if trying to climb out of its bowl. She stopped it and set the timer for 45 minutes of rising time. We made another starter, to begin fermenting for the next day. For this, Laizu explained, the water must be exactly 100 degrees. "I don't feel right unless I use this thermometer," she said, waving a yellow digital affair.
Starter recipes:
White
4 cups water
2 teaspoons yeast (active dry)
1 pound 4 oz. flour

Wheat
4 cups water
2 teaspoons yeast
15 oz. wheat
7 oz. rye

The ingredients go in in that order, and when I measured the yeast into the flour by mistake Laizu considered it for only a few seconds before announcing, "Well, we just have to throw it out." Then--perhaps reminded that I am in an altered state--she makes coffee (perhaps the caffeine has catapulted me into the present tense) and tells me I have to help myself. "You're not a customer this morning." Then she takes the perfect scones from the oven and insists I try. "They are totally different when they are hot." Taught berrries burst between my teeth.
She dabs a hand in flour and lifts the mixing bowl, scrapping the dough onto the counter. "You see this?" she points at the web of glutenous threads that form as the dough pulls away from the bowl. "That's how you know it's ready." She cuts the dough and I weigh it: 1 pound 12 ounces is what we are shooting for. She's right almost every time.
"Now," she says. "Watch very closely." She spreads out the dough then folds in one edge to the middle, deftly turns and folds again, turn, fold, turn until it was a springy little ball, unwilling to fold anymore. Laizu gathers up a bit from each side and gathers it to the top, as you would to turn a square of fabric into a satchel. She lifts this package, wraps one hand around the neck to hold it in place, dunks it-upside down-in a mound of flour, then closes the edges over the flour-dusted bit and twists it closed. When I try the loaf disintegrates to glue in my hands. Each loaf sits in its own floured basket next to the oven for 20 minutes.
Laizu keeps moving though, feeding croissants into the oven (she made them the night before), making various flavors of muffins, which she dislikes preparing ("I hate making these, everyone asks me why - I don't know I just do." I think I know though: The muffins are easy. When I ask her what she liked to make she replied "croissants." She does it by hand, without a sheeter, a challenge if there ever was one.) She is thinking of leaving, she says. She'll go to Europe then visit her family in Florida, where it is so hot - especially because the women in her family all wear burkas (though she doesn't even wear a headscarf here in San Francisco). She stops and tells me to check the loaves. They must feel like skin, like the dry skin from the back of your grandmother's hand, she says. Also, if you poke the side and it doesn't completely rebound - it's ready. Then, don't wait, put it in the oven! She opens the 400 degree oven on top. She takes the basket and gently pours the loaf onto a pizza peel, then slides it in and shakes it until the loaf slips off onto the hot stone. When all the loafs are lined up she produced a bucket of ice. "This must be very quick," she says, and takes a great scoop of ice and flings it, skittering down one side of the oven. Then another, down the other side. Then she slams the oven closed as it popped and sizzled and steam frothed out from the cracks.
Twenty minutes later she pulled out the golden loaves, and selected one whose internal tension had caused it to split the most on top, revealing a lacework of glutenous strands. "Take this home to your lovely wife," she said. "And melt a little butter on a slice for her."

The adventures of yeastman: Part 1

2010-01-03T23:27:00.000-08:00

I’ve been meaning to write about my initiation into the select novitiate of the dark arts of bread-making, but I was particularly busy in the days leading up to the holidays and then particularly lazy during. Now that they are ending I feel a stirring of the communal sap—now that other people are girding up for a real working Monday, it is much easier to brush off the feeling that there might be some richer form of amusement out there for me to capture. Amazing how persuasive is that sense that other people are working – or playing – in convincing me that I should be doing the same.
All that is to say that this happened more than a month ago. It started when Beth and I went to the Liberty Café Bakery one morning for coffee and pastries. I love this bakery. It’s on top of the hill, in the “downtown” of our neighborhood, but tucked back behind the row of shops on the street so that you have to slip down a three-foot wide passageway between the buildings to find it. The bakery’s existence in this secret garden would not be enough, on its own to secure a permanent right of tenancy in one of the chambers of my heart—that guarantee was ensured by the cinnamon rolls. And then by the custard-like quiche whose essence is infinitely rich yet light – ephemeral on the tongue and on the plate.

It’s best not to arrive at the bakery with fixed hopes – some days the cinnamon rolls are gone by 10am. So when Beth and I arrived that morning we were eyeing the wares and calculating the potential return on an investment in savory or sweet. I was also eying the bread with some frustration. I’d been trying to make bread for months and had succeeded only in making dense little balls of baked play-dough. The Liberty Café bread, by contrast is fluffy and so delicious it’s hard to believe it’s merely flour, water and yeast. So when Laizu, the baker, squeezed through the line to drop off some fresh loaves I asked her if she made them.
“Why,” she asked alarmed, “was something wrong?”
“No, I love them, I want my bread to be more like them. Is there something special you do?”
She considered. “How long do you let it rise? That’s one thing – when it’s ready you need to put it in right away, don’t wait.”
“How can you tell?”
“When the top feels like skin.” She wrinkled her nose, “like old dry skin.”
I nodded half-heartedly.
“You could be using the wrong temperature water when you make the starter,” she mused. “What about ice, do you use ice in the oven?”
I shook my head. I didn’t even use a starter. This was way beyond anything I could find on the internet.
She shrugged. “It’s hard to say. If you really want to learn you should come see how it’s done. You can come watch if you like, I start at 3 am.”
That’s what I’d been angling for. “I’ll set my alarm,” I said.
whew - that's all for tonight. I'll have to get into the nitty gritty of the arcane art later.

Uncle Everybodydies

2009-12-14T00:11:00.000-08:00

This is fun. Though to be fair, I think it's only recently that "Mother Nature" has gained the cloying connotations. It comes from the mystery religions that position the mother as both the giver of life and the destroyer - the chthonic deities that facilitated the cycle of decay and growth.

Reading Journal: Contingency, irony, and solidarity

2009-12-08T00:30:00.000-08:00

In the first part of this book Richard Rorty challenges the (almost universal) assumption that science is in the business of describing the truth. Instead of thinking of science as clearing the window that allows us to see truth, we should see it as providing tools that we can use to navigate our surroundings. I tend to bristle at this sort of thing: You wonder if the philosopher is pausing to check the implications of his tortuous argument against the world outside his head. But then, there have been a series of physicists doing exactly that - checking the implications of quantum mechanics against the world we can see and touch and coming to the conclusion that what we think of as reality may not be real. Crazy I know. To describe this sort of thing you really need a cranky old physicist with a french accent:

For my purposes here, I'm not really that interested in delving into the ultimate nature of reality. I'm content to try to grapple with the problem of living well in the reality we experience every day. I only post this Bernard d'Espagnat video because, if you accept any of what he's saying, it starts to make sense to think of the study of the natural world, not revealing as revealing the Truth bit by bit, but instead giving us tools to better make our way through our surroundings. Science is not in the Truth business, and it should be valued for it's results, if it makes our lives better, the same way politics, or art, or carpentry can be valued for making lives better.
Note that for d'Espagnat the goal is still finding the real. He mentions that Bell's inequalities show a gap between reality "as it really is" versus how we conceptualize it. He doesn't entertain the idea that there is no such thing as reality as it really is. ~~For him the truth is still out there, we just have to deal with the minor inconvenience of an unreliable sense of reality as we search for it.~~ (Not sure this is true, he thinks reality is out there, I guess the question is can you conceive of and describe that reality in a way that gets at Truth?)

Rorty is not specifically interested in science (which is a problem for me), he is principally interested in language, which is contingent: It depends on people's use and thinking for its meaning. And he uses the contingency of language to draw a fine line between the existence of reality and our ability to describe reality:

Truth cannot be out there - cannot exist independently of the human mind - because sentences cannot so exist, or be out there. The world is out there, but descriptions of the world are not. Only descriptions of the world can be true or false. The world on its own - unaided by the describing activities of human beings - cannot.

Truth is made rather than found, Rorty writes, in that truth consists of a critical mass of facts and facts are sentences made up of words and words are made rather than found. So you can observe say a bluebird singing, but once you start thinking about it in language you are creating something different - an abstraction of the bluebird (that will likely cause you to overlook some details of the actual creature in front of you). So when you say, "the blue bird is singing," you are making something up. This fact that you have made is a useful tool (like the tools provided by science) for helping other people imagine something like what you saw. There's one big problem with this tool metaphor (which comes from Wittgenstein, incidentally),

The craftsman typically knows what job he needs to do before picking or inventing tools with which to do it. By contrast, someone like Galileo, Yeats, or Hegel (a "poet" in my wide sense of the term - the sense of "one who makes things new" is typically unable to make clear exactly what it is that he wants to do before developing the language in which he succeeds in doing it.

Which I think is a lovely way of painting up the word poetry. Making something that has not been dreamed. Finding a new way to take pictures of viruses and writing a poem, under this conception, are on the same order and should not be judged, Rorty writes, by how closely the new things they allow us to see, conform to reality. You could do that - but remember that you'd be comparing a description of this new invention against a reality that you described in words - you wouldn't be doing either justice. The distinction you'd be making would be between "familiar and unfamiliar uses of noises and marks." Instead, the invention should be judged on its ability to more ably navigate the world.

Romantics v. Rationalists
Rorty argues that Romanticism is simply inverted Platonism:

"Whereas the metaphorical looks irrelevant to Platonists and positivists, the literal looks irrelevant to Romantics. For the former thinks the point of language is to represent a hidden reality which lies outside us, and the latter thinks its purpose is to express a hidden reality which lies within us.

"Positivist history of culture thus sees language" (ie science) "as gradually shaping itself around the contours of the physical world. Romantic history of culture sees language as gradually bringing Spirit to self-consciousness."

Rorty is not interested in whether this is true, and neither am I. We are interested whether this new language is useful. Specifically, for Rorty, if it causes a decrease in suffering. Ascribing something access to Truth causes problems. In the Enlightenment we tried to

"substitute a love of truth for a love of God, treating the world described by science as a quasi-divinity. Beginning at the end of the eighteenth century we tried to substitute a love of ourselves for a love of scientific truth, a worship of our own deep spiritual or poetic nature, treated as one more quasi-divinity."

The desire for a quasi-divinity comes from the desire to deny chance its caprice. Chance is terrifying. And if science (or religion, or poetry) offers access to the Truth, it also offers the ability to predict and control our fate. Both scientists and priests are faced with the problem of overreach among the laity who ask, why does God deliver Daniel but not me? Why does science save the lives of some, but not mine? The result of such a crisis is either acceptance of merciless chance, disillusionment with the vocabulary (science, religion), or the concoction of new theories to preserve certainty. Instead of deciding that there is no God or that science is bunk, you say the Truth is out there, but it is hidden. And often, people or governments are hiding it.
The alternative is to know yourself, to admit that circumstance has shaped you and will continue to do so, search out the best possible tools with which to navigate this uncertain world and sally forth clear-eyed. In the end we cannot conquer chance and suffering - only recognize it - and Rorty says this recognition is the only power against implacable force we can hope to have. We can decrease suffering with better tools, but we can't end it.

Reading Journal: The Cure Within

2009-11-26T22:28:00.000-08:00

Most of this book is content to document the history of mind-body medicine without asking about efficacy. The story at the beginning and the list of "bodies behaving badly" at the end are interesting examples:
1. Children (even with their physical needs being met) can be physically stunted and developmentally retarded without love.
2. Mortality levels dip below expected levels for ethnic groups just before culturally significant days (Jews don't die the day before Passover).
3. The 200 women imprisoned by the Khmer Rouge who "cried until they could not see," seem to have been physically blinded by metaphor.

(lots more examples in Daniel Moreman's book).
Stress, a term borrowed from metallurgy, has two definitions - a scientific definition that becomes more specific as we study it, and a cultural definition that means all kinds of unease.
Harrington brings it home here: "Stories ... allow everyone--scientists, patients, the rest of us--to recognize and think about the reality of mind body effects, but to do so in a way that do not force us to confront head-on the age-old dualisms..." Perhaps - I'm not sure the dualism is a problem. The key might be in the first part of the sentence - the democracy of meaning that storytelling provides. They are "devices for bridging the lacunae in our thinking" and the nature of these stories shape the way bodies react - they create behaviors and experiences that had not previously been there before.

Reading Journal: Life is a Miracle

2009-11-24T20:52:00.000-08:00

This was a good book to follow the other recent reads. Toulmin says we don't want a science that is based on the expectation of universal truth (and subliminally on controlling the populace). The question then is, what tool do you use to reliably make difficult decisions? Capra proposes to give a new vision of science - it's built on multiple pillars on knowledge and it uses reduction sometimes but not all the time, and it looks for patterns - but I'm still not clear as to how that helps me in figuring out how to counsel a friend who is skeptical of vaccines. In this book, Wendell Berry does a nice job of honing in on how you figure out what to do in a world without certainty, on where reduction is useful and where it's destructive, and on how these big ideas apply to quotidian human decisions.
Before I get into that though, I'd like to pause to acknowledge the design of this book. It was such a pleasure to hold, so agreeable to observe.
The cover is some sort of silky material - not slick - there's just enough grain to give it some substance. It feels a lot like finely sanded wood does before you apply the stain and varnish. It's just the right size, easy to slip into a jacket pocket, easy to hold open with one hand - and the page design is so clean, understated, classy... The Kindle has a long way to go before it matches this. All of which is appropriate because the pages contain the argument that the component parts of a thing (for instance the sentiment of the words and the way it feels in the hand) cannot be separated without some loss.
In doing this Berry is getting directly at what I'll call the the crying baby test. If I'm talking to someone about their proposal for a new paradigm or some big new way of thinking, I'll try and stop at some point and think - this is all very exciting, but does it help me in any way if I've got a screaming baby and I want to figure out how to get it to stop crying? It's a test for science as well as philosophy: You can find over 2000 scientific articles about excessive crying on PubMed - you'll find broad surveys that talk about how economic status and age correlates with average crying time - and you'll find narrow studies of a cascade of chemicals may trigger crying in the brain. There are a few semi-useful articles on treatments (swaddling - regular sleep schedule). But then there's another review showing that it's impossible to define excessive crying and saying that normality is a clinically useless concept. None of this is likely to help with the crisis at hand. Science can offer some clues - but it never provides certainty.

