On money, nursing home care, and Covid-19.

In April, I wrote several essays and articles about our collective response to Covid-19.

I was worried – and am still worried, honestly – that we weren’t making the best choices.

It’s hard not to feel cynical about the reasons why we’ve failed. For instance, our president seems more concerned about minimizing the visibility of disaster than addressing the disaster itself. We didn’t respond until this virus had spread for months, and even now our response has become politicized.

Also, the best plans now would include a stratified response based on risk factor. Much more than seasonal influenza, the risk of serious complications from Covid-19 increases with age. Because we didn’t act until the virus was widespread, eighty-year-olds should be receiving very different recommendations from forty- and fifty-year-olds.

Our national response is being led by an eighty-year-old physician, though, and he might be biased against imposing exceptional burdens on members of his own generation (even when their lives are at stake) and may be less sensitive to the harms that his recommendations have caused younger people.

I’m aware that this sounds prejudiced against older folks. That’s not my intent.

I care about saving lives.

Indeed, throughout April, I was arguing that our limited Covid-19 PCR testing capacity shouldn’t be used at hospitals. These tests were providing useful epidemiological data, but in most cases the results weren’t relevant for treatment. The best therapies for Covid-19 are supportive care – anti-inflammatories, inhalers, rest – delivered as early as possible, before a patient has begun to struggle for breath and further damage their lungs. Medical doctors provided this same care whether a Covid-19 test came back positive or negative.

(Or, they should have. Many patients were simply sent home and told to come back if they felt short of breath. Because they didn’t receive treatment early enough, some of these patients then died.)

Instead, our limited testing capacity should have been used at nursing homes. We should have been testing everyone before they went through the doors of a nursing home, because people in nursing homes are the most vulnerable to this virus.

I realize that it’s an imposition to make people get tested before going in, either for care or to work – even with real-time reverse-transcription PCR, you have to wait about two hours to see the results. But the inconvenience seems worthwhile, because it would save lives.


From March 25 until May 10 – at the same time that I was arguing that our limited Covid-19 tests be used at nursing homes instead of hospitals – the state of New York had a policy stating that nursing homes were prohibited from testing people for Covid-19.

I really dislike the phrase “asymptomatic transmission” – it’s both confusing and inaccurate, because viral shedding is itself a symptom – but we knew early on that Covid-19 could be spread by people who felt fine. That’s why we should have been using PCR tests before letting people into nursing homes.

But in New York, nursing homes were “prohibited from requiring a hospitalized resident who is determined medically stable to be tested for COVID-19 prior to admission or readmission.

This policy caused huge numbers of deaths.

Not only do nursing homes have the highest concentration of vulnerable people, they also have far fewer resources than hospitals with which to keep people safe. Nursing home budgets are smaller. Hallways are narrower. Air circulation is worse. The workers lack protective gear and training in sterile procedure. Nursing home workers are horrendously underpaid.

The low wages of nursing home workers aren’t just unethical, they’re dangerous. A recent study found that higher pay for nursing home workers led to significantly better health outcomes for residents.

This study’s result as described in the New York Times – “if every county increased its minimum wage by 10 percent, there could be 15,000 fewer deaths in nursing homes each year” – is obviously false. But even though the math doesn’t work out, raising the minimum wage is the right thing to do.

If we raised the minimum wage, we probably would have a few years in which fewer people died in nursing homes. But then we’d see just as many deaths.

Humans can’t live forever. With our current quality of care, maybe nursing home residents die at an average age of 85. If we raise the minimum wage, we’ll get better care, and then nursing home residents might die at an average age of 87. After two years, we’d reach a new equilibrium and the death rate would be unchanged from before.

But the raw number here – how many people die each year – isn’t our biggest concern. We want people to be happy, and an increase in the minimum wage would improve lives: both nursing home residents and workers. Which I’m sure that study’s lead author, economist Kristina Ruffini, also believes. The only problem is that things like “happiness” or “quality of life” are hard to quantify.

Especially when you’re dealing with an opposition party that argues that collective action can never improve the world, you have to focus on quantifiable data. Happiness is squishy. A death is unassailable.

Indeed, that’s partly why we’ve gotten our response to Covid-19 wrong. Some things are harder to measure than others. It’s easy to track the number of deaths caused by Covid-19. (Or at least, it should be – our president is still understating the numbers.)

It’s much harder to track the lives lost to fear, to domestic violence, and to despair (no link for this one – suddenly Fox News cares about “deaths of despair,” only because they dislike the shutdown even more than they dislike poor people).  It’s hard to put a number on the value of 60 million young people’s education.

But we can’t discount the parts of our lives that are hard to measure – often, they’re the most important.

On immunity.

On immunity.

Our efforts to “flatten the curve” of the Covid-19 epidemic are onerous. 

Children aren’t allowed to go to school.  We’re forcing small retailers out of business.  People aren’t hugging when they greet.

Some people think these sacrifices are worthwhile, though, if they reduce the number of people who die from Covid-19.

Unfortunately, the effort to “flatten the curve” can cause more people to die of Covid-19 — including more of our elders — than if we’d carried on with life as usual.


Antibodies are like the memory of your immune system.  After you’ve been infected with a particular virus, your body can destroy further copies of that virus.

This memory doesn’t last forever.  Your body will “forget” how to fight off the coronavirus that causes the common cold within a year.

If we carried on with life as usual, the coronavirus that causes Covid-19 would probably make its rounds through the population of the United States within a few months.  After that, there would be no new people to infect, and so the virus would disappear.

If, however, we practice social distancing and slow the rate of transmission – the same number of infections spaced over eighteen months instead of eighteen weeks – your immune system has a chance “forget” how to fight off the virus while this virus is still circulating in the population.  By slowing the rate of transmission, you give yourself the opportunity to contract the infection twice

If we slow the rate of transmission enough, this coronavirus will survive indefinitely.  Then people will continue to die of Covid-19 forever.

Even if you are currently at risk — elderly or immunocompromised — you should still fear this possibility. Will you be less at risk when this virus hits your hometown again in another year?


When a virus infects a cell, it uses that cell’s replicative machinery to make more copies of itself.  A virus can’t reproduce on its own – it can only co-opt its host’s cells into making more copies for it.

Each time the host makes a new copy, it must replicate the entire genome of the virus.  Our cells are pretty good at copying genomes – every time the cells of our own bodies divide, they produce a new copy of our 3-billion-base-pair genome, and the copies usually have only a handful of mistakes.

Of course, a handful of mistakes compounded over time can be deadly.  That’s what cancer is – your cells didn’t copy your DNA perfectly, and so you wound up with slightly mutated DNA, and this mutated DNA instructs cells to form a tumor that kills you.

The same accumulation of errors can change a virus.  In the 1918 influenza epidemic, huge numbers of people died because the virus mutated to become more deadly.

The longer we allow the Covid-19 outbreak to go on – the more we strive to “flatten the curve” – the more mutations will accrue in its genome. 

Consider a city in which ten people live, one of whom has the virus.  If they throw a party, the other nine will be infected all at once – they will all come down with the Nth generation of the virus, whatever the current sick person is shedding.  If, however, they practice social distancing and get sick one at a time, each passing the infection to the next, the last person in the chain will be infected with viral generation N+9.  It could be very different, and more dangerous, than the initial virus.

Mutation doesn’t always make a virus more dangerous.  It’s entirely random.  It was bad luck that a mutation in 1918 made that strain of influenza more deadly.

But the risk is real.  It’s a risk we aggravate if we “flatten the curve.”  Right now, very few young healthy people will be hurt by Covid-19, but no one can know what monstrosity we’ll produce if we allow this virus to cycle through enough generations.

Inconveniently for us, Covid-19 is caused by an RNA virus.  Our cellular machinary is pretty good at making copies of DNA – every round of cell division makes a few mistakes, but not so many.  Our cellular machinary is worse at making accurate copies of RNA.  A virus with an RNA genome will mutate faster.


People are worried that, without drastic efforts to slow the rate of transmission of Covid-19, the influx of new cases would overwhelm our hospitals.  We might run out of ventilators and be forced to triage, providing heroic medical interventions only to those people most likely to survive.  Some number of elderly patients with a low chance of survival would not receive care.

Is this bad?

Most medical doctors have signed “do not resuscitate” orders.  I have, too.  Most medical doctors, who have seen over and over again what it’s like when elderly patients with a low chance of survival receive heroic medical interventions, don’t want it for themselves.  They would rather die in peace.

The New York Times – which, alongside the New York Review of Books, is my favorite news outlet, even though it’s been full of fear-mongering about Covid-19 – printed a quote from Giacomo Grasselli, who coordinates intensive care units throughout Lombardy, Italy.  Grasselli is working at the front-lines of the Italian Covid-19 outbreak.

“My father is 84 and I love him very much,” but it would be irresponsible, he said, to make him go through the invasive procedures of an I.C.U.


In the United States, we spent over three trillion dollars on medical care in 2016.  A huge fraction of this spending is used for minuscule extensions of life.  A third of all Americans have surgery during their last month of life.  We often spend more on interventions that extend the life of wealthy patients by a month than we do on all the pre-natal, preventative, and acute care that other people receive, ever.

What’s been missing, in the United States, is a conversation about what constitutes a good life.  What needs to happen for people to be able to face death with the thought that their lives have been enough? 

Covid-19 has killed thousands of people who were privileged to live to extremely old age.  In the United States, the worst outbreak will be in New York City – a city that is so expensive to live in that it harbors huge concentrations of wealthy elderly people.

In the United States, the life expectancy is 78 years.  Of course, there are major inequalities.  If you are wealthy, you might live longer than that.  If you are poor, you’ll probably die younger.  My spouse’s parents both died in their 60s.

Covid-19 has a high mortality rate for people who have already exceeded this life expectancy.  For people under retirement age, Covid-19 is less dangerous than seasonal flu.


In the United States, life expectancy has been falling.  This decline is primarily due to an epidemic of “deaths of despair”: Drug addiction.  Suicide. 

In the United States, around 40,000 to 50,000 people die of suicide each year.  Around 60,000 people die of drug overdose.  Around 70,000 people die from alcohol abuse.

Each year, the epidemic of “deaths of despair” kill somewhere between 100,000 and 200,000 people.

Our efforts to “flatten the curve” will probably increase the number of people who die from deaths of despair.

Small towns across the United states have been gutted by the internet.  People used to visit local retailers, which could employ local salespeople.  Then we switched to buying things on Amazon, giving Jeff Bezos our money instead.

