Monday, September 30, 2013

Paul Offit: "Science it's not about being open-minded"

by Felipe Nogueira

Interview with Paul Offit
Paul Offit is an pediatrician, the Chief of the Division of Infectious Diseases of the Children's Hospital of Philadelphia, and was the co-inventor of the rotavirus vaccine. He wrote books about the importance of vaccines, clarifying the risks, which is often misunderstood by people. In example, some people believe that MMR vaccine (against measles, mumps and rubella) causes autism. However, that relationship was already analyzed scientifically and we know it's wrong. 

His last book, Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine, on which he makes a critical analysis of alternative medicine, was published this year.

I did an interview with him and it's available on Youtube. I thank Paul Offit for his time and attention. This is the first part of the interview. 

Links: second part | Youtube | versão em português

Can you pinpoint when the anti-vaccination movement started? 
I think it started with the first vaccine. The smallpox vaccine was developed by Edward Jenner in 1700s. There was violent opposition to the vaccine in the early 1800s and the reason was because that vaccine was mandated. People don't like to be told by the federal government they need to get a vaccine. That happened with the first vaccine and it's true today. If you talk to the professional anti-vaccine people, like National Vaccine Information Center, Moms Against Mercury, Safeminds, Generation Rescue, I think they will say they would stop their anti-vaccine efforts if you simply make vaccines optional.

What exactly is the risk of Guillain-Barré Syndrome with flu-shot? 
You can say with confidence that the swine flu vaccine that was given in 1976 had a risk of Guillain-Barré Syndrome in 1 per 100.000 who were given the vaccine. It is not clear that since then any vaccine causes Guillain-Barré Syndrome. But the limit of detection is 1 per million. CDC and other groups that tried to categorize this always say that we cannot say is more common than 1 per million. The people are left with this vague notion that vaccine might cause Guillain-Barré Syndrome, but since the 1976 swine flu vaccine there is no clear evidence that it has.

If a vaccine causes a problem, usually the disease that the vaccine try to prevent causes the same problem with higher risk for it. Can you elaborated on that?
The best example would be thrombocytopenia, which is lowering the platelets level. Measles vaccine can cause thrombocytopenia. There is a couple of studies and they all have been consistent and reproducible: the measles vaccine causes thrombocytopenia in 1 per 25-30 recipients. A measles virus also does that and it is far more common. When you get a chicken-pox vaccine, from 8 to 12 days after that, you can get a mild chicken-pox rash with 5 blisters, but sometimes can be 30 blisters. But if you get chicken-pox natural infection you can get 300 to 500 blisters.

Knowing that MMR vaccine does not cause autism, how do you think it is dangerous to widespread information not corroborated by science?
I wish I had the answer to that. I think once you scare people, it's hard to unscare them; once you open the Pandora’s box, it's hard to close it. When the question was raised by Andrew Wakefield in 1998 with his publication in the Lancet, that wasn't a study. That was a simply case series: 8 children whom had received the vaccine and developed symptoms of autism within 1 month. There are now 12 studies, looking to large number of people who did or didn't get the vaccine to answer the question "are you at a greater risk of having autism if you receive that vaccine?" The answer has been very reproducible: no. I think people are far more compelled by anecdote than they are by statistics. So, if Jenny McCarthy gets on Oprah and says "I watch my son get this vaccine, I watch his soul leave his eyes" and she cries, that's very compelling. If you have a scientist on the show that says "fair question: could the vaccine cause autism?  Is this a causal effect relationship? Is this just a temporal effect or it is a plausible effect?" You can answer that question. It's a scientific question, it can be answered in a scientific venue and it has been answered in a scientific venue. But how do you compel people with science? And how do you trump the anecdote with science? And the media became critical and they're not great at it.

What about your history with urologists, PSAs and prostate cancer? 
Yeah. I ended up switching urologists, because the urologists that I was seeing continuous to buy into the notion to get repeated PSA levels and repeated the biopsies. There is morbidity associated with that. And my think was to find a urologist who I though was practice medicine that was consistent with evidence that PSAs and biopsies haven't lengthened the lifespan of the american male. PSA and biopsies mean a lot of money for urologists and they make a living of this. It was nice to be able to find a urologist who was willing to practice medicine based on what was the evidence. I just saw a recent New English Journal article which look to people who took finasteride and compare them with people that didn't take finasteride. It found a lower incidence in people who take finasteride of having prostate cancer that was unlikely to kill you, the same type that causes high PSA levels, so called prostatic intraepithelial neoplasia type I and II. It's when you get to third stage [of cancer] that there is a problem. Because the urologists will continue to pursuit continuous PSAs and biopsies, finasteride avoid that, lowering your risk of going through that. In any case, it's a flawed system for all the biopsies and PSAs that were done: it hasn't lengthened the lifespan of the american male. But it's a big money maker for urologists, so I think they are slow to give it up.

