Saturday, July 31, 2010

Knot Useful?

A couple of weeks ago I posted about safety on the water. The links on cold water survival and understanding what drowning look like were from a site called gCaptain. gCpatain also pointed me towards sites on tying knots and making splices.

As soon as one post caught my interest I found another post on the same subject as usual. As soon as you start thinking about something you're bound to find more of it in your travels. So may I present Andy's Most Useful Knots. If you're interested in how to make rope do useful things with easy to follow pictures and directions then that is a great page to start with.

Have fun.

Friday, July 30, 2010

Medical Controversy: Gender Bias in Medicine

Yup. You read it right. I'm going to cover gender bias in medicine. Don't worry about me I'm wearing my asbestos outfit. Even so... hang on. This is not going to be a short post and it may occasionally sound like a rant.

Before I begin I'll start with a disclaimer. I have an unavoidable bias on this topic. You see I'm male. I thought I'd better get that out of the way before I start. Full disclosure is important after all.

In case you think this will just be a review of the literature... you're only partially right. I'll also explain my view on gender-bias in medicine and list for you what I wish could happen to further the discussion in a sane and sensible manner. So let me give you my position on gender-bias in medicine before I get into the thick of things.

To the question "Is there gender bias in medicine?" my answer is "No and Yes - in that order". And that's a firm answer which isn't at all indecisive. Don't believe me? I'll explain later.

I've worked my entire career in healthcare. First in hospital computer departments and now for a regional digital imaging repository. I'm not a clinician nor do I have any medical training. I work with computers, systems, software, and users. Even though I have no formal medical training there have been occasions over time where people start telling me their theories about healthcare and medicine as soon as they learn I work in healthcare.

One topic that bubbles to the surface every once in a while is how the medical community isn't serving the best interests of women and gives preferencial and better treatment to men. When the topic would get raised I had a decision to make.

You see if the conversation was about specifics and based on some new study I didn't mind participating at all. If someone just wanted to make a small point or just make small talk I'd be nice and polite. When the blanket accusations and sweeping statements started appearing I had to decide how polite to be.

Should I be quiet and nod quietly? Bite my tongue? Politely ask questions to find out how much the other person actually knows about the subject? Or start asking pointed questions and bring out the heavy guns of evidence to shoot down an endlessly repeated list of baseless and disproven claims?

Let me be clear. I don't believe that all claims of bias are baseless or without merit. What would get me going is when a person would go from "I read in the paper that..." to "...and that's why women are suffering and not getting adequate care..." to "...women are still treated like second class citizens." all in one breath.

 This was usually followed by one or more of these:
  • women are underrepresented in medical studies
  • women were (or are) not allowed in clinical drug trials
  • men are getting more surgical procedures than women
  • men get more medical care than women
  • women get fewer diagnostic tests and procedures than men
  • medical technology is developed for men first
All these are vague accusations that people, men and women, make against medicine and medical research. I've pushed a few people over the years and asked how they know these things and what convinces them that they're true. One person in particular tried to make me feel inadequate and stupid since I didn't just 'know' that this is the way the world is. Apparently having coherent arguments to back up one's claims wasn't that important. He felt that if I didn't agree with him that there was a problem then I was a perfect example of how the medical community looks at women.

Did I mention I'm not part of the medical community?

Plus trying to make me feel inadequate because I didn't 'know' these truths didn't work. Usually I tried to be somewhat polite but I did push back quite hard in that particular case.

It's not just the general wisdom that tells us repeatedly that women are not being treated as well as they can be by the medical establishment. Just recently there were three op-eds in the journal Nature that were summarized in a press release that made the rounds. One place the press release landed was at The Institute for Women's Health Research at Northwestern University. Dramatic reading for a press release. Nature magazine wants you to log in or pay to read the op-eds... so for most of us the press release is all we're going to get. Give it a read. It won't take long. It's just a press release.

The Nature op-eds aside I've noticed that the trend seems to be changing. There are less outright claims of sweeping bias in the media. The press coverage tends to be very specific now. If there is a study that shows some bias against women then it gets written about. The article is filled with the usual "it may be a subconscious bias but it still exists" type of wording. There is usually a subtle underlying assumption that this is just more of the same and shouldn't come as too much of a surprise. Often there is some wording to the that says "this just shows how much progress still needs to be made". The articles start specific but then subtly reinforce the notion that there is a large underlying problem.

Notice that we don't seem to hear about studies that show a lack of bias against women. Who's going to read those? If someone finds that women are treated as well as possible will I read it in the paper?

An example of this type of article comes from closer to home than the journal Nature. The Globe and Mail has a perfect recent example with Men twice as likely to get knee surgery. It's an article that covers research on gender bias. The research was based on checking on only 29 orthopedic surgeons and 38 family doctors (of which only 12 were women) by sending fake patients of both genders and seeing if knee surgery was recommended. A small study with a small sample size gets a write up in the Life section of the Globe and Mail. I'd be much more interested if and when there is a bigger and more controlled follow up study myself.

On those few occasions where I started to take people to task and ask them how they 'knew' women were not being treated well in medicine I had an ace up my sleeve. I had counter arguments and challenges because of an article that appeared in the Atlantic magazine back in the summer of 1994. The Sex-Bias Myth in Medicine by Dr. Andrew G. Kadar took me by surprise when I first read it.

If you had asked me about sex-bias before I read Dr. Kadar's article I would have blindly agreed with the common wisdom. Of course women are mistreated by modern medicine. It's simple and obvious. Everyone says they are mistreated so it has to be. Right?

Wrong. Potentially very wrong. Don't believe me? Go read Dr. Kadar's article. Go on. I'll wait.

Dr. Kadar made me think about the assumption that women are short changed by the medical community. He did so by first presenting the accusations and the prevailing common wisdom. Taken as a whole they are damning. To quote Dr. Kadar:
Discrimination on such a large scale cries out for restitution--if the charges are true.
He then looks at each accusation and they are all found wanting. From discrimination in the number of diagnostic tests, to the number of referrals for bypass surgery, to the question of women in heart disease research, to whole new surgical techniques that were developed for women first, to the development of ultrasound imaging originally for women, to the amount of research funding spent specifically on each gender. For each Dr. Kadar slowly builds the case that women are doing quite well and that the bias either isn't there, has other legitimate explanations when you get past the initial apparent bias in the numbers, or is against men and not women.

When it comes to research dollars the apples-to-oranges comparison he makes is between breast cancer and prostate cancer research. This is a particular chestnut used by people arguing against gender-bias against women and this is one case where I'm not sure I agree with the premise.

The premise is that breast cancer predominately afflicts women and prostate cancer occurs in men. The number of deaths are similar but not the amount of money spent on research. Much more money is spent on breast cancer research. Therefore there is an inequality or bias against men. At least that's the premise.

I'll be honest on this one. I'm not going to take this argument at face value. Breast cancer and prostate cancer are different. I don't know enough about when in a person's life breast cancer and prostate cancer occur. I don't know enough about whether breast cancer and its treatments make a bigger difference to quality of life than prostate cancer and its treatments do. I don't know if more money should be spent on one or the other. I do know however that at first glance the disparity in research funding seems quite disgraceful. As do many of the facts and figures presented by those arguing that there is a bias against women. At first glance the numbers can look damning. With some investigation the numbers may be much less damning. They may even signs of bias the other way.

As I said I'm not sure on what the correct view of the breast cancer vs prostate cancer research funding discrepancy should be. I don't know if breast and prostate cancer should have similar research funding levels. That's one of the problems with the blanket arguments that women are not being well served by medicine. There are usually more factors at work and other explanations to think about. Statistics without background are meaningless.

