Thursday, March 31, 2005

The Fifth Skeptics' Circle

The Fifth Edition of the Skeptics' Circle is now posted at Science and Politics. Go forth and receive your fifth innoculation against the rampant credulity of the blogosphere.

What I'm reading now

As I mentioned yesterday, logging will be light until sometime this weekend or next Monday. There are two reasons. First, my parents are in town, and I won't be spending a lot of time composing those epic posts like the one I did this Monday. The second reason is that I'm gearing up to host Tangled Bank next week. (Did you get your submission in yet? If not, what are you waiting for?) I'll probably manage to post something almost every day, but it's likely to be the short blogging variety of links and brief comments--with the exception of today, for the simple reason that I wrote this a couple of weeks ago and never got around to posting it. What better use for it than right now?

I don't think I've ever done one of these posts since starting Respectful Insolence, but I thought it might be fun to describe the sorts of books Orac likes to read. In the old days (back when I was in high school, college, and medical school), most of my reading fare consisted of science fiction. In those days, I'd devour a book a week on average. Unfortunately, work, and the amount of reading of the medical and scientific literature that I have to do, made reading for pleasure more difficult, and now that I've started bloggin I find that I spend a lot of the timethat I would in the past have spent reading books blogging (and reading magazines like The Atlantic) . Although I still get into science fiction and fantasy, over the last ten years or so as my pace of reading for pleasure slowed down, it seems that those genres have been making up progressively less and less of what I read and history and other topics have been making up more and more. don't get me wrong. I still love science fiction/fantasy, and, in fact, J. R. R. Tolkien's The Lord of the Rings is my favorite work of fiction of all time. (I've read it cover to cover at least five times since I first discovered it 30 years ago, and I often pick it up and just read the occasional chapter that I like.) Nothing even comes close. However, as I've gotten older, I've diversified.

In any case, right now, I'm near the end of reading American Brutus: John Wilkes Booth and the Lincoln Conspiracies by Michael W. Kauffman. I'm a relative newcomer to reading about the Lincoln assassination in any depth; consequently there was a lot in here that I didn't know. What makes this a fascinating read is that Kauffmann has, wherever possible, gone back to the original documents about the investigation, roamed the very paths that Booth took while escaping Washington, stayed at the Booth family home, and even burned down a tobacco shed like the one Booth was ultimately trapped in, to see how fast a fire would be likely to consume such a building. He developed a sophisticated database, into which he entered his primary source documents, and, using this tool, found connections that were not apparent before. I had never realized how much Booth had traveled and how very clever he had been putting together his conspiracy, sometimes even binding his conspirators to him by producing evidence that (he knew) investigators would find and use to tie them to the plot even if they later tried to disavow knowledge. On the other hand, he was a vain man, prone to exaggeration and hyperbole. From all this, he weaves together a history that describes the multiple strands as they happen and, during Booth's flight from Washington, reads almost like an adventure novel, as Booth eludes government troops and is finally cornered on Samuel Garrett's farm.

Before that, believe it or not, I read Harry Potter and the Goblet of Fire. All in all, I found it to be an enjoyable read. As a latecomer to the Harry Potter series (people I know have been bugging me to read it and I finally caved), I've been trying to work my way through it before the next book comes out this summer. Clearly, the books have been getting steadily better, and this was the best yet. After I finish the Lincoln book, I plan on moving on to the fifth Harry Potter book, Harry Potter and the Order of the Phoenix. I've even gotten my wife to start reading the series. She's almost through the second book.

Finally, before these two books, here are some recent reads over the last four or five months or so. I recommend them all:
  1. Frederick Taylor, Dresden: Tuesday February 13, 1945. An excellent comprehensive history of the Dresden bombing.
  2. Richard J. Evans, The Coming of the Third Reich. The first of a planned three-volume history of the Third Reich. Well-written and detailed, without being dull.
  3. Greg Bear, Darwin's Children. The sequel to Darwin's Radio. Greg Bear is one of my favorite science fiction authors. Darwin's Children is not as good as its predecessor, but still a strong example of hard SF from a master of the genre.
  4. Antony Beevor, The Fall of Berlin 1945. A little dry for my tastes, but a good history of the last battle for Berlin.
  5. Mary Roach, Stiff: The Curious Lives of Human Cadavers. A highly entertaining and informative look at what sorts of things are done with cadavers. Wait. I think I read this a year ago. It doesn't matter. It's so good that I highly recommend it. Consider it a light-hearted look at death...
On deck, sitting on my shelf waiting to be read, we have (in no particular order):
  1. Sherwin Nuland, The Mysteries Within
  2. Norman Davies, Rising '44: The Battle for Warsaw
  3. Joe Haldeman, The Forever War
  4. Robert J. Sawyer, Calculating God
  5. Max Hastings, Armaggedon: The Battle for Germany 1944-1945
  6. Gregory Benford, Across the Sea of Suns
  7. Robert J. Sawyer, Hominids
  8. Victor Klemperer, I Will Bear Witness
  9. Stephen R. Donaldson, The Runes of the Earth (The Last Chronicles of Thomas Covenant, Book 1). OK, I haven't bought this one yet, but it's on my list of must-buy books. I really liked the first two Thomas Covenant trilogies.)
  10. Deborah E. Lipstadt, History on Trial: My Day in Court with David Irving.
Hey, this is fun. Maybe I'll do a series of posts about my favorite books over the years.

Wednesday, March 30, 2005

One week reminder for Tangled Bank

Blogging will be light the rest of this week. There are two reasons. First, my parents are in town, and I won't be spending much time typing. I'll try to post something every day, but, other than a piece I wrote a while ago for just such occasions, posts are likely to be of the Instapundit variety link and comment. (In fact, we're going to leave on a road trip to New York in a couple of hours to hang out and then go and see Spamalot. Maybe I'll play theatre critic and post a review after my parents have left.) Second, as hard as it is to believe, my turn to host the Tangled Bank is only one week away. Good submissions have just started to trickle in, but I need more if I hope to live up to the high standards of previous editions. I can't do it without the help of my fellow bloggers. Submissions on all scientific topics are welcome and encouraged, but, given that I'm a physician-scientist, I tend to have a special interest in posts having to do with medical science or science as it relates to human disease. However, interesting or unusual posts about other areas of science are also highly desirable. I want to learn something putting this together!

So, if you have a blog and have written an article about science that you'd like to promote to a wider readership, send the permalink to either orac_usa AT hotmail DOT com or to host AT tangledbank.net. Please include the words "TANGLED BANK" in all caps in the Subject header. The deadline will be 9 PM, Tuesday, April 5, and my edition will be posted on the morning of April 6. Because of past snafus with hyperactive spam software preventing submissions from making it to the host, I will try to acknowledge all submissions with a return e-mail within 24-48 hours of receiving them. Of course, that means if you happen to be the type who likes to submit things at the last minute (as I have on occasion done myself), there might not be time for you to get one and you'll just have to hope I got your submission.

Oh, and the third reason blogging is likely to be light is that Blogger is acting up again this week. It's driving me crazy and not letting me post. It's not quite as bad as it was a couple of weeks ago, but it's bad. I was completely locked out from my blog earlier this morning. I thought that I wouldn't be able to post until sometime after we got back from the city, which will certainly be after midnight. Fortunately, Blogger started working and hopefully it will actually let me post this. Only one way to find out...

The Tangled Bank

Apple is evil

...but not for the reasons you'd think.

666

Joy of Tech does it again!

Tuesday, March 29, 2005

Grand Rounds XXVII

Grand Rounds XXVII has been posted at Over My Med Body. Get thee hence and be educated and edified!

Looking at the Grand Rounds schedule, I see that next week's edition will be at Polite Dissent, the only blog I've ever encountered that combines medical blogging with comic book blogging, dissecting the medical aspects of comic stories; for example, see here. My favorite post so far:



W.W.D.D. (What would Doom do?) Unfortunately, I didn't score more than the maximum score of 20. I must not have been Doom enough to realize that cheating and/or altering the space-time continuum to achieve my ends would both represent perfectly acceptable--nay, laudable--strategies to Doom.

Remind me sometime to blog about my 30 year comic book collecting habit. Given that my obsession started with Fantastic Four (a comic that I've collected more or less continuously since 1975, with occasional brief hiatuses during creative dry spells over the years--times when the comic truly sucked--and that I still read to this day), you can understand why I liked the Dr. Doom quiz.

