Responses to “On testing.”

Responses to “On testing.”

My spouse posted my previous essay on social media, and I’d like to address some of people’s comments.  There were some excellent points! 

My apologies if I failed to address everything that people said, but I tried my best.

Scroll to find my responses to:

  1. A shutdown could have prevented the Covid-19 epidemic.
  2. We know that the current shutdown is either delaying or preventing deaths due to Covid-19. 
  3. Ending this epidemic with a vaccine would be ideal. 
  4. Ending the shutdown while requesting that at-risk people continue to self-isolate would save lives.
  5. Why is it urgent to end the shutdown soon?
  6. Why might more people die of Covid-19 just because we are slowing the spread of the virus?
  7. How is the shutdown causing harm?
  8. What about the rate at which people get sick?  Isn’t the shutdown worthwhile, despite the risks described above, if it keeps our hospitals from being overwhelmed?
  9. Don’t the antibody tests have a lot of false positives?
  10. What about the political ramifications of ending the shutdown?

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1: “A shutdown could have prevented the Covid-19 epidemic.”

If we’d acted early enough, we could have isolated all cases of Covid-19 and prevented this whole debacle.

But we didn’t.

Covid-19 is highly infectious, and we made no effort toward containment or quarantine until the virus was already widespread.  We took action in March, but we already had community transmission of Covid-19 by January.  Given where we are now, current models predict that the epidemic will continue until the level of immunity reaches somewhere near 70%.

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2: “We know that the current shutdown is either delaying or preventing deaths due to Covid-19.”

To date, the data suggests that the virus has only reached saturation inside a few closed environments, such as prisons.  In Italy, both the timecourse of mortality and the results of antibody studies suggest that infections were still rising at the time of their lockdown. 

Among the passengers of the Diamond Princess cruise ship, deaths peaked 21 days after infections peaked – if the virus had already reached saturation in Italy, we’d expect to see deaths peak sooner than 21 days after the lockdown began.  They did not.

So, again, this much is clear: worldwide, there was a significant new cause of death.  When we look at mortality data, we see the curves suddenly rise in many locations.  Some researchers, such as John Ioannidis, have speculated that Covid-19 causes death primarily in people with low life expectancy, in which case we would expect to see these mortality curves drop to lower-than-average levels after the epidemic ends.  But even then, it’s unprecedented to see a number of deaths that would usually occur over the course of a year all within a matter of weeks.

Covid-19 is killing people, and the shutdown is either delaying or preventing people’s death from Covid-19.

For the shutdown to actually prevent death, one of the following needs to happen:

1.) We create a vaccine, allowing our population to reach 70% immunity without as many people contracting the illness.

2.) We take action to change which segment of the population is exposed to the virus, allowing us to reach 70% immunity without as many at-risk people being exposed.

See #3 and #4, below.

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3: “Ending this epidemic with a vaccine would be ideal.”

Vaccination is great science.  Both my spouse and I love teaching about vaccines, in part because teaching the history of vaccine use is a good component of anti-racist science class.

Developing vaccines often takes a long time.  I’ve read predictions of a year or two; my father, an infectious disease doctor, epidemiologist, research physician who runs vaccine trials, and co-developer of Merck’s HPV vaccine, guesses that it will take about five years.

And then, for the vaccine to end this epidemic, enough people will need to choose to be vaccinated that we reach approximately 70% immunity.

The reason it’s worthwhile to compare Covid-19 to seasonal influenza is that a vaccine will only end the epidemic if enough people choose to get it.  Many people’s personal risk from Covid-19 is lower than their risk from seasonal influenza.  Will those people choose to be vaccinated?

Obviously, I would be thrilled if the answer were “yes.”  I’d love to live in a nation where people’s sense of altruism and civic duty compelled them to get vaccinated.  My family is up-to-date on all of ours.

But many privileged families in the United States have elected to be freeloaders, declining the (well tested, quite safe) measles vaccine with the expectation that other people’s immunity will keep them safe.  And, despite the well-documented dangers of influenza, only 40% of our population gets each year’s influenza vaccine.

Yes, the influenza vaccine tends to be less effective than many others – some years it gives as little as ten percent protection, other years about sixty percent protection.  By way of comparison, the HPV vaccine has over 90% efficacy.

A vaccine with low efficacy will still offer better protection when more people get it.  If a higher percentage of our population were vaccinated against influenza, then influenza transmission would drop, and so each person’s immunity, whether high or low, would be less likely to be challenged.

Also, the efficacy of influenza vaccines is measured in terms of the likelihood that vaccination prevents infection.  The influenza vaccine is not great at keeping people from getting sick.  But vaccination also tends to reduce the severity of your illness, even if you do catch influenza.  Because you got sick, it seems as though the vaccine “failed,” but your case might have been far more severe if you hadn’t been vaccinated.

The influenza vaccine saves lives.  In Italy, where fewer people choose to get vaccinated against influenza (about 15% compared to our 40% of the population), the death rate from influenza is higher.  Although it’s worth noting that this comparison is complicated by the fact that our health care system is so bad, with poor people especially having limited access to health care.  In the United States, people between the ages of 18 and 49 comprise a higher proportion of influenza deaths than anywhere in Europe.  Either our obesity epidemic or limited access to health care is probably to blame; possibly a combination of both.

In summary, for this plan to help us save lives, we will need to develop an effective vaccine, and then people will have to get it. 

I am quite confident that we can eventually develop a vaccine against Covid-19.  The virus includes a proofreading enzyme, so it should mutate more slowly than most RNA viruses.  We don’t know how long it will take, but we can do it.

I am unfortunately pessimistic that people will choose to get the vaccine.  And, unfortunately, when a low-risk person chooses to forgo vaccination, they’re not just putting themselves in harm’s way, they are endangering others.  Most vaccines elicit a weaker immune response in elderly or immunocompromised recipients – exactly the group most at risk from Covid-19 – which is why we spend so much time harping about herd immunity.

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4: “Ending the shutdown while requesting that at-risk people continue to self-isolate would save lives.

This plan has major downsides, too.  Because we didn’t take action soon enough, every plan we have now is bad.

Low-risk people can still die of Covid-19.  Even if they don’t die, Covid-19 can cause permanent health effects.  Covid-19 reduces your ability to get oxygen to your body and brain.  Even a “mild” case can leave your breathing labored for weeks – you’re not getting enough oxygen.  Your muscles will ache.  Your thoughts will be sluggish.

With a more severe case, people can be looking at heart damage.  Renal failure.  It would be cruel to look at all these long-term consequences and blithely call them “recovery.”

If our health care system were better, we’d treat people sooner.  The earlier you intervene, helping to boost people’s oxygen levels, the better outcome you’ll have.  There’s a great editorial from medical doctor Richard Levitan recommending that people monitor their health with a pulse oximeter during this epidemic.

If you notice your oxygen levels declining, get help right away.  Early intervention can prevent organ damage.  And you’ll be helping everyone else, too – the sooner you intervene, the less medical care you will need.

Because medical debt can derail lives, many people in this country delay treatment as long as possible, hoping that their problems will go away naturally.  That’s why people are often so sick when they show up at the ER.  I imagine that this is yet another reason – alongside air pollution, food deserts, sleep loss, and persistent stress exacerbated by racism – that poor communities have had such a high proportion of people with severe cases of Covid-19.

And I imagine – although we don’t yet have enough data to know – that financial insecurity caused by the shutdown is making this worse.  It’s a rotten situation: you have a segment of population that has to continue working during the shutdown, which means they now have the highest likelihood to be exposed to the virus, and they’re now under more financial strain, which might increase the chance that they’ll delay treatment.

We know that early treatment saves lives, and not everyone is sufficiently privileged to access that.

All this sounds awful.  And it is.  But, if we took action to shift exposure away from high risk groups, the likelihood that any individual suffers severe consequences is lower.

And there is another caveat with this plan – some people may be at high risk of complications for Covid-19 and not even realize it.  In the United States, a lot of people either have type 2 diabetes or are pre-diabetic and don’t yet realize.  These people have elevated risk.  Both smoking and air pollution elevate risk, but people don’t always know which airborn pollutants they’ve been exposed to.  (Which, again, is why it’s particularly awful that our administration is weakening air quality standards during this epidemic.)

Even if we recommended continued self-isolation for only those people who know themselves to have high risk from Covid-19, though, we would be saving lives.  The more we can protect people in this group from being exposed to the virus – not just now, but ever – the more lives we will save.

We won’t be able to do this perfectly.  It’ll be a logistical nightmare trying to do it at all.  People at high risk from Covid-19 needs goods and services just like everybody else.  We might have to give daily Covid-19 PCR tests to anyone visiting their homes, like doctors, dentists, and even delivery workers. 

At that point, the false negative rate from Covid-19 PCR tests becomes a much bigger problem – currently, these false negatives reduce the quality of our data (but who cares?) and delay treatment (which can be deadly).  A false negative that causes inadvertent exposure could cost lives.

Stores will need to set aside morning hours for at-risk shoppers, and undertake rigorous cleaning at night.  We know that infectious viral particles can persist for days on a variety of surfaces.

Some people will be unable to work, either because they or a close relative has high risk of Covid-19.  Some children will be unable to go to school.  We will need a plan to help these people.

We will have to work very hard to keep people safe even after the shutdown ends for some. 

But, again, if everyone does the same thing, then the demographics of people infected with Covid-19 will reflect our population demographics.  We can save lives by skewing the demographics of the subset of our population that is exposed to Covid-19 to include more low-risk individuals, which will require that we stratify our recommendations by risk (at least as well as we can assess it).

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5: “Why is it urgent to end the shutdown soon?

1.) By delaying Covid-19 deaths, we run to risk of causing more total people to die of Covid-19.

2.) The shutdown itself is causing harm.

See #6 and #7, below.

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6: “Why might more people die of Covid-19 just because we are slowing the spread of the virus?

[EDIT: I wrote a more careful explanation of the takeaways of the Harvard study. That’s here if you would like to take a look!]

This is due to the interplay between duration of immunity and duration of the epidemic.  At one point in time, seasonal influenza was a novel zoogenic disease.  Human behavior allowed the influenza virus to become a perpetual burden on our species.  No one wants for humans to still be dying of Covid-19 in ten or twenty years.  (Luckily, because the virus that causes Covid-19 seems to mutate more slowly than influenza, it should be easier to design a single vaccine that protects people.)

In the Harvard model, we can see that there are many scenarios in which a single, finite shutdown leads to more deaths from Covid-19 than if we’d done nothing. Note the scenarios for which the colored cumulative incidence curves (shown on the right) exceed the black line representing how many critical cases we’d have if we had done nothing.

Furthermore, their model does not account for people’s immunity potentially waning over time.  Currently, we do not know how long people’s immunity to Covid-19 will last.  We won’t know whether people’s immunity will last at least a year until a year from now.  There’s no way to test this preemptively.

We’ve seen that immunity to other coronaviruses fades within a year.  If immunity to Covid-19 is similar, we really don’t want to prolong the epidemic past a year.

