Author Archives: susan

Artificial Intelligence and Natural Stupidity

We live in an irritating world, made all the more tiresome by the increasing, amount of tech we contend with every day. There are those Facebook algorithms, eerily sending you adverts geared to your “likes” or Linked In knowing your fourth grade classmates better than you do; that tinny  voice offering to help you navigate tech support (god help you if you have an accent); or having to prove you’re not a robot to some web site. Never mind refrigerators and “smart’ TV’s that can watch you – and be hacked  or apps professing to predict your cardiac or Alzheimer’s risk that are about as reliable as a palm reader. Human contact, it would seem, is becoming irrelevant. The few times an actual human answers a call or is there to help, well, I don’t know about you but I want to weep: things go so much more smoothly.

Yes, I know, that’s just crazy talk. The future is now and it’s automated.

Then there’s manufacturing where factories that used to employ hundreds if not thousands of people now have maybe twenty people working alongside the robots who now do the work. What would one call them I wonder? It’s a pride of lions – so perhaps a clank of robots?

Danger, Will Robinson, danger.

Algorithms, chatbots, trolls and nameless, faceless tech of all sorts are so ubiquitous we barely notice them any more, up to and including health care where, you’d think that in dealing with a sick, vulnerable person some human contact would be the basic requirement. Where’s Robot in Lost in Space to warn us, along with Will Robinson, of the danger?

In the health care realm even when there is ostensible human contact it’s technology driven. Hang out in a hospital room for a day or two as I did recently and watch as a nurse or PN (I know they’re not called that any more but I can’t keep up with the changes) wanders in, checks the beeping machines, jots something down and wafts out, without a word. Glance down the corridor and pretty much everyone at the nurse’s station is staring vacantly at a monitor, oblivious to anyone waiting to ask a question.  Honestly, it seems a pity to disturb those machines sometimes.

So why it should have come as a surprise to me I don’t know. In Ontario apparently there’s some conflict going on about robots in Canada’s operating rooms.  A handful of surgeons are seriously miffed that their toys are going to be taken away from them since there’s no real evidence that they actually work any better than the old-fashioned kind of surgery done by actual humans.

(Reminds me of a conference I attended years ago where a urologist spoke for nearly an hour about some cool new massively expensive “microwave” that was going to revolutionize prostate treatment and do away with prostate cancer forevermore. Well, it’s decades later and I haven’t noticed any revolution or reduction in cancer.  What was noteworthy at the time to me at least was that a later speaker, a woman doctor explaining cervical cancer was all about low-tech clinical matters and how to make the patient comfortable. Never noticed any patients being mentioned alongside the toys. Interestingly, a group of male prostate cancer patients made their own film around that time in which they related their experience(s) in the hope that more men would exercise caution before leaping into the high tech and/or surgical options.)

Granted, tech can be a godsend to the injured and disabled. Some of those new digital prosthetic limbs are truly miraculous. The trouble is when the outcome doesn’t match the time, money and effort it takes to create some piece of hard/software. Take robots in the operating theatre. There has to be some serious proof that the tech is superior to current care. And I don’t think I’m being a Luddite when I say if I was the person who was being cut open I’d just as soon have a thinking, adaptable being leaning over me, one whose intelligence was not artificial thank you very much, versus some robot programmed by a 17-year-old who actually believes everyone’s insides look just like that pictures in Gray’s Anatomy (the book, not the TV show). OK, I’m being facetious; presumably live human doctors have input into the development of whatever boffo artificial intelligence (AI) went into the thing. But, as with the cockpit, one would prefer to grump about legroom secure in the knowledge there are biological beings flying the plane; humans who could react to the unknown based on expertise and experience, not rote. (Highly motivated humans who also understand that they go down with plane so it behooves them to figure out how to set the damn thing down safely, maybe on the Hudson River.)

As anyone (read: all of us) who have banged on a mouse in frustration as a drop down menu or some program insists we haven’t done such-and-such even though we have, seventeen times, and there’s simply no recourse, I can see the day coming when a surgical arm needs rebooting and gosh, nobody’s there.

No doubt AI aficionados will object and tell me (in no uncertain terms) that my understanding of artificial intelligence is flawed and as biased as Will Smith’s character on I Robot. Maybe so. But as someone who read the original Asimov books way back when, I tend to think the potential for harm increases exponentially with the complexity of the task at hand. Big Blue may have won at chess and even some game called “Go” was won by some digital gamer, but surgery and flying a plane aren’t a game.

Artificial intelligence, oh my

Alas, the toys ‘r us crowd are happily moving along, research funding at the ready and PR teams salivating at the thought of the coolness of it all. In fact, any day now in won’t just be a robotic arm in the OR but dead silence as STAR (Smart Tissue Autonomous Robot – who thinks of these acronyms anyway?! ) takes over.

At the moment STAR’s a bit slow: a simple gastric bypass operation that takes a surgeon  approximately eight minutes takes it roughly an hour. But just as chatbots reply to the question you tweeted some airline in that anodyne, generalized robotic tone, soon so will your surgery. Trouble is, things can go wrong in surgery and I’m not so sure STAR is up to the challenge. Then again, if something goes wrong you can always sue the manufacturer.

Honestly, I think I’d rather go with lions and tigers and bears. At least they’re real. And their babies are cute.

Here’s where it gets seriously creepy

I suspect most people have an image of AI and tech based on the movies where our hero/heroine leaps in to land the plane or do that tracheotomy when evil terrorists have taken over but those are, by definition, fiction: scripted, directed, edited. No computer ever crashes on any of those shows – people are being chased by clever villains (who love classical music) but every time they manage to download the vital clue in ten seconds flat and get away. No memory stick eve screws up; nobody ever has an issue finding the right port and naturally no software ever needs rebooting: everything from the GPS on up or down works perfectly. Then there’s the rest of us who are simply trying to order a book on line and have spent the last half hour retyping our home address, only to see that  irritating red pop-up telling us our order can’t go through because our information is incomplete.

Inevitably, at times things get seriously creepy. Pornographic androids and now this female android called Sophie who’s been given Saudi citizenship – I kid you not.  I bet you anything this female, now Saudi, android has rights that real women in that Wahhabi  country don’t have.

Then again, what can one expect from the desert kingdom where the crown prince throws anybody and everybody in jail at whim and plans some robot-run economic free zone for the future?  Maybe Sophie can work there.

Fake news?

Moving on – and keeping to the theme of technology taking over – and androids aside, the so called health news that social media zip over for our eyes only are all too often dead wrong. And potentially dangerous. Not only are these almost inevitably disease oriented (which most minor problems are not) but their advice can be downright dangerous. I see catchy ads asking me to click on some supplement that will make smarter, fitter, thinner and no doubt taller. Needless to say I don’t click but somebody does, otherwise they’d stop posting those ads. Like spam, if nobody ever replied they’d stop doing it.

