PowerPointless*

Published on February 6, 2012 in Cranky Comments. 0 Comments

There’s a moment (usually) around week four or thereabouts of teaching that I begin to glimpse a teensy glimmer, perhaps even a glint of comprehension. In cartoon lingo one of those little light bulbs, though often it’s kind of dim and dusty like the light at some tacky hotel you didn’t really want to stay at but you missed the train and it’s all you could find at that hour of night. And at least it seemed like it didn’t rent by the hour.

So interesting I can't stay awake

I can’t take it for granted yet because I’ve learned that critical thinking, even though it’s one of those buzz phrases always used to describe higher learning, is not the cornerstone of higher education. Heck, probably isn’t even the balcony railing.

Of course it may never have been, whatever us oldies like to think of our own brilliant youth. Talking to a philosopher friend who taught at undergrads some 25 years ago, I have the sense that his students weren’t much better – in fact he says he once just gave up; the blank, stolid looks unnerved him and he just up and left. Simply told them he was available in his office if anyone wanted to discuss the material.

It’s a great idea, except I don’t really have an office – as a sessional prof I have an ugly desk in a cubicle; one of many in a large, ugly, locked room that would make Dilbert weep. I just use it to store my coat on the days I teach.  And if I actually expected any students to drop by I’d have to lurk by the door to let them in, since they can’t seem me way off in the back and the door is locked. And that would be creepy. I gather it’s really not about the learning anyway, certainly not that undergraduate thing. It’s what Jane Jacobs called ‘credentialing’.

As nearly as I can make out, reductionist thinking, dull and linear, wanders the hall like some ghost of sleepy hollow – and the reverence for expertise and white coats and science and anything that smacks of authority is put up on a pedestal so high it’s bound to fall off and hurt something. Then again, what does one expect when everything from ridiculous commercials for face cream to mattresses professes to have research (clinical trials no less) backing up their claims that their product improved people’s lives 83%?

How one would know such things always fascinates me. Questionnaires? Surveys? PR thingies? You know the ones I mean, the little sheets of paper someone with a clipboard thrusts into your hands as you’re trying not to dislocate a joint finding some leg room in that airplane seat or you’re racing from one thing to another trying to find your keys. Whereupon a painfully cheerful person asks if you’d mind answering some questions about that soggy sandwich you just ate or what you think of a new strip mall they’re thinking of building where your favorite dry cleaner now resides. Er, if I’d I’d known there was going to be a quiz I’d have studied. As it stands I haven’t the foggiest. (And even if I did, would my opinion make a damn bit of difference? Likely story. It never has before. But I’m not bitter.) Numeric reasoning at present seems to take precedence over all else, including common sense.

I blame Powerpoint.

That’s right. The program we all love even if it’s made by that Darth Vader of software, Microsoft. (Apple has a variant as well I’m sure – it’s just that their ads are hipper and their numbers are smaller so it doesn’t face the brunt of our ire.)

Powerpoint’s given form to our function, our enchantment with linear thinking. And as a speaker or teacher you can even print up your cute little bullet points so nobody has to take notes. Or listen for that matter.

What I teach doesn’t lend itself to bullet points or decision trees. When I leave the class my white board looks like a hyperactive monkey was trying to write MacBeth: a mess of words that makes zero sense to anyone who hasn’t been there to hear me talk about the interconnectedness of everything or realize that those arrows actually mean something.

A/V loves me because I leave them alone. Students, well, that remains to be seen. But, sessional or no, I refuse to reduce the complexities of science and medicine into a series of bullet points. Call me crazy, but I still believe that even these texting, smartphone addled students are capable of  – and even glad to be asked to engage in – thinking. Critically. Creatively. Contextually.

They’re capable of rising to the occasion if we’d just raise our expectations of them a jot. After all, they’re our kids. Surely they’re smarter than we’ve been giving them credit for.

 

* I wish I could take credit for the term but it was a title from the online version of The Economist – so kudos to whomever thought it up.