If we could all go into stasis and simply not move for about a month, there’d be no new cases of Covid-19, and this virus would be gone forever.  But people still need to eat during the shutdown.  Many people are still working.  So the virus is still spreading, and we have simply slowed the rate of transmission.

This seems good, because we’re slowing the rate at which people enter the hospital, but it’s actually bad if we’re increasing the number of people who will eventually enter the hospital.

Based on our research with other coronaviruses, we expect that re-infection will cause a person to experience symptoms less severe than their first case of Covid-19.  But a re-infected person can still spread the disease to others.  And we don’t know what will happen if a person’s risk factors – such as age, smoking status, diabetes status, etc. – have increased in the time since their last infection.

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7: “How is the shutdown causing harm?

If you turn on Fox News, I imagine you’d hear people talking about the damage we’re doing to our economy.  They might discuss stock market numbers.

Who gives a shit?  In my opinion, you’d have to be pretty callous to think that maintaining the Nasdaq bubble is more important than saving lives.

At the same time, I think you’d have to be pretty callous to not feel extremely concerned by the United Nations’ policy brief, “The impact of Covid-19 on children.”

In this report, they estimate that the shutdown we’ve had so far will cause hundreds of thousands of children to die, many from malnutrition and the other health impacts of poverty.  The longer the shutdown continues, the more children will die.

That’s a worldwide number, and most of those children live outside the United States.  But I’d like to think that their lives matter, too.

The report also discusses the lifelong harm that will be inflicted on children from five months (or more!) of school closure.  Drop-outs, teen pregnancy, drug abuse, recruitment of child soldiers, and the myriad health consequences of low educational attainment.

I live in a wealthy college town, but even here there is a significant population of students who don’t have internet access.  Students with special needs aren’t getting the services they deserve.  Food insecurity is worse.

You’re lucky that privacy protections prevent me from sharing a story about what can happen to poor kids when all the dentists’ offices are closed.  I felt ashamed that this was the best my country had to offer.

As the shutdown continues, domestic violence is rising.  We can assume that child abuse is rising, also, but we won’t know until later, when we finally have a chance to save children from it.  In the past, levels of child abuse have been correlated with the amount of time that children spend in the presence of their abusers (usually close family), and reporting tends to happen during tense in-person conversations at school.

We know that online sex work has increased during the shutdown.  There is an increased supply of sex workers who are experiencing increasing financial insecurity.  We don’t yet have data on this, but I’d be shocked if the shutdown hasn’t led many to feel pressured into riskier acts for lower amounts of money, including meeting clients in isolated (and therefore unsafe) spaces.

The shutdown has probably made our drug epidemic worse (and this was already killing about 70,000 people per year in the U.S.).  When people are in recovery, one of the best strategies to stay sober is to spend a lot of time working, out of the house, and meeting with a supportive group in communal space.  Luckily, many of the people I know who are in recovery have been categorized as essential workers.

But any slip can kill someone recovering from addiction.  One of my friends froze to death last year.

A neighbor recently sent me a cartoon suggesting that the biggest harm caused by the shutdown is boredom.  (I’m going to include it, below, but don’t worry: I won’t spend too much time rattling sabers with a straw man.) And, for privileged families like mine, it is.  We’re safe, we’re healthy, we get to eat.  My kids are still learning – we live in a house full of computers and books.

But many of the 75 million children in the United States don’t live in homes like mine, with the privilege we have.  Many of our 50 million primary and secondary school students are not still learning academically during the shutdown.

Whether the shutdown is preventing or merely delaying the deaths of people at risk of serious complications from Covid-19, we have to remember that the benefit comes at a cost.  What we’ve done already will negatively impact children for the rest of their lives.  And the longer this goes on, the more we’re hurting them.

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8: “What about the rate at which people get sick?  Isn’t the shutdown worthwhile, despite the risks described above, if it keeps our hospitals from being overwhelmed?

In writing this, I struggled with how best to organize the various responses.  I hope it doesn’t seem too ingenuous to address this near the end, because slowing the rate of infection so that our hospitals don’t get overwhelmed is the BEST motivation for the shutdown.  More than the hope that a delay will yield a new vaccine, or new therapies to treat severe cases, or even new diagnostics to catch people before they develop severe symptoms, we don’t want to overwhelm our hospitals.

If our physicians have to triage care, more people will die.

And I care a lot about what this epidemic will be like for our physicians.  My father is a 67-year-old infectious disease doctor who just finished another week of clinical service treating Covid-19 patients at the low-income hospital in Indianapolis.  My brother-in-law is an ER surgeon in Minneapolis.  These cities have not yet had anything like the influx of severe cases in New York City – for demographic and environmental reasons, it’s possible they never will.  But they might. 

Based on the case fatality rate measured elsewhere, I’d estimate that only 10% of the population in Minneapolis has already been infected with Covid-19, so the epidemic may have a long way yet to go.

If we ended the shutdown today for everyone, with no recommendation that at-risk groups continue to isolate and no new measures to protect them, we would see a spike in severe cases.

If we ended the shutdown for low-risk groups, and did a better job of monitoring people’s health to catch Covid-19 at early, more-easily-treatable stages (through either PCR testing or oxygen levels), we can avoid overwhelming hospitals.

And the shutdown itself is contributing toward chaos at hospitals.  Despite being on the front lines of this epidemic, ER doctors in Minneapolis have received a 30% pay cut.  I imagine my brother-in-law is not the only physician who could no longer afford day care for his children after the pay cut.  (Because so many people are delaying care out of fear of Covid-19, hospitals are running out of money.)  Precisely when we should be doing everything in our power to make physicians’ lives easier, we’re making things more stressful.

We could end the shutdown without even needing to evoke the horrible trolley-problem-esque calculations of triage.  Arguments could be made that even if it led to triage it might be worthwhile to end the shutdown – the increase in mortality would be the percentage of triaged cases that could have survived if they’d been treated, and we as a nation might decide that this number was acceptable to prevent the harms described above – but with a careful plan, we need not come to that.

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9: “Don’t the antibody tests have a lot of false positives?

False positives are a big problem when a signal is small.  I happen to like a lot of John Ioannidis’s work – I think his paper “Why Most Published Research Findings Are False” is an important contribution to the literature – but I agree that the Santa Clara study isn’t particularly convincing. 

When I read the Santa Clara paper, I nodded and thought “That sounds about right,” but I knew my reaction was most likely confirmation bias at work.

Which is why, in the essay, I mostly discussed antibody studies that found high percentages of the population had been infected with Covid-19, like the study in Germany and the study in the Italian town of Robbio.  In these studies, the signal was sufficiently high that false positives aren’t as worrisome. 

In Santa Clara, when they reported a 2% infection rate, the real number might’ve been as low as zero.  When researchers in Germany reported a 15% infection rate, the real number might’ve been anywhere in the range of 13% to 17% – or perhaps double that, if the particular chips they used had a false negative rate similar to the chips manufactured by Premier Biotech in Minneapolis.

I’m aware that German response to Covid-19 has been far superior to our bungled effort in the United States, but an antibody tests is just a basic ELISA.  We’ve been doing these for years.

Luckily for us, we should soon have data from good antibody studies here in the United States.  And I think it’s perfectly reasonable to want to see the results of those.  I’m not a sociopath – I haven’t gone out and joined the gun-toting protesters.

But we’ll have this data in a matter of weeks, so that’s the time frame we should be talking about here.  Not months.  Not years.  And I’ll be shocked if these antibody studies don’t show widespread past infection and recovery from Covid-19.

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10: “What about the political ramifications of ending the shutdown?

I am, by nature, an extremely cautious person.  And I have a really dire fear.

I’m inclined to believe that ending the shutdown is the right thing to do.  I’ve tried to explain why.  I’ve tried to explain what I think would be the best way to do it.

But also, I’m a scientist.  You’re not allowed to be a scientist unless you’re willing to be proven wrong.

So, yes.  I might be wrong.  New data might indicate that writing this essay was a horrible mistake.

Still, please bear with me for a moment.  If ending the shutdown soon turns out to be the correct thing to do, and if only horrible right-wing fanatics have been saying that we should end the shutdown soon, won’t that help our current president get re-elected?

There is a very high probability that his re-election would cause even more deaths than Covid-19.

Failing to address climate change could kill billions.  Immigration controls against migrants fleeing war zones could kill millions.  Weakened EPA protections could kill hundreds of thousands.  Reduced access to health care could kill tens of thousands.

And, yes, there are horrible developments that neither major political party in the United States has talked about, like the risk that our antibiotics stop working, but I think it’s difficult to argue that one political party isn’t more dangerous than the other, here.

I feel pretty confident about all the scientific data I’ve discussed above.  Not as confident as I’d like, which would require more data, but pretty confident.

I feel extremely confident that we need to avoid a situation in which the far right takes ownership of an idea that turns out to have been correct.  And it’ll be dumb luck, just a bad coincidence.  The only “data” they’re looking at are stock market numbers, or maybe the revenue at Trump-owned hotels.

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EDIT: I also wrote a more careful explanation of the takeaways of the Harvard study. That’s here if you would like to take a look!

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Header image by Goran Paunovic.

On testing.

On testing.

UPDATE: Wow, this got a lot of readers! Honestly, though, I wrote a response to common questions and comments about this essay and it is probably a better read.

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My spouse recently sent me a link to the article “Concerns with that Stanford study of coronavirus prevalence” by Andrew Gelman, a statistician at Columbia University.  From reading this article, I got the impression that Gelman is a good mathematician.  And he raises some legitimate concerns. 

But I’ve noticed that many of the people criticizing the work coming out of the Ioannidis group – such as the study of how many people in Santa Clara county might have antibodies to Covid-19 – don’t seem to understand the biology underlying the numbers.

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First, some background: in case you haven’t noticed, most of the United States is operating under a half-assed lockdown.  In theory, there are stay-at-home orders, but many people, such as grocery store clerks, janitors, health care workers, construction workers, restaurant chefs, delivery drivers, etc., are still going to work as normal.  However, schools have been closed, and most people are trying to stand at least six feet away from strangers.

We’re doing this out of fear that Covid-19 is an extremely dangerous new viral disease.  Our initial data suggested that as many as 10% of people infected with Covid-19 would die.

That’s terrifying!  We would be looking at tens of millions of deaths in the United States alone!  A virus like this will spread until a majority of people have immunity to it – a ballpark estimate is that 70% of the population needs immunity before the epidemic stops.  And our early data suggested that one in ten would die.

My family was scared.  We washed our hands compulsively.  We changed into clean clothes as soon as we came into the house.  The kids didn’t leave our home for a week.  My spouse went to the grocery store and bought hundreds of dollars of canned beans and cleaning supplies.

And, to make matters worse, our president was on the news saying that Covid-19 was no big deal.  His nonchalance made me freak out more.  Our ass-hat-in-chief has been wrong about basically everything, in my opinion.  His environmental policies are basically designed to make more people die.  If he claimed we had nothing to worry about, then Covid-19 was probably more deadly than I expected.