In fact, I can't wait for the Fantastic Four movie that's scheduled to come out this summer, although I look forward to it with more than a little trepidation. Will it be an entertaining, exciting summer blockbuster, like the Spider-Man movies? Will it be mediocre, like The Hulk? Or will it be an outright turkey, like the Punisher movie (or, just as bad, the 1980's version with Dolph Lundgren) or Daredevil--or, even worse, a major bomb like Howard the Duck?

I guess I'll just have to wait and see.

Monday, March 28, 2005

The smackdown continues

Geez.

I thought Paul at Wizbang had finally realized how deep the hole he had dug for himself was.

I was wrong.

Just when I thought he couldn't spout more pseudoscientific rationalizations for his ignorant position on evolution, he goes and does himself one better!

PZ has once again administered a righteous smackdown; so I don't think I need to add much other than a fervent plea to Paul: Please stop. Your posts on evolution have become a slow motion train wreck, and the more you post the more you embarrass yourself. It's becoming painful to watch, much as it's painful to watch an obviously overmatched fighter who refuses to give up get the crap kicked out of him.

UPDATE: Now the Politburo Diktat has joined in the fun, administering yet another smackdown to poor Paul.

Litmus tests

Jason Rosenhouse over at Evolutionblog posted a nice piece on the litmus tests he uses to determine when he is reading the work of a pseudoscience hack. In this case, he dissects an article by Paul McHugh from the Weekly Standard on the topic of evolution, in which Mr. McHugh pulls out all the deceptive rhetorical tools of creationist (and other pseudoscientific hacks.)

Rosenhouse seems to have listed them all. I can't think of another one; but no doubt others will.

The Galileo Gambit

The appearance of the Herbinator on my blog last week and his sarcastic invocation of Galileo reminded me of a topic I've wanted to write about almost since the beginning of Respectful Insolence. It's a favorite tactic used by alties (not to mention pseudoscientists, pseudohistorians, and other cranks). Alties frequently invoke Galileo and other scientists like Ignaz Semmelweiss, who were at first rejected by the scientific orthodoxy of the time and had to fight to get their ideas accepted. The implication, of course, is that their ideas, whatever they may be (alternative medicine, intelligent design, Holocaust denial, psychic abilities, etc.), are on the same plane as those of Galileo or Semmelweiss. Frequently, they will add a list of famous scientists or experts who made predictions about the impossibility of something or other and were later found wrong, so much so that the statements sound ridiculous today. For example, here's a famous list that's been making the rounds on Usenet for years. Some of these quotes may in fact be urban legends (and, in fact, I'd be grateful to anyone who points out urban legends in here to me), but let's for the moment assume they are all legitimate quotes:

..so many centuries after the Creation it is unlikely that anyone could find hitherto unknown lands of any value. - Committee advising Ferdinand and Isabella regarding Columbus' proposal, 1486

I would sooner believe that two Yankee professors lied, than that stones fell from the sky. - Thomas Jefferson, 1807 on hearing an eyewitness report of falling meteorites.

Drill for oil? You mean drill into the ground to try and find oil? You're crazy. - Drillers who Edwin L. Drake tried to enlist to his project to drill for oil in 1859.

Louis Pasteur's theory of germs is ridiculous fiction. - Pierre Pachet, Professor of Physiology at Toulouse, 1872

[Orac's note: This one is particularly amusing to me, given that so many alties reject Pasteur's theory in favor of Beauchamps. Here, they seem to want to have it both ways. They reject Pasteur when arguing against antibiotics, claiming that bacteria are not the cause of disease, or attacking vaccines as useless and harmful. However, they have no problem invoking this quote. Of course, they don't seem to realize that their use of this quote implicitly acknowledges that Pasteur's theories, although initially quite controversial, were ultimately proven correct.]

The abdomen, the chest, and the brain will forever be shut from the intrusion of the wise and humane surgeon. - Sir John Eric Ericksen, British surgeon, appointed Surgeon-Extraordinary to Queen Victoria 1873.

[Orac's note: As a surgeon, I have to point out that, at the time, this was not an entirely unreasonable statement. Operating in the abdomen was risky in the extreme, with a high rate of death from peritonitis (that is, until the invention of antibiotics). In fact, I sometimes wonder how the great surgeons of 100 years ago managed to operate on anyone's abdomen and have them actually survive the procedure. Operating in the chest was also out of the question, given the problem of reinflating the lung afterward, and certainly the brain was completely off-limits. In any case, there was no way Sir Ericksen (or anyone else) could be faulted for failing to forsee the advancements in anaesthesia, antibiotics, surgical technique, and patient care that would ultimately allow such surgery to succeed (although one does have to point out that surgeons were already operating in the abdomen reasonably successfully at the time).]

Such startling announcements as these should be deprecated as being unworthy of science and mischievious to to its true progress. - Sir William Siemens, 1880, on Edison's announcement of a sucessful light bulb.

We are probably nearing the limit of all we can know about astronomy. - Simon Newcomb, astronomer, 1888

Fooling around with alternating current is just a waste of time. Nobody will use it, ever. - Thomas Edison, 1889

[Orac's note: It's well-known that Thomas Edison wanted to promote the use of direct current rather than alternating current. It was a battle of rival technologies (sometimes called the War of Currents), not unlike the war between Betamax and VHS, but on a much larger scale. Edison ultimately lost.]

The more important fundamental laws and facts of physical science have all been discovered, and these are now so firmly established that the possibility of their ever being supplanted in consequence of new discoveries is exceedingly remote.... Our future discoveries must be looked for in the sixth place of decimals. - physicist Albert. A. Michelson, 1894

Heavier-than-air flying machines are impossible. - Lord Kelvin, president, Royal Society, 1895.

It is apparent to me that the possibilities of the aeroplane, which two or three years ago were thought to hold the solution to the [flying machine] problem, have been exhausted, and that we must turn elsewhere. - Thomas Edison, 1895

The demonstration that no possible combination of known substances, known forms of machinery, and known forms of force can be united in a practicable machine by which men shall fly for long distances through the air, seems to the writer as complete as it is possible for the demonstration of any physical fact to be. - astronomer S. Newcomb, 1906

Airplanes are interesting toys but of no military value. - Marechal Ferdinand Foch, Professor of Strategy, Ecole Superieure de Guerre.

Caterpillar landships are idiotic and useless. Those officers and men are wasting their time and are not pulling their proper weight in the war. - Fourth Lord of the British Admiralty, 1915, in regards to use of tanks in war.

Professor Goddard does not know the relation between action and reaction and the need to have something better than a vacuum against which to react. He seems to lack the basic knowledge ladled out daily in high schools. - 1921 New York Times editorial about Robert Goddard's revolutionary rocket work.

[Orac's note: Why the New York Times would be considered an "expert" in rocketry such that it would be of interest to use it as an example of an "expert" making a statement that is later proven wrong, I have no idea. This quote is at best irrelevant.]

The wireless music box has no imaginable commercial value. Who would pay for a message sent to nobody in particular? - David Sarnoff's associates in response to his urgings for investment in the radio in the 1920s.

"All a trick." "A Mere Mountebank." "Absolute swindler." "Doesn't know what he's about." "What's the good of it?" "What useful purpose will it serve?" - Members of Britain's Royal Society, 1926, after a demonstration of television.

This foolish idea of shooting at the moon is an example of the absurd lengths to which vicious specialisation will carry scientists. -A.W. Bickerton, physicist, NZ, 1926

Who the hell wants to hear actors talk? - H.M. Warner, Warner Brothers, 1927.

Stocks have reached what looks like a permanently high plateau. - Irving Fisher, Professor of Economics, Yale University, 1929.

[Orac's note: Of course, we had the same sort of idiotic statements coming from "experts" during the Internet bubble of the 1990's; for example, this book predicting that the Dow would reach 36,000. How many times did we hear that the Internet "changed everything" and that the stock market had no where to go but continually up?]