When it comes to women in clinical drug trials it turns out that women weren't excluded from drug trials completely. Drug trials go through 3 phases. Women with "childbearing potential" were excluded from phase 1 studies and early phase 2 studies. The reason for these exclusions in the early stages? The early stages when drugs are being tested to see if they are at all safe and not just effective for their intended use? The reason was the thalidomide tragedy of the 60s. Even so the exclusion was removed in 1993, a full year before the article was written.

Do you believe that women were completely excluded from all clinical drug trials in the U.S.? And do you think the ban is still in place? That's the common wisdom that people keep mentioning. It amazes me that people still talk about the exclusion as if it was total and as if it is still in effect.

Dr. Kadar then makes a point I hadn't seen made before. One I didn't grasp until he pointed it out. For all my life I've lived under the assumption that women naturally live longer than men. In my lifetime they always have. Historically though that wasn't the case. Women lived shorter lives than men until this century.

And yes... much of that newfound lead in life expectancy is due to better care during pregnancy and childbirth. Which is, by any definition, medical care at its finest. 

But if you look at the numbers you'll see something else. It took me a while but over time I noticed it. In 1920 men lived to 53.6 and women to 54.6 years old. In 1990 men lived to 71.8 and women to 78.8 years old. Women lived a year longer than men in 1920 and 7 years longer in 1990. But did you catch the other bit of data in those numbers?

Both men and women live longer in 1990. Men have added 18 years to their lifespan and women have added 24 years. Men and women have both benefited from better healthcare, antibiotics, curing of diseases, and advances in medical technology. I think we forget how well we all have done thanks to medical research and technology.

In a nutshell Dr. Kadar makes the point that women receive more healthcare, as many tests and procedures, as much or even more research, and have benefitted more in terms of lifespan from medicine. Yet in spite of this people still claim there is a huge bias against women in medicine and medical research is not serving women well. I couldn't help think of the What have the Romans done for us bit from the Life of Brian during those combative conversations with people who were convinced that women weren't well served by medicine.

For me Dr. Kadar's article was important because of how it took on the main accusations that were levelled against medicine and countered each one with numbers, studies, and data. His article and work didn't stand alone. I recently found a longer piece by Cathy Young and Sally Satel written in 1997. The Myth of Gender Bias in Medicine was released by the Women's Freedom Network. The WFN's website is no more but the article is still online at another site. Yes it's online at a men's site. The article is online with the permission of Cathy Young but it's current form has a few obvious typos. Young and Satel go into more detail than Dr. Kadar. This makes their article hold even more weight with counter examples.

So gender bias doesn't exist? Or if it exists it is exclusively against men then?

No. I don't believe that at all. Gender bias in medicine does exist. Sometimes the bias favours men. Sometimes it favours women. Research money can never be allocated in such a way that there will be no discrepancies. There are certainly areas in which women suffer more than men and vice versa. There are conditions for both sexes that are underfunded and not well researched. Bias of all forms, gender included, does occur in medicine and medical research. There are diseases that affect only women and those that affect only men. Things get even more complicated when you're trying to figure out the impact on quality of life various diseases have instead of just looking at mortality numbers.

But that's not what people talk about. They don't talk about specific cases or particular areas. When research shows no bias against women it doesn't make the headlines. When research shows bias against men it rarely makes the headlines. And when research does show a bias against women the resulting articles tend to overstate and sensationalize the research in question.

Want a case in point? Okay... I'll provide one. It's an article called Women in Pain by Dr. Christina Lasich published on HealthCentral. This short article does a good job of reminding its readers that women do suffer from chronic and painful conditions more often then men. This results in pain that needs relief. The article hopes that as more research is done there will be more effective pain relief for women. So far I'm on board and agreeing completely. Chronic pain is an area that affects women more than men and research has shown that pain relief works differently in women than it does in men.

In the article though Dr. Lasich mentions a study called A Review of Clinical Research and Pain Management in Women and says:
[Witney McKiernan RN - the author of the study] found that the lack of help for women in pain is due in part to the lack of research specific to women in pain. Well, the FDA prohibited the participation of women in clinical drug trials for years. That ban did not start to thaw until the late 1980’s. Now, we have something called the Women’s Health Initiative; however, there continues to be discrimination in early clinical trials and researchers are still failing to account for gender differences when the study cohort does include women. In the past fifteen years with the inclusion of women in the research of chronic pain, many gender differences have already been discovered. PET scans have documented that women respond to pain differently than men.
First off she says there is a lack of research specific to women and then she finishes by saying that women have been included in research into chronic pain and differences have been discovered. Which is it? Let's see what the study itself says. The abstract for the paper in question says:
The involvement of women in clinical research has fluctuated in the course of recent medical history. Over the past fifteen years, the enactment of federal policies supporting gender-based research reflects a new appreciation of the importance of including women in clinical research. Women are increasingly participating in clinical trials for new drugs; however, gender-specific clinical data are lacking, suggesting the absence of data analysis to determine sex-related differences in the pharmacokinetics and pharmacodynamics of drugs. In this report, clinical trial data, meta-analyses, and literature reviews from the past 25 years are used to explore the barriers to in-depth clinical research on women and examine the implications of a research bias for pain management in women. While an extensive body of research on women and pain pharmaceuticals is currently being developed, there are myriad untapped opportunities for future research and policy that have the potential to supplement the knowledge base in this area and provide critical information to clinicians and patients.
The paper suggests that there may be an "absence of data analysis" not an absence of research and that "an extensive body of research on women and pain pharmaceuticals is currently being developed". There is no mention in the abstract of the lack of research mentioned in the article. In the article there is mention that there are "myriad untapped opportunities for future research and policy that have the potential to supplement the knowledge base" as the study points out. To me a myriad of oppurtunities doesn't point to a lack of research. It points to having enough existing research to know which areas to explore next.

I'll let you read the entire study (it's very interesting) but if you don't want to here's the conclusion:
A considerable amount of research demonstrates the importance of using gender-based information when treating pain in women. It is crucial that scientific research continue to support the exploration of sex-related differences in physiology, disease pathology, and the pharmacokinetics and pharmacodynamics of drugs so that women and their care providers can access accurate information and make informed health choices.
The study says one thing... the article another. Even if the two aren't polar opposites there are differences in how the conclusions in the study are presented. Which would you think is correct - that article or the actual study?

More importantly which would you and I be more likely to read from beginning to end? Me too... I'm more likely to read the article and assume the research is well summarized. Who has the time to read all the studies to make sure?

And am I the only one who finds it ironic that it took a lot of medical research into women's chronic pain and suffering, and medical research into the differences of pain between the sexes, and medical research into the implications of those differences... to give people enough information to then claim that medical research isn't doing enough to solve the problem? That there is a growing body of research into fibromyalgia and other chronic conditions should be seen as a good sign right? Not just evidence that there is bias. Even if there is bias currently... isn't the "considerable amount of research" and the "myriad untapped opportunities" signs of progress?

Then there are the accusations that there is conscious and/or unconscious bias among medical practitioners. Such as those mentioned in the Globe and Mail article.

Let me give you a perfect example of gender bias in action. An example of conscious or unconscious bias among medical practitioners. I'll use a "Comment" article in the Journal of Epidemiology and Community Health by M. T. Ruiz and L. M. Verbrugge called A two way view of gender bias in medicine (pdf).

First off if you're going to read it sit down and take a deep breath. It's not a study or a piece of research even though it sites many studies. It reads more like a modern deconstruction of an article about medical research. I think it's heart is in the right place but I think the execution stinks. As a "comment" it can cherry pick studies that support it's conclusion without being a balanced look at the whole field. That's not a bad thing when you're trying to change attitudes and convince people of your position. As I said I think it's heart is in the right place. At least the authors seem to be trying to move the discussion on gender bias forward.

The article's two way view isn't based on men vs women by the way. It's based on the fact that women are short changed when medical research assumes men and women are biologically similar and that women are short changed when medical research assumes men and women are biologically different.