Research in general has increased exponentially over the last decades, to an extent that’s difficult to conceptualize. What we used to call the Index Medicus in the 20th century was in the tens or, eventually, hundreds of thousands; now we are in numbers too large to calculate (and getting larger all the time). And the sad thing is that most of us don’t appreciate just how much the error rate goes up as the numbers increase.

My friend Frogheart, aka Maryse de la Giroday whose gem of a blog contains everything nano you’d ever want to know passed along this piece to me; it’s about a single issue, breast cancer germ cells used over the last four decades that actually aren’t breast cancer cells at all but melanoma.

The mind boggles at just how much research might have been based on this faulty methodology/thinking and just how many patients and clinicians have been led astray. Notably because breast cancer is such an emotive topic.

Over the years I’ve read many, many research papers and articles; some I’ve been asked to review, others I’ve written about, still others have simply been out of interest (or fury). There’s a lot of bad research out there people. Fake news isn’t just about politics; it’s also about life, health and everything else. So please use caution when you read or hear that “scientists” have found X or Y may help with this or that and don’t add supplements or alter your medications based on faith on science. Science, like pretty much everything else human beings engage in, is not only fallible but subject to the same human foibles as anything else: money, position, power, jealousy, idiocy …  As the geneticist Lewontin once said, scientists come from the same world as the rest of us.

A world that these days is probably binary, digital – and not that bright.

 

 

Random Thoughts and Staircase spirits

Time, said Auden, will say nothing but I told you so. Time also gives one the opportunity to brood – darkly – on so many of the idiocies out there in the ever-expanding world of health information.  So here, in no particular order, what’s been making me especially cranky:

Monster under the bed roams city streets  

Diabetes, the latest health scourge to hit the news, is now a City of Vancouver problem, at least according to a headline in a throw-away newspaper I threw away,

“Vancouver to track and attack diabetes”.  With what, one idly wonders. Bicycle spokes dropped on those bicycle lanes? Pointed sticks? Stern warnings? Nothing so mundane it turns out. This, apparently is part of some international initiative (a word that sets my teeth on edge) and creme de la creme cities like Houston, Mexico City, Copenhagen, Shanghai and Tianjin (where?) are on board, tracking “people at risk of diabetes” as part of a campaign to promote “healthier cities”. Curiouser and curiouser. Who knew cities were sentient and could get sick.

So the plan is – what? Skulk behind anyone leaving Starbucks with a large, frothy coffee? Tap anyone who seems a bit plump on the shoulder and read them the health riot act? (Honestly officer, it’s this outfit. Makes me look fat.)

Someone with the unlikely title of managing director of social policy at, one assumes, the City of Vancouver  will start “consultations” with Vancouver Coastal Health and – wait for it – Novo Nordisk, the sponsor of this demented plan.

Of course. Silly us, not to have realized a drug company had to be involved.

Must be diabetes lurking back there in them there bushes….

 

Novo Nordisk, a nominally Danish but probably multinational drug company almost exclusively manufactures diabetes drugs (oral hypoglycemics) as well some types of insulin. (The old insulin by the way, the non-patent-able kind that came from animal pancreases and was easily tolerated isn’t around any more at least on this continent. Banting, bless him, donated his discovery to the people of the world; he didn’t believe anyone should benefit financially from diabetes. Unfortunately he had no way of knowing that by the late 20th century pretty much anything could be “property”: manufactured and sold, up to and including a person’s genome.)

This diabetes sneak attack has already started up in Houston where they “mapped” various areas (for what one wonders) and went door to door to “educate” people about diabetes. Then, if their numbers don’t match some ideal level no doubt they need some of Novo Nordisk’s boffo drugs. (This class of drugs, by the bye, doesn’t tend to have a long shelf life as they usually are fairly toxic to the liver and quite a few of them have come and gone.) These hapless people will be told to get their fasting glucose and A1C* checked and down the rabbit hole they will go. We will all go.

These days after all it has nothing to do with the actual human being who may be in there somewhere but about the numbers. (There’s an American drug ad that doesn’t even pretend it’s about anything but “bringing your numbers down”.)  I suppose racial profiling could play a part as well, given that, statistically, people of South Asian, Hispanic, Asian and First Nations background may be at greater “risk” – whatever that means.

What few people realize is that this ostensible epidemic of type 2 diabetes sweeping the world has much to do with the continual lowering of inclusion criteria. A few decades ago “normal” glucose levels were around ten. Now they’re about half that. For people over 50 the latter number is especially problematic as close to half of us, as we age, tend to have somewhat higher levels of glucose and if you think about it, it simply makes no sense that a physiologic change that affects close to half the population in a particular demographic is a pathology. It’s what’s called, um, normal.

As for me, if anybody tries to corner me and talk to me about my diabetes risk, I plan to run shrieking into oncoming traffic. At least that’s a risk that makes sense.

Fight them on the Beaches

In that previous story what initially struck me was the term “attack”. As though a glucose level that could potentially be problematic was some kind of enemy – not some fluctuating number based on a myriad factors ranging from weight to diet to sleep. A number that moves up and down depending on the time of day and a host of other factors.

Physiology is dynamic, not that you’d ever know it these days given how mesmerized we are with the numbers.

Oliver Sacks, RIP

Someone who understood the complexities of physiology – and stood up for clinical knowledge and patient narratives – was Oliver Sacks., who died last August.

Physician, author, eccentric and host of oddball characteristics, Sacks wrote some amazing books (Migraine, The Man who Mistook his Wife for a Hat, An Anthropologist from Mars, A Leg too Few are some of the ones I enjoyed reading. Apologies if I got the titles slightly wrong as I’m quoting from memory). Most important, his writing reminded us of the diversity and variation(s) there are between us; not simply the similarities that clinical trials, statistical averages and guidelines exploit. Sick or well we’re all different and, to paraphrase Hippocrates and Osler and other famous sorts, medically the person with the disease matters as much as the disease. Or ought to. Alas, the trajectory of modern medicine whether it’s so-called preventive care, apps or genetics has a tendency to iron out those differences and push us towards some mythical average or “normal” that few of us come close to.

Colourful, thoughtful clinicians like Sacks have become vanishingly rare. Perhaps it was Sacks own differences – Jewish, gay, former biker and user of psychoactive drugs, gefilte fish aficionado – that made him realize just how much one’s personal history and narrative played into one’s physiology. Or just how vital it is for clinicians to listen as well as talk.

Dem bones, dem bones

L’esprit de l’escalier is a French phrase referring to all the pithy remarks one ought to have made but which only come to mind some hours later. Usually as one’s interlocutor is long gone.