Now, local retailers are being forced to close due to fears about Covid-19.  People have to buy things online.  But local retailers still have expenses.  They still have to pay rent.  The owners still have to eat.  Many small retailers will run out of money and never open again after the Covid-19 epidemic is over.

As if our small towns needed yet more punishment.

In general, people will experience more financial woes because of our response to Covid-19.  Businesses are closed.  Work has slowed.  The stock market has tanked. 

And financial instability increases the risk of deaths of despair.  That’s a major reason why there’s been such a dramatic rise in deaths of despair among young people.


Thankfully, our efforts to “flatten the curve” aren’t guaranteed to make this coronavirus mutate.  Our efforts aren’t guaranteed to make this virus a permanent parasite on the human race. 

We might cause these calamities, but we don’t know for sure.

Indeed, we know very little about this illness.  We do know that tens of thousands of elderly people have died.  But we don’t know whether ten thousand died out of a hundred thousand who were infected, or a million, or tens of millions.

Our perception of the disease would be very different in each of those scenarios.  But we do not, and can not, know.  We have no retrospective testing, and we have never tested a random sample of the population to investigate viral prevalence.

The best we can do is estimate from small data sets, the way Stanford epidemiologist John Ioannidis has done.  Ioannidis is very clear about his methodology, so if you happen to disagree with any of his assumptions, you can re-work the math yourself.

He concludes that our response is a horrific over-reaction.


The people recommending these policies – social distancing, school closure, stay-at-home orders, or total lockdown – aren’t doing so out of malice.  They’re making the decisions they feel to be best.  But no policy is neutral, obviously. 

These policies prioritize the short-term needs of wealthy people who have exceeded their expected lifespans, at the expense of everyone under retirement age.  In particular, these policies do not value the needs of children.

Many of our country’s policies prioritize the desires of wealthy older people over the needs of children, though  “Flatten the curve” is just another example.


In many places, we are probably attempting to “flatten the curve” after the epidemic has already run its course.

More likely than not, I already had Covid-19.  In early January, a co-worker of my children’s best friends’ parent left China, stayed briefly with her daughter in Seattle, then returned to Bloomington. 

A few days later, she came down with a high fever and a bad cough.  She went in for a flu test, but tested negative.  The doctors sent her home.

A week later, my children’s best friends’ parent – the sick woman’s co-worker – came down with a high fever and a bad cough.  His children were sick enough that they stayed home from school for a day.  He was sick enough that he missed a week of work.

A week later, on February 10th, my children and I got sick.  We had a high fever and a bad cough.  The kids felt better the next day.  I felt wretched for an entire week.  I am an endurance runner with strong lungs – still, I needed puffs of my spouse’s Albuterol inhaler four times a day.  I took naproxen but still had a hallucinatory fever.  I wouldn’t wish that illness on anyone.  For the next two weeks, I was vigilant about washing my hands and tried to minimize my contact with other people.

Over the next month, many other people in town came down with a cough and fever.  It would typically last a week, then they’d feel better.

But it was pretty scary for some people. I’d felt wrecked. Another friend of mine — 55 years old, cigarette smoker, & former methamphetamine addict — felt like he could barely breathe. The doctor said that if his oxygen flow had been any lower, she would’ve kept him at the hospital.

He wasn’t tested for Covid-19. There were still no tests available. And after a horrible week, he felt better.

And then, on March 12thafter the epidemic had probably run its course in our town – our schools closed.  The university students left for spring break, and the remaining populace of our small town began to practice social distancing.

And yet, in mid-March, the first case of Covid-19 was diagnosed here.  This patient could not trace the social connections that would have led back to a known Covid-19 outbreak.  As should be expected by that late stage of an epidemic.

All around the country, reported Covid-19 cases are exponentially rising.  But that doesn’t mean that Covid-19 infections are exponentially rising.  It only means that access to Covid-19 testing has risen.

When the epidemic likely spread through my town, it went undetected – no Covid-19 tests were available in the United States, and there’s no way to test whether someone was infected in the past.  The reported numbers of Covid-19 cases are guaranteed to be lower than the true number of people infected, because you can only be counted as a Covid-19 if you feel sick enough to visit a doctor, and then somehow manage to get access to the test.

The test will only register positive during the acute phase of the illness.  There is no possible way to test whether someone who isn’t currently shedding virus has been infected.


A useful way to consider this epidemic is to imagine what would happen if the Covid-19 PCR test wasn’t invented. 

People would still get Covid-19.  We would take no extraordinary protective measures, because we wouldn’t realize what they were sick with.

This is like what happened at the beginning of the HIV crisis in the United States.  Medical doctors called the disease GRD, or “gay-related disease,” and it was terrifying.  Healthy young people suddenly wasted away.

If we lacked a PCR test to accurately diagnose Covid-19, though, we wouldn’t call it “age-related disease.”  We would call it “seasonal flu.”  This year, about 30,000 people will die of seasonal flu, including many healthy young people.  This year, my nephew almost died of the flu.  He couldn’t breathe.  He needed invasive ventilation to survive.

If we did nothing to staunch the Covid-19 outbreak, somewhere between 15,000 and 30,000 people probably would die from it.  Combined with the 30,000 deaths actually caused by influenza, we would think that between 45,000 and 60,000 people had died from seasonal flu.  No more than a dozen or so of the additional deaths would have been healthy young people.

That’s many more deaths!  But nothing exceptional.  In 2017, 60,000 people died of seasonal flu.

In 2017, we still let children go to school.  I’m not sure I read any news articles about seasonal flu in 2017.  And in the following years – after huge numbers of people died! –  about half our population didn’t bother to get a flu vaccine.

Influenza is a more dangerous illness, and it’s preventable.  But our country’s vaccination rate is too low to confer herd immunity.  Even if you are young and healthy, a bad case of the flu can kill you.  Even if you are young and healthy, your vaccination protects others.

Social distancing would protect people from the flu, also.  Every flu season, we could stay six feet away from each other for a few weeks, and then we’d vanquish the flu.  But social distancing comes at a tremendous cost, as we’re now learning.

Or we could get the vaccine.  But we, as a people, don’t.

On writing.

On writing.

At high doses, psilocybin mushrooms trigger transcendent, mystical experiences.  Many researchers are incorporating these into treatments for PTSD, depression, and other maladies that stem from a crisis of meaning or identity.

There are challenges inherent in using medicines that disrupt the workings of a person’s consciousness.  William Richards, who conducts psychedelic therapy at Johns Hopkins, writes in Sacred Knowledge that participants in his studies have felt their sense of self temporarily dissolve after a dose of psilocybin.

Most commonly, the term “death” is employed as the ego (everyday self) feels that it quite literally is dying. 

Though one may have read that others have reported subsequent immersion in the eternal and experiences of being reborn and returning to everyday existence afterward, in the moment imminence of death may feel acutely – and for some terrifyingly – real.

Because this sensation is so frightening, most researchers recommend a trip-sitter – in Richards’s words, “having someone present who one honestly can choose to trust without reservation.  The attitude ‘I can manage on my own and don’t really need anyone else’ clearly can be very counterproductive in some high-dose sessions when the ‘I’ needs to totally relinquish control.

At times, an arrogant attitude of self-reliance is unhelpful.  It is also, unsurprisingly, the attitude with which I approached nearly all aspects of my life.  I’m an athlete, an academic, usually in full command of my own mind and body.  I mostly work alone (although I’m very grateful that my spouse helps me run this website). 

Why wouldn’t I do my own psychotherapy?

I tried psilocybin mushrooms during graduate school.  Shortly after we met, the person who is now my spouse asked if we could visit her sibling in Portland for her birthday.  We left Stanford at 7 p.m. on a Friday, then drove north through the night.  We arrived at about dawn on Saturday morning, collapsed, and slept until noon. 

We were visiting a punk house, it seemed, where the bulk of the rent was paid by one person’s trust fund, with others occasionally chipping in money from various odd jobs (there was a nearby sporting event during the second day of our visit, and one of the housemates put on an official-looking reflective vest and charged people to illegally park in an abandoned lot down the street).  A dozen misshapen mattresses were strewn about the skunky-smelling attic; I picked the second-least stained to sleep on.

On Saturday night, for the birthday celebration, our hosts threw a party.  Several bands played – it was the sort of event where the scrawny white weed dealer’s terrible hip-hop group (bass, drums, and the dealer on the mic) was allowed to play a set.  The others were mostly metal bands.

One of the housemates (the faux-parking attendant, as it happens) brewed a large mason jar of psilocybin tea.  As he was gamboling about the house, we crossed paths and he proffered the nearly empty jar: “Hey, man, you want these dregs?”

I shrugged and drank it.

“Whoa,” he said.


“Just, that was a lot of dregs.”

Which, honestly, was not the best moment to be warned. I’d already drank it. I obviously couldn’t do anything about it then.

Richards and other medical professionals involved in psychedelics research would find it unsurprising that the tenor of the evening turned intensely spiritual for me.  Ken Kesey and other psychonauts would find it unsurprising that the goings on seemed exceedingly trippy, as well.  I sat on a couch in front of the bands’ performance area and watched as a singer seemed to smear her face across the microphone; soon I saw her with three mouths, the two in her neck relegated to singing harmony.

I felt intense paranoia; as I waited in line for a bathroom, people nearby seemed to be snickering at me.  Of course, snickers often follow in my wake at parties – my behavior can be outlandish – and I might’ve been making goofy facial expressions.

I understood only snippets of conversation.  A squinty-eyed Thor-looking blonde man named Hyacinth was saying, “I always wanted to get with a Gemini, and then, bam, last winter, I met this older lady with these, like, enormous eyes, and I was like, whoa, and wouldn’t you know it, bam, she’s a Gemini!” 

(I later learned that he worked as an, ahem, “intimate massage therapist,” or “hired companion,” that sort of thing.  He also cornered me and spent thirty minutes explaining his take on quantum mechanics.  His version involved a lot of positive energy radiating from crystals.  The abundance of positive energy in his own life is part of what brought him together with that Gemini, it seems. The waning disorientation from psilocybin left me totally unable to extricate myself from the conversation.)

And, as per Richards’s expectations, I felt myself losing a fundamental component of my identity.  I temporarily forgot how to speak. Then felt as though I was losing all ability to translate my thoughts into external action. 

