Physiology 2.0

Published on April 2, 2011 in Medicine and Health. 0 Comments

An older woman of my acquaintance misplaced her watch recently. Not a big deal, you’d think. She found it a few days later with the help of a friend – unbeknownst to her it had slipped off the television and into a drawer. What got my attention was her extreme secretiveness, so convinced was she that people would suspect she had Alzheimer’s or dementia or what-have-you (because of her age).

Somewhat in the same vein I am often asked – in strictest, pain-of-death confidence – about a pain here, a twinge there; a slow-to-heal cut or some bleeding that my interlocutor is convinced is something dire, cancer probably. Almost always with some judicious questions I can reassure the person; the pain is probably a pulled muscle (if it doesn’t improve over time then perhaps further investigation might be called for), the blood loss benign (and common), the cut merely infected and in need of antibacterial care. The relief is inevitably palpable. Terror had literally been keeping the person up nights.

I don’t blame them. Everything they hear about health, and there is a lot of it around, is about something horrible. In truth, we are all so inundated health “news” these days, so saturated with medical “updates” – in every medium possible – that it’s virtually impossible not to become a hypochondriac at one point or another. Especially since medical problems are presented not in terms of real physiology which is messy, unpredictable and slow (but often very resilient) but in entertainment terms: Monster tries to eat New York, hero rises to vanquish monster, stuff happens, the end.

The heroic angle is ever present. We will discover the gene that “causes” cancer (Really? How’s that working out?), tweak it and presto! Problem solved. Well, not right this instant of course. Oh, and did we mention there are these fibres in those bags you now use to carry groceries that can cause beri beri? Oopsy woopsy.

That’s not how physiology works.

From the immune system to neurons, our physical selves advance, retreat, retrench; go forward one step and back two (even with something ostensibly simple like a flu virus). Age on the one hand creates fragilities, on the other speaks to great endurance (hey, there are a lot of chances to die before you hit 75). Physiology is complex, dynamic and infinitely changeable, even in the same person, from one moment to the next.

The root of this reductionist thinking came after the second world war when money and attention, not to mention serious institutional support, went towards medical research, the National Institutes of Health, Health Canada and the like. And our focus, as the late Yale epidemiologist and physician Alvan Feinstein wrote, turned away from the person (patient) and towards disease. Plus, we started flinging large sums of money at medical research which, in turn, began singing its own praises, which is hard to do unless you create a bogeyman you are battling.

So, nobody mentions that we live longer, healthier lives (in the developed world) than any generation ever. That over half of all people over 65 are alive today and doing very well thank you very much. What we do hear is that there are umpteen dreadful diseases out there, skulking, lurking.

So we freak out over minor aches and pains and mumble “Oscar material” when some fellow played by James Franco heads into some canyon and gets stuck. Look, I’m glad the fellow saved himself and yes it must have been dreadful but the real story is not dramatic but in the day-to-day lives of all those amputees who have to cope with getting on with their lives. The real story isn’t in the escape but life after that idiotic daredevil stunt. Except life with a disability is painfully difficult, often humiliating and can make even a grown man cry from frustration. Boring. Not at all Oscar material.

Is it any wonder real life, only too often – when it hits, as it always does – comes not only as a rude shock but as a personal affront?

Take another curmudgeonly peeve of mine. Violence. Movies, television shows, games – the level of gore has steadily increased even as our ability to emphasize or react in any appropriate form has gone down. Sure, I enjoy watching the evil genius get his or (more rarely) her comeuppance; I like a watching a building blow up and cops shooting at bad guys. What I do not enjoy is the inevitable desensitization these increasing levels of violence have on our collective psyches. (Or the noise: I seem to be the only person in the western world with intact hearing.)

It seems that we have all become so immune to the ugly impact violence has that even an essentially comic-book hero like James Bond is portrayed not as the suave Sean Connery straightening his cuff links after a dustup but is rife with fake blood and cringe-worthy torture scenes that make one feel vaguely ill.

Then. Then. (Here we have to pause for me to give a heavy sigh.) Then, the victim of aforesaid torture or flying bullet gets up and carries on. If he’s the hero, that is. Later, we hear that he was lucky, the bullet “grazed” the skin, it was just a flesh wound.

Pardon me?! What flesh would this be? Um, human? Frankly, I have yet to meet a real human being who was able to recover from even a kitchen accident in a day. (Hey, you try it. Make a deep slice in your finger as you’re chopping carrots or a slice of bread and you tell me how long it takes to heal. More often than not you’ll take the bandage off way too soon, the cut gets infected and starts to throb and the whole process starts all over again.[1]) The consequences of violence are so rarely seen as to be invisible.

No doubt this is why we get those news items of seven-year-olds firing on one of their pals in jest without realizing that real guns do real damage.

