Monthly Archives: June 2010

Negative knowledge: Remembering Alfred Schutz

Alfred Schutz passport photoThe New York Times has a five part series on anosognosia, a word of Greek origin where “nosos” means disease and “gnosis” means knowledge (plus the initial “a” for not). Patients with this medical condition don’t know they have a disease and appear unaware of their symptoms, which can be as dramatic as paralysis or blindness to half their visual field.

Reflecting on the condition, the author, Errol Morris, raises a number of interesting questions, such as: Do patients really have no knowledge of their condition? Are incompetent people unable to know they’re incompetent?

He also points out the distinction between the things we know we don’t know (what the weather will be 100 years from now) and the things we’re so unaware of we don’t even know we don’t know them (unnameable by definition). He cites the now-famous words of Donald Rumsfeld: “There are things we know we know about terrorism. There are things we know we don’t know. And there are things that are unknown unknowns. We don’t know that we don’t know.”

Everyday anxiety alludes to the suspicion that meaning and value are arbitrary

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Cultural differences: Emoticons

EmoticonsThe National Geographic has a nice page (PDF) displaying QWERTY emoticons from the eastern and western hemispheres.

Note the emphasis on the mouth in the West and the eyes in the East.

Emotion/West/East

Happy            : – )       (^ _ ^)

Sad                : – (      (; _ ;)

Surprised      : O        (* o *)

Winking         ; – )      (^ _ ~)

Laughing      : D         (^ o ^)

Then there are those emotions frequently needed in the east, but not the west.

Blushing             (# ^ . ^ #)

Embarrassed      (^ ^ ;)

Apologizing         m ( _ _ ) m

And what’s the significance of the need to tilt your head to read western QWERTY emoticons, but the eastern ones are looking straight at you? Not what I’d expect culturally. But perhaps the difference here is that the western versions require fewer keystrokes – we’re in more of a hurry.

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The essential foreignness of another culture

Japanese temple and geishaI read Michael Zielenziger’s Shutting Out the Sun: How Japan Created Its Own Lost Generation to see what he had to say about suicide in Japan. There were only seven pages on suicide, but many of his other topics were interesting: the hikikomori, attitudes of Japanese women towards marriage, an apparent obsession with Louis Vuitton accessories. The lecture-like chapters in the second-half of the book — on post-war Japan, how Korea is different, the role of religion – were disappointing. They seemed oversimplified and not sufficiently insightful.

My overall objection to the book, however, is the author’s eagerness to demystify the foreignness of Japan.

The cultural imperialism of the West

Zielenziger is an American journalist who lived in Japan for seven years. His book labels and diagnoses the current “dysfunction” of Japanese society and offers a prescription for recovery. Unfortunately he sees Japan through the eyes of a Western imperialist, an extension of the post-war MacArthur era.

Look at Korea, he writes. They’ve come around to Western economic ways. They’ve even adopted Western religions. Why does Japan insist on remaining distinctly different? Let’s face it. Western culture is going to dominate the world, and if the Japanese aren’t willing to give up their quaint and antiquated culture, they’ll have no one to blame but themselves.

This strikes me as disrespectful, insulting, and unenlightened.

The Big Clod vs. the alienated individual

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Having wounded the earth, we watch as she bleeds out

Obama at oil spillFor Father’s Day, an exchange between Tony Judt and his son Daniel on BP, Barack Obama, and our collective lack of political will.

From Tony:

The gush of filth is a reminder that we have surrendered our independence to a technology we cannot master. … The challenge goes beyond oil slicks and moral revulsion. In the bigger picture, big oil has no long-term future: sooner or later the contemptible little sheikdoms that have arisen upon a pool of liquid greed will sink back into the desert. But why should BP and the emirs script the endgame?

From his son, who is in the ninth grade:

Look, we are powerless and will be for a while to come. In fact, we are in the worst possible position: we are old enough to understand better than you what has to be done, but far too young to do it.

Although this has no bearing on the ideas expressed, this exchange on Father’s Day is especially poignant in view of Tony Judt’s illness.

Related posts:
The earth’s scars
The oil spill: Why did it happen?
Tony Judt and the Move for ALS bike ride
A generation obsessed with material wealth
Tony Judt: On the edge of a terrifying world
This mess we’re in – Part 3

Resources:

Photo source: TriCityHerald

Daniel Judt and Tony Judt, Generations in the Balance, The New York Times, June 18, 2010

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Links of Interest: Modern Reproduction

Should This Be the Last Generation? (The New York Times)

Octomom babiesA provocative essay by philosopher Peter Singer on whether we should reproduce, with David Benatar’s Better Never to Have Been: The Harm of Coming into Existence as a starting point.