Perhaps I should’ve noticed that I was still passively influencing my surroundings – nobody else could stand where I was standing, and Hyacinth wouldn’t have stood there simply lecturing the air – but the flickering of my short term memory caused these examples to slip away from me.  I felt like a ghost, and the sensation terrified me.

But I was lucky.  Even at parties (to be perfectly honest, especially at loud parties), I carry a pencil and paper.  That way, I can draw horrible cartoons. Sometimes I try to use these to communicate.

It should come as no surprise that I make few friends at parties.

I found a secluded corner of the party and began to write.  And then, minutes later, when I felt another wave of loss of self pass over me, I was able look at the sheet of paper in my hand and see. I wrote that.  I did change the world.  I am changing it. 

I was able to regain a sense of object permanence, despite the ego-erasing effects of psilocybin. If I were a ghost, my marks would wisp from the page like so much abluvion. But here they are.

Because I can still communicate with the outside world, I still am.

In all, the experience was probably good for me.  Someday I could write about why.  But for now, I’d simply like to stress that, in that moment, writing saved me.  Writing kept me anchored and tamped down the terror sufficiently that I could accept whatever was happening inside my brain.  (Indeed, one of the things I wrote that night was, “Without this paper, I’d wander the streets, wake tomorrow in a gutter with a rat gnawing on my eyeball.”)

And I’ve seen the way that writing has saved other people, too.  When people fear that they’re turning into ghosts – cut off from the outside world, unable to reach their friends and families – even severely dyslexic men will start sending letters.

Being held in jail can dissolve a person’s sense of self just as surely as psilocybin mushrooms.

Each week, I bring in another dozen pencils.  I occasionally wondered what was happening to the pencils, whether they accumulated like Lincoln Logs in the block.  But I kept bringing more because we need a way to write during our class. And I’d let the guys keep them. So much has been taken from these men that I couldn’t bear to ask for the pencils back.

Eventually, somebody told me.  “Oh, yeah, my bunkie, he writes a lot at night, he always sharpens like a dozen pencils before lockdown.”

The men in jail aren’t allowed to have pens.  They can’t have mechanical pencils.  And they don’t have sharpeners in their cells.

At night … or if there’s a disciplinary infraction … or if the jail is understaffed … the men are locked into their little cells.  Unless they sharpen pencils beforehand, they cannot write.  Each broken tip brings an inmate that much closer to enforced silence, unable to communicate with the outside world.

Recently, people have been forming a big line at the pencil sharpener whenever I teach class.  I slowly pass out the poems that we’ll read that week, then pass out pencils, then pass out paper, then sit and wait. The waiting takes a while.  Guys come with twenty or thirty pencils bristling from the shirt pocket of their orange scrubs, then stand and sharpen all of them.  A dozen men, sharpening perhaps twenty pencils each.

At the table, they mention trades they’ve made.  Losses, due to theft: “At the beginning of the week I had fifteen pencils; now I’m down to three.”  They exhort me to bring more.  I say I’ll do my best.

“There’s only one pencil sharpener in the block, and it’s been broken for three months.  It’s like that one, a wall mount.  The gears are all screwed up.  The handle was broken off, but you could sort of still use it then.  But now, anybody who doesn’t get to come to your class can’t sharpen any.”

“I’m sharpening some for my bunkie,” yells the guy currently cranking the handle.  A few of the others nod; they’ll also sharpen some for charity.

Image by emdot on Flickr.

Twenty … thirty … maybe forty sharpened graphite tips.  While those last, the guys will be able to write.  Time will pass, but they’ll be able to prove to themselves, and to the outside world, that they really do exist.

With luck, those sharpened pencils will last all week.

On attentiveness and names.

On attentiveness and names.

When a scientist first discovers a function for a gene, that scientist gets to name it.  Sometimes these names seem reasonable enough: I worked with a hematologist who did a study to identify proteins involved in apoptosis, which means roughly “programmed cell death” or “cellular suicide,” and so each gene wound up named “Requiem 3”, “Requiem 4,” etc.

Fruit fly geneticists tend to give their discoveries more creative names than other scientists.  There’s the gene “cheap date” – if a fruit fly is missing that gene, it will – ha ha – be unable to process ethanol and  so quickly passes out.  Another genetic mutation produced male flies that would court either males or females, and so this was known for over a decade as “fruity,” until another scientist decided that universal courtship could be less offensively described by the term “fruitless,” because clearly any mating-like activity that does not lead to progeny is a waste of time.

Yup, some gene names were bad.  One person’s idea of a joke might seem to somebody else like a mean-spirited reference to the wider world’s power dynamics.

Other gene names were bad not out of malice, but because humor at the expense of a fruit fly doesn’t make as many people laugh when a human child is dying. 

A gene that produces a somewhat spiky-shaped protein was named after Sonic Hedgehog.  It seemed funny at the time!  See?  The protein is spiky, the video game character has spiky hair, and … get it?  You get it, right?

 Okay, so this Sonic Hedgehog protein doesn’t look all that much like Sonic the Hedgehog.  But spend enough time staring at something like protein crystal structures and you’ll experience pareidolia, like seeing animal shapes in irregularly dappled plaster ceilings, or anthropomorphic gods amongst the twinklings of the stars.

Well, the Sonic Hedgehog protein establishes a concentration gradient that allows cells to recognize their spatial position in a developing body.  If a human fetus comes to term despite having a mutation in the Sonic Hedgehog gene (genetic abnormalities will often result in a miscarriage, but not always), the resulting child will have severe brain defects.

And then a doctor has to explain, “Your baby is suffering because of a Sonic Hedgehog mutation.”

And so, in 2006, geneticists capitulated to medical doctors. No more fanciful names for genes that might lie at the root of human health problems … which, because humans and fruit flies are actually pretty similar, means most genes.  Patients would now be told about a mutation in the SHH gene instead of Sonic Hedgehog, or a mutation in the LFNG gene instead of Lunatic Fringe.

Words have power, after all.

Some people are more attentive to their environments than others.  During evolutionary time, this trait was obviously good for humanity.  If your tribe is traveling through a hostile environment, it helps to have somebody around who is paying attention to the world.  A friend who’s primed to notice encroaching threats like a hungry lion about to leap out and attack.  Maybe we should take a different path.  Which, yeah, that sounds like a good idea.

Other people are particularly inattentive to their surroundings, so it’s easy for them to ignore the world and focus instead on one single problem.  During evolutionary time, this trait was surely good for humanity, too.  It’s helpful to have somebody on the lookout for threats that might eat you, obviously.  But it’s also helpful to have somebody who might discover a way of using dried grass to weave baskets.  A way of cooking mud into pottery that could carry or store water.

Image by Herb Roe on Wikimedia Commons.

Neurodiversity is a virtue in and of itself.  Over the millennia, the world has offered our species many challenges.  Populations that were sufficiently diverse that some members were good at each of a variety of tasks were most likely to flourish.  A cooperative species like termites or Homo sapiens benefits from specialization among its members.

Left to our their own devices, people would naturally fall asleep and wake up at different times.  Some brains are primed to work best in the early morning; others work best late at night.  And that’s good.  It reduces the amount of time that a tribe would be susceptible to attack, everyone asleep.

But in the modern world, we occasionally forget to feel grateful for the diversity that allowed our species to thrive.  The high school students whose brains are primed for late-night thinking drag themselves through morning classes like zombies.  They’ll be midway through first period before the sun rises.  Their teachers glance derisively at their slumped and scruffy forms and call them lazy.

Eventually, humans invented language.  Much later, we invented writing.  Much, much later, we invented the printing press, and then written words became so widely accessible that most humans could benefit from learning how to read.

Of course, reading is easier for people who are inattentive to their environment.

If I had been born earlier in human evolution, I totally would have been lion bait.  When I’m reading a book, or am deep in thought, the rest of the world melts away.  When I’m typing at home, K or the kids sometimes shout my name several times before I even realize that I’m being spoken to. 

People like me, or this kid at a library, totally would’ve been lion bait.

Luckily for me, I wasn’t born way back then.  Instead I was born into a world where inattentive people – the people best able to block out the world and instead focus on their own thoughts – are the most likely to find academic success.  People like me become medical doctors.  Then we get to name the world’s various conditions and maladies.

And so, when it came time to categorize the sort of person who is especially attentive to the world, people like me (who obviously thought that our way of being is the best way to be) referred to those others as having an attention deficit disorder.

Identifying those people’s awareness of their environs might sound like a virtue; instead, we castigated those people’s difficulty at ignoring the world.

I’ve never read the Percy Jackson books, but I’m glad that they exist, if only for passages like this (from The Lightning Thief):

“And the ADHD – you’re impulsive, can’t sit still in the classroom.  That’s your battlefield reflexes.  In a real fight, they’d keep you alive.  As for the attention problems, that’s because you see too much, Percy, not too little.”

Childhood trauma can cause symptoms that medical doctors term “attention deficit disorder.”  Which makes sense – if you’ve gone through an experience where your environs were threatening, you should learn to be more aware of your environment.  It should become more difficult to ignore a world that has proven itself to be dangerous.

Even for somebody with my type of brain, it’s going to be easier to sit outside and read a book when there’s a squirrel nearby than if there’s a prowling grizzly fifteen meters away.

Some children have to learn early on that daddy’s sometimes a grizzly.  And if it can happen to him, why not other grown-ups, too?  Best to stay on high alert around the teacher.  She’s trying to get you absorbed in these number tables … but what if that’s a trap?

Certain drugs can narrow a person’s perception of the world.  They act like blinders, chemicals like nicotine, ritalin, and amphetamines, both un-methylated (sold under the trade name Adderall) and methylated (a CH3 group attached to the amine moiety of Adderall will slow its degradation by CYP2D6 enzymes in the liver, increasing the duration of its effects).

Note to non-chemists: the methylated analogue of Adderall goes by several names, including “ice,” “shard,” and “crystal meth.”  Perhaps you’ve heard of it — this compound played a key role in the television show Breaking Bad.  And it’s very similar to the stuff prescribed to eight year olds.  Feel free to glance at the chemical structures, below.

In poetry class last week, a man who has cycled in and out of jail several times during the few years I’ve taught there – who I’d said “hello” to on the outside just a few weeks earlier when he rode his bicycle past the high school runners and me – plonked himself down in the squeaky plastic hair next to mine.

I groaned.

“I know, I know,” he said.  “But I might be out on Monday.”

“What happened?”

“Failed a urine screen.  But I was doing good.  Out for six months, and they were screening me like all the time, I only failed three of them.”