One of our problems is that we humans cannot live without acting; we have to act. Moreover, we have to act on the basis of what we know, and what we know is incomplete. What we have come to know so far is demonstrably incomplete, since we keep on learning more, and there seems little reason to think that our knowledge will become significantly more complete. The mystery surrounding our life probably is not significantly reducible. And so the question of how to act in ignorance is paramount.

Culture provides the answer, according to Berry. But in this era where innovation has far outstripped the development of culture, we have resorted to acting on the basis of incomplete knowledge as if it were complete - or at least with the assumption "that our knowledge will increase fast enough to outrace the bad consequences of the arrogant use of incomplete knowledge. To trust 'progress' or our putative 'genius' to solve all the problems we cause is worse than bad science; it is bad religion."
Superstition, as defined by Stevie Wonder, is when you believe in things you don't understand. The problem is, if you only believe in what you do understand you are left with very little to go on - it fails the crying baby test. So scientific fundamentalists find themselves in the position on having to fill in the area between our points of accepted knowledge with theory, supposition, and faith. Berry's subtitle is "An essay against modern superstition" and he's pointing out that the faith in science (to solve all our problems) is itself a belief in something we don't understand.
I should say that this is essentially a book-long rebuttal of E.O. Wilson's Consilience, a book I liked when I read it - but one that left me with questions. Mainly - Wilson was saying that eventually science will explain everything, an effort I'm happy to support, but what do I do in the meantime? (There's also the issue of Wilson's language - he, like a lot of science writers, appeals to overblown tropes to help lift him over the thin ice. Berry characterizes it perfectly: "he is elatedly confident that he is right.") Consilience is a pretty idea, but again, it fails the crying baby test.
So how do we act in ignorance? That, Berry says, is the function of culture. In this age we honor the conquistadors of new territory, new ideas, the people who bring us new innovations - and as we do so we end up forgetting our cultural inheritance, our literature, our art, all the wrestling with angels that our ancestors have done for us. "The new must come from the old, for where else would you get it?" Culture both widens the scope of knowledge and offers ways of dealing with unsolvable problems. Widens the scope: There are other ways of knowing beyond the scientific method - imagine if you limited your actions to that which had been validated in peer reviewed journals. You wouldn't be able to get up in the morning (though it would also be impossible to justify staying in bed). "To define knowledge as merely empirical is to limit one's ability to know; it enfeebles one's ability to feel and think." (103) Art stands at the opposite end: "Works of art communicate feeling directly from mind to mind, with no intent to explain why this impact occurs. In this defining quality arts are the antithesis of science." (105) And I would say that's true of arts broadly defined - there's no need to explain the process by which a father teaches his son to throw a baseball, or to cook. On this Sunday a friend described the futility of exactitude in the art of pie-crust making, "it doesn't matter if it's six tablespoons of water or 12," she said, "what matters is getting it to the point where it feels right between your fingers." Adam Gopnik made the same point in last week's New Yorker. Ask the Australian Aborigines how they discovered the method for leaching the poison out of cycads that have killed people in Guam and Japan and Papua New Guinea, and they will tell you that it "comes from the dreaming." Clearly there are other forms of knowledge that we should take seriously, even if we don't understand them. Culture also offers ways of dealing with unsolvable problems like death and suffering. The poets offer better advice than the scientists here (remember Gary Greenberg's essay). Berry also hints at something else - that we might "make work our answer to despair." (I think he means that if we have a clearly directed moral purpose in the things we choose to do, that simply living and doing our thing another day is helping the common wealth).
Reductionism
I was struggling with this on the last book; Berry gives an elegant answer. It's a tool - like a hammer and in that capacity it's a wonderful thing. It's only when you begin to believe that you can only use the hammer for every job (the baby?) that you begin doing damage."Reductionism legitimately belongs to science; as an article of belief, it causes trouble."
Berry quotes the great biochemist Erwin Chargaff who compares culture to a tapestry, which scientists pull apart thread by thread until "even the memory of the design is lost." (75) It misses the point to pick out each thread and say, "Okay the results are in: 63.7 percent are red, 13.5 percent are golden..."
Looking at life strictly through the lens of evolution reduces living to survival. (110)
Scientific freedom
Scientific freedom, he says, demands scientific responsibility - the ability of culture to ask if new knowledge will really make our lives better. He goes further - releasing knowledge into the world is sometimes worse than not ever looking for it. (70, 77, 145) This is a hard one for me to accept. Suppose God handed you an apple shaped cask and said, "Inside are the materials that will lead you to new revelations about your biology, a great leap forward in the human understanding of how bodies work. But it also contains information that could be used to manufacture a virus that could cause immeasurable suffering if it fell into the wrong hands. Wanna open it?" It would be hard for me not to - and I'd use all the legitimizations - maybe the information with a little more work will allow us to vaccinate against the virus (ie science will solve the problems it causes), and maybe the sicknesses we cure with this will outweigh the cost (ie progress is always good - Berry talks about us losing the ability to subtract). Sure, some bells can't be unrung, some nuclei cannot be stitched back together, but restricting pursuit of knowledge is still tough for me. If we had the moral culture to deal with it I think we could cope with dangerous knowledge while letting scientists explore as they see the opportunity. The problem seems not to be the pursuit of knowledge, but the fact that application is driven by money. It takes a lot of money to get a new idea, a new drug, a new method of raising pigs, up and running. And once it's going its hard to say, well, the experiment failed, let's throw out this innovation. (There are some mechanisms for that in medicine...) "Suppose that the ultimate standard of our work were to be, not professionalism and profitability, but the health and durability of human and natural communities." (134) Innovation should be based on a local need and built for that particularity - it should ask "What will this do to our community?" (Which, I think is what Berry is getting at with the metric of propriety as well).
Other stuff
"The radii of knowledge have only pushed back--and enlarged--the circumference of mystery." (135) Which is why I love science! It opens the horizon of awe.
"We ought conscientiously to reduce our tolerance for ugliness." I love this. True progress shouldn't result in more ugliness. But it also can be read as elitist: What does it matter if my English manor becomes a coal mine if the net effect is hundreds of happier lives? I think though, that humans with good lives tend to make their surroundings beautiful. Ugliness is usually a sign of destitution and as such it can be an indicator for how we are doing with development.
"We should value familiarity over innovation." Go deep rather than wide.
"Science can teach us, and help us to resist death, but it can't teach us to prepare for death or die well."
Science applied only by a government or a corporation is tyrannical. "The use of science by or upon people who do not understand it is always potentially tyrannical, and it is always dangerous." Which explains the conspiracy theories in response to the vaccines. (148)
"Perhaps the most proper, and the most natural, response to our state of ignorance is not haste to increase the amount of available information, or even to increase knowledge, but rather a lively and convivial engagement with the issues of form, elegance, and kindness... the problem is not primarily one of mass [total knowledge]; it is a problem of form." Partake in the wholeness, in the holiness of a thing even if we don't understand it. (back to Unsettling for a moment, 103 heal, whole, wholesome, hale, hallow, holy.)

Avoid Manure Pit Explosions

2009-11-21T00:31:00.000-08:00

Photo/Compassion in World Farming

This Thanksgiving pause for a moment to give thanks not just for the food but to the brave men and women who produced it. They risk life and limb to put that turkey or ham on your table. Case in point, the other day I got my regular Nutrient Management newsletter via email. (A couple of years ago I wrote a long story about the state of hog farming in America and I still get updates from the trade magazines). I don't always read these but this one was entitled, "Avoid Manure Pit Explosions." That seemed like a good idea. It begins:

Manure pit-related explosions or flash fires have occurred recently in both Minnesota and Iowa livestock buildings. Luckily, the explosions, to date, have mainly resulted in building damage, with few animal losses and no personal injuries or fatalities reported.

Luckily indeed! Actually I think it's a testament to the ingenuity of the American farmer that this doesn't happen more often. Most pigs in this country live suspended above a fermenting pool of excrement (often 9 feet deep), which produces gas. And often pig barns are heated by burners near the ceiling, with pilot lights. I found one report of these exploding barns written up in Rochester, Minn., Post-Bulletin:

According to police officials, the owner of the hog farm, Scott Mashing, was stirring the manure pit and standing near his tractor when the explosion occurred ... The blast was so intense that it catapulted the man 40 feet into the air, across the yard, and into a gravel road. Mashing sustained burns and some singed hair. No pigs were apparently hurt in the explosion. It is unknown if Mashing was transported to an area hospital for treatment of his burns. The building sustained nearly $500,000 worth of damage.

Nutrient Management offers farmers farmers a few suggestions for not getting catapulted 40 feet and sustaining $500,000 in damages. First, they recommend ventilating intensively, and turning off heaters, pilot lights or anything that might provide a spark whenever you are stirring your slurry. If the pits are full it's important to pump until the sludge has receded a bit before you start to stir and mix it up - you need about two feet of head room between the floor and the pool of manure to allow pit fans to move methane and other dangerous gases outside. Finally, they say to watch out for foaming:

Foaming of manure pits is a growing and significant concern that may be related to the explosion incidents. Some of the recent cases have reported “foaming” or extensive bubbling on the manure surface prior to the explosions. Some reports noted that several feet of foam can develop in a matter of days. Some manure pits will foam while others do not.

Experts are working on food additives and such to control foaming. But at least explosions are highly visible and, it seems, not that deadly. There are some terrible stories about farmers going down into their pits to fix a broken agitator and keeling over when they inhale the poison gases. Then the dad goes in to save his son and also collapses and then the second son goes in... There are a couple cases like that where four or five people are killed. Industrial hog farmers are much more likely to have impaired lung function, they are on the front lines of zoonotic diseases. It's hard, dirty work. Most farmers I've talked to said they'd gladly adopt cleaner, safer forms of farming if consumers would pay for it. But that doesn't seem likely. Countries that have passed laws requiring more humane farms (like Sweden) end up simply importing most of their pork from other countries with fewer regulations. So the least you can do when you bite into your holiday ham is think of the intrepid farmers who brought it to you.

A couple other websites

2009-11-16T12:54:00.000-08:00

...with similar sensibilities for future reference. Christina Seely's class at the CCA seems to be building a new sensibility simply be piecing together scraps from artists, thinkers, designers and engineers on the blog Metro Nature. The result is an aesthetic that is fascinated with nature and more than willing to dabble in awe, but not romantic - and at the same time relying on science without resorting to the rationalist tropes.

Then there's this travel blog, Uprooted, which I find interesting mostly because it's author describes herself as, "post-hippie: dedicated to sustaining and improving the condition of our planetary systems, but not particularly excited about drum circles." Which is a lot like what I'm trying to get at (I may be more extreme - the idea of drum circles just makes be feel sad and tired - with top notes of nausea). The question Uprooted seems to have at it's core is: How does this generation go out and make meaning of the world without ending up resorting to cheap, shallow meaning - something that turns out to be our own version of drum circles? Both the author (Jessica Reeder), and I come to this search by way of our childhood indoctrination: we were given clear evidence that the earth needed saving but no feasible methods for dong anything about it. Jessica is from "Nevada City, California where hugging trees was part of my classroom curriculum." So am I. We were in the same second-grade class.

Reading Journal: The Science of Leonardo

2009-11-15T19:15:00.000-08:00

I was hoping this book (by Fritjof Capra who wrote The Tao of Physics) would describe a more humane form of science, one that does not forget richness and complexity as it travels down its reductive rabbit holes. Which seems to be what Capra is promising in the beginning: "What we need today is exactly the kind of thinking and science Leonardo da Vinci anticipated and outlined five hundred years ago, at the height of the Renaissance and the dawn of the modern scientific age." We do get some hints of what that would look like here and there. But mostly it's a biography of Leonardo da Vinci. Which is interesting. It's a nice lens through which to learn Italian renaissance history. But I'm going to focus here on the details that offer a model for a more humane, open-minded science.
Still not sure exactly what that is but Leonardo has some idea about what it isn't:

The abbreviators of works do injury to knowledge and to love... Of what value is he who, in order to abbreviate the parts of those things of which he professes to give complete knowledge, leaves out the greater part of the things of which the whole is composed? ... Oh human stupidity! ... You don't see that you are falling into the same error as one who strips a tree of its adornment of branches full of leaves, intermingled with fragrant flowers or fruit, in order to demonstrat that the tree is good for making planks. (Anatomical studies folio 173r)

The idea that reductive, abbreviated thinking could do violence to something so numinous as love is fairly instinctive. I remember a reviewer of one of Helen Fisher's books quoting Blake: ''He who binds to himself a joy / Does the winged life destroy." I'm an admirer of Fisher's work actually, and I've found her observations on the chemistry of sexual chemistry useful in my life, but I've found Shakespeare's observations on the subject infinitely more useful (also somewhat more entertaining). The idea that abbreviating could injure knowledge is more fraught: we have to zero in on specifics in order to build knowledge. In fact many neuroscientists thing that our brains are primarily filtering devices, selectively screening out the overwhelming static of sensations. With out this abbreviating function I'd be helpless, distracted by the weight and texture of the sweatshirt on my shoulders, conscious of every nuance of traffic noise from Mission Street, acutely aware - not only of how the light and shadow falls on my fern - but of the exact lobed form of each leaf, the number of frond in the business of unfurling, the way the stalks turn from green to glossy purple as they age. And as I've turned my attention to Fernando I've completely lost track of the larger point, which was... oh yeah, that we are all reductionists by necessity, we need a narrow point of focus to penetrate the dermis of reality. And it seems churlish to criticize a Helen Fisher for coming back from the tip of the needle with some very limited new facts. But I don't think that's the kind of abbreviation that Leonardo is complaining about. He did the same thing, by dissecting cadavers he was able to show that certain Medieval theories of the workings of the eye were wrong, and he correctly traced the optic nerve back into the brain, hypothesizing that the impressions from light sent "tremors" through this nerve. Now that's pretty impressive, but it's also reductive and if you leaned to much on it the idea of waves flowing through a hollow nerve could retard advances in understanding electric impulses and neural networks. And how hard one leans on a hypothesis (hypothesis can morph into dogma) may be the thing that determines whether reduction is constructive or destructive. This is a crucial point for me to understand: If abbreviation is the problem but I also want to embrace some forms of reductive science, I need to know exactly where it goes bad.
This book doesn't spell that out, but I will make some notes on Leonardo that may be useful later on.