Have you ever thought about whether to have a child? If so, what factors entered into your decision? Was it whether having children would be good for you, your partner and others close to the possible child, such as children you may already have, or perhaps your parents? … Are the interests of a future child a reason for bringing that child into existence? And is the continuance of our species justifiable in the face of our knowledge that it will certainly bring suffering to innocent future human beings?

‘Last Generation?’: A Response (The New York Times)

There was a huge response to Singer’s essay, and he replies in this article.

Even if relatively few people engage in ethical thinking before deciding whether to reproduce, the decisions are important for those who do. And since public policies affect the birthrate, we ought to be giving some thought to whether it is, other things being equal, good for there to be fewer people. Of course, in our present environmental crisis other things are not equal, but the underlying question of the value of bringing human beings into the world should still play a role in decisions that affect the size of future generations.

Study: Kids of Lesbian Parents Are Well-Adjusted (WebMD)

”Contrary to assertions from people opposed to same-sex parenting, we found that the 17-year-olds scored higher in psychological adjustment in areas of competency and lower in problem behaviors than the normative age-matched sample of kids raised in traditional families with a mom and a dad.” … How to explain the good results? “These are not accidental children,” Gartrell tells WebMD.

9/11 link to rise in male foetal death rate, study says (BBC News)

The stress caused by the 9/11 attacks on the World Trade Center may have led to an increase in miscarriages of male fetuses. … [This] support[s] the theory of “communal bereavement” … acute mental distress related to a major national event, like 9/11, even if there is no direct connection to those who died or were involved in these events. Pregnant mothers are thought to be particularly prone to this experience, as are unborn baby boys.

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Links of Interest: Sperm donors, egg donors, and surrogates

Are Sperm Donors Really Anonymous Anymore? (Slate)

Egg and sperm fertilizationIn an age of sophisticated genetic testing, the concept of anonymity is rapidly fading. With some clever sleuthing—tests that can track down ancestral origins, donor numbers, and bits of biographical information—parents and offspring can find out the donors. “With DNA testing and Google, there’s no such thing as anonymity anymore,” says Wendy Kramer, the founder of the Donor Sibling Registry. “Donors are choosing anonymity because they’re not educated. If they were properly educated on the consequences, then many would choose not to donate.” …

[I]t will become increasingly difficult for a donor to hide, which means the moral decision of whether to trace him and ignore his request for anonymity will rest less on the banks and more on the parents and offspring. If DNA testing does become more ubiquitous, it may be that even a very few traits will make the men traceable. What will they do then? wonders Kramer. “Create men without DNA?”

Mapping the God of Sperm (Newsweek)

[Kirk] Maxey, 51, happens to be one of the most prolific sperm donors in the country. Between 1980 and 1994, he donated at a Michigan clinic twice a week. He’s looked at the records of his donations, multiplied by the number of individual vials each donation produced, and estimated the success of each vial resulting in a pregnancy. By his own calculations, he concluded that he is the biological father of nearly 400 children, spread across the state [Michigan] and possibly the country.

Doctor Accused of Inseminating Patient with Own Sperm (WPIX)

A fertility doctor based in Connecticut is accused of using his own sperm – instead of a patient’s husband’s – to impregnate a woman who ultimately gave birth to twins. … According to court records, after the child was born both parents – one of whom is African American and the other Caucasian – were shocked at the baby’s fair complexion. … “DNA testing performed at the suggestion of the twins’ pediatrician showed that [the wife] was the mother but that [the husband] was not the biological father.” … Dr. Ramaley claims the whole ordeal was an accident.

Sperm Banks Can Be Sued Under Product Liability Laws, Federal Judge Rules (Law.com)

In the first decision of its kind, a federal judge has ruled that a sperm bank may be sued under product liability laws for failing to detect that a sperm donor had a genetic defect. … Senior U.S. District Judge Thomas N. O’Neill Jr. cleared the way for a 13-year-old mentally retarded girl from Pennsylvania to sue a New York sperm bank under the theory that the sperm used to conceive her had a defect known as “Fragile X,” a mutation known to cause a syndrome of maladies that include mental retardation and behavioral disorders. … [In response to the mother’s inquiries,] doctors at [sperm bank] Idant continued to assure her that Brittany’s developmental problems were not related to Fragile X and couldn’t possibly be the result of the sperm that was purchased through Idant.

