In UCSF’s local online news source Synapse, I have an article about why its a good idea for preventative medicine not to axe the Chancellor’s Concert Series here.
Month: March 2017
Learning from Science in an Age of Marketing
“It was widely believed thalidomide would be useful to control morning sickness. It did – but it did other things, too. We need evidence, but unregulated marketing does not help us get needed data.” –A colleague at UCSF
The epidemic of reductionism that has swept throughout science leads us to rely on ersatz measure for the real thing. For example, in public health, instead of looking at holistic outcomes, how well someone is doing both short- and long-term after the intervention, we increasingly rely on biomarkers of harm or health as predictive models. These molecules act as snapshots of the larger phenomena researchers wish to investigate. Biomarkers, however complex the portfolio of them, are by definition only valid insofar as they can be abstracted in a vacuum, not taking into account the other interactions of hormones, environmental stimuli, genetic specificity, and latent versus blatant (or known versus unknown) effects and interactions of a given encounter.
The very existence of individualized medicine may warn us against biomarker essentialism. In the distribution of effects of a given pharmaceutical, for example, which end of the spectrum will we end up on? We know that while most people (whatever that meant for the pharmaceutical trials involving a geographically limited and probably age limited population), most products that make to the market (in an ideal world) are tested to be benign at worst, and helpful at best. But what about for those other people who have chemical sensitivities, are near the tipping point for severe reactions to additional stimuli, or simply have extreme adverse reactions to whatever happens to be in the drug?
We may aim at treating X (e.g., morning sickness), and be successful at it, while causing a much more severe Y (e.g., retardation in babies). While there is no failsafe method to avoid any sort of side-effects, prohibiting marketing of pharmaceuticals to doctors or directly to consumers may be one way to avoid hasty clinical trials, falsified information, and widespread corruption (deliberate and unintentional) in science. Another possibility would be setting up medical companies as B-Corporations so that they have no incentive to cut corners. Otherwise, the side-effects game, where people start piling up medications to deal with the side-effects of the previous one ad infinitum, makes them poor and the corporations rich. Certainly, this is not a happy ending for the majority, and is an unsustainable, parasitic business model.
Truth and Facts in an Extramoral Sense
Today at UCSF, I had the chance to hear Michael Specter deliver the 2017 Chauncey D. Leake Lecture: “Do Facts Still Matter? And What Does It Mean If They Don’t?” It brought out all of San Francisco’s good liberals, concerned about Trump’s anti-science anti-fact Administration. Specter, a decorated journalist for some of my favorite rags, certainly has the credentials to to kvetch at the poor state of US politics.
And yet, he missed an opportunity to channel the despair, rage, and motivation of hundreds of UCSF faculty and students. Cavalierly bashing the science-bashing while not seeing that he was engaging in the same sort of zealotry the room despised, there was a fundamental disconnect in his talk. Instead of understanding the pragmatic even democratic way in which consensus and dissensus coexist in science to push it forward, or acknowledging the unscientific politicization of science which occurs when funding derives from self-interested strings-attached corporations rather than from and for the public good, Specter pontificated about the horror of Trump and basic science communication.
He emphasized how The New Yorker has sold more subscriptions since November 8th than in the past three years, and that this holds for The New York Times as well–as if the raison d’etat of the Fourth Estate is to greedily prey off people’s fears. Perhaps because of his embedded status, Specter can’t see the forest of civilization through the trees of simplistic versions of science as a monolith, failing to crucially discriminate between different motivators for science, let alone including systems thinking perspectives, prevention, or noticing that all of this stuff that medicine and scientific experimentation in the 21st century is based on draws on a dwindling supply of natural capital.
What was most revealing, however, is how his internal logic fell apart. One story he told described how his mother wouldn’t let him eat butter, and fed him only margarine, because it was better for him. She also would give him antibiotics every time he sneezed. Of course, he commented, she didn’t hate him, she loved him, and while today we know both of these “facts” to be totally wrong and harmful to health, she was doing the best she could based on the current state of science in the 1950’s. Specter went on to speak about GMOs and vaccines, and how harmless they are, and that anyone who thinks otherwise is ignorant or worse. Clearly, this narrative hangs together rather than apart.
Yet, the logical tensions of the acknowledged “whoops!” factor of the science of Specter’s youth and the total confidence he held towards the complete safety of these biochemical and genetic interventions was glaring. Like geoengineering, certain types of science are deus ex machina solutions–problems that create more problems for the future. Such science passes the buck to future generations, leaving them the bill when things don’t turn out the way we imagined. Nuclear waste is a good example of this: in the 1960’s when nuclear power generation was first really going online, there was the open question of What are we going to do with the waste? The answer, at the time was that By the time we need to dispose of nuclear waste in 20 or 30 years, our ingenuity will have long since figured out what to do with that! Here we are in 2017, and no one has a clue what to do with nuclear waste so that we don’t have to guard it for the next 10,000+ years.
There is a second type of science, however, a less glamorous, less funded, but ultimately life affording rather than killing type of science; and that is precautionary science. Precautionary science is very poorly funded because there’s no money in it. Instead of aiming to commodify more of the world, and to sink its claws into the last remaining realms that haven’t been privatized, it looks at systems-level solutions that save time and money, and hence puts dozens of obsolete cannibalistic industries out of business. Precautionary science aims at getting at the root of problems, rather than dressing up sickly symptoms with increasingly technicolor gauze.
As an example, Specter talked about a rich, liberal Florida community that plagued with dengue fever mosquitos. When presented with the option of importing genetically-engineered mosquitos (for a plump price) to breed with the dengue mosquitos, hopefully killing them off, the locals swore off any sort of genetic engineered organisms, fearing the technology and not knowing how these genetically-engineered mosquitos might actually change their ecology. Instead, Specter alleges, they deal with the mosquito problem by spraying massive amounts of toxic Dow Chemical insecticide all over their city–clearly not a desirable outcome.
The GMO-chemical dichotomy that Specter presents us with is the fallacy of the excluded middle. The options are all predicated on deus ex machina science rather than precautionary science. Systems science would look at the underlying factors of dengue mosquito inhabitation. They include climate change, urbanization, increased travel and lax controls over shipments of goods, etc. Why a vaccine wouldn’t work in this case (although one exists) is that the serotypes keep on expanding and changing, and that like the futility of the flue vaccine, any vaccine is already based on old biological versions of the virus, bacteria, or disease. Meanwhile, the disease has been evolving, and many pathogens are very adept at overcoming the hurdles we throw at them. Instead of doing the hard trench work of making progress against raising climate temperatures by stopping factory farms, war, and fossil fuels production while planting trees and reforesting using restorative conservation ecology Green Corps, its all too easy to attempt to address the symptoms (the mosquitos with dengue fever that have “invaded” Florida) rather than the cause. Yet, if we got to the cause of things, and actually acknowledged that our current way of life–including our science–is out of sync with natural processes and must be restored, then we’d have a fighting chance at creating healthier lives for all.
Otherwise, we’re involved in a shotgun approach making a holistic problem piecemeal. But if we do this, today it’s dengue fever, tomorrow it will be another one. Are we really so stubborn as a species that instead of resigning ourselves to a little epistemological humility we’d rather mow down the rest of creation because we’ve created such a destructive ecology that we have no other choice?