Inflammatory Remarks

Published on January 17, 2012 in Cranky Comments and Medicine and Health. 0 Comments

Not long after I had managed to hurl myself down the Canada Line stairs (thankfully, not headlong) last week; even as I nursed giant multicolour bruises and a lump below my knee I found myself reflecting on the extraordinary, combined, resilience and fragility of the human body.

like that ..

On the one hand, practically before my eyes, the immune system response was set in motion by the trauma: a lump the size of a goose egg beneath the knee that felt rock hard but was clearly filled with fluid; puffiness, tenderness, redness … Well, you get the picture. We’ve all been there at some point or another.

That basic inflammatory reaction was described nearly 2000 years by a Roman observer, Celsus, who – in the best empiric tradition circa 30 AD – listed the characteristics tubor (swelling), rubor (redness), calor (heat) and dolor (pain).  In response to the cellular debris that the blow had dislodged the immune system dispatches macrophages, neutrophils and various and sundry immune compounds to begin “eating” them. (The term phage was coined by a late 19th century Ukrainian immunologist, Metchnikoff, whose real expertise was food and digestion; when he observed that even a starfish ‘defended’ itself from a thorn by sending along these tiny immune substances what he saw looked like eating so he called them big eaters, macro-phages.)

The heat is generated by increased blood flow to the affected region and the redness is due to dilated blood vessels. Meanwhile, the pain serves a very useful purpose: it keeps you off the leg (or arm or what-have-you). Of course the inflammation itself is a source of pain as it acts on the nerve endings – and tugs at the skin which becomes tender as a result.

All this many years later we’ve only managed to add one more characteristic to Celsus’s, namely loss of function which is pretty damn obvious. When something’s swollen and red and painful, you tend not to favour it, and, as I found out with the leg I came down fairly hard on, it keeps you from overusing it which allows the immune system to do its thing. Bloody clever of physiology, don’t you think, creating its own splint?

The body’s resilience, adaptability and sheer cleverness never cease to amaze me. The immediate gastric response to something bad we’ve eaten, often accompanied by nausea, vomiting and diarrhea that in essence expels whatever is overtly causing the problem. The sneezing and sore throat that’s a response to a viral infection. The immediate skin response when it’s been broken and bacteria have become lodged within. Of course the immune response can also go haywire and maladaptive, as in rheumatoid arthritis which is inflammation in response to nothing. But that’s the price we pay for having this self-adjusting system inside that keeps us ‘safe’; anything that’s designed to kill can also turn on the host. As in friendly fire.

I have tried, incidentally, to put many of my military metaphors in quotes because I’m only too well aware that the immune system’s real response is not conflictive or militaristic but an attempt to achieve balance within the body. We are all a giant morass of bacteria and viruses and parasites and microbes; it is only at those times when something overwhelms that the reaction spirals out of control. In my recent case, that fall down the stairs. But that’s also why we succumb to a cold when we’re stressed or not sleeping or grieving or generally below par. It is not the virus “attacking” but our immune system not able to stay within its normal homeostatis.

(A brilliant, fairly old, book for anyone who’s interested in this idea is The Tao of Immunology by Mark Lappe, which I recommend highly.)

On the flip side of that resilience is also immense fragility. It would have been simplicity itself, had my fall taken a different turn, to imagine a broken bone or worse – brain damage, cognitive impairment, seizures, even death. I can list off without too much thought several people I’ve known to whom this has happened.

Years ago there was an ad, a simple print one, that showed an empty wheelchair and had as a tag line something to the effect of “it only takes an instant to change a life”. Which of course is true. One split second of inattention at the wheel – or on a set of stairs at the train station – or a simple glance at a text message can irrevocably change one’s life. Forever. All those cool new prosthetics and potential advances in neuroscience and this and that notwithstanding.

This is why I simply do not understand why we are so ready, so willing, so damn trusting when it comes to subjecting ourselves to screenings, such as colonoscopies, that can go sideways, nick the bowel and have one in ICU. Or willingly line up to take our radiation with a CT scan (which, I would remind you, emits up to 400 times as much radiation as an x-ray depending on the vintage of the machine) only to hear that the knee will get better on its own and if it doesn’t we’ll eventually need surgery. Um, and you needed a picture to tell you that?