According to the article it doesn't matter what medical researchers think... they're doing a diservice to women. Damned if they do. Damned if they don't.

Where's the conscious or unconscious bias? The bias is in how the authors treat the male gender. The authors never once suggest that there could be even a single case in which bias in medicine may be a bias against men. Apparently that can't happen.

I dare you. Go look yourself. I've found explicit statements in the article that there is a bias against women. I've found blanket statements that say there is bias without mentioning a gender but which seem to assume that the only bias is against women. But I couldn't find a single line that suggests that the bias may go the other way even in one case. To me that's an unconscious or unstated bias in the medical community.

When it comes to real biases in medicine we also have to be aware that trends are important. Even when one gender is doing better than the other the picture may not be rosy. In my Anatomy of a Comment I linked to a startling graph of Canadian lung cancer mortality rates. The rate of mortality for men is falling. Progress is being made. The rate for women is climbing. They haven't yet reached the same mortality level as men but that hasn't stopped cancer researchers from working to figure out what is going on. The goal isn't to find a perfect balance of mortality rates. The goal is to save and improve lives. Lung cancer kills more men than women. Based only on the mortality numbers more research and work should be done to help men exclusively. Yet based on the trends it's important to figure out why women's mortality rate is climbing. This trend is on the radar of the Canadian Cancer Society. After all they pointed the trend out to the public.

This is a good example of work being done for women when they aren't dying as often as men. Yet. But the goal isn't to balance the scorecard. The goal is to improve overall health for everyone.

So What Do I Think?

I said at the beginning that my answer on the question of gender bias in medicine is "No and Yes - in that order". Let me explain.

No. I don't think there is solid evidence of a systemic bias against women. I don't think you could make the case that there is a systemic bias against men either. Any such claim either way has a mountain of counter evidence to disprove. Extraordinary claims require extraordinary evidence. Claiming a systemic bias is an extraordinary claim.

So far I haven't seen enough convincing evidence that stands up to scrutiny to let the blanket claim against medicine stand.

Yes. Of course there is gender bias in medicine. Men and women are similar in many ways and different in many others. There are specific diseases and syndromes that are under researched and not well understood. Research money isn't always spread out fairly (and I'm not even sure that's possible). There are more than a few cases in which women could be better served. There are cases for men as well.

I'm more than willing to entertain discussion on specific cases, specific diseases, and specific research. I will try my best not to jump to the conclusion that bias doesn't or can't exist. In return allow me to be skeptical and check your numbers and your assumptions.

This is an important medical controversy. Much good work can be done to help redress the various imbalances that have appeared over time. I believe that the overall assumption that men are routinely better served than women does more harm than good in moving the discussion forward.

Feel free to disagree... I still have on my asbestos clothes.

If you've made it this far I thank you. I'm not done yet though. Let me tell you what I hope will happen to the discussions around gender bias in medicine. I'm too pragmatic (some would say cynical) to assume that people will take these seven suggestions to heart but I'm not cynical enough to not list them.

1) Let's admit that people have benefitted greatly from advances in medicine. We're all much better off now than people were one hundred years ago. Men and women have both been well served by medicine.

2) Don't assume there is a systemic bias against one sex or the other. If you do make that assumption be prepared for a lot of questions and a lot of criticism. You better bring one hell of a complete and detailed case to the table to even begin to be taken seriously.

3) Assume there are areas of gender bias in medicine. There will always be areas in which women or men aren't well served. Don't say they can't exist. Don't say that gender bias is impossible or not happening. These specific claims have to be taken seriously until they are disproved or shown to be valid. Advances in treatment and drugs may not serve both sexes equally. Of course this means that the areas that have a gender bias will change. Some will go away. Others will get worse. New ones will appear.

4) Please understand the difference between treatments and outcomes. Surgery isn't always the most effective course of treatment. More procedures for one gender may not mean better outcomes. You have to look at outcomes as well.

Different treatment guidelines exist for many diseases that depend on age, health, sex, weight, size, and other factors. When you hear "men get more this" or "women get less that" check to see which gender is getting the better outcomes. Try to determine if everyone is getting the most appropriate care necessary to receive the best possible outcomes.

If the outcomes are completely different between genders check if they've improved over time or if they are getting worse. Take the example of women and lung cancer mortality. Fewer women than men die of lung cancer yet the concern is why is the mortality rate for women rising while the rate for men is falling. Outcomes and trends are important in understanding if research and treatments are helping people.

5) Understand that research in an area doesn't necessarily guarantee results. Certainly not results right away. If a case of gender-bias is found and it seems that no progress is being made check to see the status of research before making accusations. Is there ongoing research? Are there discoveries and advances being made? Are there potential treatments and drugs in the works that haven't made it to clinical trials yet? And is the research taking time just due to the complexity of the subject matter?

A lot of money and research doesn't mean there will be a simple cure soon. Simple cures and therapies are discovered but you can't count on them.

Remember we've handled most of the easy diseases already. With the 'simple' ones taken care of we are living longer lives. Longer lives that are leading to new and challenging medical problems.

6) Even if this seems contrary to all I've said so far... it isn't. If you think there is an area where a gender isn't well served raise your voice and speak loudly and often. If you're concerned about an apparent inequality take the time to dig into the numbers a little and build your case. If you think it's a real problem raise a stink.

Be prepared for counter arguments. Be prepared for resistance. Keep raising a stink if it's required but please do so with humility and discussion. Bring facts to the discussion and not just accusations. Having facts and solid arguments on your side is more likely to get peoples attention in the medical and medical research communities than claims with no substance behind them.

Oh... and if you are more interested in muckraking, or ratings, or page views, or achieving best seller status, or getting on the talk show circuit, or in making political points then in having a useful discussion of the issue you're raising... then forgive me if I don't take you as seriously as someone who can back up their claims and is willing to be have those claims scrutinized.

7) Understand we all want to live longer. We all want a better quality of life along the way. Most of us will get it. Medicine has helped both men and women and it will continue to do so. Let's make the discussion be one of how medicine can do better for women and men instead of one where medicine is attacked, accused, and blamed.

In closing let me say I'm all for informed and sane discussion on gender bias in medicine. I know it exists. I know it will continue to exist. Over time some areas of gender bias will go away and others will be discovered. Maybe we've reached the point where the 'simpler' diseases have been taken care of. We don't die of tuberculosis. Smallpox isn't ravaging millions. Antibiotics and other wonder drugs are common place.

More and more we're left with the more complicated syndromes and diseases. We're left with the ones where gender differences have to be taken into consideration in treatment and research. We're left needing to make sure that gender and other factors are taken into consideration. What we need is to be open to informed discussions so better decisions can be made.

I don't think blanket and baseless accusations help this discussion at all.

And if you think we still need the blanket accusations and that I'm completely full of it... I'm not worried. I'm still wearing my flame proof suit.

Thursday, July 29, 2010

The Basic Laws of Human Stupidity

Imaging a graph on which you can plot human behaviour. Or at least where you can plot how people's behaviour affects themselves and others.

Start with the two axis.

The horizontal axis will represent how much a person helps or hurts themselves.
The vertical axis will represent how much a person helps or hurts others.
You could then place people generally into the four quadrants based on how they act in those two categories.

  • If someone helps themselves while helping others you'd have the intelligent people.
  • If someone hurts themselves while helping others you'd have the helpless people.
  • If someone helps themselves while hurting others you'd have the bandit people.
  • And of course those who hurt others while hurting themselves would be the stupid people.

If you think such an arrangement based on how much benefit a person provides to themselves and to others is something that came from economics you'd be right. The late economics professor Carlo Maria Cipolla came up with this way of classifying people when he wrote about stupidity.

