Pliny's Academic Freedom Statute: Teaching the Controversy

The Discovery Institute (a name that George Orwell would have loved) has posted its version of academic freedom legislation that right thinkers can use as a basis for a cavalcade of proposed bills to chip away at scientific enlightenment. So in a similar vein, Pliny is posting his language that can be used in the front of science texts or recited by teachers to satisfy these stringent requirements laid out in these statutes.

Teaching the Controversy surrounding Descent with Modification

The Board of Education of the State of _________ is another victim in an ongoing culture war between science and superstition dressed in sheep's clothing. Scared to death by the scientific and philosophical implications of the theory of evolution, which could result in a major loss in status, power and revenues, Christian fundamentalist leaning groups have successfully employed the marketing tactics and sound bites used to get us to part with billions of our hard earned dollars buying stuff we don't need, to steadily erode scientific literacy in this country further creating fertile ground for their relentless efforts to return our precious family values and world view to the safety of the 13th century.

Despite the fact that evolutionary theory is more firmly supported by mountains of evidence from multiple disparate disciplines than is our understanding of gravity, these marketeers have successfully created a sense of controversy where none exists aided by decades of work in weakening the public school system's treatment of science. In the face of a relentless stream of new discoveries supporting evolution, creationist marketeers follow the example of Major General O. P. Smith, and "attack in another direction". These opponents will stoop to amazing depths to misrepresent the science of evolution while simultaneously claiming the moral high ground. Demonstrating that lipstick on a pig can indeed be convincing, these religiously motivated groups continue to intelligently design their messaging to avoid objections that derailed their earlier efforts to snuff out the candles of enlightenment. Coining secular sounding names like Intelligent Design, these creationists deny their God thousands of times more than Saint Peter in an effort to save our morals - with the obvious exception of truth telling.

Creationists are aided by the media which either does not understand or is unwilling to present a cogent representation of the scale of the immense disparity between those who oppose evolution and the vast array of actual science supporting it. They are further aided by politicians who are either reluctant to alienate a block of voters, chose to pander to said voting block, or are ignorant of the facts to a degree that makes one fear for the nation's future.

The pseudo-controversy surrounding evolutionary theory is an outstanding example of the successful use of populist adversarial tactics to undermine the foundations of science in a Democracy. As such it is a fertile topic for discussions of group think and behavioral psychology rather than biology.

Now that that is over with, we can get on with learning some hard science. Let's all open our biology texts to page...

Citing Pliny is not necessary. Use it as you see fit...


The Seventh Seal Has been Broken :(

The Seventh Seal of the Apocalypse has been broken. I'm moving to Idaho. On second thought, I'm trying to dodge eternal damnation so maybe I should reconsider.

What has me so rattled? As predicted in the Book of Revelations: 'Yeah (or really, BOO!) unto yea will come a rumor of war in Babylon upon a cultural icon which cannot and must not be duplicated." And it has come to pass. It has been announced that a Three Stooges Movie starring Sean Penn is in the works...

Goodbye World!


Knowing, Understanding and Belief: Essential Differences Between Religion and Science

Of all of the wedge strategies used against science and science education none is potentially as damaging, in my opinion, as the notion that science and religion are just competing belief structures. This is the simplest of the fairness doctrines that social conservatives use in this culture war. The implication of course is that it’s a simple matter of choice where one is as good as the other. At the same time, they work to tip the scales by trying to associate pure science with unseemly episodes in human history or portray it as eroding a social fabric that is not of this world. Why does this work? I think because to a certain extent it seems obvious and logical to most people. After all, one can believe in the tenants of science or the teachings of faith. What makes one better then the other, particularly when we are indoctrinated to believe that divinely-inspired morality is all that keeps us at bay. Unlike many, I happen to buy the fundamentalist notion that science and faith cannot co-exist for very long so I can understand their fears if not condone their tactics.

But after years of thought on the subject I must adamantly reject the premise of equality of belief. For science, unlike religion, is not a belief system but a true methodology. Science is a true methodology because its foundation is a belief in its own fallibility - not a false fallibility used to make humans feel inferior and compliant, but a true notion of the limits of observation, the biases of observers and their methods and ways to mitigate these effects in the search for real truth.