Bad things can happen and inattention – that multitasking of which we are so proud – occasionally means mishaps.  But when people essentially feel perfectly fine; when a person has the means and wherewithal to eat reasonably well and exercise; when we have enough money to do some of the things we like to do not to mention procure the basics of life, why on earth must we be so hypochondriacal as to always worry about possible future ill health? Especially when all those dire (and erroneous) statistics like ‘one woman in four’ will end up with osteoporosis turned upside down means that three women in four will not?

How did we all become such neurotics anyway?

And the mammogram nonsense goes on …

Published on December 5, 2011 in Medicine and Health. 0 Comments

Given my previous curmudgeonly rants about the general uselessness of mammograms I was pleased, nay, delighted when when the Canadian Task Force on Preventive Health Care issued new guidelines – ever-so-gently suggesting that perhaps this pop culture myth that ‘mammograms save lives”, especially that of younger women, is a crock. Naturally they phrased it in dry, epidemiologic language, but you’d thought the poor geezers had suggested women shouldn’t be allowed to vote.

The response, anecdotal, I’ll grant you but shrill, emotive and generally overwhelming was: Well! How dare you condemn women to death you dreadful guideline-writing scum you. Letters poured into newspapers and editorials pilloried the Task Force – the inevitable line was “having a mammogram saved my life”.

Politically incorrect and uwomanly of me it may be, but my first thought was, ‘Really?! How do you know? Given that a teensy mass that couldn’t even fill the head of a pin is now called a cancer and the person who’s had it a survivor?’

Perhaps less vocal people felt relieved that the Task Force had articulated what they had thought all along, that it may not be such a splendid thing to squish your breasts between two metal plates once a year even as you ended up dosed with radiation but I don’t know.

As far as I’m concerned the Task Force didn’t go far enough. They clearly stated that women who had the BRCA1 and 2 genes or had a family history continue to have regular mammograms, even as early as 40 and added that older women, those over 70, should also be screened. They politely did not say, trust us, if you have cancer you’ll know it. Ideally, a mammogram will find a fast-growing cancer early. By and large, it won’t. What it will find is what all those cancers that don’t want to be found, the bits and pieces of slightly abnormal tissue we all have – and which will be found if we go looking for trouble. Which is essentially what screening is.

Alas, screening is all too often confused with ‘cure’. Or ‘treatment’. Which screening simply cannot be. Screening is a way to make obvious something that was there that we didn’t know about, theoretically to ‘catch’ something dangerous early. As if.

But, hey, we’ve got the runs for the cure and all those pretty celebrities (and nonentities) going on the telly to lecture us on how we should all be focused on preventive care and take our radiation. Or have someone thrust a sharp object up our colon. Yes, sharp. The kind of thing that can slip and perforate the bowel and have you in the ICU faster than you can say colonoscopy.

But I wax incoherent.

So, once again, a brief lesson in how cancerous cells evolve. Cells divide over the course of their and our lives; with each division the odds of a ‘mistake’ increases. Which is why cancer is generally a disease of old age. The more those cells divide the greater the odds that something will go askew and result in what, if found, we will call cancer or pre-cancer or some damn fool thing. (Of course as we get older our cells divide more slowly which is why most older people die with cancer not of it.)

Then we attack what we’ve found with all the tools of the early 20th century: radiation, surgery and harsh drugs. True, a handful of cancers are actually treatable with some new meds, usually fairly rare cancers, and a few drugs can increase life span. We are better at targeting and focusing and not killing quite so many non-cancerous cells. But the reality remains that we’re still focused on zapping and poisoning and cutting out cancers, just as they were in close to a hundred years ago and, barring the smoking/lung cancer connection, no closer to understanding why some people get cancer and others don’t.

That’s the question we should be asking and flinging money at, not mammograms.