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Five weeks have passed, and we now have much more data.  It seems that Covid-19 is much less dangerous than we initially feared.  For someone my age (37), Covid-19 is less dangerous than seasonal influenza.

Last year, seasonal influenza killed several thousand people between the ages of 18 and 49 in the United States – most likely 2,500 people, but perhaps as many as 5,800.  People in this age demographic account for about 10% of total flu deaths in the United States, year after year.

Seasonal influenza also killed several hundred children last year – perhaps over a thousand.

There’s a vaccine against influenza, but most people don’t bother. 

That’s shocking. 

Seasonal influenza is more dangerous than Covid-19 for people between the ages of 18 and 49, but only 35% of them chose to be vaccinated in the most recently reported year (2018).  And because the vaccination rate is so low, our society doesn’t have herd immunity.  By choosing not to get the influenza vaccine, these people are endangering themselves and others.

Some people hope that the Covid-19 epidemic will end once a vaccine is released.  I am extremely skeptical.  The biggest problem, to my mind, isn’t that years might pass before there’s a vaccine.  I just can’t imagine that a sufficient percentage of our population would choose to get a Covid-19 vaccine when most people’s personal risk is lower than their risk from influenza.

When I teach classes in jail, dudes often tell me about which vaccines they think are too dangerous for their kids to get.  I launch into a tirade about how safe most vaccines are, and how deadly the diseases they prevent. 

Seriously, get your kids vaccinated.  You don’t want to watch your child die of measles.

And, seriously, dear reader – get a flu vaccine each year.  Even if you’re too selfish to worry about the other people whom your mild case of influenza might kill, do it for yourself. 

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We already know how dangerous seasonal influenza is.  But what about Covid-19?

To answer that, we need data.  And one set of data is unmistakable – many people have died.  Hospitals around the world have experienced an influx of patients with a common set of symptoms.  They struggle to breathe; their bodies weaken from oxygen deprivation; their lungs accumulate liquid; they die.

Many people have been put on ventilators, but that’s often the beginning of the end.  Most people put on ventilators will die.  Among patients over 70 years old, three quarters who are put on ventilators will die

For each of these patients saved, three others are consigned to an agonizing death in the hospital, intubated among the flashing lights, the ceaseless blips and bleeps.  At home, they’d die in a day; in the hospital, their deaths will take three weeks.

And the sheer quantity of deaths sounds scary – especially for people who don’t realize how many tens of thousands die from influenza in the United States each year.

Or, consider: cigarette smoking causes 480,000 deaths per year in the United States, including 41,000 people who die from second-hand smoke exposure.  Those 41,000 aren’t even choosing to smoke!  But cigarettes kill them anyway.

Indeed, when people die of Covid-19, it’s often because their lungs fail.  Smoking is obviously a major risk factor for dying of Covid-19 – a significant portion of reported Covid-19 deaths could be considered cigarette deaths instead.  Or as air pollution deaths – and yet, our current president is using this crisis as an opportunity to weaken EPA air quality regulations.

Air pollution is a huge problem for a lot of Black communities in the United States.  Our racist housing policies have placed a lot of minority neighborhoods near heavily polluting factories.  Now Covid-19 is turning what is already a lifelong struggle for breath into a death sentence.

I would enthusiastically support a shutdown motivated by the battle for clean air.

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So, Covid-19.  We know how many people have died – already (CORRECTION AS OF APRIL 21) forty-two thousand in the United States

But if we want to know how scary this virus is, we need to know how many people were infected.  If that many people died after everyone in the country had it, then Covid-19 would be less dangerous than influenza.  If that many people died after only a hundred thousand had been infected, then this would be terrifying, and far more dangerous than influenza.

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Initially, our data came from PCR testing.

These are good tests.  Polymerase chain reaction is highly specific.  If you want to amplify a certain genetic sequence, you can design short DNA primers that will bind only to that sequence.  Put the whole mess in a thermocycler and you get a bunch of your target, as long as the gene is present in the test tube in the first place.  If the gene isn’t there, you’ll get nothing.

PCR works great.  Even our lovely but amnesiac lab tech never once screwed it up.

So, do the PCR test and you’ll know whether a certain gene is present in your test tube.  Target a viral gene and you’ll know whether the virus is present in your test tube.  Scoop out some nose glop from somebody to put into the test tube and you’ll know whether the virus is present in that nose glop.

The PCR test is a great test that measures whether someone is actively shedding virus.  It answers, is there virus present in the nose glop?

This is not the same question as, has this person ever been infected with Covid-19? 

It’s a similar question – most people infected with a coronavirus will have at least a brief period of viral shedding – but it’s a much more specific question.  When a healthy person is infected with a coronavirus, the period of viral shedding can be as short as a single day.

A person can get infected with a coronavirus, and if you do the PCR test either before or after that single day, the PCR test will give a negative result.  Nope, no viral RNA is in this nose glop!

And so we know that the PCR test will undercount the true number of infections.

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When we look at the age demographics for Covid-19 infections as measured by PCR test, the undercount becomes glaringly obvious.

Consider the PCR test data from the Diamond Princess cruise ship.  To date, this is our most complete set of PCR data – everyone on board was tested multiple times.  And from this data, it appears that very few children were exposed to the virus.

Friends, it is exceedingly unlikely that such a low percentage of children were exposed to this virus.  Children are disgusting.  I believe this is common knowledge.  Parents of small children are pretty much always sick because children are so disgusting. 

Seriously, my family has been doing the whole “social distancing” thing for over a month, and yet my nose is dripping while I type this.

Children are always touching everything, and then they rub their eyeballs or chew on their fingers.  If you take them someplace, they grubble around on the floor.  They pick up discarded tissues and ask, “What’s this?”

“That’s somebody’s gross kleenex, is what it is!  Just, just drop it.  I know it’s trash, I know we’re not supposed to leave trash on the ground, but just, just drop it, okay?  Somebody will come throw it away later.”

The next day: “Dad, you said somebody would throw that kleenex away, but it’s still there!”

Bloody hell.  Children are little monsters.

It seems fairly obvious that at least as high a percentage of children would be infected as any other age demographic.

But they’re not showing up from the PCR data.  On the Diamond Princess cruise ship, the lockdown began on February 5th, but PCR testing didn’t begin until February 11th.  Anyone who was infected but quickly recovered will be invisible to that PCR test.  And even people who are actively shedding viral particles can feel totally well.  People can get infected and recover without noticing a thing.

We see the same thing when we look at the PCR data from Italy.  If we mistakenly assumed that the PCR data was measuring the number of infections, and not measuring the number of people who were given a PCR test while shedding viral particles, we’d conclude that elderly people went out and socialized widely, getting each other sick, and only occasionally infected their great-grandchildren at home.

Here in the United States, children are disgusting little monsters.  I bet kids are disgusting in Italy, too.  They’re disgusting all over the world.

A much more likely scenario is that children spread this virus at school.  Many probably felt totally fine; some might’ve had a bad fever or the sniffles for a few days.  But then they recovered.

When they got their great-grandparents sick – which can happen easily since so many Italian families live in multigenerational homes – elderly people began to die.

So we know that the PCR test is undercounting the true number of infections.  Unless you’re testing every person, every day, regardless of whether or not they have symptoms, you’re going to undercount the number of infections.

In a moment, we can work through a way to get a more accurate count.  But perhaps it’s worth mentioning that, for someone my age, Covid-19 would seem to be about as dangerous as influenza even if we assumed that the PCR data matched the true number of infections.

If you’re a healthy middle-aged or young person, you should not feel personally afraid. 

That alone would not be an excuse to go out and start dancing in the street, though.  Your actions might cause other people to die. 

(NOTE & CORRECTION: After this post went up, my father recommended that I add something more about personal risk. No one has collected enough data on this yet, but he suspects that the next most important risk factor, after smoking and age, will be type 2 diabetes. And he reminded me that many people in their 30s & 40s in this country are diabetic or prediabetic and don’t even realize it yet. Everyone in this category probably has elevated risk of complications from Covid-19.)

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After you’ve been infected with a virus, your body will start making antibodies.  These protect you from being infected again.

Have you read Shel Silverstein’s Missing Piece book?  Antibodies work kind of like that.  They have a particular shape, and so they’ll glom onto a virus only if that virus has outcroppings that match the antibody’s shape.  Then your body sees the antibodies hanging out on a virus like a GPS tracker and proceeds to destroy the virus.

So to make an antibody test, you take some stuff that looks like the outcroppings on the virus and you put it on a chip.  Wash somebody’s blood over it, and if that blood contains antibodies that have the right shape to glom onto the virus, they’ll stick to the chip.  All your other antibodies, the ones that recognize different viruses, will float away.

An antibody test is going to be worse than a PCR test.  It’s easier to get a false positive result – antibodies are made of proteins, and they can unfold if you treat them roughly, and then they’ll stick to anything.  Then you’ll think that somebody has the right antibodies, but they don’t.  That’s bad.

You have to be much more careful when you’re doing an antibody test. I wouldn’t have asked our lab tech to do them for me.

An antibody test is also going to have false negatives.  A viral particle is a big honking thing, and there are lots of places on its surface where an antibody might bind.  If your antibodies recognize some aspect of the virus that’s different from what the test manufacturers included on their chip, your antibodies will float away.  Even though they’d protect you from the actual virus if you happened to be exposed to it.

If you’re a cautious person, though – and I consider myself to be pretty cautious – you’d much rather have an antibody test with a bunch of false negatives than false positives.  If you’re actually immune to Covid-19 but keep being cautious, well, so what?  You’re safe either way.  But if you think you’re immune when you’re not, then you might get sick.  That’s bad.

Because antibody tests are designed to give more false negatives than false positives, you should know that it’d be really foolish to use them to track an infection.  Like, if you’re testing people to see who is safe to work as a delivery person today, use the PCR test!  The antibody test has a bunch of false negatives, and there’s a time lag between the onset of infection and when your body will start making antibodies.

It can be dangerous to use antibody tests to address the wrong questions.

If you use the antibody test on a bunch of people, though, you can tell how many were infected.  And that’s useful information, too.

In the town of Robbio in Italy (pop. 6,000), the PCR test showed that only 23 people had been infected with Covid-19.  But then the mayor implored everyone to get an antibody test, and 10% of people had actually been infected with – and had recovered from – Covid-19.  Most of them couldn’t even recall having been sick.

The PCR test measured 23 cases.  The antibody test suggested there’d been at least 600.  And antibody tests, by design, will generally have a bunch of false negatives.  When a team at Stanford assessed the antibody tests manufactured by Premier Biotech in Minneapolis, they found that for every 3 people who’d been infected with Covid-19, the tests registered only 2 positives.

I don’t know who made the tests used in Robbio – maybe they were a little better, maybe they were a little worse.  Based on my experience, I wouldn’t be so surprised if the true infection rate with Covid-19 in that town was really just 10% – nor would I be surprised to hear that the chips had a high false-negative rate and that the infection rate was 20% or more.