He was self taught - while all the other thinkers were spending their time trying to recover the wisdom of the Greeks (and square it with their own beliefs), Leonardo (who couldn't read Greek or Latin) was trying to figure out how to make things work: How do you forge the biggest-ever sculpture of a horse? How do you defend a city against attack? How do you dispose of human waste in a big city? How do you paint moving water, human faces, rock walls, plants, birds... that look exactly right? And these questions led him to watch things intensely, experiment, dissect, develop the sciences of geology, optics, fluid dynamics. He read everything he could, but he never felt the pressure to shoehorn all his findings into some kind of grand unified theory. He was starting from the real world and working out in every direction rather than building up from a single theoretical foundation.
Fitjof proposes that his decoration of the Sala delle Asse (detail above) is emblematic of his science. The room is painted with mulberry trees, with trunks going up the columns and branches braiding across the ceiling arches. The golden ribbon, arranged in traditional knots, Fritjof claims, is an allusion to the "similarities of patterns and possesses" repeated at various scales and places throughout the universe. Rene Descartes also used a tree as a metaphor for science: "The roots are metaphysics, the trunk is physics, and the branches are all the other sciences." Here's Fitjof: "Leonardo's science, by contrast, cannot be reduced to a single foundation... It's strength does not derive from a single trunk, but from the complex interconnectedness of the branches of many trees... numerous patterns of relationships..."
Not a big fan of doctors: he wrote this alongside some anatomical drawings (taken from recently dead cadavers remember), " Strive to preserve your health in which you will be more successful the more you are wary of physicians."
References back to Aristotle and Plato 148: There's this central dichotomy set up - Platonists, for whom only ides were real and the world of the senses was illusory, and the Aristotelians, for whom the senses provided reality and ideas were mere abstraction." You had followers of Plato in Florence (interested in mathematical precision, abstraction, theory) and Aristotelians in Milan (interested in observation, and qualities rather than quantities). But the dichotomy gets jumbled pretty quickly: Aristotle thought people should gather knowledge by watching nature: "Experiments that altered natural conditions in order to bring to light some hidden properties of matter were unnatural." Which may be a clue to the problem I was thinking about above, since experimentation requires reduction - elimination of complexity and confounders. And as you trace this split forward it gets even messier. On 168 we get to the tension between mechanism and holism, "between the study of matter (or substance, structure, quantity) and the study of form (or pattern, order, quality)." Fritjof puts Aristotle (and Leonardo) in the latter camp, but is he confused? He was just saying that Aristotle was all about observing substance and structure. In the former camp (mechanism) he puts Galileo, Descartes, and Newton. Kant and Goerthe are is in holism league. I wonder if Fritjof here isn't suffering from the false dualism forces thhe choice between rationalism and romanticism (he refers to his own book here). One other note on Aristotle 146 - apparently his "observations of marine life were unsurpassed until the nineteenth century." Not sure how you measure that, but, wow.
Fritjof comes out and says what it is he thinks Leonardo prefigured on 159, that modern science keeps showing that everything is connected "and that their essential properties, in fact, derive from their relationships to other things." So in order to understand a single particle, we have to understand every particle, which has forced Fritjof to abandon "the Cartesian belief in the certainty of scientific knowledge and to realize that science can never provide complete and definitive explanations. In science, to put it bluntly, we never deal with truth..." But science can make better and better approximate models.
Leonardo talking with a man he'd later dissect: "a few hours before his death, told me that he was over a hundred years old and that he felt nothing wrong with his body other than weakness. And thus, while sitting on a bed in the hospital of Santa Maria Nuova in Florence, without any movement or other sign of any mishap, he passed out of this life.--And I mad an anatomy of him in order to see the cause of so sweet a death." (117) He then gives a textbook description of what 300 years later would be called arteriosclerosis. Then on 170 compares human veins to oranges "in which, as the skin thickens, so the pulp diminishes the older they become."

Just one more thought about injury to love and knowledge once before I sign off. In education injury is done to love of knowledge (philo sophia) when ideas and facts are given to people as abstractions in the Platonic emptiness. It sounds much more interesting to go about learning the way Leonardo did.

The overtreatment of America

2009-11-12T14:12:00.000-08:00

My latest piece. So far most of the health care debate has been over quantity: how much care delivered to how many people. It looks to me like quality may be more important. Also, if you are a man (or know one you like) this case study is going to be useful for you at some point. We all get prostate cancer eventually. Meet the characters after the jump...

Here's super-surgeon Peter Carroll, who has done the excellent research I talk about in the piece. I got the impression that he's an exacting perfectionist numbers guy. Probably what you are looking for in someone whose handling a scalpel around your tender vitals.

And here's the other doc in the piece: Wells Shoemaker, pediatrician, big picture thinker and winemaker. Wonderful guy, fabulous in keeping the data in perspective with the larger goal of having as many people as possible live the richest and happiest lives as possible. I thought that he and Dr. Carroll worked well together.

And here's the insightful and thorough patient, John Shoemaker, (with his wife Donna). He happens to be a very smart and a successful businessman - they kind of person I'd trust to give me good advice.

Reading journal: Cosmopolis

2009-11-11T01:11:00.000-08:00

I read this book, by Stephen Toulmin, in search of direction for thinking about this whole man v. nature thing. I'm finding that it's the history that's most useful for me - as usual it's not enough to have the ideas, there has to be a story containing the ideas.
The story here starts with Henri IV of France, (Henry of Navarre) trying to make everyone just get along as religious tensions between Catholics and Protestants grew. At that time people thought in a way that is remarkably recognizable to people today: Henri talked about tolerance and pluralism, his compatriot Michel de Montaigne wrote in a style that still speaks to the modern ear. There's a reason for this Toulmin says: humanists like Montaigne were on to something that we are just now getting back to after 300 years of diversion. We were sidetracked when an assassin (Francois Ravaillac) dove
into Henri's carriage and stabbed him as he drove across Paris. Lone knifeman or conspiracy? Ravaillac was the Lee Harvey Oswald of the day. There was lots of speculation and we still don't know definitively. But we do know that Henri was the last thread holding back continental sectarian warfare and for the next 30 years it pretty much sucked to live in Europe. In reaction, thinkers of the time pushed hard for stability - at all costs. And so you go from Montaigne saying - "unless some one thing is found of which we are completely certain, we can be certain about nothing" (he was reading the classical skeptics) - to Descartes directly answering "I think therefore I am," and then building on this one (dubious) piece of solid ground a kind of philosophy that resembled Euclid's proofs in its abstract precision. The idea was to get to some higher truth beyond the caprices of sectarian warlords - something that the pope and Luther could agree on. And it wasn't just about religious warfare, everything was topsy-turvy in this era as the old city states lost power and before nations formed. So "the hidden agenda of Modernity" was to give legitimacy to the heirs of power - Newton's ideas about inertia went over really well because he was saying it was right and natural for all these little atoms (people) to orbit the sun (government) and they don't move on their own - they just bounce if they get hit by a cue ball or something. This sort of thing made leaders feel confident in claiming that popular uprisings were unnatural. (Joseph Priestly showed in 1777 that accepting the idea that matter could form living thinking systems makes no difference in Newton's mechanics - at the same time he was celebrating the uprising of "mere atoms" in the French revolution. A mob, fearing a spread of that instability, burned down his house and he fled to America.)
Cosmopolis is a vision of a civilization (or polis) in perfect accord with the rules of Nature (which we see up in the cosmos) that can be decoded in these elegant formulas, which are ultimately God's rules.
Descartes and Newton could be in the certainty business because they were dealing with abstract theory (Descartes more, Newton's mechanics worked better out in space then in describing which way an apple would bounce after it fell on a head.)
Today the conflict is often science versus religion - but back then the humanists and the rationalists were both religious. While the humanists were freethinking, the rationalists were dogmatic and careful to qualify their findings in religious terms (77). We go from Montaigne and Bacon (even Copernicus) writing very freely about ... everything ("the claims of friendship, cannibalism, nudity," musical farting, sex) without worrying too much about what the authorities would think, to Newton being very circumspect and writing letters to explain how gravity was really the hand of God. "By contrast, the 17th-century founders of modern science and philosophy had theological commitments which shaped their whole enterprise. Repeatedly, Descarts and Newton express concern about the religious orthodoxy of their ideas" And this huge change happens in just 50 years - Toulmin isn't saying this change was caused by Henri's assassination and the Thirty Years War, but that these things were the visible signs of the intellectual revolution going on as Europe rediscovered classical literature and it became widely available via Gutenberg. Catholicism hardened. Where the church had once issued Summas, or philosophical treatises, it began issuing centrally authorized dogma in the form of Manuels and responsa. At the same time lay thinkers moved from "speculative and revisable docterines" to "immutable and infallable" laws.
The tension between theoretical science that traffics in these immutable laws and empiricism starts all the way back with an argument between Aristotle and Plato. Aristotle was all about observation and experimentation. He "exhorted us not to aim at certainty, necessity, or generality beyond 'the nature of the case.' ... We need not be ashamed to limit our ambitions to the reach of humanity: such modesty does us credit. Meantime, the range of particular everyday phenomena, on which human experience gives solid testimony (love that: gives solid testimony), is unlimited in the realm of human affairs, and in natural history." Science was practice to Aristotle. To Plato and his 17th century followers, science was theory. "They limited 'rationality' to theoretical arguments that achieve a quasi-geometrical certainty. (20)"
If this book has a hero it's Montaigne who stands in as the humanist exemplar. Erasmus is the humanist I heard about in school but he doesn't get much ink here. There's a nice note about Erasmus and Luther, (25) they were friends - or at least warm correspondents. Erasmus was a loyal Catholic but he felt free to critique the church's dogma. He tried to convince Luther that "private contrivance" worked better than nailing screeds to people's doors. What if instead of leading a revolution, Martin had pushed for the evolution of the church?
The renaissance humanists were skeptics - which made them conservative about advocating for revolutions. ("Human modesty alone should teach reflective Christians how limited is there ability to reach unquestioned Truth.") And Montaigne argued that they should put aside the big questions of general theory until they had a lot more data - and for the time being revel in accumulating a rich understanding of the world: How does a honeysuckle bloom unfold, how does a person fall in love, how do people around the world see things differently? The humanists recognized that Shakespeare's plays contained keen observations and a rich store of information about how power and emotion worked in human relationships. The rationalists turned up their noses at Shakespeare: plays were frivolous, and they certainly had nothing to offer science.
The fall of Cosmopolis