There is not the slightest indication that nuclear energy will ever be obtainable. It would mean that the atom would have to be shattered at will. -- Albert Einstein, 1932

The energy produced by the atom is a very poor kind of thing. Anyone who expects a source of power from the transformation of these atoms is talking moonshine. - Ernst Rutherford, 1933

The whole procedure [of shooting rockets into space]...presents difficulties of so fundamental a nature, that we are forced to dismiss the notion as essentially impracticable, in spite of the author's insistent appeal to put aside prejudice and to recollect the supposed impossibility of heavier-than-air flight before it was actually accomplished. Richard van der Riet Wooley, British astronomer, reviewing P.E. Cleator's Rockets in Space, Nature, March 14, 1936

Space travel is utter bilge! -Sir Richard Van Der Riet Wolley, astronomer

I think there is a world market for maybe five computers. - Thomas Watson, chairman of IBM, 1943

Computers in the future may weigh no more than 1.5 tons. - Popular Mechanics, forecasting the relentless march of science, 1949

[Orac's note: Heh heh. This statement isn't an incorrect prediction. Think about it. Most computers don't weigh more than 1.5 tons these days, do they?]

I have traveled the length and breadth of this country and talked with the best people, and I can assure you that data processing is a fad that won't last out the year. - The editor in charge of business books for Prentice Hall, 1957

Space travel is bunk. -Sir Harold Spencer Jones, Astronomer Royal of Britain, 1957, two weeks before the launch of Sputnik

There is practically no chance communications space satellites will be used to provide better telephone, telegraph, television, or radio service inside the United States. -T. Craven, FCC Commissioner, 1961

We don't like their sound, and guitar music is on the way out. - Decca Recording Co. rejecting the Beatles, 1962.

But what... is it good for? - Engineer at the Advanced Computing Systems Division of IBM, 1968, commenting on the microchip.

There is no reason anyone would want a computer in their home. - Ken Olson, President, Chairman and Founder of Digital Equipment Corporation, 1977

The concept is interesting and well-formed, but in order to earn better than a 'C,' the idea must be feasible. - A Yale University management professor in response to Fred Smith's paper proposing reliable overnight delivery service. (Smith went on to found Federal Express Corp.)

I'm just glad it'll be Clark Gable who's falling on his face and not Gary Cooper. - Gary Cooper on his decision not to take the leading role in Gone With The Wind.

A cookie store is a bad idea. Besides, the market research reports say America likes crispy cookies, not soft and chewy cookies like you make. - Response to Debbi Fields' idea of starting Mrs. Fields' Cookies.

If I had thought about it, I wouldn't have done the experiment. The literature was full of examples that said you can't do this. - Spencer Silver on the work that led to the unique adhesives for 3M "Post-It" Notepads.

So we went to Atari and said, 'Hey, we've got this amazing thing, even built with some of your parts, and what do you think about funding us? Or we'll give it to you. We just want to do it. Pay our salary, we'll come work for you.' And they said, 'No.' So then we went to Hewlett-Packard, and they said, 'Hey, we don't need you. You haven't got through college yet.' - Apple Computer Inc. founder Steve Jobs on attempts to get Atari and H-P interested in his and Steve Wozniak's personal computer.

You want to have consistent and uniform muscle development across all of your muscles? It can't be done. It's just a fact of life. You just have to accept inconsistent muscle development as an unalterable condition of weight training. - Response to Arthur Jones, who solved the "unsolvable" problem by inventing Nautilus.

640K ought to be enough for anybody. - Bill Gates, 1981

[Orac's note: Of course, in 1981, Gates was correct. No one really needed more than 640K in a personal computer. There wasn't much you could actually do with more than that in 1981...]
So, again, what's the point of alties or other pseudoscientists invoking Galileo or any of the hideously incorrect prognostications listed above? Again, obviously, this technique seeks to denigrate the experts who reject the altie's claims as not knowing what they're talking about or as close-minded, unable to have the vision that they do. It also deceptively tries to associate the quack, crank, pseudoscientist, or pseudohistorian with the theories and findings of great visionaries that went against conventional wisdom and were thus rejected by the experts of the day--and then later shown to be correct. It's a transparent ploy, about which Michael Shermer once said, "Heresy does not equal correctness."

Some call it the Galileo gambit (although in actuality Galileo is probably a bad example for pseudoscientists to use, given that he was persecuted by the Church, and not by his fellow scientists). History is indeed full of tales of the lone scientist working in spite of his peers and flying in the face of the doctrines of the day in his or her field of study. No doubt there are still a fair number of such scientists today. Unfortunately (or fortunately, depending upon your point of view), the vast majority of them turn out to be utterly wrong. They disappear into the mists of history, leaving not even a footnote in the grand history of science. As Shermer so correctly put it in his book Why People Believe Weird Things (a book I highly recommend to anyone interested in improving his or her critical thinking skills):
For every Galileo shown the instruments of torture for advocating scientific truth, there are a thousand (or ten thousand) unknowns whose 'truths' never pass scientific muster with other scientists. The scientific community cannot be expected to test every fanstastic claim that comes along, especially when so many are logically inconsistent.
Precisely.

For every Galileo, Ignaz Semmelweis, Nicolaus Copernicus, Charles Darwin, Louis Pasteur, etc., whose scientific ideas were either ignored, rejected, or vigorously attacked by the scientific community of his time and then later accepted, there are untold numbers of others whose ideas were either ignored or rejected initially and then were never accepted--and never will be accepted. Why? Because they were wrong! The reason the ideas of Galileo, Semmelweis, Copernicus, Darwin, Pasteur, et al, were ultimately accepted as correct by the scientific community is because they turned out to be correct! Their observations and ideas stood up to repeated observation and scientific experimentation by many scientists in many places over many years. The weight of data supporting their ideas was so overwhelming that eventually even the biggest skeptics could no longer stand. That's the way science works. It may be messy, and it may take longer, occasionally even decades or even longer, than we in the business might like to admit, but eventually in science the truth wins out. In fact, the best way for a scientist to become famous and successful in his or her field is to come up with evidence that strongly challenges established theories and concepts and then weave that evidence into a new theory. Albert Einstein didn't end up in the history books by simply reconfirming and recapitulating Newton's Laws. Semmelweis and Pasteur didn't wind up in the history books by confirming the concept that disease was caused by an "imbalance of humours" (although Semmelweis probably did hurt himself by refusing to publish his results for many years; his data was so compelling it remains puzzling why he did not do so). I daresay that none of the Nobel Prize winners won that prestigious award by demonstrating something that the scientific establishment already believed. No! They won it by discovering something new and important!

Unfortunately, to most lay people who don't have a strong background in science, the scientific method, or the history of science, such trickery can sound convincing on the surface. For example, you have a quack like Hulda Clark claiming she has a cure for cancer and AIDS and then claiming that the scientific establishment can't accept it. Add a dash of paranoia about big medicine and big pharma "suppressing" her "cure," and it's a potent brew of deception. This ploy is particularly appealing to Americans, because our whole national psyche has in its core a tendency to root for the outsider, the underdog. Alties, pseudoscientists, and cranks tap into that deep-seated sympathy we tend to have for the persecuted outsider and use it to their advantage. It's the same with creationists, who use every well-deserved debunking they get as evidence that they are a "threat" to the established scientific order. The only way to combat such deceptive comparisons is to point out again and again Shermer's dictum that "heresy does not equal correctness" and try to keep the discussion on the hard evidence.

I think it's appropriate to finish with another Michael Shermer quote: They laughed at Copernicus. They laughed at the Wright brothers. Yes, well, they also laughed at the Marx Brothers. Being laughed at does not mean you are right.

Use it the next time an altie tries to imply that the fact that the scientific establishment mocks their ideas means that they must be on to something. Except do what I do and use the Three Stooges instead of the Marx Brothers.

Especially Curly. Nyuck, nyuck, nyck.

Sunday, March 27, 2005

Happy Easter

To everyone who celebrates Easter, have a happy one!

That is all for today. Blogging will resume tomorrow.

Saturday, March 26, 2005

Another smackdown to be savored

Heh. For any who've been watching Paul at Wizbang make the huge mistake of taking on PZ (of Pharyngula), andy (of The World Wide Rant) and DarkSyde (of Unscrewing the Inscrutable) on evolution, you should check it out now. Another enjoyable smackdown. Not surprisingly, Paul's just digging himself deeper and deeper into a hole. His closing of the old threads on evolution and the opening up of a new one with his "rules" for how it will be conducted and his deleting of comments he doesn't like won't save him, nor will his dissing of PZ.

Maybe he realizes what a hole he has dug himself into. Quoth he: "This is the last evolution post for a few weeks, they wear me out."