So, to the pleasant woman who came up to me after my CAIS (Canadian Association of Independent Scholars) talk last year to ask about vitamin supplements, more specifically calcium, what I omitted to mention was that calcium is not a vitamin, it’s a mineral. An element, if one wants to be pedantic, Ca+ (20 on the Periodic Table). Hence, the “elemental calcium’ you can buy in the drug store.

The notion that we all need to take calcium supplements for our bones is based on somewhat simplistic notion, namely that simply ingesting this mineral will somehow magically increase bone density which we are told we are losing at an alarming rate, especially if we are women over 50. Clever advertising ably preys on our fears of “weak” bones, metaphors being what they are.

Bone is an amazing substance. It is dynamic – the collagen demineralizes and then degrades even as other cells (in sync) remineralize the collagen that has just .. diminished for want of a better word. It ebbs and flows (how else could a broken bone heal?) to achieve a balance; a balance that alters with age. When we are young/growing bone builds to its apex, in our twenties. It then plateaus for a time then, as we pass age 35 or thereabouts we gradually lose bone density. This is what we used to realize was normal development. And the bone in your body differs in form, hardness and elasticity depending on where it is and what it does – the vertebrae in your spine and the long bones in your body are of a different consistency and respond to changes in pressure differently than the ribs or the wrist.

The calcium/Vit D directive has become so engrained however that most people believe what they are doing is somehow maintaining or feeding their bones with supplementation.

But our endocrine system monitors the blood level of calcium and maintains it at our personal set point. One that is different for each person. This means that taking in more calcium is generally pointless as it simply cannot be absorbed. To quote Nortin Hadler, an MD, in his book, The Last Well Person, “If the blood calcium level trends down, vitamin D is converted to an active metabolite, which makes the intestinal absorption of calcium more efficient and vice versa”. More is not better; it’s useless. And potentially harmful as calcium can deposit in joints and other bits. As for vitamin D, it too has a set point that differs in each person; too large doses can build up and become toxic. So, those generic amounts you’re advised to take may or may not apply to you. Probably don’t in fact.

We tend to think that the supplements we take as a kind of top-up to diet, like adding oil to a car or salt to soup. Our bones rely on calcium so we basically assume that bone density is improved by taking supplemental calcium. And since our bones contain calcium, and as we get older our bones become less dense, we should “supplement”. It’s a mechanistic form of thinking about the body, one that took off after the Industrial Revolution when an “engineering mentality” took hold about physiology (in anthropologist Margaret Locke’s term). It certainly doesn’t hurt that the nice people at Bayer (who are taking over the world and now sell everything from vitamins to glucose meters) continually tell us we should. Alas, physiology is rarely so cut and dried and our understanding of how bone (or anything else) works remains primitive.

The real advantage of dietary calcium is when we are young and our bones are developing (in our teens). Unfortunately, short of building a time machine and going back in time there’s not much we can do to reverse the bone mass we accrued before our twenties.

So for now the basics of health remain the same as they were in decades past. Relax, eat well, exercise and stop stressing out about supplements. Most important: stop listening to all that bogus advice out there. If all we do is obsess about our health, our diets, our bodies – well, we won’t actually live any longer but it sure will seem that way.

 

*A1C is a measure of a red blood cell that is said to provide a “snapshot” of your glucose levels over the previous three months. It’s rather elegant but is still a correlation. A good one to be sure but correlation is not, as we all know, causation.

 

 

 

 

Paris, Friday the 13th and me

Tempus ends to fugit whether one remarks on it or not, so no point really. Time has passed, things happened, blog posts did not.

One of the things that did happen was Paris and yes, I was there, on Friday the 13th, in the 11th arrondissement, on the Right Bank of the Seine, Blvd Voltaire, hash-tag Paris attacks. I found out several days later that one of the attacks had been closer to me than I’d known; I was sipping Cote du Rhone, listening to jazz, oblivious that quite close by there were gunshots at the Comptoire Voltaire (where the only casualty was the somewhat, er, inept gunman who blew himself up without hurting anybody else).

It’s rather bizarre being in the centre of history as a friend puts it.

The trendy area around the Place de la Republique is not my natural habitat;; I was never especially young and trendy even when I suppose I was. But this one time, weirdly, I had made my way to the 11th to the café Aquarium where a friend, Benoit Gil, was playing.

Things were normal until half past nine or so when – perhaps in retrospect – things seemed a bit tense and, uncharacteristically, café staff made it clear they were closing. Seemed a bit early but as they were starting to mop under our feet we left. We heard some murmurs about an “explosion”. A bomb perhaps? We made our way to my friend Minnie’s car; in the street two passers-by told us something was going on at the Bataclan. (This was completely unenlightening to me as I had no idea what Bataclan meant; it was only later that I realized it was a theatre. I am a Left Bank person.)

In the car we did see the Blvd Voltaire cordoned off and a lot of police cars and SAMU (emergency vehicles) but nothing especially alarming. Still, we turned on the radio, talk was of the Stade de France and nobody knew what was happening. President Hollande had just been whisked out. Later, on TV, he seemed a tad rattled which was understandable under the circumstances.

It was, I admit, altogether a bit surreal.

Since then the attackers’ provenance has been traced to Brussels, specifically Molenbeek. A former resident Teun Voeten, cultural anthropologist and photographer, clearly knows more about this area of Brussels than I do (though I think I have wandered through on the odd occasion) and his take is dead on I think. I suspect that many young men (and perhaps a few young women) fall into terrorism for banal reasons: boredom, a desire to belong, the usual preoccupations of the young like heartbreak or being in with the in crowd. And becoming a martyr provides purpose and a higher calling, structure even, that the boring and commonplace does not. (And what one does not realize at that age is that much of life is neither dramatic nor extraordinary or that youth in general – contrary to the cultural myth  –  is an anxious, difficult time for most.)  Alas, at the moment too many conflate that discomfiture into violence or the Caliphate.

“To be willing to die for an idea is to set a rather high price on conjecture.” Anatole France *

At the Place St. Sulpice on the other side of the Seine, just after 10, all was quiet and the man at the hotel desk knew nothing. I told him what I knew, which wasn’t much but turned out to be more than BBC World which told me the sky was falling and the end was nigh. Oh good. It seemed that all of Paris was burning, even though I had just seen it was not. I checked Twitter (unhelpful) then, just in case the news made it to Vancouver, sent a few messages and went to bed to the sound of sirens and helicopters. The next day Paris became the nexus of a terrifying news cycle (for about five days) and I woke up to some 40 concerned texts and mails. I then did something I’d never done in my life, I changed, my “status” on Facebook, which had obligingly provided a phrase along the lines of “safe in Paris” for me to tick.

I had always known but never experienced first hand the parallel universe(s) of reality and news but here it was. The next day Paris was essentially fine, though subdued; quiet for a Saturday. By afternoon reaction had set in and museums closed though metros and buses ran and people milled about in cafes and elsewhere.