If you calculate the fatality rate of Covid-19 in Italy by assuming that the PCR tests caught every infection, you’d get a terrifying 10%.

If you instead assume that many other towns had a similar infection rate to Robbio, you’ll instead calculate that the fatality rate was well under one percent. 

Italy has higher risk than the United States due to age demographics, smoking rates, and multigenerational households – and even in Italy, the fatality rate was probably well under one percent.

When researchers in Germany randomly chose people to take a Covid-19 PCR test (many of whom had no symptoms), they found that 2% of the population was actively shedding virus – a much higher number of cases than they would have found if they tested only sick people.  And when they randomly chose people to take an antibody test, they found that 15% had already recovered from the infection (again, many of whom had never felt sick).  According to these numbers – which are expected to be an undercount, due to false negatives and the time lag before antibody production – they calculated a case fatality rate of 0.37%

That would be about three-fold more dangerous than seasonal influenza.

In the United States, our bungling president gutted the CDC, leaving us without the expertise needed to address Covid-19 (or myriad other problems that might arise).  During the first few months of this epidemic, very few people managed to get a PCR test.  That’s why our data from the PCR tests is likely to be a dramatic undercount – indeed, when we finally started producing accurate tests, the apparent growth in Covid-19 caseload superimposed with the growth in test availability.

In the absence of good PCR data, we have to rely on antibody data to track infections after the fact.  Which is why a town in Colorado with zero reported infections, as measured by PCR, had sufficiently widespread exposure that 2% of the population had already recovered from Covid-19.

And it’s why the data from the Stanford Santa Clara county study is so unsurprising. 

Yes, there were problems with the Stanford study’s data collection – they displayed advertisements to a random selection of people, but then a self-selected subset responded.  The pool of respondents were enriched for white women, but Santa Clara’s outbreak probably began among Asian-Americans.  And we all know that random sampling doesn’t always give you an accurate depiction of the population at large – after all, random polling predicted that a competent president would be elected in 2016.

Now look at us.

It’s also likely that people with a poor understanding of the biology could misinterpret the result of the Stanford study.  They found that PCR tests had undercounted the infection rate in Santa Clara county, at the time of this study, by 85-fold.

It would be absurd to assume that you could simply multiply all PCR results by 85 to determine the true infection rate, but some people did.  And then pointed out the absurdity of their own bad math.

In places where more people are being tested by PCR, and they’re being tested more often, the PCR results will be closer to the true infection rate.  If you gave everyone in the United States a PCR test, and did it every day, then the PCR data would be exactly equal to the true infection rate.

If we had data like that from the beginning, we wouldn’t have been scared.  We would’ve known the true case fatality rate early on, and, also, at-risk people could’ve been treated as soon as they got infected.  We’d be able to save many more lives.

If access to health care were considered a basic right in the United States, we might’ve done something like this. 

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In Italy, it seems like Covid-19 is three- or four-fold more dangerous than seasonal influenza.  My guess is that Italy might have had about 50,000 deaths if they hadn’t enacted the lockdown.

In the United States, on a population level, Covid-19 is probably also more dangerous than seasonal influenza.  But there’s a big difference in terms of the distribution of risk.

The New York Times is running a series with short biographies of people who’ve died of Covid-19.  As of noon on April 17, about 10% of the people profiled were younger than 35.

10% is roughly the proportion of young people who die of seasonal influenza.  But only 1% of Covid-19 deaths are people younger than 35.  The news reports don’t always make clear how much the risk of Covid-19 is clustered in a small segment of the population.

This has serious implications for what we should do next.  If we were dealing with a virus that was about three-fold more dangerous than seasonal influenza for everyone, we might just return to life as normal.  (Indeed, we carried on as normal during the bad years when seasonal influenza killed 90,000 people instead of last year’s 30,000.)

Because the risk from Covid-19 is so concentrated, though, we can come up with a plan that will save a lot of lives. 

Healthy people under retirement age should resume most parts of their lives as normal.  Schools should re-open: for students, Covid-19 is much less dangerous than seasonal influenza.  I think that people should still try to work from home when possible, because it’s the right thing to do to fight climate change.

At-risk people should continue to isolate themselves as much as possible.

This sounds crummy, but at-risk people would just continue to do the thing that everyone is doing currently.  And the plan would save many lives because the epidemic would end in about 3 months, after the virus had spread to saturation among our nation’s low-risk cohort. 

Indeed, when a team of researchers from Harvard’s School of Public Health modeled the Covid-19 epidemic, they found that social distancing was generally unhelpful.  That’s what their data show, at least – but in their abstract, they instead recommend that we continue social distancing for the better part of two years.

Their data are easy enough to understand.  In each of these graphs, they show a blue box for how long social distancing would last, and then four colored lines to represent how many infections we’d see if we did no social distancing (black), medium quality social distancing (red), good social distancing (blue), or excellent social distancing (green).

So, from top to bottom, you’re looking at the graphs of what happens if we do a month of social distancing … or two months … or three, or four … or forever.

And you can see the outcomes in the panels on the right-hand side.  The black line shows what would happen if we did nothing.  Infections rise fast, then level off after the virus has reached saturation.  There are two important features of this graph – the final height that it reaches, which is the total number of severe cases (and so a good proxy for the number of deaths), and the slope of the line, which is how fast the severe cases appear.  A steeper hill means many people getting sick at the same time, which means hospitals might be overwhelmed.

So, okay.  Looking at their graphs, we see that social distancing saves lives … if we do it forever.  If you never leave your house again, you won’t die of Covid-19.

But if social distancing ends, it doesn’t help.  The slopes are nearly as steep as if we’d done nothing, and the final height – the total number of people who die – is higher.

(Often, one of their curves will have a gentler slope than the others — usually the good-but-not-excellent social distancing seems best. So you’d have to pray that you were doing a precisely mediocre job of not infecting strangers. Do it a little better or a little worse and you cause people to die. This isn’t an artifact — it’s based on the density of uninfected people when social distancing ends — but let’s just say “mathematical models are wonky” and leave it at that.)

In a subsequent figure, the Harvard team tried to model what might happen if we occasionally resumed our lives for a month or so at a time, but then had another shutdown.  This is the only scenario in which their model predicts that social distancing would be helpful.

But, unfortunately, there’s a problem.  Research done with other coronaviruses shows that immunity fades within a year.  Because the Harvard model would cause the epidemic to last longer than a year, people would have time to lose their immunity and get infected again.

Even in the extreme case that we mostly stayed in our homes for the better part of two years, social distancing would case more deaths from Covid-19 than if we had done nothing.

That’s not even accounting for all the people who would die from a greater risk of domestic violence, hunger, drug addiction, suicide, and sedentary behavior during the shutdown.  

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When our data was limited, the shutdown seemed reasonable.  We wouldn’t be able to undo the damage we’d done by waiting.

Except, whoops, we waited anyway.  We didn’t quarantine travelers in January.  The shutdown didn’t begin March, when the epidemic was well underway in many places. 

Now that we have more data, we should re-open schools, though.  For most people, Covid-19 is no more dangerous than seasonal influenza.  We already have enough data from antibody testing to be pretty confident about this, and even if we want to be extremely cautious, we should continue the shutdown for a matter of weeks while we conduct a few more antibody studies.  Not months, and certainly not years.

At the same time, we need to do a better job of protecting at-risk people.  This means providing health care for everyone.  This means cleaning our air, staunching the pollution that plagues low-income neighborhoods.  This might mean daily medical checkups and PCR tests for people who work closely with at-risk populations.

Our country will have to be different in the future, but mostly because we, as a people, have done such a shitty job of creating justice and liberty for all.  We need to focus on addressing the inequities that we’ve let fester for generations.  That’ll help far more than using a bandanna to cover up your smile.

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UPDATE: Wow, this got a lot of readers! Thanks if you made it this far. I’ve also written a response to common questions and comments about this essay.

On smuggling.

On smuggling.

While I was working in a research laboratory at Stanford, my advisor mentioned that she was waiting for a package from ________.

“Oh, we got something from him,” said our technician John, “but it was just an Invitrogen catalog.  Their rep brought us a newer copy last week, so I threw it out.”

“What!” my advisor shouted, causing him to jump.  “Which trash can?!” 

She and John rooted through the garbage together.  Luckily the package had arrived that day.  The now-gooey catalog (I was smashing a lot of cow brains in those days, and the bleached muck went into the trash) was still there.

We didn’t need another Invitrogen catalog.  But it’s illegal to ship DNA through the mail, so researchers often smuggle it by dotting some onto paper then circling the spot.  When you receive DNA this way, you cut out the circle, dip it in water, and then add bacteria.

The bacteria make more copies of your DNA.  Antibiotics kill off any bacteria that aren’t helping.  And the U.S. post office is none the wiser.

Then you can throw out the useless catalog.


I’ve been volunteering with the Midwest Pages to Prisoners project for about a decade.  We ship books to people who would be otherwise deprived.  Occasionally, though, administrators at a prison will instruct their mailroom staff to return all our packages.  Or, worse, quietly pitch them into the trash.  Months might pass before people inside let us know that our books aren’t getting in.

Usually, the administrators will relent and let us send books again, but it might take a few years of phone calls.  During one such frustrating episode, I wrote a poem.

Sympathy for the Devil

I am a writer as in a vulture, plucking words from

others’ pain. & sing penance, but never loud enough:

we feast upon this world of hurt we’ve made.

Words might salve even the poor, so we send free

books to inmates. At one prison, packages never

arrived. We called & were told we impregnated

literature with suboxone. We lacked both will &

way: we have no budget; drugged pages wilt &

yellow; no one would read. Later I heard the state

was shunting sex criminals there. Books were

a privilege, underhandedly revoked.

                                                               Gangs rule

inside: Aryan Brotherhood for whites, Gangland

Disciples for black men. We are free to believe in

post-racial America: in prison, meals might mean

a stack of trays sloughed inside a then-locked door.

Some men take two. Others will go hungry. The

ache of want sends us seeking for what symbols

of solidarity we find, hoping for allies against the

world.

             AB oft allies with the guards. Members reap

cushy jobs, access to visitors, untrammelled mail.

At the prison binning our books, gang & guards

were very close, COs inked in crosses, runic letters,

shields & shamrocks. Yet AB, there, was weak. So

they were fed sex criminals – easy, friendless kills.

A guard outs the doomed man’s past – everyone

lies, asked why he’s doing time – and members

murder him in the shower.  They look tougher

than they are.

                         A dozen deaths. No indictments.

Activists began to smuggle phones, hoping to

document abuse. That’s when our packages ceased

to be received.

                           I’ve no deep love for these men –

friends of mine were abused.  But if those who molest

should be punished by death, let’s force judge & juries

to say it. Not read a shadow sentence of 10 or 20 years.