What is your opinion about medicine students have been taught in medical schools things that are not scientific?
I think it's criminal. I got an email from a student who was at third year medical school in New York State University. He said he had a lecture from a homeopath that explains the water can remember that there was an active substance in some point of the past. Nonsense. He wrote a letter to dean of the medical school saying he is offended that this man came to teach him in a medical school that should be evidence based, not mystical. The dean wrote him back that he need to be more open minded. Very painful. This has nothing to do with being open-minded, it's all about evidence. Science it's not about being open-minded, it's about forming a hypothesis, establish burdens of proofs and subject those proofs to statistical analysis. Science has nothing to do with politics; it has nothing to do with being open-minded. I would think the dean of New York medical school would know that, but he didn't.

It could be said that the one who is not being open-minded is the dean of medicine, because he is not willing to accept homeopathy does not work. 
But maybe sometimes it does work. I mean, maybe sometimes you take something that you think is going to benefit you and it does benefit you simply because you think it's true. Placebo effect is not trivial, it's a real effect, and it can have a physiological base. I talk about that in the last chapter of my book. People can learn to release neuroendorphines and to regulate the immune system.

Sunday, September 29, 2013

Michael Shermer's Moral Arc of Science

by Felipe Nogueira

Michael Shermer is a psychologist, the Founding Publisher of Skeptic Magazine, the Executive Director of Skeptics Society and monthly columnist for Scientific American (his columns have not been published in the Brazilian edition of SciAm for a long time).

Readers of the portuguese version of this blog are aware of Michael Shermer's work, since I had posted my translation to portuguese to some of his articles. As a leader in skeptic movement and his continuous very well done work to promote science, Michael Shermer is, no less, a true inspirer to me. In response to my first email, in which I had explained how weak is the skeptic movement around here in Brazil, he answered that I should create my own Skeptic Society! Unfortunately, I am not that far, at least not yet, but I am really trying to promote skepticism and science over here.

Michael Shermer´s last book is The Believing Brain, in which he explained the psychological drives for beliefs in things such as conspiracy theory, ghosts, and God. Now, he is focusing on his next book, The Moral Arc of Science. He already posted some articles about this topic here and here. Michael´s Moral Arc of Science thesis is that a science of morality is possible, as he puts it:
the survival and flourishing of individuals is a basis for establishing moral and values, and so determining conditions by which humans best flourish ought to be the goal of science of morality.
Michael Shermer is not alone on this. The neurologist Sam Harris had written a book about the subject titled The Moral Landscape: How Science Can Determine Our Values. Sam Harris argument is based on (quoted from the book):
1) questions about values—about meaning, morality, and life’s larger purpose—are really questions about the well-being of conscious creatures.  
2) human well-being entirely depends on events in the world and on states of the human brain. Consequently, there must be scientific truths to be known about it.
It's a controversial issue and they engaged on online discussions: Michael discussed with the philosopher Massimo Pigliucci and Sam Harris with the cosmologist Sean Carroll. Science have been studying sucessfully and determined the impacts of human actions in other issues, such as the risk of tobacco smoking and global warming; I think it can do the same with morality. I not only agree that science can study, it should study, like Shermer and Harris are arguing, and it should start now: the best thing to guide our actions is empirical evidence, which is the realm of science. So, I totally agree with the main thesis of Shermer´s theory about science of morality, but I do not agree with him about every detail he mentioned on his last lecture about the subject, presented on the Northeast Conference on Science and Skepticism 2013

1) Michael defines the Ask-First principle :
To find out an action is right or wrong, ask first.
I think it's good principle in some cases, like adultery, the example Michael gave. He makes clear (and I agree, of course) the principle can't be applied to all cases, like asking to Hitler or Bin Laden if it's right to kill them. But my concern is that the Ask-First Principle is, at least a little, subjective. Consider the case of female genital mutilation. Two different woman had been mutilated and we go there and ask them if the mutilations were wrong. One says yes, like Michael presented, but the other says no, because, even she was in pain, that was God´s plan for her (or whatever the reason). How can we get out of this situation with the Ask-First Principle? We have two identitical situations. And yet we have two different answers. How can we decide now? Are we (the science of morality) going to say female genitalia mutilation is right in the case of the second woman (I think female genitalia mutilation wrong in all cases!)? The best analogy to the point I am trying to make is with medicine. The two women are analogous of two different patients with same diagnosis and the same disease severity. Are we going to prescribe different treatments for these patients? It is possible that the treatment of choice differs from one doctor to another, but, if we want consistence, the same doctor must prescribe the same treatment. And the difference between one doctors´s choice to another doctor´s is only acceptable in the case there is no conclusive evidence of what  is the best treament ; when empirical evidence settles down the issue, all doctors should do the same. Medicine will not say the best available treatment is wrong because a patient does not want to receive that treatment. This is not possible with the ask-first principle: we´re never going to find a empirical evidence of what´s the right answer in the example I gave, because the definition of what is right and what is wrong can be different among different people in the same conditions. We need a better tool, or, at least, we need to define better the cases we would use the Ask-First Principle. 