Toulmin says the quest for certainty did nothing to stop the Thirty Years War, but for 266 years after the peace of Westphalia in 1648 it seemed like Cosmopolis was working. It's hard to say whether it was this new way of thinking that brought stability, or if the various powers were simply too distracted by the colonial race overseas to fight it out at home (of course there are places like Ireland where the fight never stopped). Right up into the 20th century, the science founded in Cartesian rationalism was outgrowing its theoretical scaffolding. Enterprising scientists branching out into new fields found that they could do a lot more if they relied on Aristotelian (or da Vincian) experimentation than if they kept reasoning out more and more complicated proofs based on Descartes' original cogito ergo sum. And science began knocking down the old assumptions. Einstein and Planck "broke the links between current physical theory and earlier Newtonian orthodoxy." Darwin's ideas were growing stronger and providing new metaphors. And Freud was dismantling the wall between reason and emotion. We were just about back to the intellectual freedom and human tolerance that Henri IV and Montaigne had seen just beyond their reach. But then things fell apart in The Great War.
And here Toulmin does a nice job of showing how the entire force of culture swung back toward Descartes. "Gustav Mahler's chromatism was condemned as romantic excess, overripeness verging on corruption, like the texture of a persimmon" (my emphasis) and mathematical music like Arnold Schoenberg ("How the music sounds is not the point.") was seen as the future. Piet Mondriaan and the painters in vogue had the same "intellectual cool." Mies van der Rohe led an architectural revolt against local color (history, geography, story), instead seeking universal design principles. Thinkers and scientists went back to looking for formal theory to govern inherently messy systems (like genetic code). But these motions toward stability were futile after the First World War when it became clear that Cosmopolis (and the foundation of nationalism) was an illusion. In 1921 Yeats wrote The Second Coming, Werner Heisenberg undermined the last shreds of Cartesian certainty in 1927 and Hitler rose to power in Germany.
Humanism, or romanticism?
That brings us up to the history we all know: The swing back to abstraction lasts into the '50s and then the '60s finally get us back to humanism and all that that implies with art and music and the rest. This is where I think Toulmin goes off track a little. Rather than a triumphant return to humanism, I see the '60s as a confused swing into romanticism. The kids saw the hollowness of rationalism (they worried about being "phonies") but no one remembered Montainge and skepticism, instead they looked for another kind of certainty, one rooted in emotion and Nature and sensuality. Toulmin has a good characterization of romanticism:
"As a19th-century position, romanticism never broke with rationalism: rather, it was rationalism's mirror-image." Wordsworth and Goethe say: "human life that is ruled by calculative reason alone is scarcely worth living, and nobility attaches to a readiness to surrender to the experience of deep emotions. This is not a position that transcends 17th-century dualism: rather it accepts dualism, but votes for the opposite side of every dichotomy."
The humanists valued civility highly - the hippies not so much. Civility was collateral damage in the culture wars. "the 1960s saw a move away from a politics of national goals - which aimed at consensus - toward a politics aimed at redressing traditional injustices, driven by confrontation of sectional interests." It's hard to imagine Erasmus arguing for confrontation. However, some parts of society understood the promise of humanism better than others: The bloody wars that Martin Luther started were not replayed by Martin Luther King Jr. He managed to stage a revolution without sacrificing civility.
Toulmin remarks on the many similarities between Henri IV and JFK (both ladies men, both popular, both assasinated, both seen as emblematic of hope for guiding the world to a more humane place), but he sees them as coincidental bookends. I disagree. Kennedy's assasination had the same affect as Henri's: It confused and delayed the realization of humanism.
This is a key point for thinking about nature - if everybody had begun thinking like Montaigne we'd be a lot less confused about nature and technology. Instead, we still have a sturdy force of rationalists in economics, nutrition, ag-science, public health (and probably every field) who omit the local, the particular, and the timely to make objective quantifications which (sometimes - sometimes quantification can be very useful) end up serving a cold rationalist vision rather than truly serving humanity. People still ardently defend the split between humans and nature (for some it's a spiritual problem, for some a culinary one). There are still a lot of rationalists working to insulate humans from nature, who still see nature as an static backdrop and technological progress as a ladder to the mind of God. Of course these people aren't going to worry about climate change,
On the other side you have a lot of romantics throwing the scientific baby out with the bathwater. They are trying to get back to an Edenic harmony with Nature, which is really a mirror image of Cosmopolis. After the history of scientific rationalism, with its many blindspots and missteps, you can see why they might be shy of vaccines.
Then there are a lot of post-modern thinkers working toward something new - but most of them are so focused on deconstruction that there is very little construction going on. There's very little to stand on if you throw your lot in with them - absurdity and relativim. No thanks.
21st-century renaissance
By using Montainge as our model we can throw out Cartesian "Reason" and reclaim human reasoning. We don't throw out science - the renaissance humanists were excited by the window to wonder provided by science. But rather than theorize about foundational principles and then set up science to bolster those ideas, we need science rooted in evidence and applicable to human practice. Science "that serves humanity" is often based in the old rationalist ideal of progress (see Feyerabend) rather than an honest assessment of what will actually make people happier. This sort of thing requires scientists to consider values - to tear down the wall between science and the humanties. Technology is forcing this merging in places - especially in clinical medicine where our technological ability to extend life and alter the body has thwarted "all attempts to freeze the distinction between "facts" and 'values.'" (181) Toulmin tells the story of how the scientists working on the Manhattan Project took on the "sweet" technical problem while handing moral responsibility to the politicians - they were the "sons of bitches." But as scientist Ken Bainbridge realized upon the first test blast, "Now we're all sons of bitches." (I’d like to see a section in every scientific paper – perhaps as part of the conclusion - that talks about (speculates on perhaps) what the findings mean when put back into the context of the larger human frame with all it’s idiosyncratic uncertainties.)

Skepticism doesn't mean everything is relative and up for grabs. It means that we approach problems with humility. We do the best that we can with the understanding that we have. We adapt our techniques to (and pay attention to) the local, the particular and the timely. We stop worrying so much about episteme and start directing a lot more energy toward techne, "the wisdom needed to put techniques to work in concrete cases dealing with actual problems." Instead of building a society that is stable (like Newton's solar system) we need a society that is adaptive. Perhaps we should replace the mechanistic metaphors with biological ones - instead of revolution (and a clean slate from which to build new, perfect foundations) we need civil evolution (where species in parasitic relationships often transform their interactions into mutualism). One last quote "we may ignore the ideal of intellectual exactitude, with its idolization of geometrical proof and certainty. Instead, we must try to recapture the practical modesty of the humanists, which let them live free of anxiety, despite uncertainty, ambiguity, and pluralism." (105)

--
Other points:
The civility issue is an important one. At this point we are stuck because the practical and the specific require small quiet conversations and everything these days is confrontational and conversations take place through the bullhorn of mass media.

Rhetoric to formal logic
The humanists saw rhetoric and logic as complimentary disciplines - the way you make the argument is as important as the argument itself - they came from an oral storytelling tradition. Rationalists saw argument as the subterfuge - a way of dressing up faulty logic. (As a result you get all these philosophers who almost take pride in making their writing impenetrable - and I would argue that bad ideas have made their way into the canon under the subterfuge of bad rhetoric.) This was also a move from oral to written: Medieval teaching took the form of preaching. And this reinforced an interest in the particular because the clergy had a therapeutic or confessorial responsibility as well as a pedagogical one - they were responsible for individual souls, they had to bring these ideas to bear in the lives of real people. Once it was all on the written page it was much easier for theory to become abstract and general.
Local to the universal, particular to general

We go from case studies, practical philosophy to the search for universal principles. Valuing local knowledge and a curiosity about the diversity of the world gets thrown out. Local variation doesn't matter if you can understand the abstract axioms that govern the universe. Descartes: "History is like foreign travel. It broadens the mind, but it does not deepen it." He favored wiping the slate clean, and ignoring all traditional ideas in favor of cultural universals.
Timely to timeless
Renaissance humanists trying to deal with "legal, medical, or confessional practice" had to structure advice as the occasion required. Rationalist were not interested in the transitory, they wanted to understand the timeless properties that determined all of nature's changeable ephemera.
Artificial divisions
The "chief girder" in the scaffolding of Modernity was the Cartesian dichotomy - the idea that humans are separate from nature, that we are somehow fundamentally different than other animals and that nature is this stable "set" on which we play out our lives (and which we can't fundamentally change). This split also happens inside the body - the mind is cut away from the flesh. Emotion comes from nature and is utterly separate from "reason." (108)
This split was important because the quest for certainty depended on decoding the fixed laws God made to spin the wheels of nature's clock. Scientists are really about "reading His mind." If humans are in there gumming up the works and moving the gears around the whole project becomes futile.
Sex
Basically Modernism was (is) all about stability and shutting down anything that threatens that. Sex really threatens stability - it breaks down family structure and class barriers and occasionally causes big wars (see Troy). Montaigne treats sex "as spontaneous, mutually pleasurable, and equal between sexes." And Toulmin says that's not a quirk - people were more relaxed about sex before the old order came crumbling down in 1610. Sexual inhibition sprang "from the fears that came into existence de novo, when the class-based state was devised as a solution to the early-17th-century's problems."
Leviathan to Lilliput
Toulmin offers his own image to contrast with Hobbes' Leviathan - a Gulliverian government hogtied by a million tiny cords from "willful social atoms" NGOs, social organizations, AARP, the Chamber of Commerce... I don't know. I live in that world and every once in a while I want Gulliver to get up and do something useful.

At some point check out Donald McCloskey "The rhetoric of economics"

On Genius and Distraction

2009-10-31T23:33:00.000-07:00

I'm reading Fitjof Capra's book on Leonardo da Vinci, which, as far as I can tell so far makes the case that Leonardo was a great "systems" scientist - the emerging field that embraces nature's messiness and looks for patterns within it rather than searching for one mathematical proof to rule them all. But that's not the point - Capra was making the case that Leonardo was a genius and he cites what (he says) psychologists agree are three traits of genius. Despite my better instincts I became hopeful that I'd find myself described in the following lines.

Sign #1 - Insatiable curiosity, and enthusiasm for discovery (okay!)

Sign #2 - Ability to memorize large amounts of information (...)

Sign #3 - Capacity for intense concentration over long periods of time (um, brb, the podcast I'm listening to just ended and I have to cue up the next one)

Immediately after reading that I went for a run - intent on concentrating on a problem I was facing in a piece I'm writing. But instead my brain was channel surfing, from a scientific paper I'd read, to musings on the nature of gentrification in the neighborhood I was passing, and just when I was about to get back on track some rogue element interrupted (I'm embarrassed to say) with a booming rendition of "Sweet Caroline."

But then, just as I was ready to conclude that the Twitter-era kills geniuses, I come back to the book and learn that Leonardo would work for years doing background studies for a painting, then take off for some new project, leaving it half finished. A lot. Later Capra writes, "He always looked for patterns that would interconnect observations from different disciplines; his mind seemed to work best when it was occupied with multiple projects." Hmm. So maybe there is value in being bombarded by information in gathering ideas, as long as you are able to achieve that trance-like focus every once and a while to actually produce something.

So are the distractions of the information age creating, or crippling, genius?

If you want to be sure your food is really all natural

2009-10-26T22:04:00.000-07:00

... then grow it yourself. From scratch. That's the modest proposal Meghan Laslocky makes here. As yet there is no sign of outrage. What's wrong? Have all the tone-deaf people abandoned the Internet at once?

So cute I could just eat him! But medium well, okay?

Like A Natural Woman

2009-10-21T00:11:00.000-07:00

Okay this is off topic, but my profile of San Francisco politician/police commissioner/future icon Theresa Sparks just came out in San Francisco Magazine. I suppose it is on topic if you stretch to consider how people use the term natural in moral arguments. To me Theresa represents another realization as well: Natural can connote a sense of comfort. She may not have the body nature gave her, but spend 5 minutes with her and I guarantee that you'll forget about that. The conversation feels perfectly natural.

Salt wars

2009-10-18T22:46:00.000-07:00

An interesting paper came out last week in that delightful wellspring of whimsy - The Clinical Journal of the American Society of Nephrology (not actually one of the many periodicals I follow). It made a splash because the authors were saying that - despite the fact that nutritionists have been trying to cut back on salt intake - despite the fact that we're getting more and more salt in processed foods - that the country's nutrition experts have set recommended salt intake levels too low. It got picked up in a lot of papers because this is how health/science news works: Conventional wisdom is established with a few articles (and reinforced with simpering on morning television) and we all assume that we are dealing with certainty (Salt: Still Bad For You!) so we don't see it in the papers again until you get a study that perks everyone up by questioning that conventional wisdom. This is the structure that forces every science article to say "everything you knew is wrong." Furthermore - we should pause to note that two of the authors of this paper have buddied up to consult with the pro-salt lobbying group, the Salt Institute. Nevertheless, it's worth taking seriously for the following reasons:

1. We need salt: We die real quick without it. We can't store it like we store fat, or vitamin A. We can't manufacture it in our bodies. We can get rid of it quickly by sweating and peeing if we have too much. There is evidence that appetite for saltiness is regulated by the brain based on how much sodium we have in our bloodstream.

2. We all tend to eat the same amount of salt: There was no new evidence in this study, it was a review of data from the past. Most of it having to do with measuring pee. This is science folks, testing cup after cup of pee and determining sodium content. It's the best way we have of telling how much salt people eat. The numbers fall between 2,700 and 4,900 mg per day. Which is a lot higher than recommended (2,300 mg if you are healthy 1,500 mg if you have high blood pressure). If people tend to gravitate to this zone, why push them lower (the authors argue)?

3. Salt is politicized: The debate over salt is not conducted in the dulcet dinner-party tones we NPR-types favor. Everyone is screaming at each other with their fingers stuck in their ears as Gary Taubes demonstrated nicely here. We have pushed out the necessary level of uncertainty in coming to our consensus that salt is bad.

But wait, I hear you saying, the salt hypothesis makes sense. True. When you eat salt you retain more fluids so pressure rises. And we don't need much salt to survive. The original argument for less salt came from comparing cultures: There were these pre-industrial people without much salt in their environment and they seemed a lot healthier than people that ate a lot of salty french-fries. We evolved without a lot of salt in our diet, so we were wired to seek it out, and now that we have plenty of salt we can't control ourselves. Perhaps. Or perhaps it was the entire industrial lifestyle that made those french-fry eaters less healthy rather than just the salt.

And what about the money from the Salt Institute? Keep in mind that those authors were only invited to work as consultants after they had published a paper trying to show an association between salt consumption and blood pressure (they had to do some statistical gymnastics to do so).

So is it all a lie? Salt doesn't cause strokes or heart attacks? Well that's just it, we don't know - we're still a long way off from knowing. So what do you do with scientific uncertainty like this? First of all, stop worrying and eat what makes you happy. We know for sure that stress raises blood pressure. After that, it couldn't hurt to avoid food so over-processed that it must use salt as a crutch in limping it's way toward palatablity. And finally, exercise: If you have too much sodium for your kidneys to handle you can sweat it out, and I'll bet that the biggest difference between the healthy pre-industrial folks and the unhealthy Americans has to do with the relative amount of time we spend in limp repose.