Context is best found, I think, in poetry, in art, in history and narrative.  Auden, in the poem Musee des Beaux Arts wrote: “About suffering they were never wrong, The Old Masters.” In the Brueghel painting Icarus: even as the young man falls from the sky with a large splash, the ploughman, head down, keeps working, the sun shines and “dogs go on with their doggy life”. It was “something amazing, a boy falling from the sky” but to most people it was “not an important failure”. Paris, of course, was hard to miss; but that ploughman of Brueghel’s had no smart phone.

bruegel5

Speculation (and heavy police presence) continues and no doubt will continue for a long time. A few days later it was Mali. What a world, what a world, as that great philosopher, the evil witch in The Wizard of Oz, said. On a side note, I have to say I have wondered about those small cafes, especially le Petit Cambodge. I’ve seen small Asian cafes like that all over Paris and it seemed like an odd target. Call me crazy but that one felt personal to me. Being fired or a former girlfriend working there? Too often the political is personal even if we don’t realize it at the time.

However. The City of Light recovers, the news cycle has moved on – and next week there will be jazz again at the café on the Blvd Voltaire. Tout passe. That is the nature of it all.

 

*etre pret a mourir pour une idee est de fixer un priz assez eleve sur des conjectures

 

Civil Scientific Discourse RIP

It’s no secret that I am not fond of hot weather in general and summer in particular. Making me especially cranky at the moment is the hyperbole surrounding the science/non-science discourse, e.g., around childhood diseases like chicken pox or measles, mumps and rubella (the three dire conditions the MMR vaccine is supposed to prevent). The crux  appears to be that either you’re either one of those unscientific, Jenny McCarthy-quoting, loons who believes vaccines causes autism – or you’re a normal, nice, sane person who believes in science. Paradoxically, science appears to have gained the status of a deity in this discourse.

No need to get hysterical about skepticism.

No need to get hysterical about skepticism, Hume might way.

Case in point, a headline last year: “Shun anti-vaccine talk, SFU urged”. Some anti vaccine conference was going to take place at some SFU campus and an angry group of critics were whopping mad lest this event “lend credibility” to this “dangerous quackery”.  This, er, quackery was some symposium where the discussion was on how “families are facing increasingly intense pressure from the vaccine lobby and big government to comply with vaccine mandates” and was  organized by something calling itself the “Vaccine Resistance Movement”. Hardly saving the free world from tyranny but hey, the resistance carries on, large as life and flakier than thou.

The 18th century philosopher David Hume, the granddaddy of skepticism would no doubt be turning in his grave at this hysterical, humourless assault.

BC’s Chief Medical Officer replied in his usual vein: “Vaccines, like any medicine, can have side effects, but the benefits … outweigh the risks,” By and large this would seem to be true. But, surely, it can’t be verboten to wonder whether suppressing all childhood diseases may perhaps also have consequences? Especially the trend towards vaccinations against diseases “such as chicken pox which cause only inconvenience rather than danger” in the words of British sociologist and science and technology writer Trevor Pinch. (In Dr. Golem: How to Think About Medicine by Harry Collins and Trevor Pinch, University of Chicago Press, 2005). Especially given the sheer number of jabs (approx. 20 I think) that infants now get.

SFU president Andrew Petter apparently refused to cancel anything, merely saying universities stand for freedom of expression and, as far as I know, the conference went ahead. I have no idea what was discussed but I suspect it was a lot of nonsense. That’s not the point. What’s perturbing is the vitriol of the protesting group and the smug suggestion that if one dares to question the many vaccines tiny babies are subjected to (or suggest these might, just might, have adverse immune or other effects) one has no right to speak. Either you toe the party line or you’re a crazy person. One who should be run out of town on a rail to coin a phrase. (I’ve never been sure why being run out on a rail – which to me implies a train – would be such a bad thing. Personally I am mega fond of trains.)

The photo of the conference protestor indicates that the group (“The Centre for Inquiry”) is just as obscure as the one they’re protesting. Maybe the whole thing was a publicity stunt or performance art, who knows.

Any child not vaccinated against the measles should not be allowed in school, someone firmly said to me last month. Measles can cause deafness and blindness, not to mention encephalitis, someone else said. I mildly agreed, merely pointing out that the numbers on these dire effects in the developed world were actually vanishing small, at least based on the (admittedly limited) research I had done. Buried in the contradictory numbers one small group of children was clearly at risk from measles, namely children undergoing cancer treatment.

Years ago, when I wrote a book on the immune system, I did a bit of desultory research on measles; there was some evidence that a natural bout of measles appears to reduce the incidence of allergies and asthma in later life. (Operative word appears – the data was correlational and based on medical records; there is no way to know for sure if this was cause and effect. Bearing in mind that most health recommendations, from lowering cholesterol to vitamins, are based on correlation.)

Immunologically measles appears to have a modulating effect; in a way allowing the immune system to become less inappropriately reactive and reducing the incidence of asthma and allergies. Perhaps this struck a cord with me because in my own case a natural bout of German measles (rubella) massively and obviously cleared the really bad eczema (also an auto immune over reaction) I had suffered since I was two or three. Large, itchy welts covering my legs, arms and face, especially knees and elbows. Then poof, I get sick, high temp, general malaise and my eczema essentially clears. I still occasionally get eczema, usually in reaction to an allergen (like aloe). But, by and large, I’m fine. The research I did years later gave me a context for that (better than my grandmother’s “well, the high fever burned it off” which made the eczema sound like a forest fire – though, come to think of it, that’s not the worst description).

But when I wondered out loud some weeks ago if maybe, maybe, over zealous vaccination programs could have anything to do with the increase in peanut allergies out loud some months ago you’d have thought I had suggested a plot for Criminal Minds. It was speculation, people. I’m not the vaccine police.

I’m not sure quite how this binary, myopic perspective evolved and became so engrained, but it seems now that any questioning of standard medical dogma (“vaccines are good”, “sugar is bad”) ends up as some version of t’is/t’isn’t, t’is/t’is NOT: all the subtle dynamics of a nursery school. Either you’re a feeble minded dweeb who fell for the fraudulent, discredited Wakefield Lancet article linking vaccines with autism (actually GI problems not autism but that’s lost in the mist of rhetoric) – or a sensible, right thinking person who believes in science, good government and iPhones. (As it happens I now have a Blackberry Z10 which I think is far, far superior. Were we to pause for a commercial break.)

Science is a method. Neither static nor dogmatic. But I guess if you’re going to turn science into a religion then it will end up that way. Pity, since scientific inquiry was, to a large extent, what dragged us out of the Dark Ages.