Either that, or Paul's finally realizing his mistake. He just won't admit it.

The most nauseating article on the Schiavo case I have yet seen

....is here. That this guy (Joseph Farah) has the gall to write such tripe on Good Friday is truly nauseating.

Even back when I was a lot more religious than I am now, I would have found his Jesus-Schiavo comparison offensive. In fact, I probably would have found it even more offensive than I do now, because he is comparing a woman in a persistent vegetative state with the Savior. I'm still rather uncomfortable about the means of pulling the plug in this case, because dehydration is such a protracted way to die, but I've slowly and reluctantly come to the conclusion that personal liberty is the main issue here and that, if Mrs. Schiavo truly did say that she didn't want extraordinary means used to keep her alive in such a state with no hope of improvement, then that is that. Her wishes should prevail.

But let's address this on Joseph Farah's own religious terms. I can't help but point out that, if we are to take his own comparison (such as it is) to its logical end using Christian beliefs and doctrine, then we have to point out to him that he conveniently forgot one rather big point. Jesus accepted his fate because it was ordained by God. Jesus didn't want to be "saved" from the cross. Whether or not you believe that Terri Schiavo's fate was ordained by God, courts over the course of more than a decade have looked at the evidence and found that Mrs. Schiavo never would have wanted to live the way she is living now and would have preferred to be allowed to die. So, on those terms, you could probably say that she, too, "accepted" her fate 15 years ago and that her being allowed to die is the culmination of what she accepted.

Friday shuffle on Saturday

Most other bloggers do this particular meme on Fridays. Not Orac. Orac does it on (most) Saturdays. Why? Because Orac feels like doing it that way. Sometimes he even does it on Friday, just like most others.

In any case, to do this meme, all you have to do is to take iTunes (or your MP3 software of choice), select your entire music library, set it to play on random or shuffle play, and then list the first ten songs that get played. This morning, mine was as follows:
  1. David Bowie, Conversation Piece
  2. Simon & Garfunkel, I Am A Rock
  3. Kansas, Magnum Opus
  4. Johnny Cash, Oh, What A Dream
  5. Low, On The Edge Of
  6. Rancid, 1998
  7. Elton John, I Can't Keep This From You
  8. Violent Femmes, Nightmares
  9. Frank Sinatra, Dancing in the Dark
  10. Ministry, The Land of Rape and Honey
Hmmm. A rather odd compilation. I'm particularly intrigued by the sandwiching of a Sinatra song between a Violent Femmes song and a Ministry song. Oddly enough, it seemed to work OK.

Looks like I'm in the center-right

Just for yucks, I took the World's Smallest Political Quiz, just to see where I fell:

draw.php

Not surprisingly, I fell on the centrist-conservative line. More surprisingly, my score wasn't as close to the libertarian range as I thought it would be. I never thought I leaned towards the statist side...

Oh, well, it's just a silly Internet test. I think my results on the Political Compass had me pegged better. Maybe I'll post the results sometime...

Friday, March 25, 2005

Friday dinosaur goodies

PZ over at Pharyngula has blogged about a recent report in Science in which amazingly well-preserved dinosaur soft tissues were found deep within the fossilized bones of Tyrannosaurus rex. Cool. Of particular interest to me is the vascular endothelial structures that were identified. Given that my main research interest is tumor angiogenesis, most of my lab work revolves around endothelial cells. Unfortunately, I haven't received the March 25 issue of Science yet, but I'll definitely check this out when it arrives.

In fact, I can see a new grant proposal from this: Dinosaur angiogenesis, anyone?

A response to the "Herbinator"

My, my, Orac has been in a combative mood this week, hasn't he? (Being on call for six days straight--with three more to go, two weekends in a row--does that to him sometimes, particularly since it also often leaves a lot of "hurry up and wait" time to blog.) First there were the rants about the Schiavo case, then another broadside against a chelationist. What's next? Well, I think it's time for a little more light-hearted fare. Two days ago, an herbal "healer" named J. Mark Taylor somehow found my little blog and left a sarcastic comment. No biggie; I'm used to far worse from alties. I found it more amusing than anything else. However, I thought it might be interesting blog fodder to reply to Mr. Taylor publicly. Don't worry, Orac-philes, I'll be polite. (Aren't I always?)

But don't confuse "polite" with going easy on him. Here goes:


Dear "Herbinator":

I see you've found my humble blog. Your sarcastic little comment about how you've supposedly discovered a "blog dedicated to the celebration of conformity" amused me, but unfortunately that is an incorrect characterization. In fact, Respectful Insolence is a blog dedicated mainly to science, evidence-based medicine, and skepticism (none of which alties like yourself appear to understand or embrace)--plus whatever else the inimitable Orac feels like blogging about at any given time. In actuality, I leave the conformity to alties, too many of whom will defend even quacks like Hulda Clark rather than admit that they might have a problem with quacks among their ranks. They're much better at lockstep conformity and adherence rigid dogma than I. Oh, and before you go accusing me of the same sort of "circle the wagon no matter what" behavior with regard to conventional medicine, I suggest you read this, in which I go after conventional doctors for selling unnecessarily and potentially harmful "screening" MRIs for breast cancer. I am an advocate of evidence-based medicine, and I try to apply the same standards consistently to so-called "alternative" treatments and conventional medical treatments.

Your sarcasm notwithstanding, however, I'm still glad that someone like you discovered my blog. In fact, I even hope you'll stick around. You might actually learn something. You'll also likely find that I'm far more receptive to honest criticism than most alties are. Perhaps, if I have time later, I'll go back to your blog and politely politely on some of the stuff I encountered the first time I visited. Then, we'll find out what your tolerance for honest debate really is.

In fact, let's find out a little right now. How about a little taste of Orac's own special brand of respectful insolence? I'm afraid you're just plain wrong when you assert on your blog that little or no progress has been made against cancer in 50 years. One example: Childhood cancers that were death sentences in 1955 are now, thanks to chemotherapy, anywhere from 75-90% curable. Another example: leukemias and lymphomas that were also death sentences 50 years ago are now treatable, and, depending upon the specific disease, anywhere from 30-80% curable. It is true that we haven't made much progress for certain tumors over the last 30 years or so, but admitting that is a very different thing than saying (as you did) that we've made "little progress or no progress against" cancer in 50 years. Let me put it this way: If you were diagnosed with cancer, would you rather be treated with the methods we have now or the methods that were the standard of care in 1955? I realize it's likely that you would simply say you'd prefer "natural" methods. If so, I wish you good luck and hope you never get cancer, even more so than I hope the same thing for anyone--because if you do get a treatable cancer and opt for the "natural" treatments that you advocate on your blog over conventional therapy, you'll be screwed. And I don't wish death from cancer on anyone. Putting that aside, however, I know what my answer to the question would be (not to mention, I daresay, the answer of anyone capable of critical thinking).

But how about another little taste? In another post, you say, "Cancer treatment is probably no more effective today than it was in the 1930's." Oh really? Can you back up that assertion with, oh, say, some actual facts? Do you have some survival statistics? Have you considered not just mortality, but morbidity as well? For example, if you were a woman with an early stage breast cancer, would you want a radical mastectomy (the standard of care for even small breast cancers in the 1930's) or a lumpectomy with sentinel lymph node biopsy (the standard of care for most early stage cancers today) as your surgical therapy? And, if you were unfortunate enough to have a tumor large enough to require a mastectomy, why bother with breast reconstruction (nonexistent in the 1930's) when you can have a deformed chest? Would you want to increase your odds of long-term survival with chemotherapy or take the lower chance that surgery alone would do the trick? How about hormonal therapy? The standard means of hormonal therapy before Tamoxifen and the newer aromatase inhibitors was to do an oophorectomy to stop the body's natural production of estrogen. Now we have drugs that will do the same thing. The same is true for prostate cancer. Castration used to be the first treatment of choice for metastatic prostate cancer, even as recently as my early residency days in the late 1980's. Now, we have drugs that accomplish the same thing. The list goes on and on.