“With … ?”

“Meth,” he said, nodding.  “But I wasn’t hitting it bad, this time.  I know I look like I lost some weight, dropped from 230 down to 205, but that’s just cause it was hard getting enough to eat.  Wasn’t like last time.  I don’t know if you remember, like, just how gaunt my whole face looked when they brought me in.  But, man, it’s just … as soon as I step outside this place, my anxiety shoots through the roof … “

This is apparently a common phenomenon.  When we incarcerate people, we carve away so much of their experience of the world.  Inside the jail, there is a set routine.  Somebody is often barking orders, telling people exactly what to do.  There aren’t even many colors to be distracted by, just the white-painted concrete walls, the faded orange of inmate scrubs, the dull tan CO shirts and dark brown pants.

The world in there is bleak, which means there are very few choices to make.  Will you sit and try to listen to the TV?  (The screen is visible from three or four of the twelve cells, but not from the others.)  Try, against all odds, to read a book?  Or add your shouting voice to the din, trying to have a conversation (there’s no weather, so instead the fall-back topic is speculating what’s going to be served for dinner)?

After spending time locked up, a person’s ability to navigate the wider world atrophies, the same as your leg would if you spent months with it bundled up in a cast.

And these are people whom we should be helping to learn how to navigate the world better.

“ … so I vape a lot, outside.  I step out of this place, that’s the first thing I do, suck down a cigarette.  And, every now and then … “

He feels physically pained, being so attentive to his surroundings.  And so he doses himself with chemicals that let him ignore the world as well as I can.

And, yes.  He grew up with an abusive stepfather.  This led to his acting squirrelly in school.  And so, at ten years old, medical doctors began dosing him with powerful stimulants.

Meanwhile, our man dutifully internalized the thought that he had a personal failing.  The doctors referred to his hyper-vigilance as an attention deficit disorder.

Words have power.

We can’t know now, after all the hurt we’ve piled on him, but think: where might our man be if he’d learned to think of his attentiveness as a virtue?

On nature.

On nature.

The modern world is a stressful place – some medical doctors advocate “therapeutic” nature walks.  Surround yourself with trees, wildlife, a babbling stream or waterfall, and your body will remember what it means to be alive.

Image by Steven Depolo on Flickr.

For millions of years, our ancestors needed specific environments in order to survive.  Almost every animal species experiences instinctual urges toward healthful habitats – it would be surprising if our own minds didn’t have a residual response toward landscapes that provide what our forebears needed.  Running water, trees for shelter, grassy meadows to hunt, fecund animal life suggesting a thriving ecosystem.

But people who need to heal are cut off from these environs.

When somebody doesn’t fit in our world, they wind up in jail.  Maybe this person has trouble holding down a job and so forged checks, or counterfeited money, or robbed a store.  Maybe somebody is plagued by nightmares and takes methamphetamine to forgo sleep.  Or shoots opiates to stave off the pain of withdrawal.  Maybe somebody has so much tension and anger that he threw a television at his girlfriend.

These are people who’d probably benefit from a de-stressing stroll through the woods.

Instead, they’re surrounded by concrete, in a clanging, reverberating room with 25-foot-high ceilings, locked doors stacked atop each other, steel tables, boaters crowding the floor (with two tiers of 8 double-occupancy cells, the jail could hold 32 per block … but most have wobbled between 35 and 40 people all year, with the excess sleeping on plastic “boats” on the common area floor.  Things were worst in July, when they were so many inmates that the jail ran out of boats – then people slept on a blanket spread directly over the concrete), toilets overflowing with the excreta of many men shitting their way through withdrawal.

grow posterIn the classroom where I teach poetry, there’s a picture of a redwood forest.  It’s shot from the ground, the trunks soaring up to the canopy overhead, and at the bottom of the poster there’s the word “GROW” above a corny quote from Ronald Reagan.

Stephen “Greazy” Sapp wrote the following poem at the end of class one day; he’d spent almost the whole hour staring at the picture of those trees:





I want to live to see things grow –

From the fury of a great storm, started from

A single drop –

To the ten foot tree from one tiny seed, one sheet

Of paper as from any other tree

Knocked down by a great storm –

The child who grew from a seed in the spouse

Of the man who held paper from the tree –

Maybe the seed buried in his mind could become

Greater in life than the tree that withstood

The storm, now given opportunity to transform

Into stories – of future, generations who dwell

In the single rain drop in

The forest of days to come –


Greazy told me that he loves plants.

(My inclination is to use people’s first names as a sign of respect, but he told me not to – “nobody calls me ‘Stephen’ unless they’re mad about something.  You know, like, my grandma, if she was pissed, I might hear her yell, like, Stephen!  Even the cops.  They pulled up one day, they were like, ‘Greazy, come here, we want to talk to you,’ I knew everything was fine.  They were like, ‘look, man, we know you’re selling pot … but stay up near 17th street or something.  We don’t want you downtown, selling it to college kids.’  But then, another day, they came down, spotted me, said ‘Stephen, get over here!’ I was like, ‘man, I know they’re gonna haul me in.’ ”)

Greazy was in the jail all through autumn, waiting on his trial, and he told me that one day he was sitting in his cell on the fourth floor, watching a leaf blowing around on the sidewalk down below, and he found himself thinking, “Man, I’d sign whatever, I’d take whatever plea they wanted, if they’d just let me out there, get to look up close at that little leaf.”

Another man told me that he felt so starved for the world that he started gardening inside the jail.  He didn’t want for me to include his name but graciously allowed me to share his story.  Here’s a poem I wrote:




by sprouting seeds in a paper towel,

planting one in dust & dirt

he collected scraping his fingers along

each corner of the concrete walls,

& using an Irish Spring soap box as a shelf

to lift his sapling to the light.


Our man only wanted to

oxygenate his air

but soon the whole block shuffles by

checking on the tree each day.

They’re surprised that it survived,

but proud to see it grow

until the warden declares it contraband.



On Sci-Hub, the Napster of science.

On Sci-Hub, the Napster of science.

Here’s a story you’ve probably heard: the music industry was great until Napster came along and complete strangers could “share” their collections online and profits tanked.  Metallica went berserk suing their fans.  It was too late.  The industry has never been the same.napster

Sci-Hub has been called a Napster equivalent for scientific research papers, and the major publishing companies are suing to shut it down.  The neuroscience grad student who created it faces financial ruin.  The original website was quickly shuttered by a legal injunction, but the internet is a slippery place.  Now the same service is hosted outside U.S. jurisdiction.

[Note: between writing and posting this essay, Sci-Hub has lost another lawsuit requesting all such sites to be blocked by internet service providers.]

The outcomes of these lawsuits are a big deal.  Not just for the idealistic Kazakhstani grad student charged with millions in damages.  Academic publishers will do all they can to accentuate the parallels between Sci-Hub and Napster – and, look, nearly a quarter of my living relatives are professional musicians, so I realize how much damage was wrought by Napster’s culture of theft – but comparing research papers to pop songs is a rotten analogy.  Even if you’ve never wanted to read original research yet … even if you think – reasonably – that content producers should be paid, you should care about the open access movement.  Of which Sci-Hub is the most dramatic foray.

My own perspective changed after I did some ghostwriting for a pop medicine book.  Maybe you know the type: “Do you have SCARY DISEASE X?  It’ll get better if you take these nutritional supplements and do this type of yoga and buy these experimental home-use medical devices!”  Total hokum.  And yet, people buy these books.  So there I was, unhelpfully – quite possibly unethically – collaborating with a friend who’d been hired to ghostwrite a new one.

Central_core_disease_NADH_stainI read huge numbers of research papers and wrote chapters about treating this particular SCARY DISEASE with different foods, nutritional supplements, and off-label pharmaceuticals.  My sentences were riddled with un-truths.  The foods and drugs I described are exceedingly unlikely to benefit patients in any way.

Still, I found research papers purporting to have found benefits.  I dutifully described the results.  I focused on the sort of semi-farcical study that concludes, for instance, that cancer patients who drink sufficient quantities of green tea have reduced tumor growth, at which point newspapers announce that green tea is a “superfood” that cures cancer, at which point spurious claims get slathered all over the packaging.

Maybe nobody has written a paper (yet!) claiming that green tea ameliorates your particular SCARY DISEASE.  But there’s also turmeric, kale, fish oil, bittermelon, cranberries… I’m not sure any ingredient is so mundane that it won’t eventually be declared a superfood.  Toxoplasma gondii has been linked to schizophrenia, but low-level schizophrenia has been linked to creativity: will it be long before cat excrement is marketed as a superfood for budding artists?

cat-shit-2-flat-1.jpgAs it happens, enough people suffer from our book’s SCARY DISEASE that many low-quality studies exist.  I was able to write those chapters.  And then felt grim.  The things I’d written about food weren’t so bad, because although turmeric, coconut oil, and carpaccio won’t cure anybody, they won’t cause much harm either.  But the drugs?  They won’t help, and most have nasty side effects.

My words might mislead people into wasting money on unnecessary dietary supplements or, worse, causing serious damage with self-prescribed pharmaceuticals.  Patients might follow the book’s rotten advice instead of consulting with a trained medical professional.  I’d like to think that nobody would be foolish enough to trust that book – the ostensible author is probably even less qualified to have written that book than I am, because at least I have a Ph.D. in biochemistry from Stanford – but, based on the money being thrown around, somebody thinks it’ll sell.

And I helped.

Whoops.  Mea culpa, and all of that.

But I didn’t perpetrate my sins alone.  And I’m not just blaming the book’s publishers here.  After all, the spurious results I described came from real research papers, often written by professors at major universities, often published in legitimate scientific journals.

It’s crummy to concentrate all that slop in a slim pop medicine book, I agree, but isn’t it also crummy for all those spurious research papers to exist at all?

Maybe you’ve heard that various scientific fields suffer from a “replication crisis.”  There’s been coverage on John Oliver’s Last Week Tonight and in the New York Times about major failures in psychology and medicine.  Scientists write a paper claiming something happens, but that thing doesn’t happen in anyone else’s hands.  That’s if anyone even bothers to check.  Most of the time, nobody does.  Verifying someone else’s results won’t help researchers win grants, so it’s generally seen as a waste of time and money.

Still, the news coverage I’ve seen hasn’t stated the problem sufficiently bluntly.  Modern academic science is designed to be false.