 

 

Lyme Lies – Ticks me Off

Each season has its own medical threats or so they tell us, so by rights I should be warning you about the flu – but I’ve already done that. Or I could warn you about carnivorous Christmas trees (sorry, old joke c/o the late Chuck Davis who mocked a pamphlet referring to “deciduous and carnivorous* trees”) but I promised you Lyme Disease and Lyme Disease it shall be. As it happens,  to my way of thinking, Lyme and flu may well share an immunologic link: as with the flu, where the virus is spoken of as though it’s a rampaging army, similarly, with Lyme Disease it is that original tick bite that has gained iconic status. Differences (biological, physiological, genetic) between people ironed out in the search for easy answers and someone to blame.

 

Lyme Disease, for anyone raised by wolves who’s missed the thousands of news items over the last 40 years, is a tick-borne disease that tends to cluster in areas such as New England where there are deer, believed to be the vector. Named after the county in Connecticut where it is said to have originated, Lyme has garnered increasing attention as some patients seem to develop vague but debilitating symptoms usually years after the original infection; symptoms that experts tend to dismiss as psychosomatic and unrelated to Lyme (even as conspiracy theorists maintain these medical denials are a plot and There Be Skullduggery afoot). Maybe aliens are involved, who knows.

 

(I use the term “disease” here , by the bye, with some disquiet; there seems to be much overlap in descriptions and discussions of Lyme between disease and illness – illness usually being defined as the patient’s experience versus the more objective signs and symptoms which are classified as a disease.)

 

It all begins with a bull’s eye – usually, maybe, sometimes

 

Ticks, said, Aristotle, clearly not a fan, are “disgusting and parasitic”. Ugly too. These tiny thumbtack creatures survive by boring into a host organism such as mouse, deer or human and – a la Twilight – sucking its blood. They’re vampires in other words. Once the tick has sunk its, er, fangs some patients develop a rash resembling a target or bull’s eye and a bacterial infection that may or may not have symptoms. This, it is said, results from the tick passing on a rare type of bacterium called a spirochete.  Known as Borrelia burgdorferi (after Willy Burgdorfer, who painstakingly identified spirochete in a tick the early 1980’s) a spirochete looks a bit like a coiled telephone cord, hence its name. I will not bore you with the intricacies of the different types of tick, the link to another disease, babesiosis, a malaria like illness also found in New England, though I could. Believe it or not parasitology is actually quite fascinating.

 

The problem, at least from a purely scientific perspective, is that the spirochete hypothesis came after the realization that, in most cases, Lyme Disease responded quickly and well to antibiotics. This led researchers to work backwards to find the culprit bacterium. In other words, as physician Robert Aronowitz in Making Sense of Illness (Cambridge University Press, 1998) writes, “To say that the discovery of the Lyme spirochete led to rational treatment is to put the cart before the horse [and] owes more the idealization of the relationship between basic science and therapeutics than to the actual chronology of investigation.” It is, Aronowitz suggests, more like a Texas bull’s-eye: you shoot the gun then draw the bull’s eye around the bullet hole.

 

This is especially problematic since early antibiotic treatment means that any trace of bacteria are usually wiped out and their existence is more in the abstract than anything else.

 

If you’re a disease, at least be new, modern and famous

 

Nevertheless, the narrative that’s evolved around Lyme Disease is as follows, this quote from that recent New Yorker article that sparked my curmudgeonly instincts: “Lyme Disease was all but unknown until 1977 when Allern Steere, a Yale rheumatologist produced the first definitive account of the infection.”  Just one problem. It ain’t necessarily so.

 

If we want to nitpick (and you know I do), a disease called ECM  (erythema chronicum migrans) which is uncannily similar to Lyme Disease appears in European medical texts as far back as the late 19th century. Also characterized by a bull’s-eye rash (called erythema migrans wouldn’t you know) – ECM, in some people, also appeared to result in flu-like symptoms. It was never definitely demonstrated whether it was a tick (which are also common in northern Europe) or a virus, and since the majority of cases were mild and self limiting, nobody paid that much attention.

 

Plus, ECM was described by a lowly branch of medicine, dermatology (think, Lars, Phyllis’s husband on the Mary Tyler Moore Show if you can remember that far back). Lyme Disease though, was identified through the exalted ranks of a specialty with more nous, rheumatology and then championed by a group of angry, well-off mothers in New England who were furious that their children seemed to be coming down with some kind of disease nobody knew much about; a disease, moreover, that seemed to mimic rheumatoid arthritis.  Since the focus was children, the media immediately jumped on board (and the ringleader-mother, Polly Murray, appears to have been adept at channeling their interest). There may have been joint pain in the European ECM patients but the patients were all adults, in whom joint pain may well have been considered more or less normal.

 

But in New England, well, there you had a veritable PR maelstrom: children being bitten by these vampiric insects; distraught mothers and heroic scientists swooping in to figure out what this strange, dire new disease could be.

 

Why does this matter? It matters because new things, new diseases are always more terrifying than old, known ones. Just as we all relax when we find out the potentially lethal symptoms keeping us up at night are actually shared by three quarters of the people in our office and is just what’s “going around”. But a new disease? Affecting children? With bizarre symptoms? That’s scary. And whenever there are descriptions of disease, incidence of that disease increase.

 

In the case of Lyme Disease, that interest hasn’t waned, with the end point always the same: a plea for more good science (not that bad kind of science people usually like to do).

 

Guidelines uber alles

 

The American Infectious Diseases Society guidelines maintain that Lyme Disease is usually easy to treat and cure. A few weeks of antibiotics does the trick in most cases and relapses are rare. Patients, advocates, as well as some rather strange conspiracy sorts, disagree and here’s where we run into one of my pet peeves, that objective/subjective, disease/illness demarcation that shouldn’t be a problem but all too often is.

 

Patients and their families and friends, at least in the fairly small number of Lyme sufferers who develop lingering and mysterious symptoms (ranging unpleasant but benign ones like headache and insomnia to weird and wonderful: “joints on fire”, “brain wrapped in a dense fog”), feel that the medical community has deserted them and is ignoring their very real pain, the very real fact that their lives have been horribly affected. As with chronic pain and other conditions that simply defy our reductionist explanations, the rhetoric descends into and either/or proposition. Either the disease exists as explained by the guidelines, or it does not. Either the tick bite leads to dreadful long-term symptoms in everyone – or it does not. Nothing in between.

 

Which is clearly nonsense.

 

Terms like “idiopathic” (of unknown origin) or “post” (post-viral, post traumatic) have been coined to describe these symptoms, these patients, mostly because we simply don’t know what to do with them. And by “we” I mean everyone.  Society. The culture at large. (I wrote about our issues around chronic pain in an earlier post.)

 

 

The biomedical model simply cannot explain the complexities of human experience, human disease, illness. Not only are there vast differences between individuals in their physical and physiological selves, there are social and cultural and dietary and a myriad others. It is simply not feasible to “fix” every underlying “cause” to get rid of a “disease”. Even infectious disease that we know is caused by a virus or bacterium does not affect everyone. Necessary but not sufficient is the phrase. The TB (or any other) bacterium is necessary for TB but not sufficient. Other factors must be present.