But as a simpler explanation I present the following: The implications of 3 words to the scientist vs the theologian - Knowing, Understanding, and Belief. These differences distinguish science from any other human approach to knowledge and in in my humble opinion make it clearly superior.

In many discussions of religion, knowing is a self-referential given. One knows the truth of religion because of the existence of works which claim to be the product of revealed truth. Not the revealed truth that comes from relentlessly peeling back the fabric of reality through cycles of hypotheses, experimentation, observation and reassessment (science) but their claim to truth comes from the claim itself. Justification to the claim is unnecessary because it is defended by a powerful entity shown in the same texts to not be a fan of explanation. Questioning is impolite, impious or just plain dangerous. Take Christianity for example, Doubting Thomas is portrayed not so much as a reasonable guy wanting to see extraordinary evidence of an extraordinary claim but rather as a less pious follower. ‘Blessed are those that have to see to believe but far better are those who just take our word for it over the generations’, - not the actual text but pretty close to the intent I fear. And what of poor Moses, who suffered for years as an agent of God, got punished for what happened while he was away getting the Ten Commandments and then is denied the promised land because he whacked a rock twice instead of once like he was told. My point is not to quibble with the Bible but merely to point out a couple of examples illustrating religion’s approach to squelching human curiosity - a critical requirement of science.

In religion, understanding is often portrayed as impossible or impious as the follower cannot reasonably expect to fathom the why or the how of the omnipotent. This paternalistic approach is mimicked in a million households each day where a child’s push back is answered with ‘because I said so’ backed by the power to enforce the edict - maybe not by an omnipotent force but one with sufficient force none the less. Knowing is unquestionable so there is no requirement or allowance for the formulation of new beliefs or questions. It is knowing in its least examined form.

No in religion, belief leaps over understanding to the knowing. Understanding, the foundation of science, is forever veiled behind the inscrutable face of the divine revealer. All that need be known has been revealed and understanding is beyond you anyway.

To the scientist, understanding is a vital step in the process of knowing. Science does not act in inscrutable ways beyond the understanding of men as many theologians would have us believe. No science acts according to principles, though often challenging, which are amenable to codification through iterative experimentation. In essence, science provides a method for proposing a belief and formulating a means to test the explanation required to express our understanding of how this belief is possible. Only when this belief (and its foundational understanding) has been subjected to rigorous testing can it hope to achieve the status of knowing. A status that is almost without exception understood to be tentative.

Knowing in science is never a process of ‘take our word for it’. Science always leaves a trail of intellectual bread crumbs that others may follow in order to gain understanding of how a particular belief became knowing. It may be difficult and technical and beyond the average person’s education, but it is always there. Relativity is not an understanding because Einstein said so but because he took the time to leave both formulae representing his understanding but also unambiguous predictions that could be tested and which had to be true in order for his beliefs to survive to the present day. These weren’t cryptic ‘and a nation will rise and fall and there will be a great war..’ kinds of predictions. No, for his understanding to be correct, there had to exist singularities in space with infinite gravity, a prediction which worried even he. And one which has now been observed.

Science dares us to pose new questions and seek new understandings. And it rewards us not with eternal torment for our temerity, but with a greater knowledge of the universe. That is about as cool as it gets.


Is Ignorance Winning?

The hydra that is Intelligent Design Creationism has sprouted almost too many new heads to count in the recent spate of 'Academic Freedom' legislations that have sprung up throughout the land guided by hands at the Discovery institute. It seems that most of what they discover are new ways to set back objective thought in an effort to prop up bronze age mysticism, but marketing and logos aren't required to be factual. If they were, we would have stormed the gates the first time a bottle left the factory labeled Coke Classic. If these guys applied the same vigor to something useful they might make a difference in the world other than to dim the lights. But they won’t. I find it very depressing that so much of the 21st century seems to be devoted to gleefully promulgating ignorance.