We should say what we mean:

I sentence you to a cruel and unusual death.  It will

come suddenly in a shower stall, faux-Odinist skin-

head slamming your head against the tile until your

bruised brain ruptures from repeated trauma.  Your

eyes will loosen from their sockets, your skull will

crack, blood will whelm through your nostrils.  In a

final indignity, bowels relax.  You will know the brief

hell of hoping to live when you cannot.  Your limp

body will drop while the water runs, cascading over

your corpse.  Although news of your death will not

reach those who sentenced you, they will know that

justice has been done.


Quite likely, drugs were being smuggled into that prison.  I’ve been told that it’s easier to buy drugs in prison than out on the street.  Which is rough – people who are recovering from addiction often relapse after being sent to prison.  In those bleak environs, there aren’t a lot of other ways to occupy your time.

The drugs weren’t coming from Pages to Prisoners, though.  We always embalm our packages in tape so that correctional officers can’t tamper with them (as easily) on their way in.  And, seriously, our organization doesn’t have the budget for drugs – we’re shipping donated books wrapped in old grocery bags!  I’ve never tried to buy opiates, but I assume they’re expensive.  Guys in jail sometimes mention how many thousands they were spending on their habits each week, which helps explain why they’re broke.

I understand why prison administrators worry, though.  Scientists use books to smuggle DNA; you could illicitly ship a variety of drugs that way.

Although our organization ships books to people incarcerated in twelve different states, local prisons are the only ones that ban us.  Which is sad.  From a community perspective, we’d like to help people locally.  We can recruit volunteers by mentioning that the people inside will be coming back to our community.

From a health and safety perspective, though, prison administrators would prefer that books come from out of state.  Then they can feel more confident that packages are being sent by people who’ve never met the inmates. 

The recipients would be like my colleague John, evaluating each book based solely on its title: an Invitrogen catalog?  We don’t need that! 

Or, after receiving one of the packages sent by Pages to Prisoners recently: sweet, advanced Dungeons & Dragons!

Prison administrators have good reason to keep drugs out.  People’s tolerance wanes during their time in jail – somebody might take too much and die.  Whereas they’re unlikely to OD on D&D.

 Of course, prisons don’t have to be so bleak & punitive, let alone violent & PTSD-inducing.  Prisons like we have in the U.S. don’t need to exist at all.  And then organizations like Pages to Prisoners wouldn’t need to send books.

On ethics and Luke Dittrich’s “Patient H.M.”

On ethics and Luke Dittrich’s “Patient H.M.”

The scientific method is the best way to investigate the world.

Do you want to know how something works?  Start by making a guess, consider the implications of your guess, and then take action.  Muck something up and see if it responds the way you expect it to.  If not, make a new guess and repeat the whole process.

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Image by Derek K. Miller on Flickr.

This is slow and arduous, however.  If your goal is not to understand the world, but rather to convince other people that you do, the scientific method is a bad bet.  Instead you should muck something up, see how it responds, and then make your guess.  When you know the outcome in advance, you can appear to be much more clever.

A large proportion of biomedical science publications are inaccurate because researchers follow the second strategy.  Given our incentives, this is reasonable.  Yes, it’s nice to be right.  It’d be cool to understand all the nuances of how cells work, for instance.  But it’s more urgent to build a career.

Both labs I worked in at Stanford cheerfully published bad science.  Unfortunately, it would be nearly impossible for an outsider to notice the flaws because primary data aren’t published.

A colleague of mine obtained data by varying several parameters simultaneously, but then graphed his findings against only one of these.  As it happens, his observations were caused by the variable he left out of his charts.  Whoops!

(Nobel laureate Arieh Warshel quickly responded that my colleague’s conclusions probably weren’t correct.  Unfortunately, Warshel’s argument was based on unrealistic simulations – in his model, a key molecule spins in unnatural ways.  This next sentence is pretty wonky, so feel free to skip it, but … to show the error in my colleague’s paper, Warshel should have modeled multiple molecules entering the enzyme active site, not molecules entering backward.  Whoops!)

Another colleague of mine published his findings about unusual behavior from a human protein.  But then his collaborator realized that they’d accidentally purified and studied a similarly-sized bacterial protein, and were attempting to map its location in cells with an antibody that didn’t work.  Whoops!

No apologies or corrections were ever given.  They rarely are, especially not from researchers at our nation’s fanciest universities.  When somebody with impressive credentials claims a thing is true, people often feel ready to believe.

antibodies.JPGIndeed, for my own thesis work, we wanted to test whether two proteins are in the same place inside cells.  You can do this by staining with light-up antibodies for each.  If one antibody is green and the other is red, you’ll know how often the proteins are in the same place based on how much yellow light you see.

Before conducting the experiment, I wrote a computer program that would assess the data.  My program could identify various cellular structures and check the fraction that were each color.

As it happened, I didn’t get the results we wanted.  My data suggested that our guess was wrong.

But we couldn’t publish that.  And so my advisor told me to count again, by hand, claiming that I should be counting things of a different size.  And then she continued to revise her instructions until we could plausibly claim that we’d seen what we expected.  We made a graph and published the paper.

This is crummy.  It’s falsehood with the veneer of truth.  But it’s also tragically routine.

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41B1pZkOwmL._SX329_BO1,204,203,200_Luke Dittrich intertwines two horror stories about scientific ethics in Patient H.M.: A Story of Memory, Madness, and Family Secrets.

One of these nightmares is driven by the perverse incentives facing early neurosurgeons.  Perhaps you noticed, above, that an essential step of the scientific method involves mucking things up.  You can’t tell whether your guesses are correct until you perform an experiment.  Dittrich provides a lovely summary of this idea:

The broken illuminate the unbroken.

An underdeveloped dwarf with misfiring adrenal glands might shine a light on the functional purpose of these glands.  An impulsive man with rod-obliterated frontal lobes [Phineas Gage] might provide clues to what intact frontal lobes do.

This history of modern brain science has been particularly reliant on broken brains, and almost every significant step forward in our understanding of cerebral localization – that is, discovering what functions rely on which parts of the brain – has relied on breakthroughs provided by the study of individuals who lacked some portion of their gray matter.

. . .

While the therapeutic value of the lobotomy remained murky, its scientific potential was clear: Human beings were no longer off-limits as test subjects in brain-lesioning experiments.  This was a fundamental shift.  Broken men like Phineas Gage and Monsieur Tan may have always illuminated the unbroken, but in the past they had always become broken by accident.  No longer.  By the middle of the twentieth century, the breaking of human brains was intentional, premeditated, clinical.

Dittrich was dismayed to learn that his own grandfather had participated in this sort of research, intentionally wrecking at least one human brain in order to study the effects of his meddling.

Lacking a specific target in a specific hemisphere of Henry’s medial temporal lobes, my grandfather had decided to destroy both.

This decision was the riskiest possible one for Henry.  Whatever the functions of the medial temporal lobe structures were – and, again, nobody at the time had any idea what they were – my grandfather would be eliminating them.  The risks to Henry were as inarguable as they were unimaginable.

The risks to my grandfather, on the other hand, were not.

At that moment, the riskiest possible option for his patient was the one with the most potential rewards for him.

Turning_the_Mind_Inside_Out_Saturday_Evening_Post_24_May_1941_a_detail_1

By destroying part of a brain, Dittrich’s grandfather could create a valuable research subject.  Yes, there was a chance of curing the patient – Henry agreed to surgery because he was suffering from epileptic seizures.  But Henry didn’t understand what the proposed “cure” would be.  This cure was very likely to be devastating.

At other times, devastation was the intent.  During an interview with one of his grandfather’s former colleagues, Dittrich is told that his grandmother was strapped to the operating table as well.

It was a different era,” he said.  “And he did what at the time he thought was okay: He lobotomized his wife.  And she became much more tractable.  And so he succeeded in getting what he wanted: a tractable wife.”

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Compared to slicing up a brain so that its bearer might better conform to our society’s misogynistic expectations of female behavior, a bit of scientific fraud probably doesn’t sound so bad.  Which is a shame.  I love science.  I’ve written previously about the manifold virtues of the scientific method.  And we need truth to save the world.

Which is precisely why those who purport to search for truth need to live clean.  In the cut-throat world of modern academia, they often don’t.

Dittrich investigated the rest of Henry’s life: after part of his brain was destroyed, Henry became a famous study subject.  He unwittingly enabled the career of a striving scientist, Suzanne Corkin.

Dittrich writes that

Unlike Teuber’s patients, most of the research subjects Corkin had worked with were not “accidents of nature” [a bullet to the brain, for instance] but instead the willful products of surgery, and one of them, Patient H.M., was already clearly among the most important lesion patients in history.  There was a word that scientists had begun using to describe him.  They called him pure.  The purity in question didn’t have anything to do with morals or hygiene.  It was entirely anatomical.  My grandfather’s resection had produced a living, breathing test subject whose lesioned brain provided an opportunity to probe the neurological underpinnings of memory in unprecedented ways.  The unlikelihood that a patient like Henry could ever have come to be without an act of surgery was important.

. . .

By hiring Corkin, Teuber was acquiring not only a first-rate scientist practiced in his beloved lesion method but also by extension the world’s premier lesion patient.

. . .

According to [Howard] Eichenbaum, [a colleague at MIT,] Corkin’s fierceness as a gatekeeper was understandable.  After all, he said, “her career is based on having that exclusive access.”

Because Corkin had (coercively) gained exclusive access to this patient, most of her claims about the workings of memory would be difficult to contradict.  No one could conduct the experiments needed to rebut her.

Which makes me very skeptical of her claims.

Like most scientists, Corkin stumbled across occasional data that seemed to contradict the models she’d built her career around.  And so she reacted in the same was as the professors I’ve worked with: she hid the data.

Dittrich: Right.  And what’s going to happen to the files themselves?

She paused for several seconds.

Corkin: Shredded

Dittrich: Shredded?  Why would they be shredded?

Corkin: Nobody’s gonna look at them.

Dittrich: Really?  I can’t imagine shredding the files of the most important research subject in history.  Why would you do that?

. . .

Corkin: Well, the things that aren’t published are, you know, experiments that just didn’t … [another long pause] go right.

shredder-779850_1280.jpg

On Alvaro Enrigue’s ‘Sudden Death,’ translation, and the power of narrative control.

On Alvaro Enrigue’s ‘Sudden Death,’ translation, and the power of narrative control.

A friend of mine spent a summer teaching English to Roma children in Hungary.  She was a college sophomore; most of the volunteer teachers were under twenty-one.  As you might expect from a gaggle of underage students on break from their elite U.S. colleges, these volunteers took advantage of the lower drinking age in Hungary to get uproariously wasted.

One morning, my bleary-eyed friend watched as her even-more-hung-over co-teacher asked child after child to translate a Hungarian word for him, only to have each break into nervous titters.  Apparently he, the co-teacher, had jotted down the words of a toast during the previous night’s drinking.  Then, as expected, he forgot what the phrase meant.