 

So why is it so difficult to believe that in some people that tick bite, with or without the bull’s eye rash, might lead to long term problems; problems amplified by the individual who also believes there is a problem that needs fixing and whose stress levels rise as a result. After all, if they feel so lousy it must be something terrible – cancer, maybe.

 

We believe in the magic of medicine so when it fails us we are hurt, angry, disappointed. This explains why Lyme (or chronic fatigue etc.) activists so often sound like such loony tunes. Even as they decry the evils of the medical establishment they search for legitimacy from it, absolution, that what they are feeling is “real”. (Which will also translate into other institutions recognizing said condition which then has other consequences like disability.)  True, there is the odd hypochondriac, Munchhausen’s, factitious patient. But there are also people who suffer from pains and disabilities that medicine cannot explain – and abandons, using the term “psychosomatic” like a cudgel. So what if it’s psychosomatic? All psychosomatic means is that the illness or symptoms originate from the mind, not the body (at least insofar as we can tell – our imaging and tests and so on not being exactly infallible). Who cares where the problem originates when people need help?  Isn’t medicine about exactly that, doing no harm, helping people feel better, function better? It seems logical that some people have the type of immune system that reacts, over time, to some kind of toxic insult, tick related or otherwise. These are the folks who develop rheumatic and other symptoms over time, the ones that medicine refuses to countenance.

 

What I do not understand is why.  Why does not having a diagnosis, a label, mean you have to deny people even have a problem?  (Some Hon. Members: Shame, Shame.)

 

 

 

 

 

* they meant coniferous

Why cats make the worst patients (and the dog ate my homework)

Charlie stopping to smell the flowers in healthier times

Charlie stopping to smell the flowers in healthier times

Charlie, one of the cats, was seriously ill and Lyme Disease (which was the designated subject for this post) went clear out of my head. It shall return. Meanwhile, I’ve been nursing Charlie, aka Houdini cat (who will literally disappear into the towel you think you’ve wrapped around him securely), reminding myself that nursing is a noble, noble profession. (That’s what you call professions that are bloody hard and nobody appreciates.) I’ll say one thing, taking a cat to the animal hospital does give one a quick lesson in the perils of for-profit medicine (my Visa may never recover) – especially in our risk-obsessed age where tests and scans trump individual history, personality and symptoms (human or animal). It also reminded me that one must be vigilant when faced with the ponderousness of Expertise.

In Charlie’s case it began with a neurological condition called Horner’s, an irritation of a nerve running down one side of the face, eye and down the neck and into the chest – not a disease but a symptom. Naturally Expertise immediately rushed to the worst possible diagnosis: lymphoma, or, in a pinch, brain tumour. (Do not pass ‘go’, just head for the hills.) I mildly posited inflammation or infection, probably ear related, particularly since Charlie’s had those before. But noooo.

Critical Care, human or animal, is rife with Expertise: grave, gravel toned and confident. Why? Because they have tech toys, that’s why. Cool devices and imaging technologies that purport to explain the mysteries of life. Even (ha ha) a cat scan. All of which push the patient into ever higher levels of care – because they can. Problem is, the patient often can’t.

I tried to hold my ground but it’s a slippery slope that one; the surer they are the more one caves, especially when they start to say, well, with cats elevated white blood cell count could mean X. I mean, what do I know from cat physiology?

So the cash register tinged and Charlie looked steadily worse. Of course nobody looks good in ICU between the ugly fluorescent light and the tubes but there’s something especially pathetic about a small furry creature sitting in a cage. And Charlie, well that cat could have taught Stanislavsky a thing or two about looking sad.

I kept getting calls to tell me things I already knew (he has a heart murmur). The last time I snapped, “I know. I have one too. Big deal.” That didn’t, naturally stop them from getting a cardiology consult. Bearing in mind that cats don’t hold still for much of these so need to be anaesthetized.

Finally, after every possible dire diagnosis had been ruled out, we came round to my original hypothesis: ear infection.

Don’t get me wrong. I have enormous respect for veterinary physicians. They study long and hard (far longer than human doctors) and by and large they are great. They deal with a diverse patient population who’s uncooperative and uncommunicative. And when I say diverse I’m talking species. And they need to make a living, I get that.

What they, and most of us, do not get however is that they are part of the culture at large and the culture at large is obsessed with the “science “ of medicine, leaving the art further and further behind. Watching Charlie work his way through the system reminded me of just how much medical focus has shifted away from the patient and towards disease, technology; towards what tend to be called “objective” results (versus the messy subjective ones patients bring).

I see this on a human level very time I go to the retinologist with my mother (that, by the bye, is a sub-specialty of ophthalmology). First, they get her to read the letters on the chart and are all impressed at how well she sees. Then they take their pictures and look grave: how could she possibly see that well with those terrible ridges in her retina? (To me they just look like the Alps.) Then they look puzzled. Scan says you can’t but you actually did see. What a gonzo dilemma. So, they go with the scan and give her the medication. Objective trumps subjective.

Question is, should it? Does it make sense for the patient to get lost in this morass of ostensibly objective ‘data’?

Not to my way of thinking. “Normal” – blood pressure, lipid level, whatever – is a best-guess average based on population statistics and what some committee has deemed appropriate. If you’re truly sick it shows up. C-reactive protein in the clouds – well, objective and subjective tend to match. Your joints hurt, you have some kind of inflammatory condition and the test backs you up. It’s that grey zone that’s problematic. Levels fluctuate in every individual, tests can be wrong (some more than others).  Error rates in some tests are as high as 75%. But we forget that.

So, cat or human we are lumped in with the many-too-many – and our individual narrative gets lost. In Charlie’s case nobody believed this pretty little cat who had only been ailing for a week could possibly “just” have a madly inflamed  ear affecting his balance and appetite. An infection is no picnic. But it’s not a brain tumour. And of course Charlie’s Oscar winning ability to look mournful didn’t help. This cat can look sad when he feels ignored; imagine how dreadful he looked when he was dizzy and queasy. It’s a gift. But it’s not diagnostic.

You need a proper history; the back story. The person with the disease is as important as the disease, said Hippocrates. Let’s say you end up in hospital with severe abdominal pain. It matters whether you’ve had this pain before, but less intense or of shorter duration. Sudden abdominal pain could be many dire things; a worsening of an existing problem is probably nothing that will kill you (otherwise you wouldn’t be in the ER in the first place). The clinical picture changes with the history. Someone has to factor it in.

Charlie’s doing better now. As for the rest of us – who knows. We may never survive the tech age.