His definition of stupidity is the best I've ever heard. Stupidity is the act of hurting others without even benefiting yourself.

His treatise on the subject is the aptly titled The Basic Laws of Human Stupidity. If you want to think about economics in a new light give it a read. I'm sure you'll end up nodding your head while agreeing with his five laws of stupidity:

  1. Always and inevitably everyone underestimates the number of stupid individuals in circulation.
  2. The probability that a certain person will be stupid is independent of any other characteristic of that person.
  3. A stupid person is a person who causes losses to another person or to a group of persons while himself deriving no gain and even possibly incurring losses. (The golden rule of stupidity)
  4. Non-stupid people always underestimate the damaging power of stupid individuals. In particular non-stupid people constantly forget that at all times and places and under any circumstances to deal and/or associate with stupid people always turns out to be a costly mistake.
  5. A stupid person is the most dangerous type of person.
    A stupid person is more dangerous than a bandit.
I have a newfound respect for the insights professors of economics can give into the human condition and human behaviour. I also have a newfound appreciation for the dangers posed by stupid people.

So as you look around at people just remember there are stupid people everywhere.

Wednesday, July 28, 2010

Medical Controversy: Where are all the New Cures?

Do some research. Find a drug. Test it on animals. Then on humans. Get approval. Profit. That's all there is to finding a cure and getting it to market. Right?

The more sobering truth is told in Why Don't More Medical Discoveries Become Cures? It's a wonder anything gets to market at all.

Tuesday, July 27, 2010

The Magic of The Computer in Your Pocket

I put off having a cellphone for the longest time. Not because I'm a Luddite. I am in fact a died in the wool technofile. For me it was not that I disliked cellphones but that I wanted to be able to be out of touch. Having been on call in some form or another for various jobs for years on end led me to want to sever the wireless tether whenever possible.

Soon after I broke down and bought a cellphone I started a new job and instead of a land line and a pager they handed me a Blackberry. Email, phone, and apps all in one place. Do you know how hard it is not to be addicted to a device like the Crackberry? So while I own a simple cellphone I tend not to use it. I use the smartphone I need for work instead.

Smartphones are an interesting breed. More than a phone and less than a computer. Their history is fascinating on its own. One of the best ways to get introduced to the whole idea of the smartphone is to sit back and read Stephen Fry's personal telephonic history Devices and Desires.

One part of smartphone usage that is intriguing is the differences in usage between Europe and North America. The two continents treat smartphones differently. Or at least they did. A Tale of Two Smartphones: US vs Rest of World compared is a good overview of the divide.

I'm not sure I'd get a smartphone if work wasn't paying the bill. Canada has high phone and data rates so a truly unlimited plan with all the trimmings is not cheap. Though that's finally beginning to change. It's nice to have a small computer in the palm of my hand. I can live without one without suffering. I'm just not sure I want to anymore.

Monday, July 26, 2010

Medical Controversy: Apparently Everyone is an Expert

With many areas of medicine most of us laypeople know how little we know. We may have an opinion on cancer or leukemia but unless we have personal knowledge we tend to leave those to the experts. For much of what medicine covers we leave things to the experts. After all would you trust just anyone to look after your heart problems?

There is one area in which people have more than just opinions. An area where people are sure they know what's right and they know what's wrong. That's health, fitness, and weight loss.

If you think about it for a second those are areas that medicine, or at least biology, could be authoritative on. Want to know how to lose weight? Consult the current best practice guidelines given to physicians and health professionals. Want to know how to achieve a fit body? Consult similar guidelines for the type of body you want. Unfortunately there is no such set of best practices and guidelines. Or at least none that I've found that covers these areas authoritatively.

Which isn't to say that people haven't written on these topics at length. Some with more rigor than others. For example there's the Beginner's Health and Fitness Guide which is one of many such guides and sites on the web. Even in publications that specialize in these sorts of guides the current best practice changes all the time. The article Interval Training Doesn't Work from T Nation is a good example of this.

I'm not sure if I have an opinion on weight loss or fitness. All I know is what worked for me when I lost a great deal of weight. Like anyone who was successful (at least for a time) I like the approach I took. Unlike many I don't go around evangelizing it because I'm not sure it will work for anyone else. If you're interested I lost weight using a personal variation on The Hacker's Diet.

Sunday, July 25, 2010

The Power of Inexpensive Video Editing?

Warning: The Longer Web, and anyone associated with The Longer Web, will in no way be responsible for any time lost due to the contents of this post.

Have you ever wondered:

  • What almost all of Alfred Hitchcock's cameos looked like in his movies?
  • How many "frak"s are in the first season of Battlestar Galactica?
  • How many times characters in Lost say the word "What?"?
  • Which actor swore the most in Glengarry Glen Ross?
  • How many people Charles Bronson killed in the Death Wish movie series?
  • What you'd be left with if you edited all the dialog out of His Girl Friday?
  • How much swearing is in a single episode of Deadwood?
Well wonder no more. These and many other questions are answered in a collection of Fanboy Supercuts, Obsessive Video Montages from

Don't say I didn't warn you. The long list of videos is enough to keep you busy for quite a while.

Saturday, July 24, 2010

Staying Safe Around Dangerous Substances

With all the recent posts about medical controversies I've ended up doing a bit of extra research. After all it helps to know how many people are affected by various syndromes or diseases. Along the way I found a summary of the leading causes of deaths in the United States. Reading down the page I came to the section on leading causes of accidental deaths.

Number 1? Motor Vehicles. They're not just out to kill you in the movies. After that comes unspecified non-transport accidents. Then falls. Then poisoning and noxious substances.

13% of accidental deaths are caused by poisoning. That seems about right to me when it comes to covering all ages.

What surprised me is the stats for poisoning when they're broken down into age groups. The percentage of accidental deaths caused by poisoning for different ages looks like this:

  • < 1 yr - 1.6%
  • 1-4 yrs - 1.8%
  • 5-14 yrs - 1.5%
  • 15-24 yrs - 8.2%
  • 25-34 yrs - 30.3%
  • 45-54 yrs - 24.9%
  • 55-64 yrs - 9.2%
  • 65-74 yrs - 3.6%
  • 75-84 yrs - 2.1%
  • > 85 yrs - 1.6%
Those numbers had me thinking. They just didn't make much sense at first. Aren't we supposed to be worried about accidental poisoning in children? Isn't the push to keep chemicals, cleaners, and other noxious substances away from little kids and their inquisitive nature?

The low percentage or under 1 year old makes sense. Not too many infants can poison themselves and parents are very careful around infants. Almost 65% of accidental infant deaths are due to unspecified non-transport accidents. That sounds about right.

Moving up the list though I'd thought that the percentages of accidental deaths would be higher in kids and even in teens. Yes I know there are other accidental causes of death that come in to play as we get older but I never suspected that poisoning was responsible for over a quarter of the accidental deaths for Americans between 25 and 54. What are we doing to ourselves?

What the numbers do show is that poisoning is a significant cause of accidental deaths. National Poison Prevention Week (video) is in March. There are ample tips to be found on protecting your children from dangerous substances. And if you look around you can also find information on preventing poisonings among the elderly (pdf).

All of which is good information and incredibly useful and has saved lives. Even so... maybe all of us in the middle of our lives should be careful as well. Maybe we don't take the chance we'll accidentally poison ourselves seriously enough.

Friday, July 23, 2010

Medical Controversy: Change Can Take a While

There's something powerful about time. What is controversial for one generation is no big deal for the next. Attitudes and perspectives change. Even strongly held beliefs can find themselves weaker over time.