This is tragic.  It’s part of why I chose not to stop working in the field.  I became a writer.  Of course, this led to my stint of ghostwriting, which… well, whoops.

Here’s how modern science works: most research is publishable only if it is “statistically significant.”  This means comparing any result to a “null hypothesis” – if you’re investigating the effect of green tea on cancer, the null hypothesis is simply “green tea does nothing” – then throwing out your results if you had more than a one in twenty chance to see what you did if the null hypothesis were true.

If you have a hundred patients, some of their tumors will shrink no matter what you do.  If you give everybody buckets of green tea and see the usual number of people improve, you shouldn’t claim that green tea saved them.

Here’s a graphic from Wikipedia to help:


Logical enough.  But bad.  Why?  Because cancer is a SCARY DISEASE.  Far more than twenty people are studying it.  If twenty scientists each decide to test whether green tea reduces tumors, the “one in twenty” statistical test means that somebody from that set of scientists will probably see an above-average number of patients improve.  When you’re dealing with random chance, there are always flukes.  If twenty researchers all decided to flip four coins in a row, somebody would probably see all four come up heads – doesn’t mean that researcher did anything special.

Or, did you hear the news that high folate might be correlated with autism?  This study probably sounds legitimate – the lead scientist is a professor at Johns Hopkins, after all – but the result is quite unlikely to be real.  That scientist hasn’t written about folate previously, so my best guess (this new study is currently unpublished) is that pregnant women were tested for many different biomarkers, things like folate, iron, testosterone, and more, and then tracked to see whose children would develop autism.  If the researchers tested the concentrations of twenty different nutrients and hormones, of course they’d see one that appeared to correlate with autism.

[Edit: these findings were recently published.  Indeed, the data appear rather unconvincing, and the measurements for folate were made after the fact, using blood samples – it’s quite possible that other data was gathered but excluded from the published version of the study.]

This is not science.  But if you neglect to mention how many biomarkers you studied, and you retroactively concoct a conspiracy theory-esque narrative explaining why you were concerned about folate, it can do a fine job of masquerading as science.  At least long enough to win the next grant.

Which means that, even though the results of many of these studies are false, they get published.  When somebody checks twenty nutrients, one might appear to cause autism.  When twenty scientists study green tea and cancer, somebody might get results suggesting green tea does work.  Even if it doesn’t do a thing.

In our current system, though, only the mistaken researcher’s results get published.  Nobody knows that there were twenty tests.  The nineteen other biomarkers that were measured get left out of the final paper.  The nineteen researchers who found that green tea does nothing don’t publish anything.  Showing that a food doesn’t cure cancer?  How mundane.  Nobody wants to read that; publishers don’t want it in their journals.  But the single spurious result showing that green tea is a tumor-busting superfood?  That is exciting.  That study lands in a fancy journal and gets described in even briefer, more flattering language in the popular press.  Soon big-name computer CEOs are guzzling green tea instead of risking surgery or chemo.

I generally assume that the conclusions of research studies using this type of statistical testing are false.  And there’s more.  Data are often presented misleadingly.  Plenty of scientists are willing to test a pet theory many ways and report only the approach that “works,” not necessarily because they want to lie to people, but because it’s so easy to rationalize why the test you tried first (and second, and third…) was not quite right.  I worked in many laboratories over a decade and there were often results that everybody in the lab knew weren’t true.  Both professors I worked under at Stanford published studies that I know weren’t done correctly.  Sadly, they know it too.

This subterfuge can be hard for outsiders to notice.  But sometimes the flaws are things that anybody could be taught to identify.  With just a little bit of guidance, anybody foolish enough to purchase the pop medicine book I worked on would be able to look up the original research papers and read them and realize that they’re garbage.

There’s a catch: most of those papers cost between twenty and thirty dollars a pop.  The chapters I wrote cite nearly a hundred articles.  I’d describe a few studies about the off-label use of this drug, a few about that one, on and on, “so that our readers feel empowered to make their own decisions instead of being held at the paternalistic mercy of their healthcare professionals.”  A noble goal.  But I’m not sure that recommending patients dabble with ineffectual, oft-risky alternative medicines is the best way to pursue it.  Especially when the book publisher was discussing revenue sharing agreements with sellers of some of the weird stuff we shilled.

So, those hundred citations?  You could spend three thousand dollars figuring out that the chapters I wrote are crap.  The situation is slowly getting better – the National Institute of Health has mandated that taxpayer-funded studies be made available after a year, but this doesn’t apply to anything published before 2008, and I’m not sure how keen sick patients will be to twiddle their thumbs for a year before learning the latest information about their diseases.  Plus, there are many granting organizations out there.  Researchers who get their money elsewhere aren’t bound by this requirement.  If somebody asks you, “Would you like to donate money to fight childhood cancer?” and you chip in a buck, you’re actually contributing to the problem.

Photo by diylibrarian on Flickr.

I was only able to write my chapters of that book because I live next to a big university.  I could stroll to the library and use their permissions to access the papers I’d need.  Sometimes, though, that wasn’t enough.  Each obscure journal, of which there are legion, can cost a university several thousand dollars a year for a subscription.  A few studies I cited were published in specialty journals too narrowly focused for Indiana University to subscribe, so I’d send an email to a buddy still working at Stanford and ask him to send me a copy.

If you get sick and worry yourself into looking for the truth, you’ll probably be out of luck.  Even doing your research at a big state university library might not be enough.

That’s if you keep your research legal.

Or you could search for the papers you need on Sci-Hub.  Then you’d just type the title, complete a CAPTCHA on a page with instructions in Cyrillic (on what was until recently http://www.sci-hub.cc, at least), and, bam!  You have it!  You can spend your thirty dollars on something else.  Food, maybe, or rent.

Of course, this means you are a thief.  The publisher didn’t get the thirty dollars they charge for access to a paper.  And those academic publishers would like for you to feel the same ethical qualms that we’re retraining people to feel when they pirate music or movies.  If you steal, content producers won’t be paid, they’ll starve, and we’ll staunch the flow of beautiful art to which we’ve become accustomed.

The comparison between Napster and Sci-Hub is a false analogy.  Slate correspondent Justin Peters described the perverse economics of academic publishing, in particular the inelastic demand – nobody reads research journals for fun.

With music and movies, purchasing legitimate access funds creators.  Not so in academia.  My laboratory had to pay a journal to publish my thesis work; this is standard practice.  It costs the authors a lot of money to publish a research article, and “content producers” only do it, as opposed to slapping their work up on a personal website for everyone to read free, because they need publication credits on their CVs to keep winning grants.

With music and movies, stealing electronic copies makes content producers sad.  With research articles, it makes them happy.

In fact, almost everyone believes research articles should be free.  At the European Union’s recent Competitiveness Council, the member states agreed that all scientific papers should be freely available by 2020 – these  are the governments whose enforcement is necessary to maintain the current copyright system!  The only people making statements in favor of the status quo are employed by the academic publishers themselves.  Their ideological positions may be swayed somewhat by the $2 billion plus profit margins major publishers are able to extract from their current racket.

Academic publishers would argue that they serve an important role as curators of the myriad discoveries made daily.  This doesn’t persuade me.  The “referees” they rely on to assess whether each study is sound are all unpaid volunteers.  Plus, if the journals were curating well, wouldn’t it have been harder for me to fill that pop medicine book with so much legitimate-looking crap?

Most importantly, by availing yourself of Sci-Hub’s pirated material, you the thief no longer live in ignorance.  With our current healthcare model, ignorance is deadly.  The United States is moving toward an a la carte method of delivering treatment, where sick people are expected to be knowledgeable, price-sensitive consumers rather than patients who place their trust in a physician.  Most sick people no longer have a primary care physician who knows much about their personal lives – instead, doctors are forced for financial reasons to join large corporate conglomerates.  Doctors try their best moment by moment, but they might never see someone a second time.  It’s more important than ever for patients to stay well-informed.

Unless Sci-Hub wins its lawsuit, you probably can’t afford to.

On minotaurs (and whether or not mothers are the root of all maladies).

While reading Eula Biss’s On Immunity, I was often reminded of Rebecca Kukla’s Mass Hysteria.  Both works analyze the permeability of bodies, especially mothers and children, while drawing from literature, philosophy, and medicine.  Their major divergence is in tone; Kukla’s work can veer academic (which I enjoy, being a pedantic fuddyduddy myself); Biss’s writing is much more accessible.  A great choice, in my opinion, since Biss seems to have a strong social justice motivation for her work.  The fact that her writing is so consistently chatty and approachable, and that the work as a whole is structured with snack-sized chapters perfect for reading while a napping baby was sprawled atop my chest, seems essential for reaching her intended audience.

I felt the works were most similar in sections discussing putative moral shortcomings in mothers and the way those ills could be passed along to children, either physically through the womb or breastmilk, or psychologically through maternal behavior.  Here’s Biss on the litany of ill-conceived castigations that have been applied to women, which I think of collectively as the “blame the mother” hypotheses:

In the twentieth century, psychologists blamed schizophrenia on overbearing mothers who smothered their children.  Homosexuality, categorized as a mental illness until 1973, was blamed on anxious mothers who coddled their children.  Autism, according to the prevailing theory of the 1950s, was blamed on cold, insensitive “refrigerator mothers.”  Even now, mothers provide “a convenient missing link in germ theory,” as the psychotherapist Janna Malamud Smith observes.  “If it is not viral or bacteria,” she quips, “it must be maternal.”

These are all relatively modern theories — we have to delve slightly deeper into medical history to reach my favorite “blame the mother” hypothesis: the maternal imagination theory that purportedly explained birth defects.

9780312427733I first learned about this theory from Jeffrey Eugenides’s wonderful novel Middlesex.  If you haven’t read it yet, you’re in for a treat!  As in, why waste your time reading this essay?  Go read his book!  Soon!  Now!

But if you’re still here (I should finish writing this essay, after all, in case you’re at work or something and stuck sitting at a computer), you’ll get only a small taste.

In this passage, Eugenides shows a doctor explaining the causes of birth defects to a nervous expectant mother; the doctor blusters forth with a charming (and in my opinion very true to life) lack of emotional intelligence.  He’s so pleased with his own erudition that he doesn’t even notice the burgeoning worries of his patient — the fearful mother is bearing her brother’s child.

Sourmelina let out an exasperated sigh and wiped her mouth with her napkin.  There was a strained silence.  Dr. Philobosian, pouring himself another glass of wine, rushed in.