Physiology is hard. Healing takes time. Bodies are fragile yet amazingly resilient. It all depends on the person, the situation, the amount and place of the damage. Even a broken ankle can lead to a lifetime of causalgia (you don’t want to know – major, lifelong pain) and someone can fall off a cliff and survive with minimal injuries. It’s not possible to predict and it’s probably better not to try that last one. Politically, such attitudes end up reflected in the acceptance for President Bush’s redefining torture in defiance of the Geneva Conventions and in our nonchalance around so much global suffering – even as it convinces us that we’re dying from some dreadful disease – when all we’ve got is a hemorrhoid.

[1] (First Aid note: when you’ve cut your finger or hand and the skin has healed over but it’s red, swollen and painful, what’s happened is that bacteria are trapped and your immune system is responding, but slowly. To help the macrophages along, you need to clean out the bacteria physically by making a tiny incision and letting the blood and pus ooze out. Sounds horrible but there’s physiology for you. Then soak in hot water with a drop of disinfectant, e.g. Dettol, or just water in a pinch.  Cover with antibacterial cream and bandaid.)

Staying Alive

Published on January 27, 2011 in Cranky Comments and Health Care. 0 Comments

The absurdity is beyond irony. In a country obsessed with “proactive” health, screenings and tests; a country where celebrity figures urge everyone to “fight” this or that cancer with mammograms or colonoscopies or PSA tests; a country that spends over 16% of GDP on health care and still has the poorest health outcomes of any developed country, one of the biggest threats to health is an amendment to a 300-year-old document professing the right to “bear arms”.

Originating in a different time and frame of mind, the American constitution was a masterpiece of hope and imagination; that “well armed militia” (bearing aforesaid arms) and hope, all that stood between a young country and its colonial past.

Today, in the age of iPads and wifi, environmental change and globalization, it all seems so sad and silly. Particularly in the wake of the tragedy in Tucson a few weeks ago, where a Congresswoman and many others were wounded and six people died.

In terms of health it seems to me that that the United States would do well to stop its preoccupation with political rhetoric (not to mention those colonoscopies) and – for five minutes – consider whether the number of guns in circulation might, just might, have something to do with the incident.

bang bang, you're dead (the healthiest corpse I've ever seen)

As the Economist put it:  (January 15, 2011 print edition, here)

“Opportunists who seek to gain political advantage by blaming the shootings on words would do America better service if they focused on bullets. In no other country could any civilian, let alone a deranged one, legally get his hands on a Glock semi automatic. Even in America, the extended 31-shot magazine that Mr. Loughner used was banned until 2004. As the Brady Centre, established after the Reagan shooting to commemorate one of its victims, has noted, more Americans were killed by guns in the 18 years between 1979 and 1997 than died in all of America’s foreign wars since its independence from. Around 30,000 people a year are killed by one of the almost 300m guns in America – almost one for every citizen. Those deaths are not just murders and suicides: some are accidents, often involving children. The tragedy is that gun control is moving in the wrong direction….”

I couldn’t have said it better myself.

Loathsome Lycra

Published on January 18, 2011 in Cranky Comments and Economics and Business. 0 Comments

What do Lycra, Stainmaster carpet, Dixie cups and oil refineries in Alaska and Texas have in common?

They’re all owned by Koch Industries, ranked by Forbes as the second largest private company in the United States. The biggest corporation nobody’s heard of.

Owned by the brothers Koch, the company also has the distinction of being one of the top ten polluters in the U.S. not to mention a staunch (financial) supporter of the Tea Party movement. (The brothers’ father started the company – apparently Koch pere trained Bolshevik and helped Stalin set up some oil refineries in the Soviet Union, well, until Stalin turned on him), Not only for libertarian reasons but solid business ones: after all, less government means less government meddling in pesky details like environmental laws and lower corporate taxes.

So that, girls and boys, is what you’re supporting when you pay good money for stretch material, spandex  – or, as the labels proudly hanging on virtually every piece of clothing one sees these days, “Lycra”.  Jeans, dress pants, cotton shirts, sweaters: you name it, the damn thing has umpteen percent Lycra.

mah-ve-lous stretchy Lycra

I have never understood the attraction of clothes that stick to you, refuse to hold their shape after you’ve worn them once; have that synthetic feel and make Koch Industries richer. So ubiquitous is Lycra that even Levi jeans ostensibly made of “100% organic cotton” contain 3% of the vile stuff. I know this because I fell for the “organic cotton” line (I absolve the saleswoman of all guilt; I doubt she even realized there was Lycra in the jeans) and ended up giving them to the hotel chambermaid in disgust.

Maybe it’s my shape – or my orneriness – but on me, jeans with spandex/Lycra fit too tightly when washed, then start to droop upon second wearing. In a day, not only am I tugging at myself like some demented ferret but my crotch is hanging lower and lower. And trust me, nobody will mistake a woman of a certain age for Fi’ty Cent. Worse, Lycra, being synthetic (and a particularly noxious one at that) doesn’t breathe and if there is any humidity in the air I end up hot and cranky. OK, crankier than usual.