The cure for health care coverage

2009-10-18T16:36:00.000-07:00

If anyone is feeling confused about health care it's probably because you haven't listened to the This American Life episodes on the topic. They did a great job. And I say that as a reporter who is doing work on these same issues (actually preparing a radio piece that overlaps with their segment on PSA tests a lot). They zeroed in on the fundamental problem: skyrocketing costs. They explained exactly why they are so high. There are a lot of factors - but all in all it's not so complicated. The real mystery to me is why no one has done this before. Instead we get reporters running around in manic circles, yelling at the insurance agencies, or the doctors, or big pharma. Are we so oriented on rooting out the villains that we journalists lost the ability to do good reporting on this? It's as if we are back to the time when the crops fail (or premiums rise) and to solve the problem we tie some woman (or HMO executive) to a tree and light the fire.
Admittedly, there's a lot to health care reform that is utterly counterintuitive (eg more doctors competing drives the cost of care up, eg care can kill) and people like Shannon Brownlee have traversed this path before (actually it seemed like TAL was borrowing a lot from "Overtreated"). But still, hats off to TAL.

God travels back in time to thwart the collider

2009-10-14T11:53:00.000-07:00

A fun essay by Dennis Overbye. I love it when science finds itself forced to confront first principles, it happens all too rarely. Often, scientists are like these lonely dwarfs, chipping away at the end of some tunnel that has wound down into some truly esoteric schist. If I try and pull them up to the surface to talk about how the little gems and fossils they've found contribute to the big picture, the stumble around in a kind of dazed cranky fashion, as if they are overwhelmed by the scale, aggravated by the light. Of course there are those scientists who have the disposition to do the small-scale chipping (the only way to make real progress) and also to pull back at the end of the day and think about what it all means, and why (or if) we should be digging in that spot at all. People like Stephen Jay Gould - cheers to them.

Is the Future our version of Heaven?

2009-10-09T10:58:00.000-07:00

painting/Robert Shetterly

I'm reading Wendell Barry's "The Unsettling of America." He writes: "The modern mind longs for the future as the medieval mind longed for Heaven." These are the sort of profundities that he's able to jot off (with ostensible ease) that stop me in my tracks. This one especially because it hits close to home. I don't really believe in Heaven, but I do have a deeply ingrained belief that the future is a better place, that we are constantly making progress, moving forward, making the world a better place. But by what metric do you measure improvement? The number of people living in poverty has grown. Large portions of the earth have become much less hospitable for human living. We have just closed the door on a millennium red from tip to toe with genocide. We all can tick off the improvements:

vaccines and antibiotics, cheap transportation, effortless global communication, huge gains in food production, and various creature comforts that certainly make my life better (This American Life podcast, the glory of hot water). But are we really happier?
Berry makes the case that people are inclined to control things - to put farms indoors where variables like sunshine and plant/insect interaction can be pinned down. But at the end of this road the individual is left with little under his control - these days we have not much control over what food we eat (the supermarket determines the selection and nutritionists choose what goes in each product), who sells us our gasoline, our electricity. We can choose between five mobile phone companies that offer suspiciously similar plans. Ditto for health insurance. We have no control over the means of production - we are at the mercy of doctors, mechanics, garbagemen, lumberers, Chinese assembly-line workers. There are a lot of people (Matthew Crawford, Kelly Lambert) who have cataloged the things we lose when we give up responsibility for these tasks to machines and outsourced labor. The average middle-class American is not left with much to call his own when the big decisions are the domain of experts and small decisions (like how thick to cut the carrots) are made be machines and foreign labor. It's no wonder Americans are so in love with conspiracy fantasies: only the lone wolf who sees the truth that everyone else has missed can hope to rise to the level of the experts, that's the surest path for a normal person to be able to make a difference in this world that seems so resistant to change, that's a sure way to seize back some control. Perhaps that's the root of the Birther/Truther psychosis. I can kind of understand it when I think of it that way ie how can all those mainstream-media experts be right where the feeling that something is deeply wrong in the world? Their assurances that everything is all right when something seems so deeply wrong only serves to strengthen the case for conspiracy.
Whew, long winding, awfully earnest post here. I'm neither a conspiracy theorist re: Obama or 9/11 please note. But I think I'm beginning to understand where they are coming from.

That soaring feeling

2009-10-04T22:07:00.000-07:00

One of the great things about living in San Francisco is that every once and a while I'll come across a prospect that just lifts me a bit, as if I'd achieved aerodynamic properties for a fraction of a second. That happened today as I was walking up Coleridge St. I looked out to the west where the Golden Gate is and instead saw towering clouds sweeping in from the sea. I get the same sort of surge at the sight of certain mountains, waterfalls, summer thunderstorms. I feel at once very small, and powerful. Small, because it's clear that whatever I'm looking at could crush me, and powerful because it doesn't, because in fact I'm warm and secure - despite the fact that nature is overwhelming and incomprehensible, and the fact that there's a stiff wind whipping in off the Pacific - I'm able to stand there looking into the closest approximation of the eye of God I can imagine, and then walk away unscathed.

2009-09-29T23:47:00.000-07:00

Olivia Judson offers this:

grasshoppers that have to take measures to avoid spiders grow more slowly and lay fewer eggs than grasshoppers in spider-free zones. In areas of Yellowstone where wolves are abundant, female elk give birth to fewer young. Birds that perceive their breeding area to be full of animals that will eat their eggs or young may skip breeding altogether, or lay fewer eggs than usual. In other words, predators keep prey numbers down simply by being scary.

But aren't there many more examples where the opposite is true - where predation urges growth? Where - even more counter-intuitively - predator and prey are cooperating on some level? As my teacher Michael Pollan elegantly demonstrated in Botany of Desire, predator prey relationships can turn into mutualism: The apple tree, rather than trying to poison its predator, instead pulls a kind of evolutionary judo move and uses the fact that it's being eaten to its benefit. Of course the apple did this by luck (the right configuration of genes at the right moment), but the fable of the apple seems useful in this recessionary world: When someone comes to eat you, the impulse is to react like the grasshopper - but if you can figure out a way to act like the apple, that looks like a far better strategy.

Death at sea

2009-09-16T11:58:00.000-07:00

I did a story for Crosscurrents about the strange season we've been having off the California coast. In it - mea culpa - I sin by saying some of these animal deaths are natural while the "dead zones" are not. It's such a convenient shorthand for a 4 minute radio piece. You can see how it has become a convenient (though blinding) shorthand for our thinking.
But a fun story for those armchair naturalists who want to know why all these animals are having such a hard time this year.

Photo by Chad King/NOAA

Surgery versus therapy

2009-09-12T00:54:00.000-07:00

If you carefully squint at the top right corner of this picture you'll see me running the upper North Fork of the Kaweah. I love kayaking. But as a kid I popped my right shoulder out doing it - a lot (I had some bad habits - plus I've always had loose shoulders). By the time I was in college my shoulder would slip out if I so much as made an expressive gesture ("Just go that way, over th-aargahhaaaaaa!"). So I got surgery. The doctor told me he "tightened everything up" and "cleaned it out" and he gave me the video to prove that he hadn't just been messing with me while I was under. So I gobble Vicodin, wear the sling for a few months, and am not allowed to kayak for a full year. That was spring of 2000. And all was well until spring of 2009.
We were up in Downieville to run Pauly Creek (I don't have pictures but there are great ones here). It's a short run with lots of waterfalls and I was feeling great. I ran the big (20 foot or so) drop at the bottom which I'd never done before (because my friend Eric nearly died there and his stories spooked me). It was still early in the day so we drove back up to the top and I convinced a small contingent to hike a couple miles upstream to get a little more for our money. None of us had ever seen it before, and the light was starting to turn amber with evening as I led the crew down the first drop. Things went well until about the fifth rapid. I had lined up to charge from right to left, break through a hole, and end up in an eddy on the far side of the creek. But just as I reached for my first paddle stroke a hidden rock caught the downstream edge of my boat and stopped it dead. The rest of my body rotated around that pivot point like a cracking whip. As I went under, the paddle blade caught the water. You are supposed to have a loose hand - so that you release the paddle shaft in these situations were the opposing forces are getting big. I had a death grip. (more after the jump)

When your shoulder dislocates there's a sickening grinding slipperiness as tendons give and the humerus slides off the scapula and into the viscera. I knew immediately what had happened, but was in denial as I tried to roll up. Things were not working right - it was definitely out. All this had taken place in a little under three seconds, and though underwater, I knew I was still above the drop. I shrugged back violently and felt the humerus slide back into place, then rolled up just in time to hit the hole and go back under. I reached for the surface again - the swift water on the downstream side caught my blade and the shoulder was out again. I shrugged it back in and tucked my body up close to the boat. At this point I was rattled. I was upside down - my head acting as a keel - moving fast down a creek I had never seen before. I knew I had to get to the dry side before I floated into something dangerous, but I was also in shock - I wanted to keep my arms in tight - not expose my shoulders by rolling. I steeled myself and rolled on my left side. My paddle found a rock and I vaulted inelegantly up.
I looked around. I was in a granite slot. Above the rocks the forest rose in steep banks. Trying to scramble up that with a boat and one bad arm would have been nearly impossible. I signaled to my buddies that I was okay by pounding on my helmet. If I could just pick my way down the next mile and a half there was a trail where I could hike out.
That mile and a half was miserable. My shoulder came out several more times. Once, I clawed my way up a rock face to the surface, and found myself clinging just inches from the lip of a waterfall. By the time I finished, I was shaking with adrenalin.
The Ericksons - old friends - live not far from Downieville and that night I drove to their house. Bob and Liese gave me lots of TLC - ice, an omelet and toast (at 10 pm) and a soft bed. And naturally, the conversation turned to treatment. Would I get it fixed? Or let it heal on its own. My father in law is an orthopedic surgeon. He told me it will be completely better in about 20 years if I did nothing (and didn't re-injure it). "But you are young, you like to do active things like kayak..."
That was just it though - I was only kayaking because I thought the surgery had turned me into a bionic superman with titanium screws. If I knew that my shoulder was a liability I probably wouldn't have been there in the first place. And now that I'd lost some trust in the surgery...
There was also something else. As I made my year long recovery in 2000-2001 I began to wonder how I would have fared if I had just skipped the surgery and just spent 15 months doing intensive physical therapy. If I built up massive shoulders I wouldn't have this problem. But of course I also absolutely believed that the surgery helped a lot.
Then again - that belief can be a confounding factor. The amount of faith you have in a treatment -it has been demonstrated again and again - has a huge effect on its success. Consider what Daniel Moerman has to say about heart surgery - first he talks about bypass surgery, then:

In angioplasty, a little balloon is threaded up to the coronary arteries and inflated. This expands the artery, allowing more blood flow to the heart. Given these theories of blocked "pipes" (that's what heart surgeons call arteries), these procedures easily visualized when you look at a bit of rusted plumbing from the laundry tub, make very good sense.
But there's more to it than that. These "pipes" are part of thinking, knowing people. Angina pectoris ... is, it turns out, highly responsive to inert treatment as well.

In several experiments doctors did sham surgeries on angina patients - just cut them open and closed them back up. Stunningly, the patients of the sham surgeries showed more improvement than those with real surgeries. One sham surgery patient from Kansas City:

"Yes. Practically immediately I felt better. I felt I could take a deep breath ... I figure I'm about 95% better. I was taking five nitros a day before surgery. In the five weeks following I have taken a total of twelve." This patient's arteries were not ligated. But he did have two scars on his chest, and he had an explanation that made sense.

Surgery has a very powerful placebo effect - or as Moerman prefers "meaning response." We can visualize the rusty clogged pipes - and how a bypass will fix it. I can understand how my arm is sliding around - and how I really want to just "tighten it up" and "clean out" all the grit out of there. Our bodies respond to meaning - and surgery fits nicely with our conception of ourselves as complex machines. We really get that - so surgery really works. Now, none of this is to say that many forms of surgery don't work without the aid of the patient's mind. But it does give me pause. The idea of titanium screws and tight ligaments had me feeling pretty bomber (as we say when engaged in extreme sports). Maybe a little too bomber.

For now I'm going to take it easy, keep doing my thera-band and see how it shapes up. It's been about six months and I hardly notice my shoulder anymore - pain is very infrequent. Range of motion is back. I don't flinch anymore when someone approaches from the right side. I'll add updates later. But what do you think. Should I get surgery - and take all the placebo I can get along with it?
I know one thing - I'm not doing anything even class IV unless I build up bigger shoulder than I've ever had before. Anyone know how to do that? I'm terrible at bulking up.

2009-09-04T21:25:00.000-07:00

David Brooks calls some attention to that Goldhill article. He's saying - look: enough with futzing with the window treatments, we've got to do something about the sinkhole under the corner of the house. I feel the same way, and yet...

There's a tendency for us journalists to crave fundamental change - because it's exciting. And because we like to believe that good ideas can change the world (because that's our stock and trade). History is full of examples though, of big changes leading to big problems. There's more success when the changes are of the tinkering sort - a gradual sort of coevolutionary growth between insurers, government, business and medicine.

The all-natural-Heidi-force in me wants big change of course. It wants a system that doesn't push treatment (and kill hundreds of thousands a year with overtreatment). The inner Heidi applauds Bruce McCall's Shouts an Murmurs:

Did You Know: Human illness adds two trillion dollars annually to America’s gross domestic product. Are you contributing your fair share?

and this brilliant miniature:

Q. & A. of the Month
Q: My current statement lists two hundred and thirty-one charges for “brain surgery,” even though I have had no brain surgery. How can I rectify this?
A: Invalid question. Brain surgery is not covered under your plan.