Of course why the guidelines come as a shock to anybody I do not know, since we’ve known, definitively, since the 90′s that mammography is a crude screening tool at best. Plus, for women under 50 the risk benefit ratio is beyond ridiculous. (What we really mean by that, of course, is women who have not yet gone through menopause not women under 50 but we do love our decimal groupings – maybe it’s that counting-on-ten-fingers thing, so much easier). In other words, the number of false positives, biopsies to confirm one does not have cancer and actual false diagnoses are phenomenally high. (That last one, by the bye, simply refers to the women who end up being told they have cancer when they do not and end up in that most dismal of all “treatment” regimens for no reason at all.)

We have also known for a long time that not all cancers want to be found; that in fact over-diagnosing and over-treatment are rife when public policy institutionalizes screening, whether it’s PSA testing or colonscopies or mammograms.

But the emotional anecdotes continue to mount as individuals tearfully ask why the rest of us (and that nasty Task Force) would condemn them to death. Ah, easy there sport. Nobody’s condemning you to anything. Yes, women do get breast cancer. We have all had a friend or relative die of the disease. (Yes, including me. I sat with her as she died.) But simply because something happens does not mean it’s an epidemic or a scourge.

Finally, health policy is not clinical practice. Policy, guidelines, are simply a way for institutions to recommend what appears to be best practice. This does not mean that individual women cannot have mammograms or that individual doctors cannot counsel individual patients to have them. It simply means that a blanket policy recommending all women over a certain age undergo a procedure that is neither benign nor risk free is not a good idea.

Furthermore, something the Task Force did not mention, probably because they did not know it, is that women prior to menopause go through a phrase of life called perimenopause. Perhaps you’ve heard of it. It’s the years leading up to the cessation of the menstrual cycle when some women have hot flushes and mood swings and can get depressed and irritable. Estrogen levels fluctuate during this time and estrogen, boys and girls, is a hormone that causes cells to proliferate. It does that in the uterus during the menstrual cycle and also in the breast. So, the risk of a false positive raises commensurately for perimenopausal women because higher estrogen = lumpy breasts. More often than not these will resolve, go away, with time as an elegant Scandinavian study demonstrated some years ago.

So tell me again why women in their 40′s would want to subject themselves to this? Oh yes, because they believe in the medical model and the linear nature of physiology. Worst, we have all been subjected to such a barrage of pink ribbons and nonsense about prevention that women honestly believe the dratted technology actually works.

For my part, a certain weariness sets in as I watched this play out, not to mention the inevitable expert huffily saying, look, it’s science and you can’t argue with that. Actually I can. But this is one time the best-guess statistics, hypothesis testing, and empirical data all back up the physiology and common sense.

But I guess a lot of women have decided that the Forces of Evil want to take their mammograms away. How does one explain the Forces of Evil have a lot more on their mind these days than women’s breasts?

No Genius, Just Insanity

Published on November 16, 2011 in Uncategorized. 0 Comments

Yesterday, sitting with my friend Joan, who is American but has been living in Paris for some twelve years, talk turned to the U.S. and Obama and the Republicans and the general insanity that appears to have taken over American politics. And all one could do is shake one’s head. Today, Joan sent me this link from the Huffington Post – the bit she wanted me to see was the video, her friend Jake, talking about his take on Obama – and I have to admit Jake’s points are well made. Certainly, were I American, Obama’s calmness and intelligence would seem a right treat given the general craziness of the Bush years.

Still, there’s a part of me, I admit, that wants Obama to blast the Republicans; lose some of that civility and tell them they’re bloody idiots. Not to mention the part of me that’s just so damn irritated by these voodoo economics the Republican are espousing that I think, fine, go ahead, do it. Destroy your lousy economy and your country. That’ll teach you. Of course that’s like the depressed person who wants to kill themselves and thinks, that’ll show them.What exactly it would show ‘them’ is unclear.

It just seems so ridiculous. Why would raising taxes on corporations and on those earning huge incomes be such a bad thing?  How is it that Warren Buffet is willing to pay a larger portion of his considerable income in taxes but the party that ought to be his natural ally refuses to countenance it? And finally, what kind of bonehead actually believes that an economic downturn, a recession – with unemployment hovering around 10% – can be “fixed” with harsh cuts in government spending? Even The Economist, bastion of open markets and general right winged-ness for nearly two centuries, warns against austerity during a time when the economy is grinding to a halt.