I'm not going to take mine or anyone else's time trying to debate the merits of Descent with Modification. To be honest, I’m hoping to never do that again. If, at some time in the future, a well articulated and scientifically plausible theory disputing the facts of evolution should appear, then I will be interested but until that dubious day arrives, I'm done. Intelligent Design ain’t it. Put all the lipstick you want on that pig. It is nothing more than crap marketing and it’s high time we just started dismissing this pseudoscience for what it is. Philip Johnson, science isn’t the law. It isn’t an arena where theatrics means more than evidence. Dembski, making up an equation and filling it with hand picked variables is not mathematics. Behe, irreducible complexity is just your word for not being clever or honest enough to find the real mechanisms - which were out there when you republished your book of rubbish. The scientific results are in, have been for some time, and are more than compelling. Debate is not what magical thinkers want anyway. From now on, I plan to refer scientific dissenters to a reading list of selections that I have found useful on topics not directly associated with my primary expertise. I hope to add a favorite reading list on selected topics to my blog soon. If they aren't willing to read the material they are a lost cause anyway. Evolutionary theory is an amazing and elegant discovery that explains a lot about why we are what we are. More compelling and far more beautiful to me than any magic. My kids will be brought up understanding and appreciating it for what it is without having to dumb it down or sugar coat some aspects of it to avoid offending somebody’s beliefs. A knowledge of science and mathematics should put them in great demand in the future idiocracy this nation seems determined to become.

As for academic freedom that does not nor should it ever be an excuse to replace intellectual rigor with lazy ignorance. Every view point is not equal in science. Yes, you are free to write whatever answers you want to any test question presented; and your instructors are free to fail you for being ignorant. That is academic freedom.

Why, the vehemence? For two reasons mostly that I am working to correct. I've fallen victim to a weakness in my character and to the siren's call of the Internet. Neither is helping my blood pressure. This coming year is going to be a wild ride so I need some zen in my life.

I’ve been thinking about this particular character flaw (I should say, one of many...). It’s a fear of being unfair. I guess the real question has been whether I'm concerned with being fair or being perceived as fair. As it turns out, it makes a huge difference. Having an open mind vs worrying about if anyone else agrees with that assessment. I think it's an important distinction because if you really only care about fairness, as opposed to perception, then things like the Discovery wedge strategy can't work - i.e., they can't force us to engage in senseless defense of that which needs none. They keep the perception of controversy alive in large part because we rise constantly to the bait. As Bertrand Russell so eloquently phrased, "we need to be open minded but not so open minded that your brain falls out." We respond to everyone of their idiot claims as if it warrants an answer other than to stop wasting my time or our kids time. Our champions (for the most part other than the most rabid) try to be polite and respectful of their opponents in the mistaken belief that polite discourse is convincing to the undecided but it may just be confusing to those who are simply ignorant of the facts. Instead let's concentrate on questions without answers instead of rehashing the known. My response from now on is going to be 'stop your bitching until you can come up with a valid solution that doesn't require magic'. I think that will work for a whole lot of topics in politics as well. I hate to be polarizing but enough is enough and the purposefully ignorant won't be carried by facts anyway. They just retreat further into the gaps until the next set of discoveries roots them out. The simply ignorant need to be made aware that there is no controversy at all, or at least it is one of degrees or relative contributions rather than deep substance.

A epiphany of sorts came a few weeks ago when I was talking to a colleague of mine who, prior to that day, I'd greatly respected. How we ended up arguing evolutionary theory escapes me, but we did. I was blown away by his complete ignorance of any of the science. And this guy is a graduate level professional in a scientifically based field. He sounded like he'd been programmed by the Discovery Institute and kept referring to fairness and controversy. Except he couldn’t come up with any actual controversies. Listening to him talk, I came to the conclusion that what wasn't fair, was that I had to be bothered by his clueless parroting. I ended the debate with a question to him; "Are you interested in facts or is this just stuff you picked up in church?" He said he was open to learning so we sat down at Amazon and I pointed him to a list of excellent references on modern evolutionary theory and the wedge strategy which I had found very useful and enlightening. We'll see.

Some might push back and say that to not debate on these topics will allow things like the wedge strategy to work, but I'm not sure that ignorance can be defeated in a nation that seems to have an inexhaustible capacity to create new nonsense in which to believe and on which to spend money (Scientology, anyone?). How can we hope to overcome established belief structures when we can't even keep new ones from arising right under our noses? I wonder sometimes if my little rants don't contribute to the problem in a small way - at least the ones outside of my area of expertise. Unfortunately, The Internet didn't make me smarter just allowed me to add to the static surrounding objective truth. And I worry if it isn’t true that all these voices don’t end up adding to the confusion. Hard to know. That’s one of the problems with having an open mind; we always calibrate it against outside perspectives. But on the Web there’s a hell of a lot of chaff for every grain of truth. I enjoy a lot of the insights I get from those of you I encounter frequently but I find that the overwhelming amount of flarge on the Web is depressing as hell. At some point you just have to decide that you have an open mind, in the sense of being open to rational arguments, and leave it at that.