2) The Ask-First Principle should be applied to the individual, the moral agent that has been acted upon. Why the individual? Michael offers the following explanation:
The individual is the primary moral agent because the individual is the principal target of natural selection and social evolution.
He goes on saying he rejects group selection (it is an interesting question by itself: is there any scientist  - I mean serious scientist, not figures like creationists or Intelligent Designer proponents that call themselves "scientists" - that still supports group selection?). Is the individual the principal target of natural selection? I rather say the gene is the unit target of natural selection, the individual is the vehicle. So, saying the individual is the target of natural selection is not a good justification for the individual as the primary moral agent. The important point here is that I don´t think the science of morality should constraint itself on evolutionary theory. Even if the group or species would be the target of natural selection, how would that change the science of morality? The individual is the primary moral agent, because it´s the individual that suffers, or in Michael´s words, "it is the individual who is most affected by moral and immoral acts." Suffering, well-being is a function of the individual; there is no way we can, i.e, increase well-being in a group without increasing it at least in some individuals of this group.  It's interesting to note that science of morality can have more than one focus: some moral scientists can focus in the individual, studying how to maximize flourishing for particular individuals, and others can focus in a group or society, studying how to maximize flourishing of a group of individuals. Having one does not excludes the other.

3) "If Gay is natural then gays ought Moral Progress: Gay Decriminalization."

I do think it´s very wrong to discriminate people based on race, gender, sexual orientation, weight, height, etc. So,  I agree with gay decriminalization, but it´s not because gay is natural. This remembers me the fallacy that everything natural is good or right, everything unnatural is bad or wrong (appeal to nature/naturalistic fallacy). Some conditions like psycopathy or pedophilia can be classified as natural (at least part of it, since neurogenetics plays a huge influence), but I don´t think psychopaths killers, or pedophiles who abuse children, ought moral progress; I think they should be in jail, even it was "natural" for them to do the attrocities they´ve done. Also, science of morality should recommend changes to our nature, if that leads to more flourishing (less suffering, more happiness, more well-being, more freedom, more liberty, more justice, more prosperity, etc).

In this article, since I agree with Michael´s first premise, I tried to mention things I don´t agree with him in order to add something interesting to this discussion or to Shermer´s new book. In the end, we are not asking too much and can be summarized on his following statement:
All moral systems have shortcomings, so why not add one more arrow to quiver of ethics by adding science?
If I haven´t added anything on the discussion, maybe others have learned something, like I did with this discussion and others within the skepticism and science promoting movement. Also, as I said in the beginning, skepticism and science promoting movement is very weak in Brazil, so hopefully this discussion brings some attention to the importance of science, evidence and scientific thinking to Brazilian people; science is making our lifes better, and can make it even better. This is why Michael and I are employing and promoting science, critical thinking, asking for evidence instead of superstitious thinking, pseudoscience, anti-scientific thinking, and faith: science is the best tool to understand how the world works and our nature is and we want a society based on truth, justice, freedom and prosperity.

Thank you, Michael Shermer!                      

About the blog

by Felipe Nogueira 

As the title of the blog suggests, my objective with it is popularizing science and skepticism. Actually, I already had a blog written in portuguese with the same objective, for brazilian readers. As I often say, science and skepticism promoting here in Brazil is very weak. For example, online articles and books are constantly written by several scientists, like the evolutionary biologists Richard Dawkins and Jerry Coyne, the theoretical physicists Lawrence Krauss and Sean Carroll, the psychologists Steven Pinker and Michael Shermer, and the medical doctors Edzard Ernst and Paul Offit, just to name a few.  But, unfortunately, only a few of this books had been translated to portuguese and english language is still a barrier for brazilian people. 

So, in 2012, I decided to open a blog for brazilian people. I had written few articles myself. But, since several topics had been very well covered by others in online articles, some of my posts are translations, authorized by its autors, keeping all the credits and with the source to the original article. 

At this moment, I have the need to publish some things in english for the following reasons. I had contacted some of this scientists and authors and I plan to contact others, so now they could know what I am doing. Second, part of what I am doing can help promoting science not only in Brazil.

Just to keep things more organized, I created this blog for english texts only. In the other one, I will continue to translate and writing in portuguese.
My twitter: @felipejacknog