$35,000 for One of My Eggs? (Hastings Center Bioethics Forum)

My eggs are ripe for the taking – I am a 22-year-old female Yale graduate. On a semi-regular basis in college, I opened the school newspaper to find advertisements soliciting my demographic to donate. … Nearly all offered high sums of money for prospective donors, ranging from $5,000 to $35,000. … High payments could lead to “undue inducement and exploitation” that cause women to discount the physical and emotional risks associated with donation. Such payments could also lead prospective donors to conceal medical information relevant to their biological offspring, make donor oocytes available only to the very wealthy, commodify gametes and devalue human life, or promote the birth of persons with traits deemed “socially desirable.” … In addition to physical risks, young women [donors] face psychological ones, such as stress caused by feelings of attachment to the eggs or resulting offspring.

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My Daddy’s name is donor

My Daddy's name is donorWhat’s it like to have an anonymous sperm donor for a father?

Many people think that because these young people resulted from wanted pregnancies, how they were conceived doesn’t matter to them. But … when they are adults, sperm donor offspring struggle with serious losses from being purposefully denied knowledge of, or a relationship with, their sperm donor biological fathers.

That’s the conclusion of a provocative research study that compared adults fathered by sperm donors with adults adopted as infants or raised by biological parents. It’s estimated that 30,000 to 60,000 children each year are fathered by sperm donors, and another 6,000 children are conceived by egg donation. By now there may be as many as a million American adults with a sperm donor for a genetic dad.

What’s not to like about a donor daddy?

Publicity for this study – fifteen major findings that were featured — included some neutral findings (donor conception is not “just like” adoption). But the emphasis was on decidedly negative conclusions.

The study reveals that, on average, young adults conceived through sperm donation are hurting more, are more confused, and feel more isolated from their families. They fare worse than their peers raised by biological parents on important outcomes such as depression, delinquency, and substance abuse.

Among the major findings:

• Young adults conceived through sperm donation (or “donor offspring”) experience profound struggles with their origins and identities.

• Family relationships for donor offspring are more often characterized by confusion, tension, and loss.

• Donor offspring often worry about the implications of interacting with – and possibly forming intimate relationships with – unknown, blood-related family members.

• Donor offspring are significantly more likely than those raised by their biological parents to struggle with serious, negative outcomes such as delinquency, substance abuse, and depression, even when controlling for socio-economic and other factors.

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Understanding the Tea Party

Tea Party "We came unarmed"National politics may well determine the future of health care. How to make sense of the angry rhetoric coming from the political right. While MSNCB runs antagonizing documentary footage of Joe McCarthy and Pat Buchanan, the New York Times publishes a thought-provoking essay by philosopher J.M. Bernstein. It’s called “The Very Angry Tea Party” (emphasis added).

Hegel’s thesis is that all social life is structurally akin to the conditions of love and friendship; we are all bound to one another as firmly as lovers are, with the terrible reminder that the ways of love are harsh, unpredictable and changeable. And here is the source of the great anger: because you are the source of my being, when our love goes bad I am suddenly, absolutely dependent on someone for whom I no longer count and who I no longer know how to count; I am exposed, vulnerable, needy, unanchored and without resource. In fury, I lash out, I deny that you are my end and my satisfaction, in rage I claim that I can manage without you, that I can be a full person, free and self-moving, without you. I am everything and you are nothing.

This is the rage and anger I hear in the Tea Party movement; it is the sound of jilted lovers furious that the other — the anonymous blob called simply “government” — has suddenly let them down, suddenly made clear that they are dependent and limited beings, suddenly revealed them as vulnerable. And just as in love, the one-sided reminder of dependence is experienced as an injury. All the rhetoric of self-sufficiency, all the grand talk of wanting to be left alone is just the hollow insistence of the bereft lover that she can and will survive without her beloved. However, in political life, unlike love, there are no second marriages; we have only the one partner, and although we can rework our relationship, nothing can remove the actuality of dependence. That is permanent.