People think doctors are all-knowing

2009-09-02T11:11:00.000-07:00

Just got off a call going over the release of a poll by the Campaign for Effective Patient Care. The biggest takeaway for me was this: 65 percent of people in California think that their medical care is backed up by solid scientific evidence. Of course in reality - as Shannon Brownlee writes in the group's report -

In a landmark 2008 report, the prestigious Institute of Medicine reported that at most half of the care that doctors deliver is evidence-based.

This is important to the health care debate - people have been awful upset about comparative treatment reviews (the extremists think looking at how effective something is and how much it costs will lead to death panels). But at the same time nobody wants care that's not effective - we all want our doctors to know what treatments work and what don't. How to explain this contradiction? Well this poll explains it. People oppose comparative effectiveness research because they (65 percent) think their doctor already knows what's best for them. So a minority that sees this research as cover for a rationing regime is not drowned out by the reasonable majority who should be saying we want to stop spending so much (and being injured by) care that doesn't work.

How health care killed David Goldhill's dad

2009-09-02T00:01:00.000-07:00

The Atlantic recently published a great piece of contrarian thinking on health care. David Goldhill points out that all the incentives in our medical system encourage more treatment - and that's making us sicker (plus, it killed his dad, or at least made the end of his life unpleasant).

All of the actors in health care—from doctors to insurers to pharmaceutical companies—work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create. Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing.

So far so good. I'm pretty convinced that we have too much medical treatment and that there are some foundational problems causing that. But Goldhill thinks these problems all come down to one thing: Lack of market pressure. It's an interesting point, but one that I think has some problems. But before I get to his proposal, here's one more interesting critique:

Consider the oft-quoted “statistic” that emergency-room care is the most expensive form of treatment. Has anyone who believes this ever actually been to an emergency room? My sister is an emergency-medicine physician; unlike most other specialists, ER docs usually work on scheduled shifts and are paid fixed salaries that place them in the lower ranks of physician compensation. The doctors and other workers are hardly underemployed: typically, ERs are unbelievably crowded. They have access to the facilities and equipment of the entire hospital, but require very few dedicated resources of their own. They benefit from the group buying power of the entire institution. No expensive art decorates the walls, and the waiting rooms resemble train-station waiting areas. So what exactly makes an ER more expensive than other forms of treatment?

Perhaps it’s the accounting. Since charity care, which is often performed in the ER, is one justification for hospitals’ protected place in law and regulation, it’s in hospitals’ interest to shift costs from overhead and other parts of the hospital to the ER, so that the costs of charity care—the public service that hospitals are providing—will appear to be high. Hospitals certainly lose money on their ERs; after all, many of their customers pay nothing. But to argue that ERs are costly compared with other treatment options, hospitals need to claim expenses well beyond the marginal (or incremental) cost of serving ER patients.

Huh. Fascinating. Though I'd love to get a hospital administrator's response. But Goldhill doesn't have time for that. Here's what he's thinking: We all pay into a national catastrophic insurance fund and we can get money if our expenses go above $50,000. We pay for everything lower by putting money away in health savings accounts and by getting financing if we don't have enough. Basically - taking out the insurance companies and trying to make health care like any other market. You should be able to pay because (he says) right now taxes and lost wages and higher prices - all indirectly due to health care are costing every one of us $1.77 million over the course of our lives. For the very poor? Well we abolish Medicade and give them $3,000 a year for their HSAs (plus the universal catastrophic insurance). Finally - everyone gets a government voucher for a free checkup every two years.

Here's what I like: I'm all for medical transparency - it infuriates me that hospitals won't tell you how much something will cost before they perform the procedure. I like the fact that it puts consumers in charge - I think it would help recenter service to us patients and do a lot to get rid of perverse incentives, create competition and bring down costs.

Here are the big problems:
1. Medical treatment is not a commodity: In many cases it is - but in emergencies you don't have the ability to shop around or bargain.
2. We believe in solving problems with medicine: Sure there are foundational problems in the economics - but the original reason those were built in had a lot to do with the foundational problems that exist in our heads. As Goldhill notes, we conflate health with health care (and health care with insurance). But he doesn't make the next logical step and conclude that people are not rational actors in this. If you are depressed, or sleepy, or lonely (or oftentimes even hurt) there are usually better ways to address the problem than going to the doctor. Yet we go. And demand the priciest treatment - after all, what's more valuable than our health? The problem here is that we've set up science as the only legitimate source to turn to in solving our problems. But when it comes down to everyday human life, science actually doesn't have very good answers. We are way too complex. So part of the solution (and my interest in this blog) has to be looking for other paths to health and the good life.
3. I don't see how this proposal would work for people like my friend Catherine Price, The Reluctant Diabetic, who has a chronic, expensive condition.

Update - Catherine and I have had an interesting exchange about this. I'll post below. She goes to doctors a lot. I think that's a bad idea. Yet we agree that there's a lot to like in Goldhill's ideas.

Catherine:
I did actually read that piece -- actually, it was some night where I was waiting for my blood sugar to come down and wasn't able to go to bed till like 2. I think I made it through the Atlantic *and* the Economist.

I actually found his piece really revelatory. I think it completely makes sense -- that is, that it will be impossible to do anything that really cuts costs/doesn't further bankrupt our country until we make a stronger financial connection between consumers and providers. I thought one of his salient points was the part where he compared our current approach to "insurance" with the idea of asking Geico to pay every time we fill up our tank with gas. I mean, unless you've just got a catastrophic plan, you're expecting your insurance company to subsidize -- or pick up the cost of -- visits that really are just routine.

Also, to address your thought on how we all go to the doctor too much anyway, I think that his approach would actually help solve that problem. I mean, dude, I go to the doctor ALL THE TIME. I've seen three separate dermatologists/allergists and three orthopedists this year alone, none of which had anything to do with diabetes. If I were paying for it out of pocket, I probably would have been more selective -- done more research online, shopped around, etc. I also know for a fact I would have gotten fewer prescriptions -- I'm trying to stock up on everything I can right now before Jan 1st, when the $6,000 deductible for peter's work plan kicks in again. (They pick up 80 % of it, so it's not so bad, but still.) I think the problem is that once you assume something should be free, people are going to want more of it. And until we reconnect consumers to providers -- in a financial sense, like Goldhill proposes -- we are never going to be able to control costs. It's just human nature.

And I also think that we should put a little more faith in consumers' ability to shop around and make informed choices. Consider all the tools that already exist when you're trying to say, pick a restaurant or buy a digital camera or hell, even pick a doctor. You go to yelp, you read reviews on amazon and cnet, you pull up "google shopping," and you make a smart choice. If people were paying things out of pocket, they'd be motivated to do the research -- and more tools would emerge that would help them.

Anyway. All this is not actually addressing your question about my particular condition. Goldberg mentions situations like diabetes, but only in a parenthetical on p. 53 -- "(Chronic conditions with expected annual costs above some lower threshold [than $50,000] would also be covered.)" As I'm remembering it, he's proposing that the main catastrophic plan would be government-run, which means that the government would also have a separate pool of money to help out in cases like mine.

I think that in theory this sounds great and makes sense -- you prove you have a chronic disease, your threshold is lowered and you're entered into a special pool. The problem, however, would be that if this catastrophic plan were the only way to get healthcare, it would also have a monopoly on what kind of treatment and medication were available. For example, just this year I got Blue Shield to approve a continuous glucometer, a device that I wear on my arm that tells me my blood sugar every single minute. (It replaces finger sticks, which are less convenient and give a far less nuanced picture.) I'm thrilled that they're covering it, because the supplies and device are really expensive -- if you don't count the blue shield discounts, the bills have totalled some $12,000 this year so far. (I can't remember what it was after the discount but it's definitely been above $6,000.) If the government were the only insurance option (or, rather, if ANY company were the only insurance option) and they decided not to cover this device -- which is a no-brainer in terms of whether it improves control and reduces risk of diabetic emergencies -- I'd be out of luck (especially since freelancers don't really ever have that $1.7 million pool of leftover cash he's talking about). I mean, seriously, this machine has changed my life. Likewise, I'm about to try a new drug called Symlin, which is uncommonly used but very promising for smoothing out blood sugar (and thus lessening the risk of expensive complications like blindness and kidney failure down the line). A three-month supply, without needles, is over $500. Why would anyone want to cover that when insulin, which you *definitely* need to stay alive, gets 80% of the job done?

You get what I'm saying: reduce the number of providers and you risk having one company or government-run entity in charge of making coverage decisions and you may not be able to get a treatment that is expensive, yes, but which is truly valuable -- and which, by preventing complications, would save the provider money down the line.

So in short, I completely agree with Goldhill's underlying principle, and I would support the type of reform that he suggests -- I really do think that it's the only way to control costs (i.e. a bottom-up, consumer-driven approach to cost-cutting rather than top-down government control) and to steer the country off our current path to medicare/aid-driven financial ruin (for a terrifying look at this, read "The Coming Generational Storm," a book that came out a couple years ago about our path to financial disaster). But before I could really assess how it would impact say, diabetes, I'd need to find out more about how they were going to establish that lower threshold, and how decisions on coverage were going to be made.

(Oh, also, as a side note -- till Peter and I were married I was on a gov't subsidized plan called major risk medical insurance pool -- or "Mr. Mip" -- which was funded through the tobacco tax. It was a blue cross plan (shield?) and was the only way I was ever going to get covered as a self-employed diabetic. It worked well and appeared to have a sustainable source of funding, which was great. But then again, you can't really get smokers to subsidize the entire healthcare system -- and Mr. Mip did nothing to connect me to the cost of my care.)

That's probably more than you were looking for . . . but I found that article really interesting and wish more people would read it!

C

Nate:
Atlantic and the Economist - so you're saying that if I want to be well informed all I need to do is get diabetes?

It was a really clearly thought out piece - that was nice. Lots of stuff so far has been confused or myopic - focused on insurance companies v drug companies etc. The part about the hospitals refusing to tell him how much the MRI's would cost made me so mad. And the LASIK example was really interesting.

I totally agree that we should put more faith in the patient's ability to shop around and make informed choices. Right now the patient is almost incidental - if the doctor were a tailor the patient would be the ripped shirt and the insurance company would be the person bringing it in (and more importantly, paying). That's not a good system if you want to respect the patient and really find out what's best for us.

It's interesting that you as a go-to-the-doctor-all-the-time person would be in favor of a system that would encourage you to go less. I would think that people who equate health with health care and get lots of it would be in favor of other people picking up the bill as much as possible. Is it just that you are reasoned enough to know that those two things are not the same? My thinking was that in order to get something like this passed we'd have to convince people who think that going-to-the-doctor-all-the-

time makes their lives better that it actually makes them sicker and poorer and less happy.

The final thing I worry about with the Goldhill plan is that, indeed, freelancers aren't really going to have an extra $1.7 M at the end of the day. And day-laborers are going to have even less. But maybe media and technology executives like David Goldhill will. My point is that right now the way we pay for health care redistributes wealth. Granted - it's ridiculously inefficient (it's like steal from the rich and give to the poor while handing an 80% share to the medico/insure/pharma complex) - but it still helps even things out a little bit. Right? I mean, he says the cost of worker's health insurance comes out of their paycheck. But if the business gets to stop paying, do you really think 100 percent of that windfall would go to raises? I'm guessing owners would skim at least a little off in profits.

Re: Government only option - I see no reason why insurance should be illegal. If people want to buy private insurance - and companies can set up competitive options that address those needs you point out.

Catherine:
Hi Nate,

I'll have to answer this quickly because guess what? I'm going to the doctor! But a few thoughts --

Your last point first -- I agree there should be no ban on secondary insurance -- if you want to pay more, you should be able to get additional coverage. Problem is that in cases like mine, we're not a "risk" -- we're a definite liability. I've got diabetes, I'm never going to not have it (unless they figure out a cure) and it would take a really stupid company to sell me a plan that would help pay for it. I like to compare myself to a broken car -- why would you buy me when I am GUARANTEED to lose you money, year after year? There's no way I would not cost you money -- so you wouldn't be "insuring" me -- you'd be subsidizing me.

As for the question of why I, as a doctor-lover, would advocate a system where we're encouraged to go less -- yeah, I love going to the doctor, but one of the reasons I go so much is that it's (superficially) free. I also love expensive dinners, but I limit those because they come out of my own wallet. I think the best way to get people to go to the doctor less is not to try to tell them that it's making them sicker -- that's going to be a tough argument to sell -- but to make them responsible for the cost and then promote less expensive alternatives. In other words, if my choice is to go to a therapist and spend X amount of money per week -- but I've also heard that taking a meditation class or reading a book might be helpful and costs far less -- I might try the second option. But if the first option is free and easy, I'l just go with that instead.

As for redistributing wealth. . . I'm wary of that concept in general, but I'm not sure if the current system would qualify. I mean, basically people with good jobs also get good health insurance. People with crappy jobs don't have (as good if any) health insurance. But at the same time, we're ALL getting screwed by under-funded entitlement programs -- a situation that's going to hurt everyone in the long run. I think my primary concern about our whole country right now is our financial situation and thus i'm very very wary of expanding any kind of entitlement program -- because let's face it: when are you ever going to get re-elected by promising people that you'll take things away from them? Once that stuff gets out there and established, there's no taking it back.

Oh, and lastly, about the question about whether employers would really step up and give pay raises -- I completely share your concern. I doubt they'd be like, hey, guess what? You're getting a 30% raise! But at the same time, I do think that if health insurance were no longer employer-provided, employers would have to find another bargaining chip/incentive to lure people to their companies. And the main incentive left would be pay raises. So in other words, you probably wouldn't recoup the whole $1.7 million, but companies compete with each other, and if they can't compete by offering better health benefits, they'd have to find some other way to make themselves seem more appealing than their competitors. Not that that would help the lowly freelancer. But still.

