Lousy protracted battles where all the doctors are on one side and the actresses (save one) are on the other.

Read this excellent review of Paul Offit’s Autism’s False Prophets. It sounds like a rightfully strong book.

Also, I’ve now lost a lot of respect for Jim Carrey.

Sad But True

Patrick Swayze on “alternative medicine”.

Saying “Push” in Mandarin

So now that I’ve got that whole college thing out of the way, I can finally start cleaning, sorting, and packing for the big road trip to the new home ahead, and doing more reading. Lord of the Flies (which I had never read) is first on the list. And a whole bunch of stuff from the New York Times. Like this one:

Over the following months, Dr. Gregorius learned many things, including how to deliver babies while saying “push!” in Cantonese, Mandarin, Russian and several languages he had never heard of. He learned that Chinese people brought babies into the pediatric E.R. between 11 p.m. and midnight, apparently after restaurants closed, that Pakistani babies showed up between 3 and 5 a.m., when cabdrivers changed shifts, and Hasidic babies seemed to arrive at 10 p.m., for reasons no one could explain. He knew it seemed like stereotyping, but that’s when a sudden rush of sick babies would arrive each night.

Breathtaking Inanity

Nicholas Kristof has an excellent op-ed today on conspiracy theories and America’s collective intellect (or lack thereof). Kristof manages to work in Jeremiah Wright, 9/11, AIDS, evolution, and education all in one column. Pretty good.

Ten days ago, I noted the reckless assertion of Barack Obama’s former pastor that the United States government had deliberately engineered AIDS to kill blacks, but I tried to put it in context by citing a poll showing that 30 percent of African-Americans believe such a plot is at least plausible.

My point was that the Rev. Jeremiah Wright is not the far-out fringe figure that many whites assume. But I had a deluge of e-mail from incredulous whites saying, in effect: If 30 percent of blacks believe such bunk, then that’s a worse scandal than anything Mr. Wright said.

It’s true that conspiracy theories are a bane of the African-American community. Perhaps partly as a legacy of slavery, Tuskegee and Jim Crow, many blacks are convinced that crack cocaine was a government plot to harm African-Americans and that the levees in New Orleans were deliberately opened to destroy black neighborhoods.

White readers expressed shock (and a hint of smugness) at these delusions, but the sad reality is that conspiracy theories and irrationality aren’t a black problem. They are an American problem.

Jeremiah Wright’s statements that the US government created AIDS and was responsible for 9/11 disturbed me even more than his racist rants. The latter is more understandable in my eyes, whereas the former are such a departure from rational thinking that I can find no excuse for believing them. Of course, 9/11 conspiracy theories are fairly widespread in the general population too. Kristof continues:

These days, whites may not believe in a government plot to spread AIDS, but they do entertain the equally malevolent theory that the United States government had a hand in the 9/11 attacks. A Ohio University poll in 2006 found that 36 percent of Americans believed that federal officials assisted in the attacks on the twin towers or knowingly let them happen so that the U.S. could go to war in the Middle East.

And on to science education:

Then there’s this embarrassing fact about the United States in the 21st century: Americans are as likely to believe in flying saucers as in evolution. Depending on how the questions are asked, roughly 30 to 40 percent of Americans believe in each… President Bush is also the only Western leader I know of who doesn’t believe in evolution, saying “the jury is still out.” No word on whether he believes in little green men.

One thing I’d like to know here is in regards to how the question about “flying saucers” is asked. Are people asked if they have seen a flying saucer, or if they believe they exist, or if they believe there may possibly be extraterrestrial life somewhere in the universe. If it’s the latter, then I’m crazy too, because the astrobiology grants I’ve done research for NASA under are all aimed at looking for extraterrerstrial microbial life. But I think there’s a big difference between believing reports of so-called flying saucers and having a more Carl Sagan-esque view on life in the universe.

Our breathtaking collective ignorance (and/or paranoia) has an impact on public policy in a democracy as well:

Only one American in 10 understands radiation, and only one in three has an idea of what DNA does. One in five does know that the Sun orbits the Earth …oh, oops…. How can we decide on embryonic stem cells if we don’t understand biology? How can we judge whether to invade Iraq if we don’t know a Sunni from a Shiite?

And then there’s a disturbing little bit about our political process. This is one reason someone like Mike Huckabee can rise to national prominence, while many of the most education and intelligent Americans are probably disqualified from our highest office because they’re too elitist:

From Singapore to Japan, politicians pretend to be smarter and better- educated than they actually are, because intellect is an asset at the polls. In the United States, almost alone among developed countries, politicians pretend to be less worldly and erudite than they are (Bill Clinton was masterful at hiding a brilliant mind behind folksy Arkansas sayings about pigs). Alas, when a politician has the double disadvantage of obvious intelligence and an elite education and then on top of that tries to educate the public on a complex issue — as Al Gore did about climate change — then that candidate is derided as arrogant and out of touch.