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Links of interest: Antibiotic resistance

Rising Plague (Brad Spellberg)

Children and chickens in peruBefore getting to the numerous recent news items on antibiotic resistance and urinary tract infections, let me quote from Dr. Brad Spellberg’s Rising Plague: The Global Threat from Deadly Bacteria and Our Dwindling Arsenal to Fight Them. (In the following, “community-acquired” means an infection that begins outside a hospital, and fluoroquinolones are commonly used broad-spectrum antibiotics. Emphasis added.)

[R]esistance of E. coli to fluoroquinolone antibiotics (such as ciprofloxacin) is making it increasingly difficult to treat urinary tract infections with oral antibiotics. Unfortunately E. coli are by far the most common cause of urinary tract infections, accounting for 80 percent or more of them. As the resistance to fluoroquinolones begins to approach 50 percent in community strains of E. coli, it is possible that tens of thousands of women per year will have to be hospitalized to receive intravenous antibiotics just to treat urinary tract infections! How close are we to this nightmare scenario? A recent international study has reported that up to 30 percent of E. coli isolates [separated pure strains of bacteria] from urinary tract infections are now resistant to fluoroquinolones. That compares to less than 5 percent only a decade earlier. Although the resistance rates are lower for community-acquired infections as compared to hospital-acquired infections, the resistance rate among community-acquired E. coli infections has still risen fiftyfold in just the last decade. It is expected that a continued increase is going to occur in the coming decade, which means we may reach 50 percent resistance of community-acquired E. coli to fluoroquinolones within the next ten to twenty years.

Drug-resistant urinary infections (NHS)

A study in Hong Kong concludes that antibiotic resistance may arise from the overuse of antibiotics in food-producing animals. When researchers examined bacteria resistant to the antibiotic gentamicin, 84% of human samples and 75% of animal samples had an identical gene for antibiotic resistance.

The study, published in the Journal of Medical Microbiology, asserts that “Consumers may acquire antibiotic-resistant bacteria from contaminated food,” and ”Good personal and food hygiene are the best ways to prevent this.”

The National Health Service draws a different conclusion:

This was a small study, which found that resistance to the antibiotic gentamicin was granted by the same gene sampled from both animals and humans. However, it did not look at the possible routes by which this resistance may be transmitted between animals and humans. For example, it could not say whether consuming animals with antibiotic-resistant E. coli in their guts is a possible route of transmission.

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Overuse of antibiotics: A remote study (part 2)

conolophus-pallidus-iguana-galapagosThe controversy about the overuse of antibiotics in raising livestock (see the last post) is background for an interesting scientific study that took place in the Galapagos. It looked at the spread of antibiotic resistant strains of bacteria among animals that were totally removed from antibiotics.

Would antibiotic resistance become widespread in the absence of antibiotics?

The immediate motivation for the research was two contradictory studies. In a wooded area of northwest England, researchers had found that wildlife developed antibiotic resistance even though they had not been exposed to antibiotics. This would argue against the idea that antibiotic use in animals should be restricted, since it suggests that antibiotic resistance would develop anyway.

Another study, however, found that wildlife in a remote area of Finland had an almost complete absence of antibiotic resistance. This would argue that resistance could be reduced by restricting antibiotics.

So which was it? How could you design an experiment that controlled possibly confounding factors, such as climate, animal interaction, and human interference?

Coprophagial iguanas

The researchers chose to study a species of iguanas (Conolophus pallidus) on an isolated island (Santa Fe) in the Galapagos . Unlike the English countryside, the island was uninhabited by humans, though tourists made daytime excursions to a restricted area. It offered an example of what life was like in a pre-antibiotic era. This tropical island, which was near the equator, was also unlike the remote area of Finland, where winters were long and cold, the population density of animals was low, and there was limited interaction among animal species.

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Overuse of antibiotics: Follow the money (part 1)

sleeping-pigUnlike climate change, where there’s a large contingent of denialists who spread doubt about the scientific evidence, no one denies that antibiotic resistance is a problem. There is controversy, however, on the question of just how much the widespread use of antibiotics contributes to the problem.

The mechanism is not in dispute: If you expose bacteria to antibiotics, they will mutate to become resistant. But “overuse” of antibiotics is not the only thing that creates antibiotic resistance. Is there irrefutable scientific evidence that the overuse of antibiotics in raising livestock, for example, is harmful to human health? It’s not easy to prove direct cause and effect. If you feed a pig a steady diet of antibiotics, can you irrefutably prove that this results in the illness or death of someone who later eats that pig?