These days I’ve taken to walking into all manner of posh stores I didn’t used to frequent, secure in the knowledge there will be no natural fibres in sight, all our fine talk of “green” products notwithstanding. I saunter jauntily into Hugo Boss, Max Mara, Holt Renfrew … Once the statuesque salesperson has realized that like the universe I really do exist and do expect service, being posh they immediately treat me like royalty.

Whereupon I pleasantly ask if there’s anything in the store – a pant suit maybe – that consists of natural fibres: cotton, silk, hemp, wool, bamboo, whatever. “Of course,” they assure me in somewhat superior tones. Then I see The Look. Perplexed, followed by darting eyes back and forth across the hangers … and then the “Umm … actually …

Actually no. Yes, there’s one wool jacket in a noxious beige my grandmother wouldn’t have worn, lined in polyester and oh, there’s 5% Lycra. Occasionally there is a triumphant leap towards a cashmere sweater or a cotton shirt, neither of which I want (or would wear on a bet).

Does anyone even remember that cotton jersey stretches? That denim jeans are briefly tight after  being washed but then have plenty of give? That good fabrics feel nice – versus petroleum by-products, aka nylon, polyester, spandex that are slimy smooth, don’t breathe, pick up very jot of ambient odour and make one hot and sweaty?

I am actually beginning to wonder if spandex/Lycra isn’t one of the reasons we’re all so fat. After all, if your clothes never feel tight, you never know if your clothes are getting tight and perhaps you should cut back on calories for a week or two and get back to your normal weight. All normal cues disappear in the absence of clothes that fit.

Wasn’t this supposed to be the age of the whatsit graph, that long tail; the age of the choice? When even people with wants outside the norm should be able to tap into an existing market? The internet and globalization were going to make it all possible.

Instead, it’s all made in China and contains Lycra.A friend who’s a seamstress and tailour tells me that spandex “eats” cotton and other fabrics so clothes don’t last as long. Maybe that’s the real point.

If it’s not finding uses for all those leftovers from some nice oil refinery. Like the Koch brothers, who, according to a long article in The New Yorker, “have given millions of dollars to nonprofit groups that criticize government environmental regulation and support lower taxes for industry”. Who says industrialists don’t know how to spend wisely.

Too bad the rest of us don’t.

“Information is power” (not)

Published on January 9, 2011 in Cranky Comments and Medicine and Health. 0 Comments

As I raced through Waterfront Station last week, late for something or t’other, I overheard a well-dressed young man intone, “Information is power.” The pretty young woman he was with enthusiastically agreed.I moved on, dodging slower pedestrians and trying to figure out why and how such a cockamamie truism had taken such a stranglehold on us all. Information is power? Says who?

Information, aka data, is not even knowledge, never mind power. Without context, without a hypothesis, without a narrative of some kind, simply having access to Google and disparate bits of information means nil.

Anyway, isn’t the usual phrase knowledge is power? And even knowledge, moreover, rarely translates into power- unless you’re a blackmailer.

Unfortunately, the cliché has taken off and far too many people actually believe that having access to information, be it minute by minute stock/business data, medical information or Google (“facts”) actually means something.

Let’s take one example of basic information: observational studies. We observe one thing, see that it seems to happen whenever something else does and presto, we have a correlation on our hands that we conveniently forget are simply disembodied bits of information that probably mean nothing – but which we assume reflect cause.

Epidemiology had one major success with that: cigarette smoking and lung cancer. And they’ve never let us forget it. The problem is that almost no observational studies epidemiology threw at us ever turned out to be accurate when properly scrutinized.

Take the estrogen debacle. For years observational studies and epidemiology insisted that women who took estrogen, particularly at midlife, were healthier, lived longer, had fewer heart attacks and even suffered less from dementia. The problem was that this link came from well-off women who had the time to fill out those surveys and questionnaires, which meant they were better educated and of a higher socio-economic background. This meant that they were also healthier – in fact there’s even a name for it: the healthy user bias. People who are from a higher socio-economic status are healthier. Period. Why? We don’t know.

Perhaps they eat better or have less stress; perhaps they have better genes and it’s that which has led them to be better off in the first place. Maybe they breathe cleaner air and live in nicer areas where they don’t breathe or step in toxic gunk. After all, it’s not the CEO of a company, whether in India or the United States, whose house abuts the factory runoff, it’s the hapless janitor and his family who can’t afford anything better.

The media loves reporting on observational studies, where the inevitable term used in the headline is “linked”. Vitamin D is “linked” to better health. In healthy societies women’s choice of mate is “linked” to more masculine features, which naturally means that evolution has had something to do with the preponderance of older men marrying women young enough to be their daughters.