After that, how can you not want just one last taste? Correct me if I'm interpreting incorrectly, but here, you seem to be implying strongly, if not saying outright, that a "nature-cure approach is at least as effective as Standard medical treatments." You wouldn't happen to have, oh, say, some actual scientific or clinical trial evidence showing that this is so. Any disease will do, but, since I'm primarily a cancer surgeon, I'd be most interested in evidence showing such a result for a cancer, any cancer, for which there is presently effective "conventional treatment." Failing that, how about any disease for which there is presently an effective conventional treatment? Or even diseases for which present treatments leave much to be desired? No testimonials, please, because they do not show any generalizable effect, and are impossible to evaluate to see if the presentation of the case is accurate, nor do they tell us actual success rates. I'm talking hard data from well-designed, controlled clinical trials that show your therapies are as "effective as Standard medical treatments." And, if you don't think your therapies should be subjected to such testing, I would then have to ask: Why not? Why should your therapies be exempt from the same testing that mine are subject to? How do you know that your treatments work? Again, as I explained extensively before, anecdotes don't constitute adequate evidence. I will give you this, however. You said, "In the end, you either believe or you don't." The problem is, nature doesn't work on "belief." You can "believe" anything you want, but that doesn't make it so.

That ought to do it for now. I hope you don't think I was too hard on you. However, if you show up and leave sarcastic comments on my blog, don't expect me to take it lying down (although I do always reserve the right to ignore them). I've dealt with alties for a long time now on Usenet in misc.health.alternative; I highly doubt you can show me anything new, but feel free to give it your best shot, should you be so inclined. I'm always interested in honest discussions with advocates of alternative medicine who might be able to show me that I am wrong. I just haven't found one yet. Be advised, as well, that no one but Orac drives the agenda of this blog and certainly not you; so I will not allow myself to become drawn into prolonged exchanges. Orac, and Orac alone, decides when he will and will not respond. I'm sure you run your own blog the same way, which I may find out if I start leaving some comments.

Finally, don't forget Orac's favorite saying: "A statement of fact cannot be insolent!"

Sincerely,

Orac

P.S. Have a nice Easter weekend.

Thursday, March 24, 2005

Revenge of the chelationist

A few weeks ago, I described a flier I received at my office advertising a talk at a local extended care facility. Through the flier, the speaker, a local physician who also employs alternative medicine, touted all sorts of wonderful effects that one could enjoy if one tried chelation therapy. Among other things, the flier claimed chelation therapy was good for aches and pains, hardened or blocked arteries, Alzheimer's disease, elevated blood cholesterol, leg cramp pain (claudication), diabetes, angina pain, osteoporosis, poor circulation, cold extremities, elevated blood pressure, skin ulcers, kidney stones, impaired memory or concentration. This physician even went so far as to characterize chelation therapy as “the most successful method to extend maximum life span.” (In fact, based on the flier, I was beginning to wonder if there was anything that chelation therapy wouldn't cure.) The only problem is, there is no good scientific evidence that chelation therapy does any of these things or is useful for treating anything except for documented cases of iron overload or heavy metal poisoning. I emphasize the word "documented," because alties frequently blame "heavy metal toxicity" for a wide variety of ailments, without ever definitively proving excess of heavy metals. ("Heavy metal toxicity"? I may have suffered some of that in my teen years, when I was very much a fan of Ted Nugent. Just ask my sisters or my parents. It's a wonder I still have my hearing.)

Naturally, as a bona fide member of the Skeptics' Society and advocate of evidence-based medicine (and because I was unable to show up at this event myself due to preexisting obligations), I felt obligated to write to try to set the director of this company straight. Fortunately, I wasn’t the only one, and a flood of letters and e-mails convinced the company to cancel the talk. It was over. Score a small victory for reason and evidence-based medicine. Or so I thought.

About a week ago, I learned that the chelationist is almost certainly going to have his revenge.

That's when another flier arrived in my mailbox at work. It looked very much like the one I had received before and is reproduced below (with addresses, phone numbers, and names obscured, of course).

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Damn.

It makes me wonder if the company gave this guy a non-refundable deposit and are trying to get something out of him. Or maybe he's a buddy of someone on the board of directors of the company. Why else, having hurt its own reputation in the local medical community by inviting this guy and sending out advertisements to all the doctors in the area in the first place, would the extended care facility risk compounding the damage to its reputation by re-inviting him? Never mind that this guy offers a veritable cornucopia of unsupported therapies, as described on his own website, including "Intravenous Chelation Therapy, Vitamin C Intravenous Therapy, Hydrogen Peroxide Intravenous Therapy, Mercury Detoxification via DMPS injections and Colon Hydrotherapy," among others, all of which are well-debunked on Quackwatch. Regular readers may recall that I ranted a bit last time about the somewhat weasely letter I got from a company flack apologizing but excusing the invitation with a line about how his company's goal is to "educate, never endorse." A few commented that I was being too harsh on the guy, and I was been beginning to wonder if perhaps I had indeed been too harsh. Now that the company has invited Dr. "GHL" back, despite the fact that they now know that he is an advocate of unproven and scientifically unsupported "therapies" (like chelation therapy for cardiovascular disease or colonic irrigation for other maladies), I now contend that I wasn't harsh enough.

Notice, though, how Dr. GHL is much cleverer this time. He's clearly learned from his first experience. I have a sneaking hunch that he probably didn't know that his first flier would be mailed to physicians. It was clearly designed for the lay public, most of whom don't have the medical knowledge or background to understand why his claims for chelation therapy were so obviously overblown. This time, he knew. The claims listed on this new flier are much less specific and much more innocuous-sounding. However, they are still very much of a kind to the claims alties like to make. "Strengthen the immune system"? Gee, who wouldn't want to strengthen his or her immune system? (The contrarian in me can't help mentioning people autoimmune disorders here.) "Slow the aging process"? Who wouldn't want that as well? (Who knows what that means, though.) What about environmental pollutants or toxins? Of course they must be bad! (Of course, alties rarely tell you which toxins are at fault or show you clear epidemiologic, biochemical, or phsyiological evidence that they are at fault. It's always some general vague "toxicity.") This guy should go on Bill Maher's show, for cryin' out loud!

[A side note: Normally I wouldn't be nearly so hard on someone advertising a talk like this. If this were the first flier I had seen, I probably would have just shrugged it off and tossed it in the old circular file. After all, who can complain too much about someone saying that a bad diet might make you unhealthy? Unfortunately, Dr. GHL had already revealed himself to be someone who buys the exaggerated and unfounded claims for chelation therapy, even for diseases for which there is even less evidence for efficacy than atherosclerotic vascular disease.]

Sadly, the company also got a representative of the local chapter of the American Cancer Society to appear with our altie. Whether this is just another example of a misguided attempt to provide "balance" or whether it's an attempt to cover its behind, I don't know, but I have to wonder if the invited ACS representative is even aware of Dr. GHL's advocacy of dubious therapies like chelation for cardiovascular disease or colonic irrigation. Questionable or bogus cancer therapies are a huge problem, and the ACS has in general wisely tried to maintain a balance between not unduly discouraging the use of complementary therapies that might be helpful, particularly in improving quality of life, but still protecting the patient from quack "cures" of the sort Hulda Clark pushes.

With the Bat-signal thus activated, my alter-ego Orac just had to leap into action. (Too bad he doesn't have as bitchin' ride as the Batman does.) Unfortunately, once again, the date and time of the conference are such (early evening of a clinic day during a week I am on call for the group) that I cannot possibly attend it myself. Disappointed, I did the next best thing to being there and fired off another letter:
Dear Mr. X:

I wrote to you a while back to express my concern about a flyer I received for an event to be hosted at your facility. In my e-mail, I voiced my concerns over the topic of the talk, namely chelation therapy. The flyer contained some highly exaggerated and simply incorrect claims for the supposed benefits of chelation therapy. Presumably, the speaker, Dr. GHL, was planning on touting these dubious benefits in his talk (benefits for which there is no good scientific evidence). As a strong advocate of evidence-based medicine, I pointed out that there is no good scientific evidence or evidence from randomized clinical trials that chelation therapy does any better than placebo.

Your company wisely canceled Dr. GHL's talk on chelation therapy after a number of physicians wrote or called to complain before I got around to doing so. Unfortunately, you appear to have rescheduled Dr. GHL with a different topic. A few days ago I received another flier advertising a talk by Dr. GHL entitled "The Nutrition and Health Link." Putting aside for the moment that Dr. GHL just got burned for openly touting unproven benefits of chelation therapy for cardiovascular disease, Alzheimer's, and a number of other diseases for which there is no evidence of its efficacy (it is also a therapy that he himself administers, as described on his practice's own website), this new flier still manages to raise my concern again, to the point where I feel I must write again.