“Birth is a fascinating subject.  Take deformities, for instance.  People used to think they were caused by maternal imagination.  During the conjugal act, whatever the mother happened to look at or think about would affect the child.  There’s a story in Damascene about a woman who had a picture of John the Baptist over her bed.  Wearing the traditional hair shirt.  In the throes of passion, the poor woman happened to glance up at this portrait.  Nine months later, her baby was born–furry as a bear!”  The doctor laughed, enjoying himself, sipping more wine.

“That can’t happen, can it?”  Desdemona, suddenly alarmed, wanted to know.

But Dr. Philobosian was on a roll.  “There’s another story about a woman who touched a toad while making love.  Her baby came out with pop eyes and covered with warts.”

“This is in a book you read?” Desdemona’s voice was tight.

“Pare’s On Monsters and Marvels has most of this.  The Church got into it, too.  In his Embryological Sacra, Cangiamilla recommended intra-uterine baptisms.  Suppose you were worried that you might be carrying a monstrous baby.  Well, there was a cure for that.  You simply filled a syringe with holy water and baptized the infant before it was born.”

“Don’t worry, Desdemona,” Lefty said, seeing how anxious she looked.  “Doctors don’t think that anymore.”

“Of course not,” said Dr. Philobosian.  “All this nonsense comes from the Dark Ages.  We know now that most birth deformities result from the consanguinity of the parents.”

“From the what?” asked Desdemona.

“From families intermarrying.”

Desdemona went white.

“Causes all kinds of problems.  Imbecility.  Hemophilia.  Look at the Romanovs.  Look at any royal family.  Mutants, all of them.”

3wombsTo me, that’s a great medical hypothesis.  Not the idea that consanguinity causes birth defects; that’s too commonly understood, and too true, to be a lot of fun.  But maternal imagination?  A fine piece of work.  Doctors, out of prudishness, refused to examine women’s bodies.  Then, in their ignorance, they claimed those bodies were malleable and consisted primarily of empty space that the women’s organs could migrate through (i.e. “hysteria,” from “hustera” meaning womb, a disease in which the uterus has wandered too far.  Like a parasitic worm, perhaps, if it reaches her brain the womb might cause a woman to say crazy things).  And so they logically assumed, hey, if women’s bodies are such porous, malleable things, and babies are growing inside them, then anything a mother does or even thinks might affect the baby!

Brilliant logic, right?

Here’s a snippet of Kulka’s perspicacious analysis about how the maternal imagination theory related to the culture of the times:

This cluster of anxieties is sometimes intertwined with other familiar social anxieties that circulate around reproduction.  In a fascinating twist, Sadler warns that the child of an adulteress may still look like her husband because she may have been thinking about him during coitus.  In this case, anxieties about how paternity can be secured intersect with anxieties about the maternal imagination, through the warning that fathers cannot even trust family resemblance as a marker of proper paternity.  This example doubles the call to carefully police women’s appetites: her wayward cravings may betray her husband and her child at once.  Sadler also cites a commonly mentioned report of a woman who “conceived and brought forth an Ethiopian” because she looked at a painting of a black man during conception, thereby adding anxieties surrounding racial purity to the mix of concerns.  Women’s cravings and imagination can thus deform and denature both the kinship order and the racial order, along with the order of their children’s bodies, in ways that normal, external controls over sexual activity cannot prevent.

Tight bind, eh?  If your baby looks “wrong,” it’s your fault: you, as a mother, must’ve somehow sinned.  You saw something you should not have seen.  You ate something you should not have eaten.  You made yourself impure.  And even if your baby looks “right,” there’s a chance that you’re bad anyway, that you somehow cheated and used virtuous thoughts while sinning in order to conceal your crimes.

Here is another passage from Kukla wherein she presents — from an ostensibly-scientific medical text! — a list of maternal-derived illnesses even broader and more morally-castigating than was delineated by Biss:

The seventeenth-century textbooks are particularly concerned about and often organized around the possibility of deformed births, with a special focus on the dangers of the impure, permeated womb.  Sadler’s book, for instance, is organized primarily as a list of ways in which the womb can fail to maintain its purity and its integrity–the womb here leaks and ‘weeps,’ and various ‘corrupt humours’ flow in and out of it, making nothing more ‘perilous’ to the body than the ‘ill-affected womb.’  Many of the works go into elaborate detail, describing and often visually representing famous cases of monstrous births.  Monstrous births could be the product of weak seed or impure blood, of conception during menstruation, of the woman fertilizing herself with her own seed (!), or, most importantly and consistently, of maternal ingestions of sights and substances that could pollute or deform the womb.  In justifying the need for careful knowledge and monitoring of the maternal body, in the preface of his book, Sadler warns us: “From the womb come convulsions, epilepsies, apoplexies, palseys, hecticke fevers, dropsies, malignant ulcers, and to bee short, there is no disease so ill but may proceed from the evil quality of it.”

CaptureGiven that my novel is primarily about violence against women, especially as has been affected in the name of science, I couldn’t resist incorporating the theory of maternal imagination.  For linguistic reasons (and because the traditional myth impugns women and their appetites still further), the problem children in my work are minotaurs.

Surprisingly, the old medical texts do not specifically address monsters from mythology, but it’s not much of a stretch to imagine one of those books containing explicit warnings about women and bestiality.  Or that barns be kept out of the sight line of bedroom windows.  Or that pregnant women stay away from farms in general.  In a time when medical texts posited the sponge-like permeability of women, risk must have seemed to be everywhere.

Of course, doctors could have checked.  Perhaps they would have noticed that human women in all variety of circumstances were giving birth to perfectly normal human babies.

But where’s the fun in that?  And, worse, if it did turn out that women’s thoughts were no more dangerous than men’s, how would you argue that they needed to be shielded from dangers like the pursuit of meaningful professions?

On autism and vaccines.

Another vaccine in the news.

Let’s get one thing out of the way first, shall we?  Vaccines don’t cause autism.  If you’ve got a kid with a standard operating immune system, you oughta get that sucker vaccinated.  If you yourself have a standard operating immune system, and you’re considering living in a place where certain diseases that you aren’t immune to are prevalent, you oughta get yourself vaccinated.

But, okay, now that we’ve stated that much, there is an essay about vaccines and autism that I’ve been meaning to write.  Prompted, at the moment, by my turn in the queue for Eula Biss’s On Vaccination finally arriving.  Biss writes, with a lack of emphasis that I assume is ironic, though I am of course only a quarter of the way through her book at the time of this writing and so cannot know for certain, “Even so, the evidence reviewed by the committee ‘favors rejection’ of the theory that the MMR vaccine causes autism.”

Sure.  Let’s reject that theory.  There’s no evidence that vaccines cause autism; a scientist might use the word “hypothesis” to describe the idea that one might, but never “theory,” not given the data we have (by way of contrast, evolution is a theory.  Gravity is a theory; the next thing you drop, unless you’re on the space station, is probably gonna fall).  The conjecture that vaccines cause autism is a hypothesis, one that’s been tested and rejected.  Unless we accumulate a lot of new data that’s very dissimilar from the data we have now, rejected is how that hypothesis will stay.

And yet.  I wanted to write an essay about my favorite contemporary model for the cause of autism, and the idea that vaccination (or “mock vaccination,” actually, in which a child undergoes the ritual of vaccination but nothing is injected) might trigger the onset of autism.  This would happen only in children who were more or less guaranteed to have autism, but I can envision a compelling narrative in which the parents of many such children would all be able to point to an incidence of vaccination as the triggering moment.

There are, you may have noticed, many theories about what causes autism.  There’s the hippocampal under-pruning hypothesis; people with autism might have too many neural connections, trigger too many memories when it’s time to make decisions!  And of course there is also the over-pruning hypothesis; yup, the exact opposite idea has been proposed as the cause of autism, too!  It’s been proposed that autism results in underactivation of the fusiform gyrus, which is a part of the brain associated with processing faces and emotions.  And, yes, it’s been proposed that autism results in overactivation of the fusiform gyrus in emotional contexts, as though it’s hard to make eye contact, process emotions, etc., because they are perceived too strongly, not too weakly.  It’s been proposed that the condition is akin to a defensive response to stress, or that it’s linked to a deficit of oxytocin (the “cuddle molecule,” which K is planning to get a tattoo of once she’s done nursing), or that there are insufficient GABA-mediated inhibitory signals.

In short, many proposals, and nobody knows what’s correct.

Honestly, we don’t even how many people have autism.  You could read the CDC report and say, ah, 1 in 68 children have an autism spectrum disorder, but there are clear peculiarities in their numbers.  For instance, the huge increase relative to prior reports.  For instance, massive regional disparities; should we believe that autism is 4-fold more common in New Jersey than Alabama, or is there a difference in diagnostic capabilities?  And, as a point of contention near and dear to my own heart, the possibility that autistic children learn to mask their own condition.  If you asked K, for instance, she’d tell you that I have a mild autism spectrum disorder, but I’ve never been diagnosed.

And there are many proposed cures for autism.  Exogenous oxytocin (would hugs work instead, to promote endogenous oxytocin?); suramin, which reduces stress response (this hasn’t been proposed as a cure for humans, because the compound is toxic, but it seems to ameliorate autism-like symptoms in a mouse model); behavioral therapies …

… and my nomination for the all-time absolute WORST proposed cure, daily injection of massive doses of LSD. (This was first tested in humans, orphaned children, primarily, and was sometimes coupled with electroshock therapy.  But I should point out that our definition of the word “autism” has evolved somewhat in the time since these experiments were performed; if we go by modern usage, I think a more accurate description of these children would be “surly” rather than “autistic.” Still, reason enough to give them daily LSD. For months.)

All of which I’m mentioning so that you know to take everything I say about a possible “link” between autism and the practice of vaccination with a hefty dose of salt.  Clearly, nobody knows what’s up.

So, with all our caveats carefully stipulated, let’s get to it!  My current favorite model for the cause of autism, and how that might also relate to vaccines!

(Do I need to mention, here, that my use of the word model, singular, is somewhat silly since it seems very likely that there are multiple causes, perhaps multiple brain states that all get referred to as “autism” but which have differing neurological mechanisms?  I’m not sure.  I’ll mention it coyly, like this, in a parenthetical aside… that’s a good halfway approach, right?)

The model: maybe certain babies get too stressed out during birth, and that triggers autism (there is a nice summary of this model on the Simons Foundation Autism Research Initiative website).