We forget that correlation has nothing do with cause. The Women’s Health Initiative clinical trial was stopped early because it was the women who took estrogen who were dying in droves from breast cancer and heart disease. All those years researcher upon researcher had insisted that their hypothesis, namely that estrogen was the female hormone, was right and had absolutely nothing to do with the binary nature of our socio-cultural classifications. But gosh, they were wrong.

Failure of imagination follows in the tracks of information – simply knowing that something happens tells us absolutely nothing about why it happens or whether manipulating one factor will have an effect on the other. It could be incidental, an artifact, or just plain wrong.

Still, we walk around, secure in the knowledge that our platitudes, like information, give us an edge.  But it’s not power, just swagger.

A Grinchy perspective on WikiLeaks

Published on December 25, 2010 in Cranky Comments. 0 Comments

T’is the season to be jolly, shop till you drop and generally try to live life through the lens of a Hallmark card or a TV movie. Too bad the movie is usually one of those rapid-fire, vapid latter-day concoctions where they pour on the saccharine and bang home the message with a sledgehammer.

I watched The Bishop’s Wife tonight. A lovely old movie with Cary Grant, Loretta Lynn and David Niven, the movie is neither sentimental nor overtly Christian, title notwithstanding. It’s just a simple story (granted, a simple story with the original McDreamy, Cary Grant) that reminds us not to forget that there are people less fortunate than ourselves during this holiday season when it’s all too easy to lose oneself in grandiose schemes and commercial concerns.

Sometimes not seeing the whole is what makes a good picture

Meanwhile, the cultural leitmotif of the day remains WikiLeaks and the wraith-like Julian Assange whose tens of thousands of cyberspaced emails and cables appear to have thrown everyone into a bit of a tizzy.

Although I’ve read bits and pieces on the subject (not to mention interminable commentaries), I have no idea if the information in these leaks is a genuine, eureka, Pentagon-Papers, moment that will save democracy (as Assange in his best delusions-of-grandeur tone asserts) or just a lot of nonsense.

But as a person who spent many years writing for old media (not to mention a curmudgeon), I tend towards the latter.

Journalism, like life, is largely humdrum. What people know and say – well, most of what they say consists of details that are neither here nor there – and have little relevance to anyone outside of those directly involved. Hey, just because people have titles and embossed business cards doesn’t mean they’re smart, witty or fun at parties.

As a journalist, it wasn’t the ideas (i.e., problems) that were difficult to find; it was the execution of it as a viable story.: Finding the right people to interview, the apt quote, the pattern that would turn a jumble of information into a coherent whole.

Let’s face it, good journalism is a lot of work. Hours on “ignore” as you wait to talk to the right person (or to find the right person) who might know a thing or three about your topic. Yet more hours talking to them (bearing in mind that the bulk of most interviews consists of babbling incoherencies) then umpteen more hours transcribing said interview. Finally, the denouement: pacing and rearranging the top drawer of your desk, rereading your notes, trying to find a way to make all this gobbledygook make sense.

Assange and his cohorts cleverly did away with all those boring bits. They were given the cables and mails, downloaded them onto their site and now they’re firmly clamped onto the moral high ground.

Er, OK.

Except as nearly as I can make out all we’ve found out some minor gossip and some tragic bits we all already knew, namely, that “friendly fire” has killed a lot of innocent people – and that those young men and women in uniform, all the hype notwithstanding, are young men and women. Emphasis on the young. Who don’t know who the enemy is half the time and when they do, usually can’t shoot straight.

I once read that in the second world war easily half or more of the casualties were killed by their own “side”. In the heat of battle the vast majority of soldiers panic and shoot at anything that moves. Including their own feet. Is there any reason things are any different now? Don’t think so.

Other shocking revelations from the WikiLeaks crew consist of the earth shattering information that politicians and diplomats say indiscreet things behind the scenes that they’d rather not say in public. Who knew. Unless you’re from a galaxy far far away, you I suspect. Hell, half the time the stuff they say on the record is drivel.

As children we believe in Santa Claus and it is the mystery, the not knowing that gives Christmas Eve its magic. Diplomacy, relationships – well, they also need a touch of that. If everything is thrown out in the open it’s difficult to figure out what’s trash and what’s real.

While there may be some nobility in preventing shady backroom deals, with all the information technology out there today even “elites” have trouble hiding. In general there is far more information than we needed to know.

Tonight, as small children breathlessly await the arrival of Santa Claus, it is perhaps a good time to contemplate that magic and mystery are sometimes more relevant than knowing the minutae. There’s actually a kind of beauty in not knowing – but believing. Believing that overall most people are decent; that most people will respond in kind if we treat them well and that the ultimate transparency is trust. And like Cary Grant in that old movie, angels might just be our better selves.

Merry Christmas.