I once heard the argument that the late Canadian Prime Minister Pierre Trudeau had done more to solve the problem of Quebec Nationalism by changing immigration laws than by any other means. Changing the laws allowed for a flood of immigrants to Canada from all over the world. Those who came in to Quebec learned to speak French and became Canadian citizens. They were new Quebecers who had no emotional attachment to the historic divide between French and English. They were Canadians first and Quebecers second. For them the Plains of Abraham was just a historic battle. By the time the second referendum came around there were just enough of these new Canadians in Quebec to ensure that Quebec would stay as part of Canada. A change to immigration laws helped keep Canada together years later. As the leader of the separatist movement at the time Jacques Parizeau said in his speech after losing the referendum "It's true we have been defeated, but basically by what? By money and the ethnic vote." (video). Ethnics referred to all those new Quebecers from around the world.

There is power behind those that are willing to take the long view and move towards a goal even if it takes years. Nationalist views are some of the most deeply held and yet even those can be slowly eroded and weakened. What if the same is true with other deeply held beliefs?

Could the changing of the generations and slow change towards a long term goal change the view and position of abortion in America? The New Abortion Providers in the New York Times explains how some people are trying to make this long term change happen.

It will be interesting to see what happens over time. Will attitudes change because there are more doctors and hospitals that perform abortions? Will it change because over time Roe v. Wade becomes part of the landscape? Will it become as accepted generations from now as a part of medical care as it is in other places around the world? Or will all the endeavours and time still leave America as divided as it is now over the issue?

Thursday, July 22, 2010

How Will We Do Digital Archeology?

The Sumerians wrote on clay tablets. The egyptians put hieroglyphs on stone and papyrus. What ancient people put on stone and clay has a chance of lasting through the ages. We've even stumbled across helpful bits of stone that help us translate between languages.

In the digital age things are much harder. It's hard enough to access a document created in some now obsolete program. It's a matter of digital preservation and fighting digital obsolescence.

Still not convinced it's a problem to preserve digital information for the future? How about this simple question... can you still buy a computer with a floppy disk drive? And what type of floppy disk drive? The 3.5 inch ones in the hard cases or the older 5.25 inch disks? What about the 8 inch floppies?

It's a much bigger problem than just a few different sizes of floppy disks. Take a glance at some of the ways we stored digital data at the Lost Formats Preservation Society page. Glancing over the monochrome outlines of old storage technology it makes you wonder how many digital documents have already been irretrievably lost.

Of course you could also play the geek cred game of working through the list and finding out how many of those formats you've used at one time or another. My LFPS number is 18. If I include a couple of formats that aren't on the LFPS page I'm up to 20.

And the LFPS list doesn't include any type of internal hard disks. They only cover portable media. But old hard drives are lost formats as well. Disks that I pulled from original IBM PCs can't be plugged into any new computer. The number of different hard drive types is staggering.

The more I try and wrap my mind around digital preservation the more I think it will be easier for archeologists in the centuries to come to know about the early 1900s than it will for them to dig into the details of the early twenty first century.

Wednesday, July 21, 2010

Medical Controversy: The End of Life

North American's don't seem to handle death very well. Other cultures seem to have much more robust and sane traditions on how to handle death in the family. We seem to want to get grieving over with and as a society we don't allow much time for grief or time to cope. This cultural aversion to dealing with death isn't limited to the time after loved ones have died.

The fastest growing segment of our population is the elderly. Those people who've lived a long life and one healthy enough to make them prone to the diseases and problems of the old. We face having a significant portion of our population being elderly with all the trials and tribulations that entails. We're living long enough to fall prey to dementia and to live to the point where we need help every day to just live.

Which makes dealing with the taboos around death important. Choosing how we wish to live out our later years. Or even if we wish to live them out at all under certain conditions. As more people move into the final years of their lives they will start to contemplate how they wish to handle aging and death. Spouses, children, and grandchildren will watch people making difficult and very personal decisions about life and death.

A particularly poignant example that happens to touch on many of the issues we might face is What Broke My Father's Heart by Katy Butler which also carries the telling subtitle "A Pacemaker Wrecks a Family's Life".

Our culture is not yet at the point where we feel comfortable dealing with these issues. We're not used to discussions over do not resuscitate orders or what type of life is or isn't worth living. It will be awkward. It will be challenging. If we do it right maybe we won't look forward to our later years with dread and fear. Maybe they can be our golden years.

Tuesday, July 20, 2010

From Green Toilets to a Famous Hominid

Wayne is at it again. This time sending me a link that had me digging into the depths of porcelain archeology and sent me all the way to one of our ancestors.

He sent me a link to the Wired article Pissing Match: Is the World Ready for the Waterless Urinal? The world may need a waterless urinal especially in areas where there are water shortages. After all a busy urinal may use 40,000 gallons of water a year. The article itself goes into the politics and problems of trying to get plumbing codes changed to allow the urinals to be used. One major code was changed to allow for waterless urinals as long as a water pipe was run to that area of the bathroom and then capped. While this may sound silly, redundant, and like a make work project put forth by the plumbers unions (which it was) it also means that if you decide you don't like the waterless urinal there is already a water pipe in place for its replacement.

The fascinating recent history of the waterless urinal isn't enough though. I know it isn't. Don't worry... there's a lot more out there if you go looking. has been online since 1994 with advice and links on all the issues you can imagine relating to plumbing. Heck the site still looks like it's in the late 90s. Amongst all the usefull and practical advice is a history of plumbing. A similar site toiletology has another history online though in keeping with the site it is more specifically the history of the toilet and not just plumbing. Toiletology also has been online for a while and, like theplumber, looks like it hasn't been redesigned for over a decade. If you want a more tongue in cheek history of the urinal from Gracesdad's blog Normal Chaos.

But even those histories, as well researched as any history you will find online, are nothing compared to the power of Wayne's Law when applied to the word urinal. Take the word... add "www." to the beginning... and start adding net suffixes until... voila... there is a site called Calling itself the "best place to piss away your time on the Internet" it is a priceless treasure.

It is a site where people submit photos of urinals around the world. You can gaze at the wonders of the Top Ten Urinals in the World (truly well worth a look) and behold the interactive Urinal Map. Think of what you can learn while browsing pictures of urinals around the world. Did you know that The Cleveland Museum of Natural History held the remains of Lucy for a while before returning them to Ethiopia? Neither did I until I read the caption under the picture of the museum's porcelain and went digging a little.

At which point I stepped away from the browser before I kept going. Who knows where I could have ended up if I kept surfing.

Monday, July 19, 2010

Medical Controversy: Multiple Sclerosis is a Vascular Disease?

When new unproven treatments appear I tend to think that it will be the medical profession that pushes them before they are shown to work. I keep forgetting the other side of the equation. Namely the patients.

In 1995 Elena Ravalli started suffering from the symptoms of multiple sclerosis (MS). It so happens that her husband is a professor of medicine at the University of Ferrara in Italy. He went looking for the solution to MS and came across an interesting finding. Her husband, Paolo Zamboni, went looking and found a potential link between MS and blocked veins that drain blood from the brain.

It may be that the blocked veins allow iron and other substances in the blood to cross to cerebrospinal fluid where they cause damage.

Then he performed a simple operation on his wife alongs the lines of an angioplasty. He unclogged veins and let blood flow freely. His wife hasn't had an attack since.

A couple of his scientific papers are accessible online. They do tend to have the dense titles of most scholarly medical research. For example there is Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis and the only slightly more accessible The Big Idea: Iron-dependent inflammation in venous disease and proposed parallels in multiple sclerosis.

I first heard of this research in late 2009 when The Globe and Mail covered the background of his work.

With early promising results (beyond just his own wife) patients with MS have jumped on the potentially simple cure. If a quick procedure to unblock some veins can stop and possibly reverse MS that is light years beyond any previous therapy. It makes complete sense to see patients actively trying to get treatment.