(Actually, this makes sense historically: employer-based coverage sprang up as a result of wage controls in the 30s and 40s, right? In other words, employers could no longer use straight-up money as an incentive, so they turned to health insurance and other benefits to lure workers. Take away health insurance, and wouldn't it make sense for the opposite to happen?)

Off to the doctor!

C

Nate:
So how do we get health care reform reshaped to this?

I still think there's a problem with the way it's sometimes a distorted market (people have no choice in emergencies) but overall I like it. And if this can get you and I on the same page (and I think we have very different ideas about medicine - I haven't been to the doctor since 2006) then there might be some hope for it.

Blog neglected, but plants thriving

2009-08-29T13:28:00.000-07:00

So I was on vacation recently - away from the blog - and when I got back all my editors suddenly wanted drafts. The first breaths of the brisk winds of fall, I suppose. In any case I've been doing a lot of writing these days - for which I'm actually paid (rather than the prospective research and navel gazing that feeds this project). So spending a lot of time writing hurts the blog... but it does wonders for the plants that sit in the window to my right - just past the mouse. When I'm sitting there trying to force my brain to figure out a way to make a particularly improbable transition - or how to breath some narrative life in to a sterile series of facts - it sometimes plays tricks on me to get out of the chore. One of my brain's favorite tricks is the classic "OMG what's that!" caper. It usually plays out something like this:

Okay, I wonder if it would work to have a short establishing sentence that shows how this next thing is connected to the argument. But that's boring - so maybe a dependent clause to say why it's actually exciting. But now it's a long sentence. Okay, so - GOOD GOD WHEN IS THE LAST TIME YOU WATERED THE FERN?!

Therefore - lots of writing = lots of attention for plants. What's fascinating to me is that attention = healthier plants. If you think about it, it doesn't make a lot of sense that my ministrations should be helpful. I know nothing about the inner life of a fern. I've watered it too much and too little without knowing the difference. I've attacked it with scissors when I found it aesthetically displeasing, I once reduced it to two pathetic fronds. I've haphazardly introduced foreign species into its pot. I've dumped it out and torn up its roots. Doesn't it seem like it would be better off if I just let it do it's thing?

I make crazy hypotheses about my plant's preferences and test them out and - over time - I think I'm actually figuring some stuff out. What follows is the Fern Saga: Fernando was a housewarming gift from a dear friend (Emily) about two years ago. I immediately formed several theories on the care and feeding of our new roommate.

1. Fernando did not like direct light
2. Fernando needed a bigger pot
3. Fernando hated movement and was not, under any circumstances to be jostled or (heaven forbid) carried to the sink for water.

Beth (the wife) chaffed under the imposition of my crackpot rules, but she doesn't seem to have much patience for plants, so she let me do what I wanted. With the possible exception of #2 these axioms turned out to be totally false. And as months went by Fernando go browner and browner. I experimented with different levels of moisture and heat. Then I noticed that I could lift all the soil out of the pot - suspended in a mesh of roots. I decided that the root-shoot-ratio had gotten out of hand - something was wrong with my care, causing Fernando to stop sending up new shoots and allowing the existing greenery to brown. So I waded in with the scissors and pruned him back to a few feeble fronds. Beth was aghast.
"Should we just throw it out?" she said.
"No - and don't touch! What have I told you about moving it?"
"Yeah, you can really see that sitting still has done wonders for this plant."
"Watch and learn," I said.
And indeed, new green shoots started coming up. It was oh so gratifying to see those tiny fiddleheads. Even Beth regained some hope.
"Maybe we should give it some plant food," she offered
"Schweigen." I retorted. "In this house ve adjust one variable at a time."
But the fronds that unfolded were pretty anemic. After a couple months I decided that I'd been on to something with the root-shoot-thing but I'd been going about it all wrong. The roots were overdeveloped and siphoning off all the energy from the leaves. So I pulled up Fernando and brutally tore his roots apart with my bare hands (actually I work gloves). Then I got a new pot, filled it with new earth (and worms as it turns out) and set him by my desk (in the sun btw). At this point Beth was really convinced that he was dead. It looked like I'd jumped up and down on Fernando, then taken a blowtorch to the leaves. Everything died. Then the shoots emerged again. Over the months Fernando slowly started looking - not vibrant - but at least viable. So what if the grasses that sprouted in the bowl were way taller than him. I noticed that the soil surface became covered with worm castings and I started working on a new theory - maybe the worms and bacteria in the soil were processing chemicals and giving Fernando more fuel to grow? What if he'd developed all those roots in the first place if he was starved for nutrients and needed to send exploratory tendrils to even the most barren of molecules? I walked across the street and bought some Miracle Grow from the hardware store. I got Miracid (for acid loving plants because it said it was for ferns and orchids). I took a look before I mixed it up - 30% Nitrogen, 10% Phosphorous, 10% Potassium - some trace minerals (the other 50% must be inactive ingredients - on inaccessible molecules). I poured it on and - boom! It was like someone had hit the gas under the pot, tons of new fronds sprang up and the whole plant got bigger and lusher. A month later I gave Fernando a little more fertilizer and again - it was like I was pumping him up with compressed air.

The moral of this story is that attention makes plants thrive (if they survive the initial missteps). I mean - skeptics might say that the moral should be that chemical fertilizer rocks - and yes they have a point, but I honestly don't think Fernando would be this healthy and happy if I was just going through the rote process of watering once a week and once month with plant food. I know that I wouldn't be as happy.

Pregnancy related death

2009-07-24T18:23:00.000-07:00

KALW just aired two pieces that I did on the rising rate of pregnancy related deaths and the black-white disparity. You can see a longer post from June. I'm hoping this will get more media attention - it's a particularly troubling example of the broader problem that Atul Gawande and others (and still others) have identified. How does this tie in with Nature? Well when you live in a world we look to science for all the answers, science sometimes ends up providing best-guess answers when it should just be saying - "we don't know enough about that yet."

Romantic? Rational? Or machinist?

2009-07-22T09:04:00.000-07:00

Finished Daniel Botkin's book "Discordant Harmonies" last night. It has a lot to offer, but what I'm most interested in is Botkin's perspective on the trajectory of thought on nature. We start out with competing myths: The earth is a divine creation with everything made according to a plan to foster life (Jewish creation story) - versus - The earth is a living organism passing through different stages of life (pagan/animist). And then around the industrial revolution - when people had complex machines available to refer to in their metaphor making, and when Newton's breakthroughs offered a vision of a universe governed by an elegant set of simple rules - a new myth grew and dominated the others: The earth is just an piece of machinery. There are several implications if you think of the world this way. The most important implication (to Botkin) is that the world tends toward a steady state - it should just keep chugging along unless we really screw things up.

The implication that created a big stir (it also created the Romantics) during the Enlightenment, was that the world was now no more sacred than a cast-iron engine. There were no longer dryads giving life to the trees - the earth could only be conceived as the predictable interaction of minerals and gases. Being a Romantic was always tough, because it forced you to argue from the weak position of opposing the mechanical Rationalists just because they were killjoys. Botkin offers a sturdier platform: Oppose them because they are wrong
I submit that joy is inextricably bound to truth, and that the feeling of disappointment we feel when we learn there is no longer any magic in the world is not sentimentality, but an instinct for truth. Botkin shows that the universe is not a lifeless machine. It is full of wonders and complexities so magnificent that the term "magic" in the old conjurer sense is insufficient to encompass them. As we learn more, Botkin says, the hard divisions between organic and machine, between cosmos and Earth, and between the living and non-living are blurring. (For instance, the fact that we now have self-replicating, self-improving computer programs forces us to think about the life-nonlife in a way that's more similar to the animists).
"We can feel part of the world in a way that our nineteenth-century ancestors could not, but our ancestors before them could."
But here is the interesting part - though the Romantics came into being as a reaction to the machinist Rationalists, they lived in the same time and referred to the same metaphors. So they (or we - perhaps I should come clean) still suffer the same blind spots that come from thinking of the Earth as a machine: The assumption that nature knows best, that, if we stay out of the way it is constant, that if we stay out of the way ecological succession will lead to a paradise of biodiversity. (Interesting tangent: Botkin gives three examples of ecological succession leading to less biodiversity in the climax stage eg in Alaska you get alders as pioneer species and their root bacteria fix nitrogen, which makes it possible for big evergreens to move in and shade out the alder hells and you get this nice open boreal forest. But then the spruce trees use up the nitrogen and when they die sphagnum moss takes over, soaking up water and making the soil acidic - the climax is a bog).
What this means according to me:
1. The only acceptable way to regard the universe (down to our immediate surroundings) is with a profound sense of humility and reverance.
2. We can toss out the Rationalist lenses that ask us to see only minerals and timber in board feet when looking at Yosemite Valley.
3. But we should also get rid of our machine-based Romantic assumptions: this doesn't mean we should tread lightly or try to protect nature for its own sake - instead we should actively manage ourselves and our surroundings to make the world a more delightful place to live.
4. As we grope around for new metaphors to explain the world (Earth as computer - Lovelock's Gaia hypothesis), we should try to be aware of the assumptions implicit in those comparisons.

Fatted

2009-07-20T20:22:00.000-07:00

A series of studies have shown that being "overweight" makes you live longer. Slate has a good wrap up. This is the sort of thing that makes me want to abandon modern medicine and run off to the Alps with Heidi. We adopt this overly simplistic flawed measurement (the body mass index) and build all of this architecture on that foundation (from giving dieting advice to giving pills). And eventually that becomes the only thing visible to us - instead of thinking "hmm, I feel healthy, strong, I still can get to the top of the hill without breathing hard, I'm happy so I must be doing something right" the tendency is to think "the number says I'm fat! the number says I'm fat!"

The Future and its Enemies

2009-07-13T17:49:00.000-07:00

Virginia Postrel has posted a chapter from her book by this name - it's a trenchant critique of Bill McKibben's "The End of Nature" and others though she does spend a lot of time beating up McKibben. I learned a couple things from this.

I found this especially interesting:

"As a 19th-century position, romanticism never broke with rationalism: rather, it was rationalism's mirror-image," writes the historian and philosopher of science Stephen Toulmin.

"Descartes exalted a capacity for formal rationality and logical calculation as the supremely 'mental' thing in human nature, at the expense of emotional experience, which is a regrettable by-product of our bodily natures. From Wordsworth or Goethe on, romantic poets and novelists tilted the other way: human life that is ruled by calculative reason alone is scarcely worth living, and nobility attaches to a readiness to surrender to the experience of deep emotions. This is not a position that transcends 17th-century dualism: rather, it accepts dualism, but votes for the opposite side of every dichotomy."

This is my point exactly - that the fight between the techies and the all-naturals is stupid one and that we should stop arguing about it. (So thanks, Virginia, for introducing me to Mr. Toulmin) I think Postrel is proposing the same thing - though she wants to replace reason v. passion with what she calls dynamism. Dynamism sounds basically like libertarianism. Get a lot of minds working creatively on figuring out problems for themselves and then let the market and natural selection do its thing. Rather than trying to predict and control the future, she says, allow the process to take its course.

Hmm. What about cases where we are pretty darn sure of the future? Should we really cut down the last Truffula tree to improve our lives - knowing that we are eating off the plates of our children? Or climate change blah blah blah?

One quarter of new foods are "natural"

2009-07-13T14:21:00.000-07:00

Just came across this from Mintel. Apparently the most common way to get you to buy a new food product is for manufacturers to put the word "natural" somewhere on the packaging. That word was used to sell almost a quarter of all new food launches worldwide in 2008, up nine percent from 2007. I the U.S. "natural" is even more powerful - it was on a full third of new launches, up 16 percent from 2007.

I'd now like to make up a new law - Nate's law if you will. I haven't thought about this at all and have no idea if it's really right - but hey, isn't that what blogging is all about?
Nate's law: Whenever a simple gesture toward a concept creates massive sales, it means we must have deep and (crucially) unexamined associations with that concept. ie, it's gotta be universal, and vague.

My explanation for the appeal of natural is that the pendulum swings back and forth between the desire for "natural goodness" (pristine waters blessed by the singing of tree sprites), and mechanical control. (Glaceau manages to have it both ways - check out this brilliant copy: "smartwater is inspired by the way mother nature makes water, known as the hydrologic cycle (you remember the ocean, cloud, raindrop diorama from fifth grade right? Actually, it's how we got our name too (hydro=water/logic=smart)." But then they "one up ma nature with electrolytes.") Anyway - I think we are still swinging toward natural but as we do we are going to see a lot more mixing like this - where products are going both back to the land and back to the lab. With any luck that will lead to confusion and a lot of tough questions about what's actually natural and what's not. Science is going to be prominent in this confusion: Is science natural? any sane smart person is on the side of science right? But as the graf below demonstrates (also from the Mintel presser) science (ie calorie, fortified) easily falls into the role of opposite to nature (ie pure, holistic, genuine).

"In the past, low-fat and low-calorie were the hallmarks of good nutrition and
dieting, but today, that lifestyle seems passé. On top of this, fortified
products are falling out of favor," comments Lynn Dornblaser. "Food and drink
manufacturers today realize that natural and pure have become healthy eating
ideals, as people look for holistic, genuine nutrition they can trust."

Pride weekend

2009-07-01T09:56:00.000-07:00

This weekend was Pride in San Francisco. In the morning Dan Choi gave a stirring speech (the three words that got him kicked out of the military, he said, were not "I am gay," but "I love you").