And here’s a good (and true) slam on where the conservative movement as a whole is going:

The dumbing-down of discourse has been particularly striking since the 1970s. Think of the devolution of the emblematic conservative voice from William Buckley to Bill O’Reilly. It’s enough to make one doubt Darwin.

Really, is there anyone comparable to the late Buckley? Bill O’Reilly, Rush Limbaugh, and the like have certainly expanded conservative media, but they’ve consistently done it by making it ever more xenophobic and ignorant. But let’s not forget the stupidity and misleading tactics of people like Michael Moore either.

There’s no simple solution, but the complex and incomplete solution is a greater emphasis on education at every level. And maybe, just maybe, this cycle has run its course, for the last seven years perhaps have discredited the anti-intellectualism movement. President Bush, after all, is the movement’s epitome — and its fruit.

Please, oh please.

Good News, Bad News

The World Health Organization has announced that polio has been eradicated from Somalia. This was an incredibly difficult task, given Somalia’s endemic violence and instability. And it took a huge effort:

More than 10,000 Somali volunteers and health workers vaccinated more than 1.8 million children under the age of five by visiting every household in every settlement multiple times.

However, this has happened before. Polio was eradicated from Somalia back in 2002, only to be reintroduced from Nigeria. The fact that polio was reintroduced from a country on the other side of the continent calls attention to the interrelatedness of disease control efforts in different countries (diseases know no borders) and the tragedies that occur when vaccination efforts clash with local cultures or religions.

But despite its tenuous progress in terms of total eradication, the WHO’s $4 billion polio campaign has made great steps forward:

When WHO and partners began their anti-polio campaign in 1988, the worldwide case count was more than 350,000 annually. The disease’s incidence has since been slashed by more than 99 percent and remains endemic in four countries: Afghanistan, India, Nigeria and Pakistan. Polio cases were also detected last year in Angola, Cameroon, Chad, Congo, Myanmar, Nepal, Niger and Sudan.

So that’s the good (albeit cautiously so) news. The bad news for Somalia:

Somalia’s Government Teeters on Collapse

If you read that and asked “wait, Somalia has a government?” you’re not alone. But it does have a government of sorts:

By its own admission, the Transitional Federal Government of Somalia is on life support. When it took power here in the capital 15 months ago, backed by thousands of Ethiopian troops, it was widely hailed as the best chance in years to end Somalia’s ceaseless cycles of war and suffering.

But now its leaders say that unless they get more help — international peacekeepers, weapons, training and money to pay their soldiers, among other things — this transitional government will fall just like the 13 governments that came before it.

Less than a third of the promised African Union soldiers have arrived, the United Nations has shied away from sending peacekeepers and even the Ethiopians are taking a back seat, often leaving the government’s defense to teenage Somalis with clackety guns who are overwhelmed.

The Draw of Dermatology?

This piece in the New York Times focuses on a married couple, both Harvard Medical School students, who are in their fourth year and waiting to find out about their residency placements. Like many medical students around the nation, they’re competing for competitive placements in specialty fields instead of going into less lucrative (and possibly less intellectually stimulating?) fields such as family practice and internal medicine.

And the competition is expensive:

Already saddled with about $330,000 in education loans, they borrowed $20,000 more so they could fly around the country this winter for about two dozen residency interviews each. All told, each applied to 90 such training programs.

The article makes me a little sad in general. I had a conversation at CGI U with a med school student who warned me about the “vortex” of med school. Paraphrased: “Everyone’s the same. You get to med school all idealistic, wanting to help people and stuff. Then you spend years and years studying and working, and you see the people ahead of you getting money. You see the doctors with the nice cars and comfortable lives, and you start to wonder when you’re getting yours? And you get into so much debt that you realize you have to practice, and practice well if you want to get out of that hole.”

I’m certainly idealistic about why I want to go to medical school. In fact, the struggle for me is deciding between larger scale health policy work–doing research, designing disease control programs, advocacy, etc.–and traditional clinical work, or how to balance both. I’ve never seen myself as one to get into private practice, or really even treating patients full-time as a traditional clinician. But the vortex sucks many people in.

The problem is ultimately not with the medical students who are drawn to dermatology and plastic surgery for the better pay. Medical students will inevitably be drawn toward the specialties that combine interesting work with the highest pay. From the NYTimes again:

“It is an unfortunate circumstance that you can spend an hour with a patient treating them for diabetes and hypertension and make $100, or you can do Botox and make $2,000 in the same time,” said Dr. Eric C. Parlette, 35, a dermatologist in Chestnut Hill, Mass., who chose his field because he wanted to perform procedures, like skin-cancer surgery and cosmetic treatments, while keeping regular hours and earning a rewarding salary.