And this is one of those cases where the researcher himself is urging patience and caution. Zamboni himself says that doctors who are performing the procedure are acting irresponsibly but then he tempers his words saying that vascular neurologists should recommend the procedure for patients with advanced cases. Either way much more research needs to be done. But that isn't stopping patients. They are travelling to places where doctors will perform the procedure.

Put yourself in the shoes of someone with MS. There is a potentially revolutionary breakthrough that can remove MS completely with a simple surgery but it is still being researched. If the chances of side effect or complications from the surgery was low would you travel to the ends of the earth for treatment?

Most of us would if we could afford it.

To those that have a disease medical science will usually seem too slow and too cautious.

Saturday, July 17, 2010

Staying Safe on the Water

If you want to learn about something in particular it helps to ask the experts. Just remember the experts aren't always the people with degrees and a scholarly background.  If you want to know how to stay safe in the water ask people who work on the water.

gCaptain calls itself "The Site for Maritime Professionals" and it seems to live up to its own billing. Recently on its blog there have been two articles about water safety by Mario Vittone. Drowning Doesn't Look Like Drowning and The Truth About Cold Water. They are both well worth a read.

gCaptain's blog can lead to all sorts of discoveries. I quickly stumbled across a link to Low-tech Magazine's article on Lost knowledge: ropes and knots. I have more than a few books on knots. I used to be handy at some of the more typical knots used on small water craft. The list of links at the end sent me running off to look into the art of splicing ropes together. Something I never did get around to learning to do.

With some water safety tips to learn and some knots to relearn I better be careful or I'll find myself in a dinghy soon sailing around Lake Ontario.

Friday, July 16, 2010

Medical Controversy: Placebos are Fake Aren't They?

Placebos are in the news again. This time in conjunction with homeopathy of all things. Doctors in the United Kingdom's National Health Service (NHS) voted on whether homeopathy should be provided and paid for by the NHS. There were doctors who thought it should be provided. They didn't think homeopathy was proven by evidence based medicine but because it did provide some relief as a placebo. The vote went against homeopathy but the question of how doctors should handle placebo effects was left unresolved. Martin Robbins summarizes the issue well in the Guardian.

Placebos are simple. Have a doctor give a sugar pill or a saline solution to a patient while saying it's an effective medicine. If the patient believes it is a real medicine they end up thinking that it works. Simple right?

Turns out it isn't that simple. In some cases placebos can actually generate an internal chemical response in patients. Give people a placebo painkiller and they will secret opiods that are pain killers. So it isn't all in the mind.

It gets even weirder. Expensive placebos work better than ones that cost less. We apparently adjust our internal expectations to match our value judgements.

Dan Ariely talks about his research in a talk at Cody's Books that was captured by The section on placebos in particular is excerpted here. The talk covers a wide range of topics that he's explored so expect to be drawn in to the full talk. You'll end up learning a great deal about things other than placebos.

Even weirder the power of placebos isn't just tied to how much they cost. It's tied to what we think modern medicine can do for us. Studies have shown that placebos work as well as antidepressants. But not because antidepressants don't work. They work very well. We 'allow' placebos to work because we think they are the medicine they are replacing. If you tried to give me a placebo for something I don't think medicine can cure then the placebo may not be that effective. But give me a placebo to help me with something I know is treatable and the results are different.

Jay Dixit's 2002 article New! Improved! And Still 100 Percent Fake is a great overview of the increasing power of placebos.

Both Dan Ariely's talk and Jay Dixit's article raise interesting issues. What would happen if medical studies told us how much the drug might cost? How can we take all the research into placebos and the way in which our perceptions help our treatments and turn that information into better ways of delivering care? Can we use the power of our minds that placebos uncover in conjunction with real medical treatments?

It begs the question... how can we fool ourselves into being healthier? And will it work if we know we're doing it to ourselves?

Thursday, July 15, 2010

At Least BP's Oil Spill Was In "Our" Backyard

I've noticed that it isn't called the Gulf of Mexico Spill or even just The Gulf Spill. No one calls it the Deepwater Horizon Spill or at least they haven't since after the first couple of days. None of those stuck. This one has been tagged as The BP Oil Spill.

The name has already implied blame, implied who has to stop it, and implied who will have to clean it up. Not a great bit of public relations for BP.

Of course the spill itself has had all sorts of repercussions. Citizen journalists have started grassroots efforts to document and cover the spill. The impact on wildlife is hard to look at but is being covered by the mainstream media as well. But underneath it all there is one thing we know. This spill won't be swept under the rug. People won't ignore it or forget it. Rules on drilling may or may not change but at least it will be looked at. There are lots of people already thinking hard on what the repercussions are - here are 20 Best Lectures to Learn About the Oil Spill.

What if there was a spill almost no one looked at? What if there were multiple spills? What if there was an ongoing series of oil spills that have been going on for fifty years? What if the total volume of oil spilled worked out to at least one Exxon Valdez spill for each of those 50 years?

You'd have heard about it right? You'd be up in arms over it right? We'd have stopped it, cleaned it up, and made sure it doesn't happen again right?

Wrong. The Guardian lays out the details in Nigeria's agony dwarfs the Gulf oil spill. The US and Europe ignore it. More details on the issues surrounding the Nigerian spills can be found at Global Issues.

If the BP Oil Spill hadn't happened in "our" backyard it might have occurred in a place like Nigeria where we could have ignored it for quite a while. Let's hope what we learn and what we decide based on the spill in the Gulf is applied elsewhere.

Wednesday, July 14, 2010

Medical Controversy: The Power of Prayer?

Is prayer better than a placebo? Would it help to have lots of people praying for you? Or should they rather spend their time and energy doing something else?

A lot has been written back and forth on the issue. Some studies find prayer effective and more than a few popular books have been written on the subject. More studies find little or no effect at all. I don't think as many books have been written on that side of the debate. Certainly they don't seem to sell as well.

Back in 2002 A Prayer Before Dying appeared in Wired magazine. A story about the life and death of Elisabeth Targ. Elisabeth was a psychiatrist who ran a small double blind study about the power of prayer to help AIDS victims in 1995. The initial, albeit small, sample showed great promise so she went on to do more research. On the face of it you'd expect the article to them move on to her subsequent research and especially the attempts to find significant results in a study that wasn't turning out so well for the position of prayer. And those areas are covered. But the irony is that Elisabeth Targ was subsequently diagnosed with a brain tumour. The results of that diagnosis make everything that happened afterwards even more pointed and poignant.

Trying to find a reproducible, tangible, and useful effect of prayer to help illness is an ongoing effort. So many people assume that there is a connection that I don't think the research will stop anytime soon. Even if little has been found so far. Of course for those who think there is a link each study that contradicts their conclusion has to be fundamentally flawed and thrown out.

It's human nature of course.

But what happens if we

end up with more studies like this one? The simply titled Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: A multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer? A study in which some people were randomly assigned to one of three groups:

  1. People who were told they may or may not be prayed for and who were actually prayed for
  2. People who were told they may or may not be prayed for and who weren't actually prayed for
  3. People who were told they were going to be prayed for and who were prayed for
Now this is just one study. It isn't conclusive proof one way or the other. It is, however, a well run clinical study looking at the issue. By the way I like the fact that it's structured so that none of the patients is lied to. No patient is told they will get prayer and then not prayed for. I suppose that combination wouldn't have passed the ethics board. Still it is one study among many. A study with an interesting conclusion:
Intercessory prayer itself had no effect on complication-free recovery from CABG, but certainty of receiving intercessory prayer was associated with a higher incidence of complications.
In other words... the group that knew they were being prayed for (and there were actual prayers) had the more complications. There was no difference between the first two groups. In this case not knowing if you were being prayed for or not didn't make a difference. So knowing you're being prayed for turned out to be the worst option. That's not what most people would expect.