Watching the parade I started thinking about the way that "natural" has been used as a rhetorical bludgeon to fight the sort of celebration of difference that I was seeing. Now that we know there are gay dolphins and gay seagulls we should hear a change of tune from the people who argued that homosexuality was bad because it wasn't natural. But of course we won't. In cases like this the natural claim gets grafted on to support the belief - if something is bad it's unnatural.

Often, I think what we are really saying if we say something is unnatural is that it is foreign to our system of beliefs.

Backpacking

2009-06-24T10:33:00.000-07:00

Just returned after four days in Sequoia National Park. We hiked out of Mineral King over Franklin Pass, to Forester Lake. Then we turned around and came back.
It's beautiful out there and being around all those peaks and clear cold lakes rubs off on my physical sense of well being. The fact that I'm looking way up at those snowy crags, then a few hours later climbing over them, contributes to the feeling of hale puissance. Franklin Pass is like that. You climb 3000 vertical feet from the trail head to Franklin Lake, then another 1500 feet up what looks like an impassible granite face. It's a narrow trail carved into the slope - a few inches of level ground in a vertical world. When we got to the top we lost the trail under snow and as I was looking for the route over the top, I found myself staring down into thin air - and granite hundreds of feet below.
So is it just the proximity to death that makes me feel so alive? (A note to the mother in law potentially reading this: we were never in any danger, any time you are up high and look down you get that thrill). Perhaps that's part of it, but I contend that there's more than that. Here we are up where it's hard to get enough oxygen, sleeping in what amounts to stress positions all night, getting sunburned and carrying packs over ankle-twisting trails and the net result is feeling healthier and stronger? It doesn't make sense. I think it has something to do with pushing the body. We spend so much time coddling ourselves with orthopedic comfort chairs, and medical treatments for every little ailment - and in the long run we end up getting worse. Perhaps a better solution would be to go out and get bruised, scratched and sunburnt.

Photo by pab_lo49 - yes neither of us brought a camera.

Native American Ecology

2009-06-12T23:49:00.000-07:00

Just finished reading 1491, by Charles Mann which has been on my bookshelf for a long time. I was most interested in the third section - on ecology. Mann proposes that the fabled abundance of wildlife that early setters saw (the birds that darkened the sky, the herds that shook the ground) was not a result of careful management by the Indians to maximize the fertility of the land, but rather a symptom of an ecosystem reeling - unbalanced by invasive species. (That turn of phrase is not an implication of the Europeans - microbes played the starring role, as usual). The idea is that millions of Indians had controlled the fauna to protect widespread agriculture. When Old World microbes decimated the Indians, the animal populations boomed.

Oddly, I find this idea tremendously heartening. To understand why you have to know my old frame of reference: Ten million people throughout the Americas = and beautiful, bountiful land. Anything more than that and we are compromising, or really, doing injury. By this figure we are screwed (we have 300 million in the US alone, and each of us has a footprint many times larger than a 15th century American). 1491 gives me hope that we don't have to make a grim choice between people and nature (meaning: either culling ourselves or creating a form of nature so degraded that no one would want to live in it). Mann's descriptions of high density populations in the Amazon rainforest terrifies some environmentalists. That sort of thing could convince people that those lands should be populated again. And why not? If we can populate them in a way that improves the soil (as the last "urban" inhabitants did) I'm all for it. I'm for preserving the pleasure humans take in nature, I don't need to preserve nature empty of humans. If push comes to shove I'd be more than happy to have farms in the ANWR and a city in Yosemite Valley - to spread human warrens through every corner of the earth - if we could do it in such a way that preserved the qualities of those places that give us joy.

Natural birth

2009-06-05T21:30:00.000-07:00

For a couple months now I've been sitting on what I think is a huge story, trying to figure out a way that I could frame it for a national magazine. Other journalists are catching on now (there will probably be a story in the LA Times in a few weeks or so - and I'm going to do a story for KALW) so I'm going to break the news here.
Since 1997 the chances of dying in childbirth have doubled in California. When health officials working with the state showed these graphs to a group of obstetricians there were shocked gasps from the audience. New York's numbers are similar and there's enough evidence to convince me that this is a national trend. The usual suspects (older, sicker, fatter, poorer women) only account for a small part of the increase in California. No one has pinned down the root cause of the rest yet. But investigators say there's one obvious place to start looking. What else has changed significantly in childbirth? We're now delivering almost a third of kids by Cesarean. Cesareans are pretty safe as major surgeries go - but if you look at the long term risks (rather than just the immediate risks) they become less appealing. If you have another baby after a Cesarean (and especially after multiples) you have a chance of developing an abnormal placenta attachment like placenta accreta. The placenta can grow through the old C-section scar and send blood-seeking tentacles out into the organs. OB's say they are seeing an epidemic of these conditions - 8 to 10 times the number from a decade ago. They are hugely dangerous - and if they don't kill they can cause severe damage (often requiring hysterectomy). For every woman that dies there are 50 that suffer debilitating injury.
There's pretty good evidence that too much birth tech is hurting women. However - there are some very influential people (at the National Quality Forum and Berwick's Institute for Healthcare Improvement) who are working on this. In the next decade I suspect we will see a sea change in the way that this country does birth. Even conservative OBGYNs (those in the know) have been telling me that low tech, high touch is the wave of the future. They don't care that they sound like hippie midwifes. Natural - it seems - is the new high tech.
Photo/rkimpeljr

Can tech end poverty?

2009-06-04T20:13:00.000-07:00

Today I had a fascinating talk with someone who spends a lot of time thinking about how to get technology to the poor that will actually be useful to them (she's on the board of a fairly prestigious institution and therefore has to speak carefully in public so she asked me not to use her name casually).
I'm still digesting this, but our topic was basically: can technology help the poor?
Her answer: Yes, but it's tricky.
And it's tricky in some interesting ways.

The main problem is that - when it comes to tech - the market doesn't work for the poor in the way we normally think it should. Ideally, things start off with an innovator seeing some need, developing a product and marketing it. And then it competes with all the other products, and if it really does help the poor, they buy it. So the poor, the people who understand best what technology they need have a hand in drawing it in. But, my source says, it never works out that way. Instead of a pull from the poor, products must be pushed by the rich. Problem #1 There's almost never competition between technologies - at best you have one alternative to the traditional single choice. This is because the only people who are in the business of developing expensive technology for the poor are governments and charitable organizations. They are not going to pay all the development costs to get a competing vaccine out there if someone else has developed a perfectly good one. Problem #2: If you are really poor you can't afford risk. Experimenting with new things doesn't make sense when the a failed experiment means the death of a family member. Problem #3: Market surveys don't work. My source says that attempts at asking subsistence farmers what they need have failed. People focused on staving off hunger are not in a position to imagine how technology might improve their life, but they are often good at figuring out what you want to hear and telling you exactly that.

If all this is true, it means that any attempt to bring technology to the aid of the poor is paternalistic. That's kind of a bad word, and for good reason: Sometimes when we tell the poor what they should do we end up making things worse. But there are many cases where the Pater of paternalism has proved to be a wise and loving father. Spend enough time on the ground working with people and tinkering with the technology and you can make a difference.

I left that initial conversation with the feeling that the whole enterprise of trying to develop good technology and push it to the poor is incredibly sticky. First - there are the difficult Kipling overtones. Second - whenever you are successful at introducing a new technology you are taking a bit of control away from the non-human world and bestowing it upon humanity. (You could define technology as that which gives humans more control) The question is, which humans seize that control and wield it for themselves? Hopefully it's the people you are trying to help. But what if it's the corporation manufacturing the product? There is a real danger of inadvertently furthering corporate colonialism. If the devil is in the details, so is the answer. I hope to learn the details of some examples that have worked.

More Berwick!

2009-06-03T10:53:00.000-07:00

I just can't get enough of him. I know it's incredibly nerdy to get all gushy over a guy who specializes in health care systems analysis and improvement. But think for a second - here's a guy buried to the hip in jargon and numbers of his field, and he's still able to bring to it the perspective of the everyman (not to mention communicate with the everyman). Plus, he's doing some great thinking about technology.

In "Taming the Technology Beast" (JAMA - subscription req), he starts by riffing on a paper showing that RFID tags in hospitals can mess up the pump on your IV. Not cool. So ban them from the premises? Maybe not quite. He's arguing that we should "tame" technology rather than shun it. Okay sure. How does that work? Well here Berwick gets into the tall grass a little with acronyms like FMEA and SHEL (That's software, hardware, environment, and liveware ie people if you were interested). But I think his most important point boils down to this: In complex systems like health care (or ecology) you can't predict the subtle chain of reactions that may lead to dire but remote consequences, even with the best analysis. What you can do is keep tuning up the system and correcting problems as they materialize. "Design in isolation is risky" he says.

What emerges sounds an awful lot like Aldo Leopold's intelligent tinkering. You introduce a little at a time. Watch it closely - adjust - and keep watching and adjusting. Interesting to consider how this can apply for, say, agriculture. Is there an intelligent way to integrate genetically engineered crops into ecosystems? What about our big haphazard experiments with microbiology known as confined animal feeding operations? In these, we are essentially designing new microbes - in isolation from cities. And in the cities, we are designing a new kind of microbial gut ecosystem in people. When those two ecosystems bleed into each other the results tend to neither intelligent - nor incremental.

One other comment from Berwick:

Nuclear power, military operations and weaponry, aviation, rail transport, space programs, and many more high-hazard endeavors have for decades enlisted the attention of scientists of safety, and most of those fields have a far better track record of taming the technology beast than health care yet does.

My question is why? Why is health care allowed to get away with using technology willy nilly regardless of harms when Boeing is not?

Unnatural medicine

2009-06-02T17:28:00.000-07:00

A lot of people don't like hospitals. They are sterile, unbeautiful, they are a place where you might die. Most of all they are radically abstracted from the natural world in which the individual has agency. They are a kind of bureaucratic sleep-away camp, where the needs of the organization trump the desires of the individual. Health care visionary Dr. Don Berwick, had a nice article about this in which he makes the case that patients should be in charge. He gives agruments for the ways he thinks it will improve medicine, but in the end he confesses that his extreme views stem from his fear of being a patient:

Last month, a close friend called a clinic for her mammogram report and was told, “You have to come here; we don’t give that information out on the telephone.”
She said, “It’s OK, you can tell me.”
They said, “No, we can’t do that.”Of course, they “can” do that. They choose not to, and their choice trumps hers: period.
That’s what scares me: to be made helpless before my time, to be made ignorant when I want to know, to be made to sit when I wish to stand, to be alone when I need to hold my wife’s hand, to eat what I do not wish to eat, to be named what I do not wish to be named to be told when I wish to be asked to be awoken when I wish to sleep.

Got to love a guy who is able to put dialogue into a scientific journal.

The uses of nature

2009-06-01T09:22:00.000-07:00

Psychologist Paul Bloom had a piece in the New York Times Magazine that neatly captures the essence of what I'm trying to get at with this blog. He gives the argument against the Heidi Hypothesis:

No sane person would give up antibiotics and anesthesia, farming and the written word. Our constructed environments shield us from heat and cold and protect us from predators. We have access to food and drink and drugs that have been devised to stimulate our nervous systems in magnificent ways. We sleep in soft beds and have immediate access to virtual experiences from pornography to classical symphonies. If a family of hunter-gatherers were dropped into this life, they would think of it as a literal heaven.

And then provides evidence that it's correct:

Many studies show that even a limited dose of nature, like a chance to look at the outside world through a window, is good for your health. Hospitalized patients heal more quickly; prisoners get sick less often. Being in the wild reduces stress; spending time with a pet enhances the lives of everyone from autistic children to Alzheimer’s patients. The author Richard Louv argues that modern children suffer from “nature-deficit disorder” because they have been shut out from the physical and psychic benefits of unstructured physical contact with the natural world.

His conclusion is that we should make a cold-blooded, utilitarian assessment of nature - and figure out what parts make our lives better and what parts we can do without. (Should the Endangered Species Act protect the smallpox virus?) He has no problem eventually replacing nature with technology as long as we do it in a way that improves human happiness.

The recession is good for America

2009-05-31T23:01:00.000-07:00

I'm starting this off late at night - so the description of what I'm doing here will have to come later. For now I just wanted to mention something that's been bothering me for a while. Every day when I hear the business news it's reporters praying to the gods of finance for growth. There's no questioning whether growth is good - or what type of growth we would want - or even what growth means outside the abstract world of econ numbers.

Of course, like everyone else I want growth that stimulates hiring so people like the guy in interviewed in North Richmond (California) don't lose their homes. But for most of my young life in Nevada City, growth represented cutting down forests and putting up strip malls. It meant destruction of that which was meaningful and beautiful and it's replacement with opportunities to buy. Even from a dispassionate money-is-the-only-object economic standpoint, it never seemed like this was a good idea in the long run. They were building all these Circuit City's and tanning salons - but these were all things that depend on people making money elsewhere for their support. They are luxuries really. The money to feed these retail centers had to come from somewhere and I wasn't seeing the growth of actual useful industry - the creation of new wealth from the land. There was no new mining or timber or farming - we were just shuttling money around from the therapist to the tanning salon, to the record store, to the grocery store. And every time someone bought something real, like food, a little money got siphoned off to the Midwest or China or Peru.

All that is a hastily worded way of saying that I've been a little worried that we are scrambling so hard to get out of this recession that we aren't taking time to solve the problems that got us into it in the first place. I was bothered enough about this that I found an economist who thinks about such things and interviewed him for Crosscurrents (KALW 91.7). I was especially interested to learn about the history of how the belief that economic growth is essential got ingrained in the '50s. You can listen here: Richard Norgaard - he's an interesting guy
Here's his website.