So, if I continue with this little indulgence, it will mostly be on topics in which I have some true expertise, or just to share an occasional lark that amuses me at least. And maybe some more recipes...


Why We Stopped Watching '24'

The other day a couple of our friends were over and in the process of entertainment conversation they ended up asking Mrs. Pliny and I why we had stopped watching Fox's '24' a couple of years ago. It turns out that it was pretty simple. Although it had initially been mildly entertaining with its over the top senarios, Mrs. Pliny and I came to see the show '24' as an ongoing propaganda film to both justify and desensitize Americans to the notion of torture and the elimination of due process. Each season a new and terrible threat has been completely missed by the conventional intelligence and judicial system and with only hours to spare, old Jack Bauer has to torture his way to the truth. The show creates this sense of constant threat that can only be stopped by turning to evil and discarding the Constitution. Amazingly, even when Jack gets it wrong and tortures the wrong guy, his victims understand that he had to do it to protect us and shrug it off. It's all part of Fox's complete package of fear mongering and apologetics for evil. We are kidding ourselves if we think that these kinds of ploys don't work over time. I suppose that I can be dismissed as a conspiracy nut for thinking such things but just because you are paranoid doesn't mean they aren't out to get you...


Healthcare at the Crossroads or in the Crosshairs?

This week a number of ‘experts’ in healthcare policy met as part of the President’s plan to reform healthcare within the next year. One of the reasons that Pliny has been a bit slow to post over the last few weeks is that I am involved in the healthcare reform movement and have been busily trying to get some relevant information in front of those people in Washington. As a fighter in this particular war for more than 20 years some of what I am hearing from them is good, potentially great in fact - some not so much. But for the first time in my career policy wonks are starting to say the right things. The challenge will be to prevent greed, ignorance or ego to derail this process. If things go terribly wrong, the 40 billion dollars to be spent on medical infrastructure will simply go to entrenching the existing records systems which contribute to the problems and which compete against the systems that hold true promise.

What good have I been hearing? Three things mainly: 1) we need to change the way care is delivered and by whom, 2) advanced Information Technology needs to be developed to support reforms, and 3) existing electronic health records aren’t the answer to 2. Now if we can just keep them on track and not allow the economic Philistines who will see this as the biggest land grab at least since Iraqi no-bid contracts from dominating the field. If we do, within five years the USA will have the most advanced healthcare delivery system in the world and it may be possible to obtain it at half the cost we spend today. That is not a pipe dream.

For 15 years I have been telling anyone who will listen that healthcare reform is not about changing how we pay for services - it’s about changing the way the care is delivered in the first place. Now, for the first time, these same words are coming from the President of the AMA, and both sides of the Congressional aisle. They don’t agree on what that means or even where to start, but that is a huge positive shift in thinking. Why is that so important? One reason is because the changes in the payment structure (especially on the federal side) has contributed greatly to the cost problems we face now. Money gets shifted around kind of like the deck chairs on the Titanic but nothing is done to address how care is best delivered- and by whom... or what... The larger answer is frankly that we don’t have a healthcare system: we have an acute and emergency care system. And even that isn’t nearly as good as it could be.

Nuts and Bolts of Medical Care

The diagram below is a somewhat simplified representation of the problem faced by clinicians caring for patients. This is the diagnostic and management curve. It represents the fact that there is a continuum of complexity in medical conditions. On the left are a few conditions either so simple or benign that anyone can deal with them and as we move to the right, the conditions become harder and harder to either diagnose in the first place or manage once they are identified. Some are darn near impossible to recognize. Most conditions are clustered somewhere in the middle.