Neither national budgets nor global finance are comparable to domestic ones any more. Once upon a time one could argue that well, you take in so much in taxes, you spend so much (more or less) and things generally work out. That’s when governments were small and things weren’t so interconnected, complex and debt-ridden. Virtually all countries, even those who have weathered the recession reasonably well, like Canada, have borrowed large sums of money and the lucky ones are the ones whose debts are intra-national (in other words, the money isn’t owed to another country).

But no doubt I’m preaching to the choir here. The people who agree with me already do that and the ones who don’t wouldn’t be caught dead reading this. Not that I think there’re that many people, dead or alive, who are reading this. Voice in the wilderness etc.

Still, as I tell my students, life will go on; shops will still sell things and people will still go to work and school and day care and so on. Markets may fall at bad news from the euro but markets aren’t economies. Markets are just a bunch of jittery folks who follow the crowd(s) and are bears of very little brain.

Too bad the politicans are too.

The Wrong Stuff

Published on October 17, 2011 in Cranky Comments. 0 Comments

So the dishwasher broke. Again. It wasn’t the first or even the second time it had broken down but this time it hadn’t even been a year – the last time took two weeks for the part and over $300 to fix. It seemed time for a new one.

The new one is from Asia somewhere, possibly South Korea (though, who knows, the South Koreans may well be outsourcing to China now). And it will probably work for a year. That’s how the nice man at Sears explained it and he made perfect sense. You buy a washer/dryer, he pointed out, and the manufacturer gives you a ten-year warranty. A dishwasher? That comes with a one-year guarantee – which means that is how long the manufacturer actually expects the dratted thing to work. I was much struck by the obvious obviousness of this as it had no occurred to me before.

(In humour it’s called simple, unexpected truth. “Why do you think you lost the election, Senator?” “Too few votes.” A response so basic it surprises, and makes one laugh. Or perhaps cry.)

Hence, the truth about this brand new stainless steel dishwasher is that even though it ended up costing a whisper below a thousand dollars it was built, manufactured, to last 365 days. I’d heard of planned obsolescence but surely this is ridiculous.

Meanwhile, we are exhorted to reduce, reuse, recycle and just say no to carbon. Problem is, the one thing that life in the 21st century is not about is conserving, keeping things, reducing waste. It’s about that dishwasher, built to last a year and ending up in a landfill.

As a woman I met recently said, in our parents’ day appliances were, granted, bulky and less than beautiful but they lasted. Once you bought that new stove or washing machine or dishwasher you could relax. If it broke down (which it rarely did) you called the repairman who’d call, have the part on him and that was that. Another decade would go by without any trouble.

Today we have smug self-satisfied little stickers on our appliances and dozens of pretty buttons that let us delay start and auto this or powersave that, that’s if the damn thing actually remembers how to work.

A few years later it ends up in a landfill having forgotten how to do the job it was designed for and not worth fixing. It never was too big to fail; rather it was too small to bother. But hey, it did its tour of duty – after all, t was only expected to work for a year.

So we discard, buy the latest version and toss yet another well-made, solid piece of engineering in favour of a pretty plastic device that looks new for six months then falls apart. Is it any wonder protestors are occupying Wall Street and Robson Street and Bloor Street; people are cranky and wondering why they can’t get the jobs their parents had, the middle class lives they could aspire to or their hope for the future.

What d’you expect, when you can’t even get the dishwasher they had? In the grand scheme of things a broken dishwasher is beyond irrelevant, especially when people are losing their jobs and homes and there are people in the world without a roof over their head or enough food to eat. But it seems emblematic of the mess that we’ve made of so much. Well, I use the term “we” metaphorically since I don’t recall anyone asking me about outsourcing or globalization or corporations being people and most of the time the people I vote for don’t get in.

That dishwasher seems like a sad little paradigm for the hypocrisy of the whole thing. So go Wall Street/Bloor Street demonstrators. At least let the man know we’re tired of this nonsense.

And while you’re at it – could you ask about my dishwasher?