Follow the money

The speed with which we address the increasingly urgent problem of antibiotic resistance will depend on financial interests, not just scientific evidence or common sense. Just as with climate change, we can follow the money to identify the opponents. Who has a financial interest in convincing the public — and in turn politicians — that the overuse of antibiotics is not a problem?

It’s not the medical profession, which understands that overprescribing antibiotics contributes to the increase in antibiotic resistant bacteria. The financial interests of doctors are a little complex here. Unfortunately, because the public is not well educated about the subject, doctors find they need to satisfy the demands of their patients by offering prescriptions. Otherwise patients would simply take their business elsewhere. It takes time for doctors to educate their patients, and today’s doctors are very short of time. This is not sufficient grounds, however, to say that doctors have a financial incentive to overprescribe. Although doctors practicing today have no personal memory of the pre-antibiotic era, they are certainly among the first to appreciate that practicing medicine would become a nightmare without antibiotics.

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Are some diseases more prestigious than others?

doctor-and-patientAmong medical specialties, some are more prestigious than others. You can generally tell which ones are more prestigious by how well they pay. Surgery and cardiology, for example, rank at the top of the prestige scale. Psychiatry and dermatology are near the bottom.

One can also ask if some diseases are considered more prestigious than others, in the opinion of the medical profession.

A Norwegian doctor, Dag Album, has been investigating the prestige of both diseases and medical specialties for many years. In one study, he asked a cross-section of physicians and medical students to rank the prestige of 38 specific diseases, as well as medical specialties. He found that certain diseases consistently ranked at the top (myocardial infarction, leukemia, brain tumors) and others at the bottom (fibromyalgia, anxiety neurosis). (See complete list below.) Among medical specialties, neurosurgery and thoracic surgery ranked highest. At the bottom were geriatrics and dermatovenerology (the treatment of skin diseases associated with venereal diseases).

What makes a disease or specialty more prestigious?

One relatively objective way to view the ranking of specialties is to consider their urgency. The aim of primary care physicians, pediatricians, and psychiatrists is to keep their patients healthy. Although some of their patient encounters surely do make the difference between life and death, those are generally the exception. On the other hand, a patient only sees a brain or heart surgeon when his or her life depends on undergoing a successful operation.

Dr. Album draws a similar conclusion from his study. The more highly ranked specialties and diseases involve vital organs. Those ranked lower involve chronic conditions. But he also points out that age and the bodily location of disease contribute to high and low prestige (emphasis added):

Our interpretation of the data is that diseases and specialties associated with technologically sophisticated, immediate and invasive procedures in vital organs located in the upper parts of the body are given high prestige scores, especially where the typical patient is young or middle-aged. At the other end, low prestige scores are given to diseases and specialties associated with chronic conditions located in the lower parts of the body or having no specific bodily location, with less visible treatment procedures, and with elderly patients.

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The oil spill: Why did it happen?

Oil spill birdThere’s a nice piece in The Atlantic on risk-taking behavior – something that applies to many aspects of life, not just how we treat the environment. (Emphasis added)

How do such management disasters occur? The easy answer is, there’s a financial incentive for going forward, and a financial disincentive for holding back. Program managers are rewarded for meeting budget and schedule milestones and obtaining results. Safety generally works in opposition to all that.

In addition, risk is always theoretical until an accident occurs. It’s harder to argue for something that hasn’t occurred before, and might never occur at all. So safety sometimes gets short shrift against more tangible commercial gains and public image. … But the reason we’re so bad at risk management goes far beyond that. …

[E]ven when we’re dealing with known risks, we do a poor job of managing them. For one thing, humans have a propensity to alter our behavior in ways that negate attempts at risk management …. When seat belt laws got passed, people started driving more aggressively. Likewise, when there’s a safety or back-up system in place, people are often willing to push further into riskier territory (like drilling five miles beneath the ocean). And we often misconstrue luck (at having nothing go wrong) for proof that an activity actually contains an acceptable risk — a belief that gets stronger the longer we go without an accident. What’s more, risk taking is tangibly encouraged and rewarded in American culture and business. Just look at the bonuses given out on Wall Street, and the way we idolize entrepreneurs and the risk-taking entrepreneurial spirit.

More people are injured in crosswalks than when jaywalking because they assume they’re safe. Wearing a motorcycle helmet may encourage riskier driving. Doctors worry that if a genetic test tells you you’re not at risk for a disease, you might indulge in unhealthy behavior.

We know this is human nature, but will we be able to put this knowledge into practice?

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