It would appear that Dr. GHL has learned from the previous incident. He is not making claims as easily debunked as the ones he made for chelation therapy. Instead, he has restrained himself. Dr. GHL's claims are now harder to debunk, not because they are more any more founded in science than his claims about chelation therapy were, but rather because they are so vague and undefined. What, precisely, does "boosting the immune system" mean? Will he tell his audience specifically which functions of the immune system is boosted by his methods and how? Is it T cell-mediated immunity or antibody-mediated immunity, and what peer-reviewed scientific studies support his position? Exactly what does he mean by "slow down the aging process"? All of these are buzzwords often used by purveyors of unproven therapies, and none of them appear to have any defined meaning. Indeed, "boosting the immune system" is not unlike the "improving the vital force" that is so commonly used in various alternative medicine claims. Also, he seems to subscribe to the "toxicity" concept of disease. Unfortunately, rarely do alternative medicine advocates define exactly what these "toxins" are that are supposedly making us sick. The only thing he appears to be saying that is hard to argue with is that a bad diet can hurt your health. I am also disappointed to see that Mr. X, the Regional Executive of the American Cancer Society, will be participating in this talk as well. I have to wonder if Mr. X was aware of Dr. GHL's advocacy of an unproven therapy like chelation therapy when he agreed to appear with him. Certainly, the use of unproven and ineffective "alternative" cancer therapies are a big problem, one I would think that the American Cancer Society would not want to support. I am therefore sorry to see Mr. X lending the prestige of the American Cancer Society to this event. Given that Dr. GHL himself offers a veritable cornucopia of unproven "alternative" therapies, including (quoted from his entry on his company's own website): "Intravenous Chelation Therapy, Vitamin C Intravenous Therapy, Hydrogen Peroxide Intravenous Therapy, Mercury Detoxification via DMPS injections and Colon Hydrotherapy," among others, I find his repeat invitation by your company even more disturbing. All of these are debunked quite well on Quackwatch.org and other sites I can suggest to you, if you are so interested.

Be assured that I do not have any objections in principle to combining alternative and complementary medicine with conventional medicine, as Dr. GHL appears to advocate. Such a combination may indeed ultimately be shown to improve patient care. However, as an advocate for evidence-based medicine, I cannot support combining specific alternative and complementary medical techniques that are scientifically unproven, some of which may be potentially dangerous (like chelation therapy, which can cause cardiac arrhythmias, or colon irrigation, which can cause dangerous electrolyte imbalances), and sending any of my patients to such an institution would make me uncomfortable. I have little doubt that Dr. GHL is probably a competent physician when confining himself to conventional medicine and most likely sincerely believes that the "alternative" methods he is combining with his conventional medical practice benefit his patients. Unfortunately the hard evidence available at this time does not support such a belief, at least not with respect to the "alternative" medical therapies of chelation therapy, colonic irrigation, intravenous vitamin therapy, or intravenous hydrogen peroxide therapy. I hope that your company is more careful in the future in picking its speakers for public education events and more careful still in issuing repeat invitations.

Sincerely


Orac

I'll report back on the response (if any) I receive. I'm guessing I probably won't get a response this time.

One more thing. If they do this again and stick to the same sort of schedule in the future, I might actually be able to make a personal appearance, as my clinic schedule will soon be changing. Of course, given my only just competent public speaking skills, I may have to be careful, or I take the risk of embarrassing myself, regardless of the strength of my position. Perhaps Peter Bowditch would give me some pointers...

Wednesday, March 23, 2005

Tangled Bank XXIV is here

It's amazing how fast two weeks have gone by. It's already time for the 24th edition of the Tangled Bank, this time hosted by Syaffolee. Once more, great scientific blogging is all gathered into one place for your edification. Enjoy!

Once you've finished being edified and enlightened by Syaffolee's fine compendium of the best of the science blogosphere from the last two weeks, consider this: Believe it or not, I'm hosting the next edition, two weeks from now, on April 6. (Man, time really flies!) Somehow, I seem to have acquired a reputation for creative (or bizarre--you be the judge) ways of hosting other blog carnivals, as seen when I hosted the Second Skeptics' Circle in February and Grand Rounds XXV just last week. I really can't imagine why I might have gotten such a reputation...

The question is, can I possibly top my last two hosting gigs? Am I out of ideas? Will I resort to Tolkienesque meanderings? Or will I opt for a more conventional blog carnival approach? Who knows? In fact, as of this moment, I don't even know myself. There's only one way to find out, though. First, you can help me by submitting the best of your science blogging to orac_usa AT hotmail DOT com or host@tangledbank.net by 9 PM EDST, Tuesday, April 5. (Yes, time's going by so fast that we'll actually be on Daylight Savings Time by then.) The better the blogging that's submitted, the more it'll get my creative juices flowing, you know. Second, you can join me on April 6 for Tangled Bank XXV, where I hope to continue the Tangled Bank's tradition of presenting only the best science blogging, as exemplified by this week's edition.

Birthday wishes

I'd just like to take this opportunity to wish my Dad a very happy birthday! In fact, he and my Mom are coming out to visit next week, and I can't wait. It's been a while...

Yes, I got one of these e-mails too

The Bioethics Dude got an e-mail that was represented as having come from a law firm asking for affadavits from or testimonies by physicians about the Terri Schiavo case.

I got the same e-mail too. I'd like to know who else got it. Please comment on this post if you got one of these.

I really have to wonder what's going on, for a law firm to be soliciting bloggers who post under 'nyms, like me and the Bioethics Dude, for affadavits. They have no way of even knowing if we are doctors or not. Why is it a California law firm? Why bother soliciting affadavits from anonymous bloggers? It seems like a lot of effort for minimal payoff, trolling medical blogs for affadavits of doctors who have no personal knowledge of the case and have not reviewed any medical records or tests and, although I have some experience in caring for brain-injured patients from my trauma days and can do a serviceable job of interpreting head CTs, I am not an expert in that area. In fact, I don't even recall leaving any comments on CodeBlueBlog recently, which makes me think the only reason I got this is because of CodeBlue's link to my recent turn at hosting Grand Rounds.

It could be a monumentally bad idea on the part of the law firm, but I can't rule out a trick by someone trying to discredit or harass the law firm or even personally harass the Tracy Jackson who signed the e-mail. (For all I know, it could be the work of her disgruntled boyfriend.) I'm still looking at the e-mail headers, trying to tell if this truly came from where it appears on the surface to have come from.

In any case, it's just another measure of just how utterly bizarre this case has become.

Tuesday, March 22, 2005

Grand Rounds XXVI

Grand Rounds XXVI has been posted at the Well-Timed Period. Once again, medical blogging goodness from throughout the blogosphere is gathered into one nice, compact package. Check it out.

Cartoonists on Schiavo

I've resisted the urge to blog on Terri Schiavo thus far. Although I've always supported patient autonomy and the right to pull the plug, I've also always been uncomfortable with dehydration and starvation as the means of "pulling the plug." I don't know if I would have made the same decision as her husband. I don't know whether, like the parents, denial would lead me to continue to hold out hope, no matter how much the objective evidence indicates that there is no hope of significant neurologic recovery. They have my sympathies, and I have a hard time blaming them for pursuing their quest to keep their daughter alive, even though I think it's misguided.

However, regardless of one's position on the Schiavo case, it doesn't take much to realize that the the political gamesmanship going on over her plight is utterly disgusting. I think Pat Oliphant gets it pretty close to correct here...

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But Tom Toles nails it right on the head here...

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As does Jeff Danziger here...

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Wearing two hats, part 2

A while back, I wrote about the difficulties of wearing two hats, that of the basic scientist and that of the clinician. In that post, I wrote more in general about the problems of having dual roles and the perceptions of those around me as to my credibility and competence in each role. Having allegedly "made it" now by producing compelling enough evidence coupled to a persuasive enough case for my planned research to convince the NIH to fund my research proposal (not to mention having published a few papers on my own in good journals), I can correctly say that I have joined the ranks of credible basic scientists. (Whether I am an outstanding--or even a good--scientist or not remains to be seen). In any case, somehow I've now built a reasonably well-funded laboratory and can afford to have a few people working for me to grind out data. On the other hand, I'm still a clinician. I also happen to be on call this week, and when that happens, the practicalities of wearing two hats start to weigh on me more than at other times, because it is at these times that my clinical responsibilities increase to the point where they put more pressure on my research responsibilities.