What happens if prayer has a negative effect? What if assuming the prayers of others will help actually hurts your chances? What will people make of studies if things turn out this way instead?

And will a book telling you to avoid the prayers of others ever make the best seller lists?

Tuesday, July 13, 2010

What if the Price is Too Right?

Maybe you've seen the video. The one in which Drew Carey is hosting the Price is Right and announces that the first contestant guessed the amount of their showcase to $494 and then moves on the second contestant who.... hits the amount right on the head. $23,743 exactly. You haven't seen it? Give it a quick look.

If you think Drew Carey looks a little lackluster and doesn't seem too enthused you'd be right. The whole story is a little more complicated. I'll let Chris Jones explain in his article TV's Crowning Moment of Awesome in Esquire.

It's more fun when you know the whole story. Certainly the whole additional story of Ted Slauson adds several layers. For me the sad part is that apparently the Price is Right ended up changing the very game to help avoid further perfect guesses.

The producers no longer rely on Campbell's Cream of Mushroom soup; now they have different soups. They have different everything. They've built more luck into the games, dumb luck, and they've started doing sneaky things like changing the options on the cars — adding floor mats, taking away the stereo system — to mess with the prices.
It's just not the same anymore.

Monday, July 12, 2010

Medical Controversy: What if Medical Rescue is Unsafe?

Downtown Toronto has a cluster of hospitals along University Avenue. Whenever I'm downtown and I hear a low flying helicopter I hope for the best for the patient that's being transported. Traffic choppers fly high enough that you can barely hear them at all. Only helicopters being used to transport patients are low enough to be heard.

The medical transport helicopter is a wonder of the age. If you're in a very bad car accident you can be transported to a hospital in time to safe your life. It's comforting to know they're out there and that they are available when you need them.

Maybe that's a naive thought but it's the one I always had in mind when I thought about them.

What if the choppers aren't just used when they're necessary? What if they don't have to have all the safety equipment of other planes and helicopters? What if they are the most dangerous form of flying in the United States?

Popular Mechanics looks into the issues and problems with medical helicopters. Hold on it's a bumpy ride.

Sunday, July 11, 2010

Follow Up: Causing Cancer...

Every day you read in the paper that THIS causes cancer and THAT will help to prevent it. How are you supposed to know what's good and bad today?

Sadly this isn't an ongoing project but Kill or cure? was a one time snapshot of what the Daily Mail had reported on a whole list of items.

The idea came via an article in the Guardian by Ben Goldacre. In it he pointed out that the Daily Mail is on a quest to categorize all the inanimate objects in the world into those that cause, or cure, cancer. He pointed out that sooner or later they would stumble onto a 'real' threat and probably be laughed at.

Paul Battley built an online app to allow the crowd to categorize Daily Mail articles about cancer. You decide what the article is talking about (magnets, vegetables, or cayenne pepper) and whether the article says it causes or cures cancer. The result is a snapshot of the state of the Daily Mail's view on cancer.

I wonder if this should become an ongoing project that slowly tracks trends and changes over time?

Have fun deciding what is good or bad for you.

Saturday, July 10, 2010

Staying Safe on the Roads

There are ways of subtly changing driver's behaviour to be safer on the roads. Yet the bulk of the responsibility rests with drivers themselves.

One of the biggest dangers on the roads are trucks. Accidents between two cars tend not to be as lopsided as accidents between cars and trucks. Don't believe me? Read some first hand advice. Dailykos has collected some entries from one of their forum members into the post Don't Want to Die Slowly, Mangled Beyond Recognition? (for TBK). The collected entries paint a vivid picture of the challenges of driving a heavy truck and what other drivers can do to stay as safe as possible. The writer, who goes under the name The Baculum King, also defends his advice that some had said has the air of "truckers rule the road" about it. He countered with:
While I freely acknowledge that the rules governing right-of-way apply equally to all road users, I also firmly believe that they are trumped, every time, by the Laws of Physics.
In the entire history of motorized transport not a single post-mortum appeal of a fine point of the rules of right-of-way has overturned the original verdict.
When being whisked around strips of pavement in self powered little metal boxes it is important to b careful of the much heavier boxes that are whizzing around with you.

Drive safe.

Friday, July 9, 2010

Medical Controversy: A Diagnosis that May Change Medical Research

What would you do if you found out you had a higher chance of maybe getting a certain disease later in life? Most of us would probably learn what we could about the disease, figure out what we could do to decrease our chances of getting it, and then go on with our lives.

People who's families have dispositions for certain diseases don't stop living because of what might happen after all.

But what would you do if you had such an increased chance and you happened to have a lot of money? You'd fund research into the disease. At least that's what I would do.

What if you're not that impressed with how medical research is done? What if you think there are better ways to make progress and discover new information? What if you have enough money to have people do the type of research you want to see?

Welcome to the world of Sergey Brin. Co-founder of Google and a person who might (just might) get Parkinson's.

Wired magazine's article Sergey Brin's Search for a Parkinson's Cure  has a full rundown on what Sergey is trying to do and how he's trying to do it. There are a lot of implications for research into any number of conditions and syndromes. What's interesting to me is that Sergey isn't proposing to throw out mainstream medicine. He's trying to help it along in certain areas and in certain ways. As he says in the article:
"I’m not an expert in biological research. I write a bunch of computer code and it crashes, no big deal. But if you create a drug and it kills people, that’s a different story."
While not replacing the world of medical research as we know it the techniques he's pioneering may be ones that give us faster and deeper insight into connections that are otherwise hard to find. There may be an endless string of new insights and ideas that will be made by the same techniques that helped make Google itself so successful.

I wonder if all of this would have happened if he hadn't been diagnosed with an increased chance of acquiring Parkinson's?

Thursday, July 8, 2010

Bursting Academic Bubbles Can Be Fun

It seems that various academic disciplines like to poke fun at each other. Not just for the occasional laugh but also to illustrate when an emperor is wearing transparent new clothes. At some point the fun can turn into rather pointed and harsh criticism. An easy target for this in general is postmodernism and postmodernist literary criticism in particular.

Richard Dawkins' review of Intellectual Impostures by Alan Sokal and Jean Bircmont is a wonderful summary of some of the most pointed criticisms that have been raised.

Chip Morningstar's How to Deconstruct Anything - My Postmodern Adventure is a slightly more lighthearted and informative look at the world of literary criticism from the outside.

Either way these articles both (*ahem* I wonder if I can say this with a straight face) help redefine the dominant paradigm with respect to the nature of the cognitive structures put in place by the inherent phenomenological nature of subjects being studied.

Or something to that effect...

Wednesday, July 7, 2010

Medical Controversy: Salt Continued...

On Monday I wrote about the controversy over salt. The article I linked to was written over 10 years ago. 1999 to be exact. So now it's over a decade later and do you think the salt debate is any clearer?

Of course not.

First may I present the summary for the position of salt reduction via the New York Times. A little light on the controversy and harder on the corporate backlash at being told to reduce salt. This approach emphasizes that the controversy is over and now it's a matter of how public health and government can control salt in foods.

Then may I present a counterpoint from an editorial in the Financial Post. A lot more emphasis on the science and the still controversial nature of the debate. Emphasizing the numbers and the changes (or the lack of changes) in blood pressure.

It will be interesting to see how this all plays out over the next decade or two. Will salt reduction become public policy? Will it be shown to have any beneficial impact? Or will it have no effect or worse a negative effect? If different countries take different approaches to salt then we may all end up as part of one large study into the effects of salt.

Meanwhile I'm going to do what I think is sensible. I'll add salt to my food when it improves the flavour and when I think it's required. I'm not going out of my way to avoid salt.