Figure 2 below reveals something we don’t often talk about but which is true none the less. We tend to think (or hope) that all physicians are pretty close in their abilities. That’s no more true in medicine that is in anywhere else in life. There is great variability in skill. (There’s an old doctor joke; “Question: what do you call the guy with the lowest passing grades in medical school? Answer: Doctor...”) Some a superstars and some are dogs - and it’s often hard for patients and even some colleagues to tell the difference.

The next diagram shows why we need to care. The area between the best and the worst represents missed or delayed diagnoses, sub-optimal care, excessive testing and unnecessary costs. Variability in experience and skill results in a wide range of inefficient approaches to even common problems because everybody has their own way of doing things - regardless of whether or not it really is the best way. This variability is not only costly but it hampers our ability to collect rational data on diagnosis and therapy to see what works and what doesn’t. There’s so much static in the data it’s hard to make sense of it. And patients suffer as a result.

If everybody operated at the level of our best and brightest, then patients would get better care and costs would go down. Why? Optimal care is the cheapest care around. Conditions recognized sooner are easier to treat and success is higher. Optimal care results in fewer complications, less missed work, longer life, you name it. Optimal care is a relative bargain. Or at least it’s a justifiable expense.

How do we achieve optimal care?

People have been working on that one for decades with mixed results, but there are some things in the wings which may break this problem wide open. You no doubt have heard lots of politicos talking about evidence-based medicine - using standardized approaches to problems based upon the best available literature and a consensus of experts. Sounds great. Only problem is that people don’t use it. Take for example the most common cause of death in the USA - heart attacks. There is abundant literature and agreement on many aspects of caring for such patients. Best practice standards are readily available. One simple recommendation is an aspirin for the patient unless contraindicated. An aspirin tablet for the most common killer. Not too hard right? Wrong. Even here only about 90-93% of heart attack victims who qualify, get an aspirin.
And if our healthcare system can’t even get that done 100% of the time, what do you think happens with all the less common killers? To be fair there’s a lot of stuff to remember in medicine - especially when you are tired, overworked, distracted, stressed, you name it. There is just too much knowledge for us to reasonably expect a person to remember it.

So what do we do?

Give up. That’s right, you read that. I said give up. Clinicians cannot be expected to manage the volumes of data and knowledge needed to care for their patients. It is not humanly possible. But it may be inhumanly possible.

President Obama’s call for advanced IT systems.

The President has been counseled to support research into the creation of advanced information systems to help clinicians get a handle on all of this. Last year a group well known experts in medical IT wrote a paper trying to spur R+D into perfecting such a system. They proposed 10 ideals for it. Strangely, one system already existed that had 9 of the ten already and had three more even more advanced features that they had omitted or not considered. This system has been quietly operating under the radar in clinical trials in two states. It is nearing completion of its second phase trials even now. On May 11 of this year, this system will be unveiled to a group of researchers at the National Science Foundation. Keep your fingers crossed sports fans because you ain’t seen nothing yet.

As advanced as some of the new systems are, there is a very real chance that we may never see then in practice, or at least not for many years. Why? Because of the political and economic power of the companies that sell existing medical IT - the electronic health record vendors (EHR). EHR’s are the current crop of digital record keeping systems that are in most hospitals and some clinics. EHR’s are the vile offspring of computer system that were aimed at billing and coding of medical services and like any evolutionary system their ancestry limits their potential. They are primarily record keeping systems - big incredibly, expensive, time consuming record keeping systems.

There is no doubt that using EHR’s increases the amount of data stored on a patient compared to the days when all data was hand written into notes. It’s easier to read too. The problem is that all data is not information - at least not from the standpoint of relevancy. For the purposes of this conversation when I refer to information I mean relevant data - data which has current value in assessing a situation. When I refer to knowledge I mean recognizing key patterns within the relevant information that synthesize the information into a meaningful understanding of the situation and can lead to a reasonable set of actions. Increasing the amount of non-relevant data can increase the volume of static within the decision environment. It’s a classic signal to noise problem. The more non-relevant data that exists the harder it is to sort through it to find the nuggets (or patterns) vital to synthesizing knowledge.