As I mentioned before, one of the biggest difficulties in combining a research with a clinical career is finding the time to do the necessary work to get a credible research program going. This includes doing the background reading and developing the research plan, doing the research, writing grant applications to get funding to support the research, and writing up the research to submit to peer-reviewed scientific journals. Several "pure basic scientists" pointed out that they have problems with this, too, because administrative and teaching responsibilities eat into their research time. No doubt this is true. I have little doubt that basic science departments pile on teaching and/or administrative responsibilities in a quantity that makes it difficult for young basic science faculty to succeed in getting a research program off the ground, getting funded, and publishing enough to prove themselves to be credible scientists and thus build a reputation for themselves. For a moment, however, I would still like to address why their situation is not and cannot be the same:

If a basic scientist fails to fulfill his teaching or administrative duties or doesn't fulfill them well, no one is going to die. Nor is anyone going to suffer a complication or additional pain. Patient care often can't be put off, at least not for long. Unlike teaching, it can't always be scheduled or predicted.

It's that simple. And that stark.

That'sthe difference. It's possible to succeed as basic science faculty while being not so good at other responsibilities, like teaching. My own experience with several professors during graduate school bears this observation out. There were a few professors who were highly successful in their research, with many publications, international reputations, and oodles of grant money. Unfortunately, they were awful in the classroom. There were even more faculty who were just OK in the classroom, but--again--ran successful laboratories.

I realize that what I said may sound arrogant to some or as though I am denigrating the difficulties basic science faculty face. I assure you that it is not and I am not. Not having much experience in teaching classes, I would probably have an absolutely hellacious time at first learning to become a competent classroom teacher (as opposed to a clinical teacher, which is different) if I ever tried to be straight basic science faculty. However, it's just the nature of the beast. You can't be bad or even mediocre as a physician, regardless of whether or not you are a scientist as well. You just can't. If you are, you have no business treating patients. You have to be at least competent as a physician or surgeon, and preferably you should be excellent. It's also more difficult in a highly technical specialty, like surgery. Practice makes a difference in highly technical skills, unless you happen to be one of those lucky surgeons who is just naturally gifted.

Maintaining one's medical and surgical skills as a part-time physician is perhaps the most difficult challenge facing the surgeon-scientist or the clinician scientist. The only way most of us manage it is to focus their clinical practice like a laser very tightly on one specialized area. That's the practicality of it. The necessity for competence when you don't get as much experience and practice as a straight clinical surgeon usually mandates focus. Even then, it's difficult. As a part-time surgeon, I don't do nearly as many cases as a full-time surgeon, and, as long as I am doing research, I never will. That is another reason by my practice has to be tightly focused if I want to do right by my patients and still have the opportunity to do research.

It cuts both ways, too, although that's usually less of a consideration compared to the basic science faculty with significant teaching responsibilities. I'm in essence a part-time scientist as well. I can't devote the same amount of time to writing grants, papers, supervising the lab, or even doing experiments that most basic science faculty can and do. But perhaps the biggest issue that cuts both ways is the literature. In essence, physician-scientists have twice as much scientific/medical literature to deal try to keep up with. We have to keep up with the medical literature involving our specialties and the scientific literature involving our research, and we have less time to do it, to boot. No wonder I never feel as though I'm on top of the surgical literature. No wonder every so often I get blindsided by a paper related to my research that I never noticed, probably more so than basic scinetists do. That's why another essential practical necessity for success is to have good people working for you and good collaborators working with you. One bad hire can destroy your lab's productivity and even ultimately your lab. You need people who can work with little supervision, and you need collaborators who can help you out with the more arcane basic science that you aren't trained in. In return, you offer your collaborators your clinical understanding of the disease process and, if you happen to be a surgeon, one of the most precious resources of all for biomedical research: access to human tissues.

Finally, perhaps the key difference between being a basic scientist and a clinician-scientist is predictability. The basic scientist, even the one who has significant teaching responsibilities that take up a big chunk of his schedule, has a much more predictable schedule. Patient care can be made somewhat predictable, but emergencies will always occur, the number and frequency of which depend upon the specific specialty. There will always be calls on weekends or in the middle of the night. Disease doesn't respect weekends or nights. Moreover, the natural tendency is for patient care responsibilities to grow slowly and inexorably. In essence, you can be a victim of your own clinical success, and your success in the clinical realm can negatively impact your success in the scientific realm. I know one surgeon who has become so popular that he just can't cut back his clinical practice without risking a backlash from his referring physicians. It can go the other way, too, but when that happens the usual solution is to give up clinical practice.

Let's look at a few real-life scenarios that illustrate the conflict. Scenario number one: You are in the middle of a big experiment when the E.R. calls about a patient you recently operated on, who has returned intrabdominal sepsis. It turns out that your anastomosis has broken down, and the patient needs urgent surgery to fix the problem. However, if you take off to do the surgery, your experiment will be ruined, wasting days of work and hundreds of dollars worth of reagents. The choice is really no choice at all; you take care of the patient and trash your experiment. You could ask one of your partners to deal with it, but they have patients of their own to deal with; they're all either in clinic or in the operating room. Besides, it's your complication. You need to deal with it, because that's what surgeons do.

Scenario number two: You have a grant due in a few days. You thought you had planned well, canceling your clinic that week several months prior and telling the schedulers not to schedule any operations that week, to allow maximal time to finish the grant. However, there is a patient that your boss tells you that you must see and take care of now. (Hopefully, you don't have a boss that does this to you on a regular basis. Fortunately, mine don't and even bend over backwards sometimes to prevent such things from happening.)

Scenario number three: You have a grant due in a few days. The day before your grant is due just happens to be your clinic day. It would inconvenience 20-30 patients if you were to cancel your clinic, and you're so busy anyway that it would be hard to find spots for them in a short period of time; so you don't cancel the clinic and resolve to have the grant ready a day early. Unfortunately, a couple of emergencies (like scenario one) keep you from having it quite ready. Do you cancel clinic and inconvenience all those patients so that you can get your grant done?

Scenario number four (perhaps the most common scenario): Your clinical load has been slowly growing. Almost without your realizing it, you find yourself spending less and less time in the laboratory doing experiments until you are no longer doing benchwork at all. This alone would not necessarily be a problem, because senior basic science faculty often find themselves no longer doing benchwork after a certain period of time. However, over time, your patient load continues to increase and you now find yourself spending less and less time even meeting with your lab personnel. You find that you are no longer even sure of what is going on in your lab on a day-to-day basis. There are a pile of manuscripts that need to be finished, but you can't get to them because you're always in the clinic or in the O.R.. You try to work on them at home, but your wife and children demand their fair share of your attention when you manage to make it home for a while. You'll soon be due to try to renew your grant, something you have no idea if you'll be able to do now. You could try to cut back on your clinic time, but that would mean that patients' waiting time to be seen would increase. Patients with cancer would be forced to wait longer. Also, if you cut back your clinical productivity, your department would not like it, because you would no longer be supporting your salary and overhead with clinical revenue. Your referring physicians will also not be pleased.

These are just a few examples, but in the end the conflicts all come down to the tension between two worlds which are very different, the world of the scientist and the world of the clinician. The world of the scientist values inquisitiveness and intellectually stimulation. It is also less interested in practicality and more interested in intellectual pursuits, in answering questions that have never been asked or answered before. In constrast, the world of the clinician is almost purely practical. It tends to be task- and action-oriented, and protocol-driven. Asking and answering questions are valued, but only insofar as the questions and answers pertain to diagnosing and treating disease or overcoming problems that get in the way of good patient care. It is also much more emeshed in human contact and human relations that the world of the scientist in a way that the world of basic science. It is much less possible than it used to be for the lone scientist to labor with little human contact, but it is still possible for a scientist to labor with little human contact outside of the coccooned world of his department. It is not possible for a clinician (other than a pathologist) to do his job without dealing with many, many people every day, often at their most vulnerable or difficult to deal with. The clinician is always dealing with new patients and new people, and it's hard to succeed as a doctor without being able to deal with people. (Yes, I know that a fair number manage.)