A fetus’s brain activity is supposed to be suppressed during delivery, a process mediated by K’s favorite molecule. But something might be awry in autism, causing the suppression of brain activity to fail.  Seems there are suspicious clues speckled throughout the literature, like the fact that diazepam (Valium) often excites people with autism instead of calming them.  Indeed, my sister and I took an overnight bus ride through the mountains when I visited her in Ecuador (she was there for a three-year stint in the Peace Corps before medical school), and one of her friends lent us some Valiums.  My sister slept soundly.  I spent twelve hours chittering and jabbing her in the side with my elbow.

And, yeah, birth seems like it’d be incredibly traumatic… definitely seems like a good thing for babies’ brains to be conked.  Why not imagine that someone would be constantly musing “The horror, the horror” if there was any trace of memory about that whole ordeal?  There’s an increased percentage chance of autism after birth complications, though it’s difficult for me to say what types of delivery a baby would consider most stressful (like, would a baby think that a Cesarean delivery was easier?  Dunno, but Cesarean delivery is correlated with higher autism incidence, not lower like you might predict if your only working model were this highly speculative one I’m expounding upon).

In rodent models where pretreatment (either genetic or chemical) of fetuses tends to produce animals with some of the social disorders considered to be hallmarks of autism, it seems you can reduce the chance of producing an autistic-like animal by giving the birthing mothers a drug that stills the mind of the fetus.  Conk the baby chemically, it won’t remember its own birth, it grows into a neurotypical adult.

Within this framework, it seems possible that any episodes involving extreme stress could trigger autism onset in highly-susceptible individuals.  Vaccination, typically involving a shot, is stressful for some children.  So, there you go.  If you want to believe that there is *any* correlation between vaccination and autism beyond a coincidence in timing (i.e. when it’s first possible to diagnose autism and the standard vaccination schedule) this speculative hypothesis is the best I can come up with.  And it suggests that even if you believe there’s a link between autism and vaccination, there’s a strategy you could employ other than refusing vaccination, which endangers your own child and others.  You can simply make vaccination not stressful.

It’s not that hard, actually.  Yes, your kid is getting jabbed with a needle.  And it hurts, a little bit.  Not that much.  About as much as a hard pinch, which is crummy, and makes most kids cry, but easily fixable.  I’d say N has cried on average for about three seconds with each of her vaccinations, then we cuddle her some, she nurses, she’s happy again.  Part of why this works so well is that K stays calm and placid and cheerful throughout (I wish I could say the same about myself, but I have that thing where my blood pressure drops and I feel faint around needles.  K doesn’t; she performed thousands of injections on frogs during her doctorate and that experience washed away her needlephobia for good).  And our pediatrician is great.  And we sing, before, during, and after shots.

In summary… vaccinate your kids, kids.


p.s. Was this all too chipper?  I do want people to be vaccinated against preventable diseases.  But, here, let me throw in a brief passage that I had to cut from an early draft of my novel to show that I understand why people are afraid of doctors; obviously bad things have been done.  Bad enough that any reasonable human would feel distrustful.  It’s just that, as regards contemporary pediatric vaccination, I don’t think the mistrust needs to be acted upon.  But, here you go, a little bit of horror to mitigate the preceding essay’s good cheer.

In early vaccine trials, orphaned children drank the pureed spinal chords of smallpox-infected monkeys.  Doctors put it in their milk.  The initial vaccination attempts failed: the virus was “insufficiently inactivated.”  Some of the children got sick.  Some were crippled for life.

Of course, they were living in an orphanage.  Not the most sanitary of conditions: some number of them were going to get sick anyway.  And for that study, the intent was therapeutic.  The drink might have been a vaccine.  Much more respectful toward what might’ve been the children’s wishes than, say, the hepatitis studies, in which orphans were deliberately infected so that attending doctors could track progression of the disease.  In that study, they were fed a slurry of pooled feces from other already-sick children.  Also in their milk, although for that study the noxious agent was blended into chocolate milk.  Probably seemed like a special treat.

On the PubPeer lawsuit, scientific fraud, and anonymity.

CaptureThere are some problems with academic bioscience.

That much seems to be well agreed on.  There are a lot of contributing factors — the pyramid-scheme-like training & employment setup, the recent propagation of soft money positions (universities hiring without setting aside money for salaries, expecting salary money to come out of research grants instead), a reduction in real money available for research at the same time as more people are applying for funding, and then the myriad issues arising from journal policies.  Things like an emphasis on unexpected results, disinterest in publishing reproductions, allowing material to be published with scanty experimental details and, worse, heavily-processed data in the form of graphs and charts as opposed to raw data itself.

Which, if you’re interested in that sort of thing, probably the best place to start would be last year’s paper from Alberts et al., “Rescuing US biomedical research from its systemic flaws.”  The authors provide a thorough, accessible introduction to many of these problems.

Today, I’m just going to focus on one issue: the difficulty of identifying scientific misconduct.  As in, principal investigators publishing work that they know should not be published, at least not in the way they’re presenting it.

Which, sure, you could use the word “fraud” for this, but that’s a very harsh word that I don’t think is entirely appropriate to encompass the range of issues we ought to consider.  Like work that’s presented misleadingly to make it seem more exciting than it really is.  Or work that’s found out to be inaccurate (or partially inaccurate) after it’s sent for publication, but is never retracted.  Classifying those types of cases with the same word used to describe fabricated data seems overly harsh, even though none of that is okay.

For starters: yes, this issue has been in the news a lot more lately than it used to be.  Part of the problem is directly related to issues addressed in the Alberts article.  Biomedical research seems more competitive now than it used to be, and the people involved are objectively more replaceable; the number of available persons with the necessary training per professorship has increased, largely because each professor needs a team of people to conduct experiments, and the way those teams are currently assembled is primarily from the ranks of trainees.

The other main driver for an increase in apparent fraud is that it can pass by undetected more easily now.  Modern experiments are hard — the techniques require a lot of training to even understand the underlying physical principles, let alone to be able to correctly interpret data.  Even researchers who’ve come to very different conclusions than myself about what ought to be done acknowledge that experimental difficulty is a huge issue for the reproducibility of modern work; you could read Mina Bissell’s article “The risks of the replication drive,” for instance, where she writes:

“So why am I concerned?  Isn’t reproducibility the bedrock of the scientific process?  Yes, up to a point.  But it is sometimes much easier not to replicate than to replicate studies, because the techniques and reagents are sophisticated, time-consuming and difficult to master.  In the past ten years, every paper published on which I have been senior author has taken between four and six years to complete, and at times much longer.  People in my lab often need months–if not a year–to replicate some of the experiments we have done on the roles of the microenvironment and extracellular matrix in cancer, and that includes consulting with other lab members, as well as the original authors.”

So, let’s start with that.  Experiments are sufficiently involved that they might be difficult to reproduce even if the results were correct.  And let’s set aside the issue of whether or not results are robust; in her article, Bissell points out that tiny variations in cell line can have dramatic impacts on their response to assays.  So it might be fair to wonder in those cases whether observed results matter, but not whether they’re correct.

But there’s a confounding factor, because some results presumably are not correct.  Both John Ioannidis’s article “Why Most Published Research Findings Are False” and Chabris et al.’s article “Most Reported Genetic Associations with General Intelligence Are Probably False Positives” consider the math behind p-testing, the typical ways that researchers collect and process data, and journal publishing policies to show that our current system is likely to yield many inaccurate results. Indeed, there seem to be enough incorrect results published that many drug companies no longer trust academic results, as described in Begley and Ellis’s article “Raise standards for preclinical cancer research”  (although it’s worth noting here that Begley and Ellis are basing their conclusions on numerous instances in which famous results could not be reproduced.  Bissell’s objections, as mentioned above, could still apply).

Okay.  That’s probably a lot to take in, especially since this is all just preamble to the point I wanted to make today.  Let me give a quick summary: experiments are hard.  That makes testing reproducibility hard.  But some of what’s out there is in fact not true (almost assuredly, based on the numbers, although this can only be proven on a case by case basis).

So, how do we separate the cases of things being not true because, yes, science is hard, and it’s easy to reach incorrect conclusions, and it’s a journey, a journey in which no one expects to unravel all of nature’s mysteries right away… cases where a published result is innocently not true for those reasons, and cases of fraud?

A nice shot from PhD comics.

Because there is fraud in our current system.  Papers knowingly not retracted.  Inaccurate data published.  Data work-ups that obscure questionable aspects of a group’s results.  And it’s very difficult to draw attention to: when people do find out about it, they tend to be powerless underlings.  An ethical stance against fraud can easily result in a destroyed career: consider Peter Whoriskey’s article about a Johns Hopkins researcher who drew attention to some problems with research he was working on and was summarily fired, then harassed.  Or you could consider Yudhijit Bhattacharjee’s article about Diederik Stapel, a sociology professor who simply made up all his experimental results for decades.  Because of his past successes, his students were extremely reticent to confront him about suspected fraud, allowing the scam to persist far longer than you might imagine it should’ve.  And, and this is an excellent point that Bhattacharjee made, “Fraud like Stapel’s — brazen and careless in hindsight — might represent a lesser threat to the integrity of science than the massaging of data and selective reporting of experiments.”

And, right, the reason why I’m writing about this today?  There is an anonymous platform for commenting on scientific papers called “PubPeer.”  And, look, I know that anonymous bullying is a problem, that there are lots of horrible issues with systems like Yik Yak allowing people to write vituperative comments online with no accountability.  But PubPeer seemed like an important service simply because it can be so difficult for outsiders to know when there are flaws in scientific research, and because the insiders who do know, and who might have an incentive to report the truth, could suffer grave consequences for doing so.

And yet… PubPeer was ruled against recently.  A judge said that PubPeer should be forced to turn over identifying information for an online commenter who supposedly cost Fazlul Sarkar a job at the University of Mississippi.  To me, this is bad, because any suspicion of fraud not validated by a university investigative committee could be considered defamation — but university investigative committees are often slow to act and do not necessarily protect the careers of informants.  It seems bad to take away an anonymous venue for potentially spreading scientific truth, especially since this is an arena where the anonymity really is important for the accuser, and should not be important for the accused: the accused has objective science to defend themselves with if they are in the right.  If Sarkar had separate pieces of data for all his published experiments, he could have shown that data to whomever at the University of Mississippi to quell their concerns.  Whereas a commenting graduate student or post-doc or whomever has no guarantee that levying an accusation won’t render him or her permanently unemployed in the field.

On immortality.