The toast was, roughly, “When you tip back your drink, empty it, because a half-finished drink is no better re-drunk than a half-fucked woman re-fucked.”  The word he was asking children to translate was “re-fucked.”  Ah, Stanford.  A college for our best and brightest!

51mew0IOfFL._SX307_BO1,204,203,200_In Alvaro Enrigue’s Sudden Death (translated into English by Natasha Wimmer), the granddaughter of conquistador Hernan Cortés escorts her visiting betrothed out of the house on the night before their wedding.  The nervous, soon-to-be-married man had spent much of the afternoon talking to his future mother-in-law about  Cortés, but it seems he only dimly understood their conversation  He’d lived only in Spain, but the mother-in-law’s language was peppered with American slang, legacy of the bloody conquest.

As they were approaching the door where they would part for the last time before they were married, [he] asked with sincere and perhaps slightly alarmed curiosity: So what does it mean to xingar, would you say?

Of course, Enrigue has let his readers in on the joke.  A few pages earlier he presented a scene from the future mother-in-law’s own childhood.  Like all children who have lost a parent, she was curious about her origins:

And do you miss him, [she] asked [her mother] … Who?  Father.  He was old and rich by the time I had him, the poor thing; he imagined that he was a real nobleman and tried to behave like a gentleman.  [Her mother] laughed again, a bit hysterically, and said: He was a wolf in a fine cap.  But did you like him?  The widow opened her eyes wide and dropped her embroidery on her lap to underscore the drama of her words: Who wouldn’t like him; he was Hernan Cortés, so los xingo a todos.  Or, in Juana’s polite translation for the benefit of the ladies and maids who didn’t speak Mexican Spanish.  He fucked everybody.

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Alvaro Enrigue’s Sudden Death is a lovely novel in the tradition of Moby Dick.  An off-kilter, obsessive narrator presents a series of essays that cumulatively build toward a new perspective on the world.

In Moby Dick, Ishmael’s obsession is monolithic.  Whales!  Whales, and their killing.  Whereas the themes of Sudden Death seem manifold: tennis, Cortés, conquest, execution, painting, the upheaval of the Reformation.  Yet the novel is beautifully esemplastic.  By its end, all these concerns are interwoven.  Perhaps this is what octopus literature would be like: everything needs to be understood at once to be understood at all, and so Enrigue lets the disparate ideas tumble forth chaotically, almost haphazardly.  His goal seems to be to immerse his reader with these thoughts.

In my opinion, he succeeds.

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For the English publication of Sudden Death, Enrigue wrote new chapters about the vagaries of language (one includes the line “If you are reading this page, you are reading a translation”), which compliment a theme that I imagine was present in the original.  Translators control our experience of stories; those who control stories, control the world.  After murdering Walter Scott, a police officer composed an English-language story of the event.  A translation.  If a helpful citizen had not recorded video, the murderer’s translation would have shaped everyone’s perception.

Enrigue’s thoughts on translation are most clear in passages about Hernan Cortés, the man who destroyed an entire civilization.

Hernan_Fernando_CortesEvery second, 4.787 people are born in Mexico, and 1.639 die, which means that the population increases by an average rate of 3.148 Mexicans per second.  A nightmare.  Today there are more than 117 million Mexicans, and an unspecified number followed by six zeros in the United States.  A rough calculation suggests that between 1821, the year the country gained its independence, and the second decade of the twenty-first century, 180 million Mexicans, more or less, have been born.  Out of all of them, only Jose Vasconcelos considered Cortés to be a hero.  His unpopularity is nearly universal.

Take, for example, an inexplicable organization called the Mexican National Front, consisting of thirty-two skinheads.  The thirty-two morons who belong to the Front are admirers of Hitler – and even they explain on their website that Cortés was a bastard.

But Cortés couldn’t have done it alone.  His inability to speak any of the local languages trapped him within a bubble of ignorance.  He could function in the new world only with the help of pair of translators.  Because no one spoke both Spanish and the language of the new world, every remark had to pass through a third language, Mayan.

One of Cortés’s translators was a Spanish priest named Geronimo de Aguilar – the priest had been part of a shipwrecked expedition, watched as his shipmates were sacrificed to the local gods, but made himself sufficiently useful that he was enslaved instead of killed, giving him time to learn Mayan.  Then Cortés came and freed him.

The other translator was a native woman named Malinali Tenepatl – she had been born into royalty but was captured in a battle.  The captors relegated her to the status of a sex slave, during which time she learned Mayan.  Then Cortés came and … no, he did not free her.  But life as the personal-use sex slave of an older conquistador was an upgrade over her prior circumstance, subject to general rapine.

Cortez_&_La_Malinche

Cortés was absolutely not ready for a diplomatic conversation that first morning in Mexico.  They’ve brought gold, said the soldier, whose name was Alvaro de Campos; lots of gold.  Then I’m coming, said Cortés; wake Aguilar.  When the captain got out of bed, setting his feet on the cabin’s plank floor, there rose behind him – her hair in tangles and her skin a little bruised from the weight of his body – the face of the girl Malinalli Tenepatl, princess of Painala and courtesan of the cacique of Potonchan, skilled in arts no less valuable for being dirty.  Time to use your tongue, Cortés ordered.  She, whose polyglot brain was beginning to recognize simple orders in Spanish, asked in Chontal: On you or the gentleman?  But seeing that Cortés was getting dressed and Alvaro de Campos wasn’t getting undressed, she understood that it was her services as a translator that were required.

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During the invasion of Mexico, every message passed through three mouths.  The conquistador had a relatively simple-minded goal – gold, and lots of it – as did the local rulers – peace – but the translators had their own agendas.  With no one to contest their words, the translators could control the world.

This is what Moctezuma’s men delivered, no matter which chronicler is consulted:

  1. A solid gold sun
  2. A solid silver moon
  3. More than one hundred gold and silver plates set with jade
  4. Armbands, anklets, lip plugs
  5. Miters and tiaras encrusted with blue gems like sapphires
  6. All kinds of carved green stones
  7. Harnesses, chain mail, doublets, shooting devices, shields
  8. Plumes, fans, and capes made of featers
  9. Strange woven garments and bed hangings

Cortés thanked them for the gifts and gave them:

  1. The bracelet of glass beads

Since there was a notable imbalance between the two mounds of intercontinental memorabilia, he asked a soldier by the name of Bernardo Suarez to toss him his helmet:

  1. A helmet

When the swap was over – the Mexica ambassadors exchanging slightly disconcerted looks before proceeding, either because Cortés’s gifts were rubbish or because they would have preferred a horse to sacrifice – Cortés made a small bow and turned his back on the imperial messengers.  He was preparing to mount again when Aguilar informed him that the Aztecs had something else to add.

The main ambassador said [in Nahautl, the local language]: We bring you these valuable gifts so that you will give them to your emperor as a token of our friendship and respect; we hope that they please you and that you return to deliver them with all your men and all the terrible beasts you have brought with you; we hope that you never again set foot in our lands. 

Malinalli, [who spoke Nahautl and Chontal], who by now had her own agenda and preferred to be the wife of an absentminded old man [Cortés] than to go back to being the sex slave of a cacique and all his friends, translated this as: We bring you these very valuable gifts but in truth they are as nothing compared with what lies ahead; we hope you like them; we give them to you so that you won’t even think about advancing farther with your terrible beasts because we know that the people are so unhappy with the emperor that they would surely join your cause and not ours. 

Aguilar, [a priest who spoke Chontal and Spanish], seeing the young warriors and their clubs bristling with knives, said: They give you a warm welcome; they say that they bring you these gifts from the emperor of this land, who is troubled because his people are unhappy; they say that it’s best if you don’t help him, that in order to get anywhere you’d have to beat all the boys over there, and they are terrible. 

Cortés said [in Spanish] that he’d think about it, and everyone seemed satisfied with his response.

The conversation between the Aztecs and Spaniards continued in more or less the same vein throughout the first stage of the conquest of Mexico, which ended with the previously described stay of Cortés and his men in Tenochtitlan.  There are few better illustrations of how a whole host of people can manage to understand absolutely nothing, act in an impulsive and idiotic way, and still drastically change the course of history.

This last line hits especially hard for a U.S. reader during the chaotic reign of the 45th.  Those who control the narrative still control the world.  Although many citizens in the U.S. speak English, Fox News and Facebook can trap people in perceptual bubbles just as effectively as language barriers.

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Enrigue furthers his message with some intentional mistranslations of his own.  He includes quotations from historical documents about the origin of tennis, but these are often manipulated to fit his story; the novel is rife with falsified detail.  One chapter of Sudden Death reads, in its entirety:

On the Causes of Poverty Under the Reign of Henry VIII

And what say you of the shameless luxury all about this abject poverty?  Serving-folk, craftsmen, and even farmers themselves show excessive vanity in diet and in apparel.  What say you of the brothels, the infamous houses, and those other dens of vice, the taverns and alehouses?  And what of all the nefarious games in which money runs fast away, condemning initiates to poverty or highway robbery?  Cards, dice, foot-ball, quoits.  And worst of all: tennis.  Banish from the land these noxious plagues.

Thomas More, Utopia, 1516

723px-Hans_Holbein,_the_Younger_-_Sir_Thomas_More_-_Google_Art_ProjectMy own Latin is very poor, but this passage of Thomas More’s Utopia seems instead to say, “games played on a table, games played with paper, games with a ball, a sphere, a disc; and when the money is gone, won’t their players become brigands?”

Or there’s the early (1556) English translation from Ralph Robinson:

Nowe bawdes, queines, whoores, harlottes, flrumpettes, brothelhoufes, flewes, and yet an other flewes wynetauernes, ale houfes, and tiplinge houfes, with fo manye naughtie, lewde, and vnlawfull games, as dyce, cardes, tables, tennis, boules, coytes, do not all thefe fende the haunters of them flreyghte a ftealynge when theyr money is gone?

Obviously Robinson manipulated the original text to further an agenda of his own, listing illicit sexuality as a deadly vice six separate times.  But he does not consider the haunters of tennis to be notably worse than those who gamble on other games.  Nor do modern translators (e.g. Robert Adams: “Look at all the crooked games of chance like dice, cards, backgammon, tennis, bowling and quoits, in which money slips away so fast.  Don’t all these pastimes lead their devotees straight to robbery?”).

It’s not enough to say that control over a narrative brings power, or even to show it.  Enrigue makes his point far more effectively; he uses this power.

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I highly recommend that you read Sudden Death.  Enrigue’s writing is erudite, comical, and cutting; Wimmer’s rendering is lovely.  And the book was written for all the right reasons.  From an authorial interlude near its end:

[This] isn’t a book about Caravaggio or Quevedo, though Caravaggio and Quevedo are in the book, as are Cortés and Cuauhtemoc, and Galileo and Pius IV.  Gigantic individuals facing off.  All fucking, getting drunk, gambling in the void.

I don’t know what this book is about.  I know that as I wrote it I was angry because the bad guys always win.  Maybe all books are written simply because in every game the bad guys have the advantage and that is too much to bear.