The clinician-scientist tries to bridge the gap between these two worlds. Clinician-scientists bring a unique perspective to the study of human disease that neither a pure clinician or a pure scientist alone can. Nothing is as satisfying as making a clinical observation, taking it to the laboratory, developing a treatment based on my laboratory observations, and then testing that in patients and seeing it work.

I hope to pull that off one day.

In fact, I'm beginning to think that clinician-scientists represent an eminently practical way of doing translational research.

[Note: I may have to write a third part of this series some day on the ethical issues of wearing two hats and doing clinical research involving human subjects, as mentioned by Dr. Maurice Bernstein in a comment in my previous post on the matter.]

Monday, March 21, 2005

Hospitalization

A humorous take on the pros and cons of being hospitalized is here.

The Bull Moose is right

The Bull Moose is right. Conservatism is dead.

What is a theory?

I've been meaning to blog on this very topic for a long time, but, via Pharyngula, I've found an article by Steve Olson published in The Washington Post that explains this point better than I probably could do myself. One of the most frequent canards that creationists use is that evolution is "just a theory." In fact, a lot of those idiotic warning stickers required on biology textbooks by various school districts say this very thing. The problem is, the word "theory" has a very different meaning in science from its meaning in colloquial use. But just let Olson explain:
If you want to know one reason why the debate over teaching evolution remains so contentious, consider the stickers some school boards have wanted to paste in high school biology textbooks. They label evolution a "theory, not a fact," suggesting that an alternative explanation is possible.

It's a clever strategy. Even people sympathetic to evolution often don't know how to respond to the assertion that evolution is "just a theory." And the opposite claim -- that evolution is a fact -- can generate skepticism among those who don't like to be told what to think.

But these stickers use the words "theory" and "fact" in a very misleading way. The biggest problem is that "theory" has two separate meanings. In common usage, "theory" means an idea or a hunch: "I have a theory about why she left him." No one really knows what the reasons were, but we can guess.

That's not what "theory" means within science. When scientists speak of the theory of gravitation, cell theory or evolutionary theory, they are talking about scientific concepts that have been so thoroughly tested that they are very unlikely to change. Theories are the results of decades or centuries of scientific effort. They draw on many interconnected observations and ideas. They are the end products of science, not stages on the way to the truth.

In science, a hunch or conjecture is called a hypothesis, not a theory. When Copernicus proposed in the early 16th century that the Earth revolves around the sun rather than vice versa, his idea was a hypothesis. But four centuries of observation and thinking have convinced us that heliocentrism is a theory, not just an intriguing idea. It is compatible with everything we know about the solar system and explains observations that cannot be explained in other ways.

Ideally, English would have a different word for these comprehensive organizing concepts in science. But for now, "theory" is doing double duty. So calling evolution a theory may seem to denigrate it in everyday terms, but in scientific terms that's high praise.
Precisely. The Theory of Evolution is just as rich and based in evidence as the Theory of Relativity or any of the other major theories in science, and the reason scientists won't take creationists seriously is because they challenge a well-founded and accepted theory without presenting strong evidence contradicting evolution and/or supporting their ideas. (Alties frequently do the same thing.) My only quibble with the article is that Olson doesn't really explain how old theories are usually incorporated into new theories at some level, mainly because theories by scientific definition represent the best explanations for a scientific phenomenon that presently exists. (The contrarian in me wants to use this simple observation to illustrate that the advancement of scientific knowledge is usually evolutionary, not revolutionary.) For example, the theories behind Newton's Laws of Motion were not disproven by the Theory of Relativity. Instead, Einstein showed that Newton's Laws were a special case of relativity for situations in which the velocity is much less than the speed of light, so that the factor v/c approaches zero and Einstein's equations reduce to Newton's Laws. Given that such slow velocities were all that Newton could observe in his time, he was absolutely correct to derive the laws that he did.

I agree with PZ. We should never, ever refer to creationism or intelligent design as "theories." They are not. They don't even rise to the level of hypotheses. It's also important to remember that science is not logic. Logic is an important part of the scientific method but does not necessarily have much to do with how natural phenomena operate. Many are the scientists who have been misled by an idea of how they thought nature should be, based on logic, as opposed to how nature actually IS, based on evidence and experimentation. (After all, Lamarckian evolution is a wonderfully logical concept--logical and wrong, not the way nature operates.) "Intelligent design" creationists frequently use logic (usually bad logic, but logic nonetheless) to justify their "hypotheses." However, logic alone is not enough. Science is about evidence, experimentation, hypotheses, and reasoning. They all have to be consistent with each other for a principle to be considered valid. Creationism and its deceptive offspring intelligent design fail on all these counts.

Sunday, March 20, 2005

Sunday afternoon history lesson

Regular readers of this weblog know that I have an interest in history, particularly World War II and Holocaust history. I've posted about the 60th anniversary of the liberation of Auschwitz and how I discovered Holocaust denial. I've blogged about the bombings of Dresden and Tokyo, as well as the flag-raising at Iwo Jima. However, although this blog is now over three months old, I haven't talked much about Holocaust denial today and how Holocaust deniers seek to silence those who would refute their lies.

The most famous case of this is the David Irving trial. This trial took place in 2000 in response to David Irving's lawsuit against historian Deborah Lipstadt for her characterization of him as a Holocaust denier in her 1993 book Denying the Holocaust: The Growing Assault on Truth and Memory. Lipstadt's characterization was based on copious evidence, including statements by Irving such as "more women died on the back seat of Edward Kennedy's car at Chappaquiddick than ever died in a gas chamber in Auschwitz," among others. In response, David Irving sued Dr. Lipstadt and her British publisher, Penguin Books, for libel in a trial that made headlines around the world. The reason Irving chose to sue Professor Lipstadt in Britain is because British libel laws are among the most lenient in the world for plaintiffs, forcing the defendant accused of libel to prove that what he or she wrote is true, rather than, as is the case in the U.S. (for example), putting the burden of proof on the plaintiff to prove that what was written was false or written with a "reckless disregard for what is true."

Fortunately, Professor Lipstadt prevailed, dealing a crushing legal and moral blow to the Holocaust denier David Irving. (Unfortunately, however, despite the judgment against him for court costs, somehow David Irving manages to travel around the world giving talks and avoid paying the judgment.) At least, however, forever after now, the label of "Holocaust denier" will follow Irving, based on a verdict by a British court.

The reason this whole issue has come up again is twofold. First, Professor Lipstadt is finally getting to tell her side of the story. She has written a book entitled History on Trial: My Day in Court with David Irving. I haven't yet had the opportunity to read it, but I'm definitely going to order it from Amazon.com. The excerpts I've read from it, plus having read Professor Lipstadt's previous work, lead me to predict that it will be a detailed account of how Holocaust deniers will try to use to silence their critics, all the while claiming the mantle of free speech martyrs for themselves. Second, recently C-Span's Book TV made a very bad mistake, the same sort of mistake news organizations make when covering evolution. Book TV wanted to do a segment on Lipstadt's book. However, in order to provide "balance," they wanted to invite David Irving to speak as well. (Does this sound familiar to those of you who are involved in debunking creationism?) Professor Lipstadt's pleas that including a blatant Holocaust denier like David Irving would hurt C-Span's credibility fell on deaf ears, leading her to withdraw from the show.

Lipstadt had a ready response and Amy Roach, the C-Span producer handling the show: “Would you put on someone who says slavery did not happen?” “No,” Roach assured Lipstadt. Then why a Holocaust denier, Lipstadt asked. “Oh,” she said quite breezily, “He’s not going to talk about Holocaust denial. He’s going to talk about the trial.” Given that the trial was entirely about Holocaust denial and whether Lipstadt was correct in characterizing Irving as a Holocaust denier in her book, this quite understandably struck Professor Lipstadt as "wacko."

It's depressingly the same, whether the issue is pseudoscience (creationism being the prime example), pseudohistory (Holocaust denial being the prime example), paranormal phenomenon, or quack medicine. The media consistently confuse "balance" with letting the unsupported crank appear on the air or in print as an equal to the true expert. This puts the true expert in a bind. If, she doesn't go on the air with the crank, then the crank will get time to spout his crankery without rebuttal or debunking. On the other hand, if she does go on the air with the crank, she risks giving him credibility as an "alternative opinion." I don't know what I would have decided if I were Lipstadt, but the very fact that she had to make the choice shows how "balance" isn't really balance at all.