The market simply isn’t working here. We need more (many more!) primary care physicians. There’s a lot more demand for services there. But people who have the money to pay more for cosmetic treatments and surgery skew the demand away from those who don’t have the money to get adequate treatment for more life-threatening conditions like diabetes and high blood pressure.

I’m not sure what the solution is either. I know it would need to be a large-scale systemic change; merely getting pre-med students to read about Paul Farmer isn’t going to change everyone. Maybe having a single-payer system where doctors are compensated as much or more for basic services as they are for cosmetic services? Or maybe a loan-repayment situation where medical school is even more expensive, but all loans are automatically repaid by the government for those not going into specialties. Who knows. Suggestions?

Focus.

Many Doctors, Many Tests, No Rhyme or Reason

All of our investments in high-tech medicine and tons of tests, as well as the drive toward further specialization, aren’t really having an impact on public health indicators like life expectancy and child mortality. But for those who want to go into medicine (like me) the sexy, intellectually-stimulating, cutting-edge, fiscally-rewarding work is in those specialties.

We need to have a different focus.

“In an age of explosive development in the realm of medical technology, it is unnerving to find that the discoveries of Salk, Sabin, and even Pasteur remain irrelevant to much of humanity.” – Paul Farmer

“The physicians are the natural attorneys of the poor, and the social problems should largely be solved by them.” – Rudolf Virchow

Checklist for Quacks

Have you ever sat down and wondered, “Am I a scientific quack?” Well, probably not. But I’ve met enough True Believers in pseudoscience to give myself pause. What I really am the person to come up with a scientific breakthrough? How will anyone ever believe me? Doesn’t science trudge along, a la Thomas Kuhn, in the dominant paradigm until the evidence suggesting otherwise is just too overwhelming to ignore? What if I’m part of the new paradigm that will supplant the old, and I want to get the word out?

After all, weren’t many breakthroughs originally derided? Who believed the Earth actually revolved around the Sun? Who knew that Helicobacter pylori bacteria played a role in ulcers? Who knew that RNA interference played such a large role in cell function? Or that cells were programmed to self-destruct as a natural part of development? Or that a thing as wacky as prions actually existed? (After heliocentricity, these ideas won the Nobel Prize for Medicine and Physiology in 2005, 2006, 2002, and 1997, respectively).

Luckily for all of us, Cosmic Variance has compiled an Alternative-Science Respectability Checklist. Excerpts follow:

Believe me, I sympathize. You are in possession of a truly incredible breakthrough that offers the prospect of changing the very face of science as we know it, if not more. The only problem is, you’re coming at things from an unorthodox perspective… Perhaps you have been able to construct a machine that produces more energy than it consumes, using only common household implements; or maybe you’ve discovered a hidden pattern within the Fibonacci sequence that accurately predicts the weight that a top quark would experience on Ganymede, expressed in femtonewtons; or it might be that you’ve elaborated upon an alternative explanation for the evolution of life on Earth that augments natural selection by unspecified interventions from a vaguely-defined higher power. Whatever the specifics, the point is that certain kinds of breakthroughs just aren’t going to come from a hide-bound scholastic establishment; they require the fresh perspective and beginner’s mind that only an outsider genius (such as yourself) can bring to the table.

No sarcasm there. Rule 1:

Acquire basic competency in whatever field of science your discovery belongs to.

But! But! Seems a bit demanding, doesn’t it?

Now, you may object that steering clear of such pre-existing knowledge has played a crucial role in your unique brand of breakthrough research, and you would never have been able to make those dazzling conceptual leaps had you been weighed down by all of that established art. Let me break it down for you: no.

Rule 2:

Understand, and make a good-faith effort to confront, the fundamental objections to your claims within established science.

Continuing:

Scientific claims — whether theoretical insights or experimental breakthroughs — don’t exist all by their lonesome. They are situated within a framework of pre-existing knowledge and expectations. If the claim you are making seems manifestly inconsistent with that framework, it’s your job to explain why anyone should nevertheless take you seriously…. If you claim that the position of Venus within the Zodiac affects your love life, you’re not only positing some spooky correlation between celestial bodies and human affairs; your theory also requires some sort of long-range force that acts between you and Venus, and there aren’t any such forces strong enough to be relevant.

And finally, Rule 3:

Present your discovery in a way that is complete, transparent, and unambiguous.

Not likely. But in case someone still needs convincing, have them submit their theory to the Crackpot Index.

Srebrenica

CNN has a piece on the re-burial of victims of the massacre in Srebrenica in Bosnia in 1995, worth reading. If you haven’t already, you should check out Sheri Fink’s War Hospital, an excellent account of the siege from the perspective of national and international medical doctors trapped in the Muslim enclave.