In my last essay, I mentioned Ravana’s boon.  Immunity to harm from gods.  But that wasn’t what he wanted.  Here’s another quotation from the Uttara-kanda, this time from the Robert Biggs translation (it’s less literal than the Dutt translation, which means fewer bizarre sentences.  Less poetic, though.  But I definitely appreciate that he did all that work and then posted it online, free of charge):

“[Ravana]* fasted for ten thousand years, and at the end of each thousand years he offered one of his heads into a sacrificial fire.  In this way he passed nine thousand years and offered nine of his heads into the sacrificial fire.  At the end of ten thousand years when he was about to cut off his tenth head, Lord Brahma appeared before him.  Very satisfied by [Ravana]’s austerities, Lord Brahma stood there accompanied by other demigods.  Then he said: ‘O [Ravana], I am so pleased with you.  Quickly choose the boon you desire, O knower of what is right.  What desire should I now fulfill.  Your effort should not go in vain.’  Then, with an overjoyed heart [Ravana] bowed his head and replied in a faltering voice: ‘O lord, the greatest fear for living beings is death.  I choose immortality.’  When requested in that way, Lord Brahma replied: ‘You cannot have complete immortality, therefore ask me for some other boon.’

*The name used for Ravana throughout that passage is Dashagriva, which means “Ten-necked one.”  I substituted it throughout.  And, right, maybe it’s worth quoting just the final lines of the Dutt translation of that passage, cause it’s rather more abrupt in its denial: “Thus accosted, Brahma spoke to the Ten-necked one, ‘You can not be immortal.  Do you therefore ask of me some other boon.’ ”

So, the dude did all that meditating; once he was getting offered gifts, he wanted eternal life.  And Brahma, like most gods, was not thrilled at the request.  Jehovah was equally ticked at the prospect of his newly-enlightened playthings gaining immortality: here’s a passage from the King James Bible:

“And the Lord God said, Behold, the man is become as one of us, to know good and evil: and now, lest he put forth his hand, and take also of the tree of life, and eat, and live for ever:

Therefore the Lord God sent him forth from the garden of Eden, to till the ground from whence he was taken.

So he drove out the man; and he placed at the east of the garden of Eden Cherubims, and a flaming sword which turned every way, to keep the way of the tree of life.”

So, people want to live forever, and gods aren’t going to help them do it.  That sounds like a job for science!  Indeed, many laboratories are researching ways to extend lifespan.  I don’t think any bioscientists imagine their efforts will ever result in immortality — that’s more a computer science aim than a bioscience one at the moment; here’s a reasonable introductory review into the study of human connectomes — but it seems pretty clear that they’re hoping their work can aid human longevity.  Which I get, obviously, despite my penchant for Malthusian pessimism (“Assuming then my postulata as granted, I say, that the power of population is indefinitely greater than the power in the earth to produce subsistence for man.  Population, when unchecked, increases in a geometrical ratio.  Subsistence increases only in an arithmetical ratio.  A slight acquaintance with numbers will shew the immensity of the first power in comparison with the second.”Thomas Malthus, a legendary curmudgeon).

CaptureLike there’s my graduate school baymate (the way our labs were set up was pairs of desks tucked into long alcoves of bench space, so there always wound up being one person who you talked to and collaborated with most), who planned to study lobsters after getting his doctorate: lobsters have limited senescence.  That is, they show fewer signs of aging than humans do; if we were more like lobsters, perhaps nursing homes would be rowdier places.  Of course, they’d needed to widen the hallways, reinforce the floors, etc., but I’m sure that’d seem like a fair trade for a little bit more vivacity.  Currently my buddy isn’t actually working on lobsters – he’s pursuing research more likely to help people in the near term – but someday maybe he’ll get back to it.

But the research into lobsters is focused on figuring out why they live a long time.  And there are similar studies focused on the secrets of other long-lived creatures; the most recent one I caught was a paper on whales.  The authors analyzed the bowhead whale genome and found that there might be extra copies of some DNA repair enzymes, and less of certain metabolic proteins (like a premature stop codon in a protein named UCP1 that generates heat).  About what you might expect: if you want to live a long time, DNA repair is good, metabolism is bad.  And it’s interesting, sure, but, again, unlikely to extend lifespan in the near future.  Good-lookin’ droids, but not the droids Ravana was looking for… anything that comes from that work will help other people a long time from now.  And that’s no good.  Honestly, interrogate any Malthusian and eventually they’ll tell you: the problem with longevity is that everyone else might attain it too.  If there were an a magic plant to provide immortality to just me, right here and now, then that’d be fine.  Unless a serpent happened by and stole it.  Then I’d probably be sad and start to weep.

But in the meantime, we’ve got some strategies for life extension to discuss!  Things that you could try today.  Like perfusion with hydrogen sulfide.  That’s right – inhale a horrible toxin in order to live!

(Don’t actually try this, by the way.  Hydrogen sulfide isn’t good for you.)

The first study using hydrogen sulfide to lower metabolic rate was done in Mark Roth’s lab: they were gorking mice with it, the idea being that a low metabolic rate, low oxygen consumption, etc., might make you more likely to survive massive blood loss or nasty surgery without physiological damage ... if you’re not in a suspended animation-like state and you experience hypoxia, bad things happen to your brain.

Figure 2A, Miller and Roth (2007).

Or course, that’s all for acute episodes dosed with hydrogen sulfide.  The Roth lab also did a study where they raised worms with or without 50 parts per million hydrogen sulfide in the atmosphere, and the worms with hydrogen sulfide lived longer (see Figure 2A for a nifty graph).

The next strategy is to supplement your diet with glucosamine.  This is an inhibitor of glycolysis: roughly speaking, the process by which your cells turn food into energy.  Work done in Michael Ristow’s lab showed that when mice were fed glucosamine every day for the bulk of their lives, they lived a little longer (see Figure 3C for the nifty graph).   And they presented significance testing for whether or not lifespan was increased… but didn’t mention a percentage for how much longer the mice lived.  Glancing at it, I’d say not much.  But some!  A little bit more time!

Figure 3C, Weimer et al. (2014).

Or there’s caloric restriction.  Caloric restriction is something that’d be more reasonable for you to try at home than the whole huffing hydrogen sulfide thing, although I still wouldn’t recommend it.  Even though there’ve been very promising results in a variety of species… even in humans, so if you happened to decide today that this is something you’d want to do, the evidence is on your side.  Massively reduce the amount you eat and you might live longer.  Or not.  Caloric restriction also sounds a lot like anorexia, which causes horrible health problems.  Good job, photoshop!  And it’s apparently tricky to balance caloric restriction to be exactly right to promote lifespan without succumbing to all those anorexia-related health problems.

But in summary, it seems to be metabolism that kills you.  Oxygen eventually destroys cells.  And mitosis, which has to occur to replace your cells, involves doubling your DNA, which can never be 100% error-free.  So once you live enough, you’ll die.

The current strategies used to extend life – hydrogen sulfide, glucosamine, caloric restriction – seem primarily to slow metabolism.  So I don’t really think you’d be getting much more life.  You would persist in the world for more time, but would you be having more fun?  Would the integral of your fun vs. time graph over your entire lifespan even match that of someone living faster and less healthily?

I mean, I know my answer.  Not that I’m particularly unhealthy, but I volunteer as an assistant coach for the high school long distance runners, which means I go out and run with them a couple times a week, which means my metabolism works pretty hard.  I’m using up my heartbeats young; I won’t live forever.  But I still like doing it; I like running and I like running with them, talking with kids on the team, trying to make their time in high school a little less horrible than mine was.

img466psAnd as a last salvo for this essay, it might be worth quoting at one more curmudgeonly writer who’s pointed out some of the flaws in the whole “help everyone live longer” scheme: good old Jack Vance, whose debut novel “To Live Forever” is the best allegory for pursuing a tenure-track academic career I’ve ever read.  Seriously, if that’s your gig, you should check it out.  Yes, Jack Vance wrote pulp, but he was still a great stylist (it’s taking a great deal of restraint on my part not to quote a passage from his “Eyes of the Overworld” here… maybe I’ll try to find a way to work it in to a later, shorter essay) and the world he describes in “To Live Forever” feels eerily familiar to me, despite Vance having never taken part in it.  Here, I’ll quote a few passages from the beginning of that book: as you read, perhaps you’ll want to imagine modern terms like “impact factor” or “citation tracker” where he wrote “slope.”

At this time the word “slope” was charged with special meaning.  Slope was a measure of a man’s rise through the phyle; it traced the shape of his past, foretold the time of his passing.  By the strictest definition, slope was the angle of a man’s life line, the derivative of his achievements with respect to his age.

The Fair-Play Act carefully defined the conditions of advance.  A child was born without phyle identification.  At any time after the age of sixteen he might register in the Brood, thus submitting to the provisions of the Fair-Play Act.

If he chose not to register, he suffered no penalty and lived a natural life without benefit of the Grand-Union treatments, to an average age of 82.  These persons were the “glarks,” and commanded only small social status.

The Fair-Play Act established the life span of the Brood equal to the average life span of a non-participator–roughly 82 years.  Attaining Wedge, a man underwent the Grand-Union process halting bodily degeneration, and was allowed an added ten years of life.  Reaching Third, he won sixteen more years; Verge, another twenty years.  Breaking through into Amaranth brought the ultimate reward.

To apply this formula to the record of each individual, an enormous calculating machine called the Actuarian was constructed.  Besides calculating and recording, the Actuarian printed individual life charts on demand, revealing to the applicant the slope of his lifeline, its proximity either to the horizontal boundary of the next phyle, or the vertical terminator.

If the lifeline crossed the terminator, the Emigration Officer and his assassins carried out the grim duties required of them by the Act.  It was ruthless, but it was orderly–and starkly necessary.

The system was not without its shortcomings.  Creative thinkers tended to work in proved fields, to shun areas which might prove barren of career-points.  The arts became dominated by academic standards; nonconformity, fantasy and nonsense were produced only by the glarks–also much that was macabre and morose.

So, as soon as humans learned how to live forever — Jack Vance postulates an uploading methodology similar to the connectome-based schemes I linked to earlier — there had to be a way of determining which humans would live.  And it’s at that point that many of the most promising candidates would resort to conservative behavior; better to inch toward success than swing with all your might and maybe miss.  Better to propose a project that you know will yield something than to throw all your effort into a grand scheme and maybe come up with nothing. No publication, no grants, no tenure.