Tuesday, July 6, 2010

A TLA That Has Changed Our World: DSP

We used to live in an analog world. Phone calls were made over wires where the signal was a fluctuating voltage. Sound was recorded and turned into little wiggles that ended up pressed into vinyl. Photographs were the chemical reaction of silver to light chemically fixed to be visible and permanent.

Now we live in a digital age. Sounds and pictures are a collection of numbers. Numbers that can be copied perfectly. Numbers that can be analyzed, altered, or changed.

A world in which the TLA (or three letter acronym) DSP is more important than you might think. DSP stands for digital signal processing. It covers a large number of domains. From how to convert the analog to the digital and back. To how to manipulate and alter those collections of numbers any number of purposes.

Watch video on your television from a DVD or Blu-Ray player? Thank digital compression techniques that take video and squeeze it to fit onto a small disk. Listen to CDs? Thank the equipment that records sounds into numbers and allows music producers to mix everything together until it sounds perfect. Hate the sound of autotune where a singers voice is pitched up or down to hit a specific note? Blame another type of manipulation that's possible with the techniques of DSP.

In case you want to learn a lot more about the technology, the maths, the science, and the applications of the technology let me point you to the online DSP Guide. A large and growing work that covers much of the world of digital signal processing. The guide is a book that is available online as well as a hardcover. It's a great starting point for diving into the world of DSP. So whether you want to see how people have changed the world by changing strings of numbers using DSP or whether you want to start changing the world by changing those strings of numbers, the DSP Guide is the place to start.

Monday, July 5, 2010

Medical Controversy: When is a Controversy Over?

Quick... what change of diet is the best way to reduce your blood pressure? What has been shown to cause headaches and other problems and should be removed from processed foods? What common seasoning is bad for you?

Did all your answers involve salt? Simple ordinary table salt? It's common knowledge that salt isn't good for us. Since it's common knowledge it must be true right?


What if the science isn't so clear cut? What happens when the vast research includes studies and calculations that support both sides? What happens when researchers want to find out more about the risks and the benefits while anxious public health officials want to make decisions right now?

In 1999 Gary Taubes won a Science in Society Journalism Award from the National Association of Science Writers for his article The (Political) Science of Salt.

Maybe the link between salt and hypertension isn't as strong as we think. Maybe, as the article states over a decade ago, as research continues the benefits of salt reduction are seen to be smaller and smaller. This is a good example of how complicated issues are and how difficult it is to even agree which studies are good and useful and which aren't. To quote the article:
One-sided interpretations of the data have always been endemic to the controversy. As early as 1979, for instance, Olaf Simpson, a clinician at New Zealand’s University of Otago Medical School, described it as "a situation where the most slender piece of evidence in favor of [a salt-blood pressure link] is welcomed as further proof of the link, while failure to find such evidence is explained away by one means or another." University of Glasgow clinician Graham Watt calls it the "Bing Crosby approach to epidemiological reasoning" — in other words, "accentuate the positive, eliminate the negative." Bing Crosby epidemiology allows researchers to find the effect they’re looking for in a swamp of contradictory data but does little to establish whether it is real.
Even if the studies and the data have become clearer in the last decade there are important underlying questions brought to light in the article.
  • What happens when one piece of the puzzle (let's say salt) is only part of a much more complicated mechanism (for instance how the body maintains blood pressure)? Maybe it isn't always possible to reach simple conclusions in all cases.
  • Who gets to decide which studies are good and which are bad? The concept "it doesn't support my view so it must be wrong" works to explain every point of view.
  • When should incomplete or unfinished science be used to form public policy? Should public health officials change official policy after each new discovery or wait for long term results? What happens when science gets applied to whole populations of people?
  • Who can act as arbiter and interpreter in the middle of scientific controversies? Who can explain what is going on to the rest of us? I don't want to hear from someone who's attached to one side of each controversy.
  • If enough people think that reducing salt reduces blood pressure then is the controversy over before the science has been made clear? Could we end up with a massive public re-education campaign explaining that salt reduction isn't necessarily good in some cases?
I could go on. It's a fascinating read and well worth your time. Gary Taubes' article gives some insight into the human nature of science. All while still leaving me unsure whether I'm allowed to add salt to my food.

Sunday, July 4, 2010

Time for Another Scene

I've written about the birth of punk and the birth of jazz. Both represent music I understand and enjoy. I will admit that I enjoy jazz more than punk but I do listen to both. There are a number of genres I'm not so enamoured with. I never did get caught up in House music for instance.

Even so I find it fascinating to read a detailed history of how a single model of synthesizer had such a profound affect on House and Acid House. Don't believe me? Just read The Silver Dream Machine: The synthesizer that accidentally changed the world.

Saturday, July 3, 2010

Counterintuitive Thinking at Its Best - Traffic

How would you control traffic and drivers? How would you make roads safer? How would you lower the number of accidents and control speeding? How would you make drivers act like responsible adults instead of selfish children?

If you ignore the last question the answer would seem to be: more signs, more intersections, more speed bumps, and more ways to restrict and control traffic. All that seems the right thing to do. Treat drivers like moronic children who don't know what to do and force them to follow the rules.

What if the answer is completely the opposite. What if fewer signs are used? What if roads are changed to alter behaviour? What if we treat drivers like responsible adults?

The Traffic Guru gives an overview of the ideas of Hans Monderman. He thought that the best way to influence traffic was not to try and impose crushing control. Quite the opposite. I have no idea if we'll ever get ideas like those put in place on a large scale but it would be an interesting experiment.

Who knows, it's so crazy it just might work.

Friday, July 2, 2010

Medical Controversy: Cigarettes and Cancer

So now it's no longer controversial - smoking is closely linked to cancer. Not every smoker will get lung cancer but their chances are much higher than they are for non-smokers. And it's easy to tell why smoking is bad for you right? All those chemicals, all that tar, and the noxious fumes and gases right?

The question of the day sounds simple. How does smoking cigarettes cause cancer?

Well one theory making the rounds is that it's because of radioactivity. You heard me right - radioactivity in cigarettes. The non-scientific group that seems to push this theory the most is the pro-cannabis lobby. They like to show that smoking cannabis is less dangerous than smoking cigarettes. Any time there is a theory that shows that smoking tobacco is bad for you in a way that smoking cannabis may not be they jump on it.

Sol Lightman, in UMASS CANNABIS wrote how the hidden danger in cigarettes is radioactive material in cigarettes. The article pushes the idea that most cancers due to smoking are caused by radioactivity.

This view is disputed. Certainly the number of chemical carcinogens seems to make it hard to reach a hypothesis that only the radioactivity is bad for you. I don't think many researchers in the field would say that smoking would be safe if you could remove the radioactive compounds.

Still... did you even know there are radioactive compounds in cigarettes?

Radioactivity is a scary word for many people. Which is odd since we live in a radioactive world. Not just since the atomic age opened. Our world is slightly radioactive. It's all around us. In fact there may be more of it around you than you ever thought.

Thursday, July 1, 2010

Obvious Sources (Canadian Edition): The National Film Board

Today is Canada day. July 1st 1867 the British North America act was enacted and Canada was created. So to celebrate, and realizing it's a holiday and no one wants to work too hard, here's a bit of Canadian history as presented by the National Film Board of Canada.

The Fate of America is an amazing documentary to watch. For two reasons. First, about an hour in Laurier LaPierre will give you an interpretation of the battle of Abraham which will change the way you look at Canadian history. Secondly I don't think any documentary has had me laughing out loud for a long time. The last 20 minutes or so are not to be missed.

The NFB is a national treasure. It has an interesting history in its own right. So many of it's most famous films are on the website and freely available to watch that you could get lost for hours. If you are Canadian you'll find every favourite you remember. And no matter what your background this is an invaluable collection of films.

On the more personal side I reminisced by watching "I don't know. Looks pretty tricky" aka Path of the Paddle: Doubles Whitewater

Happy Canada Day!