641px-Caravaggio,_Michelangelo_Merisi_da_-_The_Calling_of_Saint_Matthew_-_1599-1600_(hi_res)

On perception and learning.

On perception and learning.

Cuddly.

Fearful.

Monstrous.

Peering with the unwavering focus of a watchful overlord.

A cat could seem to be many different things, and Brendan Wenzel’s recent picture book They All Saw a Cat conveys these vagrancies of perception beautifully. Though we share the world, we all see and hear and taste it differently. Each creature’s mind filters a torrential influx of information into manageable experience; we all filter the world differently.

They All Saw a Cat ends with a composite image. We see the various components that were focused on by each of the other animals, amalgamated into something approaching “cat-ness.” A human child noticed the cat’s soft fur, a mouse noticed its sharp claws, a fox noticed its swift speed, a bird noticed that it can’t fly.

All these properties are essential descriptors, but so much is blurred away by our minds. When I look at a domesticated cat, I tend to forget about the sharp claws and teeth. I certainly don’t remark on its lack of flight – being landbound myself, this seems perfectly ordinary to me. To be ensnared by gravity only seems strange from the perspective of a bird.

theyallsawThere is another way of developing the concept of “cat-ness,” though. Instead of compiling many creatures’ perceptions of a single cat, we could consider a single perceptive entity’s response to many specimens. How, for instance, do our brains learn to recognize cats?

When a friend (who teaches upper-level philosophy) and I were talking about Ludwig Wittgenstein’s Philosophical Investigations, I mentioned that I felt many of the aims of that book could be accomplished with a description of principal component analysis paired with Gideon Lewis-Kraus’s lovely New York Times Magazine article on Google Translate.

My friend looked at me with a mix of puzzlement and pity and said, “No.” Then added, as regards Philosophical Investigations, “You read it too fast.”

wittgensteinOne of Wittgenstein’s aims is to show how humans can learn to use language… which is complicated by the fact that, in my friend’s words, “Any group of objects will share more than one commonality.” He posits that no matter how many red objects you point to, they’ll always share properties other than red-ness in common.

Or cats… when you’re teaching a child how to speak and point out many cats, will they have properties other than cat-ness in common?

In some ways, I agree. After all, I think the boundaries between species are porous. I don’t think there is a set of rules that could be used to determine whether a creature qualifies for personhood, so it’d be a bit silly if I also claimed that cat-ness could be clearly defined.

But when I point and say “That’s a cat!”, chances are that you’ll think so too. Even if no one had ever taught us what cats are, most people in the United States have seen enough of them to think “All those furry, four-legged, swivel-tailed, pointy-eared, pouncing things were probably the same type of creature!”

Even a computer can pick out these commonalities. When we learn about the world, we have a huge quantity of sensory data to draw upon – cats make those noises, they look like that when they find a sunny patch of grass to lie in, they look like that when they don’t want me to pet them – but a computer can learn to identify cat-ness using nothing more than grainy stills from Youtube.

Quoc Le et al. fed a few million images from Youtube videos to a computer algorithm that was searching for commonalities between the pictures. Even though the algorithm was given no hints as to the nature of the videos, it learned that many shared an emphasis on oblong shapes with triangles on top… cat faces. Indeed, when Le et al. made a visualization of the patterns that were causing their algorithm to cluster these particular videos together, we can recognize a cat in that blur of pixels.

The computer learns in a way vaguely analogous to the formation of social cliques in a middle school cafeteria. Each kid is a beautiful and unique snowflake, sure, but there are certain properties that cause them to cluster together: the sporty ones, the bookish ones, the D&D kids. For a neural network, each individual is only distinguished by voting “yes” or “no,” but you can cluster the individuals who tend to vote “yes” at the same time. For a small grid of black and white pixels, some individuals will be assigned to the pixels and vote “yes” only when their pixels are white… but others will watch the votes of those first responders and vote “yes” if they see a long line of “yes” votes in the top quadrants, perhaps… and others could watch those votes, allowing for layers upon layers of complexity in analysis.

three-body-problem-by-cixin-liu-616x975And I should mention that I feel indebted to Liu Cixin’s sci-fi novel The Three-Body Problem for thinking to humanize a computer algorithm this way. Liu includes a lovely description of a human motherboard, with triads of trained soldiers hoisting red or green flags forming each logic gate.

In the end, the algorithm developed by Le et al. clustered only 75% of the frames from Youtube cat videos together – it could recognize many of these as being somehow similar, but it was worse at identifying cat-ness than the average human child. But it’s pretty easy to realize why: after all, Le et al. titled their paper “Building high-level features using large scale unsupervised learning.”

Proceedings of the International Conference on Machine Learning 2010
You might have to squint, but there’s a cat here. Or so says their algorithm.

When Wittgenstein writes about someone watching builders – one person calls out “Slab!”, the other brings a large flat rock – he is also considering unsupervised learning. And so it is easy for Wittgenstein to imagine that the watcher, even after exclaiming “Now I’ve got it!”, could be stymied by a situation that went beyond the training.

Many human cultures have utilized unsupervised learning as a major component of childrearing – kids are expected to watch their elders and puzzle out on their own how to do everything in life – but this potential inflexibility that Wittgenstein alludes to underlies David Lancy’s advice in The Anthropology of Childhood that children will fair best in our modern world when they have someone guiding their education and development.

Unsupervised learning may be sufficient to prepare children for life in an agrarian village. Unsupervised learning is sufficient for chimpanzees learning how to crack nuts. And unsupervised learning is sufficient to for a computer to develop an idea about what cats are.

But the best human learning employs the scientific method – purposefully seeking out “no.”

I assume most children reflexively follow the scientific method – my daughter started shortly after her first birthday. I was teaching her about animals, and we started with dogs. At first, she pointed primarily to creatures that looked like her Uncle Max. Big, brown, four-legged, slobbery.

IMG_5319.JPG
Good dog.

Eventually she started pointing to creatures that looked slightly different: white dogs, black dogs, small dogs, quiet dogs. And then the scientific method kicked in.

She’d point to a non-dog, emphatically claiming it to be a dog as well. And then I’d explain why her choice wasn’t a dog. What features cause an object to be excluded from the set of correct answers?

Eventually she caught on.

Many adults, sadly, are worse at this style of thinking than children. As we grow, it becomes more pressing to seem competent. We adults want our guesses to be right – we want to hear yes all the time – which makes it harder to learn.

The New York Times recently presented a clever demonstration of this. They showed a series of numbers that follow a rule, let readers type in new numbers to see if their guesses also followed the rule, and asked for readers to describe what the rule was.

A scientist would approach this type of puzzle by guessing a rule and then plugging in numbers that don’t follow it – nothing is ever really proven in science, but we validate theories by designing experiments that should tell us “no” if our theory is wrong. Only theories that all “falsifiable” fall under the purvey of science. And the best fields of science devote considerable resources to seeking out opportunities to prove ourselves wrong.

But many adults, wanting to seem smart all the time, fear mistakes. When that New York Times puzzle was made public, 80% of readers proposed a rule without ever hearing that a set of numbers didn’t follow it.

Wittgenstein’s watcher can’t really learn what “Slab!” means until perversely hauling over some other type of rock and being told, “no.”

We adults can’t fix the world until we learn from children that it’s okay to look ignorant sometimes. It’s okay to be wrong – just say “sorry” and “I’ll try to do better next time.”

Otherwise we’re stuck digging in our heels and arguing for things we should know to be ridiculous.

It doesn’t hurt so bad. Watch: nope, that one’s not a cat.

16785014164_0b8a71b191_z
Photo by John Mason on Flickr.

On Colson Whitehead’s ‘The Underground Railroad.’

On Colson Whitehead’s ‘The Underground Railroad.’

Whenever one of her students finished, my graduate school advisor took everyone out to dinner and paid for the meal.  These were expensive meals, too – between San Francisco’s culinary culture and Silicon Valley’s sudden money, many restaurants near Stanford turned very pricey.

I wouldn’t eat.  I’d order a glass of water, no more.  If it were lunchtime, I’d say that I planned to go running early in the afternoon.  If it were dinner, I’d murmur that K & I had eaten already.  My advisor would frown, but after the first few times this happened, she stopped arguing.  She probably thought I was anorexic, or deranged.

Nope.  But I’d read Lewis Hyde’s The Gift.  In his words:

gift_us_newGift exchange must … be refused when there is a real threat in the connections that it offers.  In ancient tales the hero who must pass through hell is warned that charity is dangerous in the underworld; if he wishes to return to the land of the living, he should lend a hand to no one, nor accept the food offered by the dead.

Gifts from evil people must also be refused lest we be bound to evil.  In folk tales the hero is well advised to refuse the food and drink offered him by a witch.

We often refuse relationship, either from the simple desire to remain unentangled, or because we sense that the proffered connection is tainted, dangerous, or frankly evil.  And when we refuse relationship, we must refuse gift exchange as well.

If I’d nibbled an eight dollar plate of french fries, I probably wouldn’t have been trapped in California.  But it wasn’t worth the risk.  That was a world with which I hoped to maintain no ties.

urThe stakes for Cora, the hero of Colson Whitehead’s The Underground Railroad, are higher.  I was miserable during graduate school, but Whitehead writes of a world in which innocent people are routinely tortured and murdered in all variety of grotesque, horrifying manner.

When Cora stumbles to the road after trekking for days through a secret subterranean tunnel, she sees several wagons trundling westward.  The first two wagons are driven by white men – she ignores the first, and, when pressed by the second, turns down his offer to help.

The third wagon was commanded by an older negro man.

You hungry?” the man asked.  He was from the south, from his voice.

I’m very hungry,” Cora said.

Despite her hunger, Cora could not accept aid from the whites.  Although her escape was facilitated by several white people (most of whom were then tortured and murdered for having aided her), she cannot trust strangers with pallid skin.

Indeed, a minor character, another survivor of the final massacre that Cora fled, gives a pithy summary of this distrust in her old age:

She lived on Long Island then, after roaming all over the country, in a small house with a Shinnecock sailor who doted on her to excess. She’d spent time in Louisiana and Virginia, where her father opened colored institutes of learning, and California.  A spell in Oklahoma … The conflict in Europe was terrible and violent, she told her sailor, but she took exception to the name.  The Great War had always been between the white and the black.  It always would be.

Several pages earlier, Whitehead proffers a speech from a character highly regarded for his intellectualism; this speech delineates the sides in this war:

Our ancestors came from all over the African continent.  It’s quite large. … They had different ways of subsistence, different customs, spoke a hundred different languages.  And that great mixture was brought to America in the holds of slave ships. … We are craftsmen and midwives and preachers and peddlers. … The word we.  We are not one people but many different people.  How can one person speak for this great, beautiful race – which is not one race but many, with a million desires and hopes and wishes for ourselves and our children?

For we are Africans in America.  Something new in the history of the world, without models for what we will become.