Summer Reruns

Everyone may stream their entertainment on their teeny tiny phones but that’s just the tech; without a good story summer still means reruns.

So in the fine old tradition of reruns, I give you  a recap of the summertime blues.

(Coming soon, Lyme Disease. Stay tuned.)

Is there an epidemiologist in the house? *

There’s an appalling advert for one of the adjunct health unions/associations/whatever where someone collapses in a restaurant and the doctor starts to call for various “technologists” (x-ray, CT scan, etc.). I don’t doubt their word that health care today is complex; still, call me crazy but if I collapsed somewhere I’d really rather have an actual health professional, a clinician, by which I mean a nurse or physician, at my side than someone who knows how to operate an ultrasound machine thank you very much. Remember, machines don’t “know” whether something is a concern or not – it’s people, actual humans, who make that determination.

A determination that all too often relies on over-optimistic beliefs regarding the accuracy of “tests”.

(But as neurologist and author Oliver Sachs once sadly remarked: They don’t give Nobel prizes to clinicians, only medical researchers.)

Worse, everything from the images and data we get from those machines not to mention the health information that’s flung at us from all sides is based on statistics. More accurately, a statistical approximation of “normal”. The normal person, whatever or whomever that may be. Another term, whether one is being statistically accurate or not, is “average”.

Now I don’t know about you but I’ve never met an “average” person. Everyone I know is distinctive, sometimes eccentric, often times interesting, funny and, well, different. People are a jumble of ethnicities, backgrounds, socio-economic and otherwise; their education and passions and hobbies and interests differ as does everything from their diets to their bad habits. Er, risky behaviours to the epidemiologists in the house.

So here we all are, contorting ourselves into bizarre shapes trying to fit into the statistical moulds they’d have us fit, from the not-so-benign lipid levels and blood pressure (for which drugs are available should one not conform to aforesaid norm) to clothing sizes and availability in everything from lipstick colours to food. Oh, yeah, tell me you haven’t noticed that your favorite kind of frozen chips appeals to you and six other people so it’s been discontinued.

From supplements to ideal weight, glucose and you-name-it, normal follows us around like some malevolent mosquito, buzzing in our ear and biting us in the you-know-what when we try to ignore it. Whether it’s Dr. Google or the news items on everything from your phone to your TV.

But when we’re feeling off, or sick or have had something bad happen what we want and need is a clinician: someone who knows how to set that broken bone, do that tracheotomy, or CPR and know just how much morphine to prescribe so we’ll keep breathing. Unfortunately, the spate of bad health news out there makes us all so nervous that all to often when we do end up at the clinic or the ER we’ve got nothing more terrifying than bronchitis or a particularly bad bout of cystitis. Not for us former generations stoicism; we race over ‘just in case’ for everything from a sore knee to a cough.

An American chap once disparagingly told me Canadian health care was simply dreadful. How did he know? Well, when he lived in Montreal he had a bad cold. One assumes in winter when people get those in cold climates. Then, late Saturday night he decides to head over to the Emerg because his cough was worrying him. Could he breathe? Yes. Was he running a temp? No. But he went anyway. And couldn’t figure out why the ER staff didn’t rush him to have tests and x-rays. Ah, d’you think you could have picked a less busy time? Of course not.

Where’s an epidemiologist when you need one?

* Not my line, though I wish it were. I read it in Gordon Clark’s column in The Vancouver Province on July 8. Laughed out loud as a matter of fact.

They got stones, I’ll give you that

I was going to call this post “nobody knows the trouble I seen” except that it seems ludicrously self indulgent to whine that one has been living through construction hell when the rest of the world has revolutions, civil wars, hurricanes and so on to contend with. (But, to paraphrase Will Rogers, everything is manageable provided it’s happening to someone else.) This isn’t to say my curmudgeonly instincts have been dormant . One particular item a while back had me seething.

“Sugary drinks are not so sweet”  was the headline in the Health section of the Globe and Mail (24 May 2013).  Apparently, drinking a sugar-sweetened drink a day not only rots your teeth and adds up to empty calories (with the added bonus that it makes New York’s Mayor Bloomburg crazy) but “may increase the risk of kidney stones”.  Gasp. I had to pause to take a sip of my ginger ale* while that sank in.

I puzzed and I puzzed, to reference one of my favorite curmudgeons, the Grinch. Didn’t make sense. How on earth could fructose cause blobs of crystallized minerals to form in the kidney? (To reinforce the point that sugary drinks are Evil the accompanying photo was of a surgeon with a scalpel. Someone had fun with that.)

The research cited was from 2007, published in a journal called Kidney International (2008, 73; 207-212).  The worthiest journal nobody’s ever heard of.  My curiosity got the better of me and I downloaded the article and read through the cringe-inducing prospective study; yet another data-mining expedition hoping to find a “link” between X and Y. (For more on my distaste for the term, see post.) The data? From – wait for it – the appalling Nurses’ Health Study, formerly used to “prove” that taking estrogen was just a boffo idea.  Here, the research cites some 19,000+ women along with some 46,000 men from the Health Professionals Follow-up Study. Impressive numbers. Pity the hypothesis is so feeble.

Not of course to our heroes, researchers Taylor and Curhan, unspecified experts at a renal division/lab at Brigham Young and Harvard who engage in enough statistical jiggery-pokery to make the world go round.  (Pity nobody blinks when data gets tortured.)

Just a few problems here. As I explained, in often far too exhaustive detail in The Estrogen Errors, extrapolating to the general population from the Nurse’s Study is massively problematic. For starters, there’s its basic design, bi-annual self reports, which are notoriously unreliable. We’re all prone to error as any gibbon with half a brain knows: we forget, lie and generally get things wrong. Good grief, most of us stutter when they ask us how much we weigh when we get a new driver’s license. Plus, there’s the healthy user bias – people who respond to any questionnaire tend to be richer, smarter, better off, i.e., healthier than the average bear. Er, person. Often they’re white and frequently younger. All of which means they are not like the real at-risk population who, by and large, tends to be poorer, less educated, older, more diverse, less health and diet conscious, more stressed and sicker. Face it, d’you think you’d have time to sit around reading some blog if you had to work at two or more minimum wage jobs just to put food on the table and pay your rent? Could you even afford an iPad or even high speed internet?

This is on top of the fact that professionals in general can’t stand in for “everyone” and basing one’s conclusions of what these people do (or say) is what’s popularly known as being spectacularly wrong.