The marginal clinical benefits of electronic records as they currently exist were realized in the 1980‘s when the first systems came into being that allowed clinicians to review patient data from a location other than the patient’s ward, could read their colleagues type-written notes (removing the legibility problem) and could enter orders remotely. To this day, one of the best systems I ever encountered was a custom installation created in the 1980‘s under the guidance of a forward thinking physician at Methodist Hospital in Indianapolis. It was simple, it was quick and it was easy but provided all the benefits described above. The systems that have replaced it are why have EHR’s gained a foothold into hospitals? Hospitals love EHR’s because they increase charge capture, reduce data storage challenges and transfer administrative burdens to the clinicians.

A common claim is that EHR’s improve patient safety - a claim most commonly promoted by non-physicians selling EHR’s. Just how much is safety improved? Let me share an experience with you. While working at a local hospital I was required (at my own expense of course) to be trained for several hours in the use of one of the popular EHR brands which had just implemented a 100 million dollar installation (no the numbers are correct). Touted as an aid to improved patient safety, I decided to try a little experiment, during our practice time, to see how smart the system was. I went to the order entry screen and ordered an anti-hypertensive medication for the practice patient. Instead of a typical dose of say 20 mg twice a day, I entered a dose of 200 mg twice a day - enough to kill the patient. The system accepted the order without comment. So I upped the dose to 2000 mg. Still no response. I ended up ordering 200,000,000 mg twice a day. That’s a dose of 400 kilograms of a drug per day. The 100 million dollar EHR accepted the order without comment. Not exactly a confidence builder that. I mentioned this to the trainer and they assured me that the pharmacist would have caught the error. Now firmly entrenched in my Colombo mode, I said that ‘My wife says I’m really dense, but the pharmacist already reviews my orders for errors and it didn’t cost us 100 million dollars.

Go to any modern hospital with an EHR system in place what you are likely to see is a bunch of clinical people huddled around computer terminals entering volumes of data most of which is to satisfy somebody’s compliance policies or capture charges. Even the lists of medical problems on the patient is stored not in a clinically relevant format but in the billing format. And all that terminal time is time away from the bedside - not a good trade off. And if the vendors have their way, all the medical stimulus money will go to install more of these bloated systems that do not improve medical care or increase our access to it. These systems definitely change how medicine is practiced but not in a good way.

Is there any alternative. Yes there is, and its name is MIKE. When I get back around to medical topics, I’ll introduce you to MIKE. And discuss how MIKE is changing that knowledge curve we talked about to something like this...


Saints and Saviors' Love of Baked Goods.

My brain was full today. The last few weeks have been hectic and I needed a break for a few minutes. So I got to thinking about one of the truly great cosmic mysteries; what is it about baked goods that draws in the spirits of the Christian dead. Perhaps it has something to do with the Eucharist but I can't help but notice that Jesus seems to like toast and cinnamon rolls and not so much the paper thin tasteless little crackers. Perhaps he's sending a message - services would be a whole lot more crowed if donuts were sanctified rather than those afore mentioned tasteless little crackers.
The first image is an example of Jesus in toast. I'm not sure. It looks a little like Leonardo to me but I am a classicist after all.

The next one is Jesus on a fish stick - which I guess is far more egalitarian than Venus on a half shell.

The original picture included the proud owner but as he had not been availed of the miracle of modern dentistry I decided to crop him out. These are food items after all. I think this looks more like Bill Pullman.

This is alleged to be the pancake Jesus. To be honest, this one looks more like a reduction woodcut of Vlad the Impaler to me, or a bad case of psoriasis, but I'm an agmystic so what do I know from Jesus.

Here a cheeto gets the divine treatment. Certainly the ultimate in cheesy iconography.

This of course is the famous Mother Teresa cinnamon roll. I would have thought that, based upon her life's work, she might have eschewed such a high calorie delight, but apparently not. Looks to me more like how she'd look in a Wallace and Gromit feature.


Jesus may like to haunt toast but Mary seems to have a thing for rust. This image suggests that she got some of her inspiration from Georgia O'Keeffe. She lurks on the side of many a dilapidated old structure, though as the next image reveals, she too, will on occasion pop out of the toaster. (Though this looks more like the other Madonna to me.)

Mary does seem to go for variety more so than the rest. She can be found in the darnedest places. Here she hitches a ride on a turtles belly. She must have some issues to deal with because, well, it's a turtles belly.

There are, of course, many others. What a great idea for a coffee table book! Oh well, coffee break is over - everyone back on their hands...