Color must suffice.  It has brought us to this night, this discussion, and it will take us into the future.  All I truly know is that we rise and fall as one, one colored family living next door to one white family.  We may not know the way through the forest, but we can pick each other up when we fall, and we will arrive together.”

The world in Whitehead’s novel is stark and brutal.  What’s worse, the most horrific elements of the story are real.

colson_whitehead_2014The Underground Railroad is a blend of historical fiction and Man-in-the-High-Castle-esque sci-fi.  The novel is set in a world that resembles the 1800s United States, but it is not our world.  Underground tunnels crisscross the country, secretly built by a coterie of technologically-advanced, presumably African-American citizens (when asked of the provenance of the tunnels, a character gnomically replies “Who builds anything in this country?”).  And a century’s worth of racial injustice has been condensed into the several years that Cora spends fleeing the torturers who claimed to own her.

Personally, I felt that this speculative re-imagining of America weakened the story.  By picking and choosing various injustices throughout history and shifting them into the past, Whitehead creates the illusion that these sins all pre-dated the Civil War.  After all, the passage about the “Great War” quoted above implies that Whitehead’s world experienced a similar abolition of slavery toward the turn of the century, else how could “colored institutes of learning” be opened in the south?

But the Tuskegee Syphilis Study, as with many of the abuses documented in Harriet Washington’s Medical Apartheid, is so chilling because it transpired long after the Civil War – the syphilis study did not officially end until the 1970s.

And Whitehead imagines a region that has outlawed the presence of any human with too much melanin in his or her skin (perhaps even European immigrants living here stayed indoors, or routinely smeared themselves with thick swaths of titanium dioxide, lest they be mobbed & murdered for a tan).  But, within the context of a sci-fi alternate history, readers might believe that the violent enforcement of a “whites only” district ended long before it did in this country.

bloodattherootThese abuses were ongoing a mere thirty years ago.  From Carol Anderson’s New York Times review of Patrick Phillips’ Blood at the Root:

A few years later, in 1987, the civil rights legend Hosea Williams … took marchers … into Forsyth County [outside Atlanta].  It wasn’t a fair fight.  Men, women, children and Klansmen, proudly waving the Confederate flag and a noose, overwhelmed law enforcement and hurled stones, debris, and epithets as they surged at the nonviolent protesters.  “Keep Forsyth white!” scraped through the air like fingernails on a chalkboard.  The only thing that finally broke Forsyth County open was the pressure of Atlanta’s sprawl and the onslaught of economic development.

Especially at this moment in history, when millions of young black men are ensnared in our nation’s incarceration crisis, when dozens have recently been murdered by the law enforcement officers sworn to protect them, it feels strange to condense horrors into a small sliver of long-ago time.  Slavery itself in many ways continued into the 1940s, as documented in Douglas Blackmon’s Slavery By Another Name.  If you read the Thirteenth Amendment, you’ll find that slavery is still constitutionally legal even today, as long as a mockery of justice is enacted first.  In The New Jim Crow, Michelle Alexander documents how egregiously unfair these mockeries of justice often are in the present-day United States.

Some of the violence in Whitehead’s The Underground Railroad is thankfully confined to the past.  The unpunished multi-day torture-cum-murder of re-captured fugitives, for instance.  And the Underground Railroad itself is an idea firmly rooted in the pre-Civil-War United States.

But I worry that, by linking these ideas to more recent examples of injustice, Whitehead’s novel won’t draw this violence into the present, but rather make contemporary injustice seem long past.  After all, we humans are adept at forgetting the suffering we cause.  After the slave catcher in Whitehead’s novel asks Cora whether she feels bad about having killed a boy during her escape, the slaver summarizes,

Of course not – it’s nothing.  Better weep for one of those burned cornfields, or this steer swimming in our soup.”

 

On the question of whom to blame for the paucity of women in science.

On the question of whom to blame for the paucity of women in science.

978-080704657-9I was super excited to read Eileen Pollack’s The Only Woman in the Room.  There are a lot of problems with academic science, and these have been getting better much more haltingly than one might expect.  And the problem isn’t just individuals with retrograde attitudes — although that’s clearly an issue — but also structural and cultural arrangements that bias against neurotypical females.

I’d hoped that the bulk of Pollack’s book would be devoted to documenting these problems and offering suggestions for corrective measures.  If we as a society value science enough that we want for the best and brightest of all genders, upbringings, personality types, etc., to participate in the field’s advancement, I think there’s a dire need for investigative journalism that’d produce that sort of book.

Pollack’s book is primarily a memoir, however.  This is useful, too.  There’s a reason why medical journals still publish narrative-driven case studies in addition to the charts detailing aggregate patient response and recovery rates.  Details can be presented in stories that might be overlooked or ignored when many people’s experiences are moshed together to make a statistic.  After all, if we want the statistics to change, it’s women’s experience, actual lived experience, that we need to fix.

si-sexisminscienceBut I felt displeased while reading Pollack’s book.  My major complaint is that most of the book castigates scientists for the paucity of women in STEM fields… but the narrative suggests clearly that, in this case, the biggest problem is the behavior of non-scientists.

I’ll get back to that point in a moment, but first I should make clear that I’m not writing from the standpoint of an apologist who thinks the current state of things is fine.

Where I studied, first-year Ph.D. students had weekly tea with the founder of the department.  These were advising / advice sessions.  Students could talk about their interests, ask questions about the history of the field, get input on their courses, their research, their search for an advisor whose interests and outlook matched their own.  All told, a valuable experience for budding scientists.  But the advisor, an elderly male, invariably asked a female student to serve tea to everyone else in the room.  Even if he believed that the advice he dispensed next was gender neutral, that initial request (reasonable enough at the first meeting, because someone has to pour tea, and even at the second, but disheartening by the nth time the same young woman is asked to serve her classmates) discolored everything he said next.

Or there were the monthly lunchtime research talks.  A modestly-dressed fourth-year student gave a presentation on her research, fecal analysis of mothers and infants to learn when and with what species a newborn human’s intestinal track is colonized, and after the talk a female faculty member said to her, “That was a nice talk, but your breasts were very distracting.”

Individuals with that sort of retrograde attitude make science worse.  And it’s not just elderly professors who’re like that.  The individual from the tea incident, for instance, has since been retired by the reaper (the prevailing mood in the department was very somber after he passed.  For most, but not all.  When we rode in the elevator together, a UPS deliveryman told me, “You know, I’d feel bad too, except the old guy yelled at me just last week.”).  But it’s not as though there’ve been no young misogynists to replace the retiring ones.

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And there are structural problems.  There’s a particular way that advisors expect scientists to talk about their research — brash, confident, competitive, as though it is magnitudes more important than anything else — that seems to come easier to the average male than the average female.  People who don’t have that sort of competitive attitude, whether male or female, can be marginalized… but for a host of both biological and cultural reasons, men in this country are more likely to have that sort of attitude than women.

Maybe this would be fine if brash, stereotypically masculine behavior resulted in better science.  It doesn’t.  Good science is intensely collaborative.  Competitive attitudes, like the race aspect of modern academic science to publish findings first before someone else “scoops” your work, diminish the quality and quantity of data that everyone has to work with.  And contributes to the irreproducibility of modern science, because researchers are pressured to specialize in niche techniques that are used on a particular problem in only one laboratory.

Of course, individual scientists don’t have the freedom to rebel from this system … if only because granting agencies are set up to fund only researchers who conform.  If one researcher decided to behave more collaboratively, the lab would probably run out of money and die.

Academic science could be changed in ways that would make it more inviting to women and would result in better science.  And those are changes that I think scientists will need to make.

Whereas Pollack’s book, despite castigating scientists, felt quite short on recommendations for changes that scientists should make to their behavior.  (I.e., changes to the behavior of a scientist who isn’t explicitly prejudiced against women, but has simply absorbed the cultural norms of modern academia.)

The most important corrective that Pollack offers is that scientists should be more emotive in complimenting students on work they’ve done well.  This is probably true.  In K.’s science class, for instance, she makes a conscious effort to praise students for their successes.  Praise them with words, not just a high score marked at the top of an exam.

Reading Pollack’s narrative, for instance, we learn that after a successful physics internship, the professor said only, “We’d like to have you back next year.”  After a successful research project in mathematics, her advisor didn’t praise her — a stark contrast to the lavish praise articulated by her writing professor.

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But I think it’s worth considering a possible reason why Pollack’s physics professors may have been less effusive than her humanities professors.  While working in physics, the primary language is mathematics.  Quite a bit of physics doesn’t make much sense when expressed in a metaphorical language like English — the language most of us use to express our feelings, or to praise people, is simply maladapted to conveying a clear understanding of the universe.  So the practice of physics enriches for people much more adept with numbers than words.

Whereas humanities professors work with words full-time.  They really ought to be able to praise people with words more effectively than scientists can.

But the problem isn’t just that evaluating their competence for verbal praise is like judging both a carpenter and a welder on their skill with a blowtorch — is it fair to blame someone for relative inexperience compared to a full-time user? — it’s that many scientists have narrative experiences of their own that train them not to be effusive.

In part because the language of science is mathematics, science enriches for people who’re vaguely on the autism spectrum (I’d much rather use the term “Asperger’s” here, but that’s a topic for another post).  And many of those people experienced bewildering derision in response to their attempts to compliment people while growing up.  There are numerous examples of this in Steve Silberman’s Neurotribes, and I certainly have stories of my own.  I learned that it was safe to state facts (akin to the physics professor’s “We’d like to have you back next year”) but that emotional content often led to mockery.

2981Indeed, much of Pollack’s book is devoted to frustration that so few people wanted to date or have sex with her.  The book is sprinkled with lines like, “The only reason I could see that I wasn’t datable was that I was majoring in a subject they saw as threatening,” or a description of a woman who “hated when her sister introduced her as an astrophysics major, because the boys would turn away.

A big reason why women and minorities need to be praised to keep them excited about STEM fields is that stigma from the outside world.  But that’s not scientists’ fault!  I felt sad, reading the book, because so much of it seemed to blame scientists and praise humanities people, yet those same humanities people create the problems that weigh most heavily on Pollack’s mind.  Yes, it’s crummy that most boys at parties considered her not date-able.  But those boys were by and large humanities majors.  Because non-scientists were mean to her, Pollack needed for scientists to give her more praise.

Sure, it’s a big problem that scientists didn’t work hard enough to retain her in the field.  But it’s a bigger problem that non-scientists were so mean that, by the time she arrived at college, those science professors needed to work to retain the two (!) female students who enrolled in the introductory physics lecture instead of trusting that a reasonable fraction of 60 female enrollees (her lecture had 120 students) would stay in the field.

I was sad that this wasn’t stated explicitly until page 254 of a 257-page book, and even then in only two sentences in the middle of a paragraph:

It’s the larger society that needs to change.  No American of either gender will want to become a scientist if studying science or math makes a middle schooler so nerdy he or she becomes undatable, or if science and math are taught in a way as to seem boring or irrelevant.