What really interested me, though, was what these researchers thought might be going on physiologically. In other words, how did we get from basic sugar metabolism to blobs of crystallized minerals in the kidney? Gremlins? Evil spirits? The authors do obligingly admit that the underlying mechanisms are “unknown” (ah, ya think?!) but postulate various processes, none of which make sense. Hence their masterful use of language:

“Fructose may also increase urinary excretion of oxalate, an important risk factor for calcium oxalate nephrolithiasis. Carbohydrates, along with amino acids, provide the majority of the carbon for glyoxylate and oxalate synthesis, and fructose may be an important dietary sugar influencing the production of oxalate.” (emphasis mine)

 The authors concede backing for their hypotheses are “sparse”; personally I would have said nonexistent. Rats make up the bulk of their research subjects in this section and the one study they cite using humans consists of eleven – yes, 11 – men whose pee was analyzed for calcium loss (versus calcium intake).  Fructose intake made no difference in the calcium these men excreted but the researchers still concluded that the reason fructose laden drinks caused kidney stones “may be related to the effect of fructose intake on urine composition”.  How they concluded this I have no idea. Maybe they were on a sugar high.

The only marginally plausible explanation had to do with uric acid metabolism and for a moment I thought, OK, this might make sense. Then I checked the reference and realized it only applied to people with gout, whose uric acid metabolism is already dysfunctional (that being the definition of gout). 

Kidney stones, by the bye, are hardly that common and rarely if ever life threatening. Even Wikipedia’s overblown, hyperventilating piece on the topic, that sounds as though it was written by a nephrologist who had just passed one, admits that the incidence or number of new cases a year is “0.5%”.  (Of course it doesn’t specify 0.5% of what which is rather an important point, but let’s not nitpick at this late point in the post.)

How did this 5-year-old study even make it into the health news section? Having spent some years as a medical writer and journalist, I can tell you exactly how. A group of people in an editorial meeting, drinking coffee – or pop – were bouncing around story ideas and someone suggested a piece vilifying soft drinks, currently Public Enemy No. 1 (see NYC, Bloomburg).  So, they wrote the headline then they contacted the hapless writer who cast about for some new and nifty problem that could be blamed on aforesaid sugary drinks.  Everyone  knowing full well that the majority of people only read the headline and the first paragraph; it’s only mutants such as myself who check the original research and parse the methods section.

If sugary drinks do give you kidney stones, these people didn’t prove it.

There are a lot of good reasons to consider soft drinks a treat, not a staple. They’re empty calories; they rot your teeth and many of them contain fairly high amounts of caffeine which can make you nervy and insomniac. But kidney stones? Really?! We think not. And it takes stones to say they do.

 

 

 

* oh get over it. It’s summer. There’s construction outside. Yes, I have the occasional ginger ale or Coke. Sometimes, when I’m especially cranky, two days in a row. Sue me.  

‘ear ‘ear (better yet, turn it down)

The Oscars were last night and no I didn’t watch. To paraphrase Ogden Nash, my interest in the subject would have to grow to be even cursory. (And you thought the curmudgeon in the title was just for alliteration.)

Frankly, I’d sooner mindlessly stare into space. At least it wouldn’t be deafening.

Well, not the Oscars so much; they are, after all, on television and one can turn the volume down. One cannot say the same thing about what the Oscar celebrate: movies.

When was it decided – and who did this deciding and why weren’t we consulted? – that we shouldn’t just hear the sound but feel it vibrate down from our toes to the top of our tinny tin heads? How did going to a movie turn into a full frontal assault on our senses, from movement and colour and flashing lights to that ubiquitous noise they are careful to remind us is the patented Dolby surround sound?

Once upon a time one could go to a movie, yes even action ones without going deaf. I was first in line when those early Star Trek movies came out and I saw the first Die Hard in the movie theatre. It was loud, but I don’t recall coming out feeling like I’d just been put through the wash cycle.

In those days I wasn’t flinching and stuffing my ears with Kleenex or covering my eyes to protect them from the flashing lights that would end up giving me a migraine. The last “action” movie I saw, one of the Johnny Depp pirate movies, well, I left that so dazed and battered that I barely remembered what I’d seen.

How did deafeningly loud become normal? Or is everyone just deaf? 

So much of the noise around us we barely notice. The hum of computers and air cleaners and refrigerators; the constant hum of traffic, the honking, the music blaring out of car stereos … And of course everyone is in their own little world of sound, with those earbuds.

I’m not a total Luddite, I got an MP3 player years ago. I filled it with music. I listened. Then I realized than as I was walking I kept turning the sound up to compensate for the noise all around me – and if I had been listening for a few hours at night there was a constant ringing in my ears. It would go away but what I know about the sensitivity of the ear told me that if I kept doing this it eventually would not and the result would be tinnitus. A ringing that simply never goes away.

I doubt most of the people on the subway or the bus or walking down the street really pay that much attention. Which suggests to me that in a decade or two anything relating to enhanced hearing will make a fortune since most people will be partially deaf. (We should all buy stock now.)

A number of big names – William Shatner, Jerome Groopman (author of the best selling How Doctors Think book) – have gone public with their tinnitus. Experts tell us that it’s probably the result of prolonged exposure to loud noise.

Then there’s the Who’s Pete Townshend, who is essentially deaf. The Who, as you might recall, is credited with having performed the loudest concert in history, at least at the time, circa 1976: decibel level 120. That’s about as loud as a jackhammer. Almost as loud as a jet engine. That’s loud.

Respect the ear – or it’ll give up on you

The human ear is an amazing thing. Inner, middle, outer ear: each have their function, each play a role in funneling sound through tiny cilia (little tiny hairs) and through the ear drum, into the brain where it’s interpreted and experienced. A human ear can pick up the dripping of a faucet in the middle of the night on another floor, hear a symphony or a the swish of even a piece of paper falling to the floor.

It’s amazingly balanced between the inside, conduit to the brain, and the outside world. Precisely balanced in between are three small bones (the smallest bones in the body) that are shaped somewhat like a stick figure or one of those triangles your music teacher would have you play if you weren’t musical enough to actually play something normal (like me). OK, I played piano but she was the one doing that.

These tiny bones can easily work their way out of alignment after a blow to the head or trauma – I believe that today they can be repaired with microsurgery but it’s complicated.  In between are the smallest bones in the body that reverberate in response to the ear drum (timpanic membrane) vibrating in response to sound waves in your environment. Like the tiniest of precision percussion instruments, eventually turning into an electrical pulse that is interpreted through the neurotransmitters in your brain.

Culture often determines what we think of as noise versus music. That dripping tap of which I spoke earlier (which has been known to drive me insane and keep me awake) is, apparently, music to the Shinto-based Japanese mind. I don’t think that anyone truly enjoys a jackhammer however.

Currently I am surrounded by construction noise and have been for the least four months. It is exhausting, tiresome, intrusive and dreadful. And my ears hurt. Even with noise reduction headphones, the noise is unrelenting. The last thing I need is to go out for an evening’s “entertainment” to find myself surrounded by noise, be it the latest James Bond, war film or science fiction flick.

I hope you enjoyed the Oscars. And the nominated films. Just remember that once your hearing is gone, it’s gone. There’s no going back.