Reflections on Pandora's Lab

Published in Skeptical Briefs volume 27, number 1, 2017.
by Felipe Nogueira

In my last column, we briefly saw that Dr. Paul Offit’ latest book is Pandora’s Lab. As the subtitles explains is about Seven Stories of Science Gone Wrong. The book theme is simple: even though science has done good in the world, every possible invention might have bad consequences. If we accept new discoveries at face value, or to better put it, without the skepticism that science itself has taught us, we might, even with the opposite intention, doing harm. In some cases, avoidable harms; in other cases even more harm than good.

“Science can be Pandora’s beautiful box”, writes Offit. The seven stories covered in the book exemplify it very well. What connected those stories, besides science going wrong, is that they started in history, but their impact can be felt until today. Thus, as Offit shows in the final chapter, their lesson is still unlearned.

The lesson of vilifying saturated fat as the cause of heart disease still lives with us today. As clear explained in the book, heart disease or atherosclerosis happens when either of the coronaries arteries is blocked, interrupting the blood flow, damaging the heart, which occasionally might result in death.  The hypothesis that diet impacts heart diseases, recollects Offit, started in 1913 when a Russian study found that rabbits fed large quantities of foods rich in cholesterol (milk and egg yolks) developed atherosclerosis. Thus, the study’s author hypothesized that heart disease might be controlled by diet, specifically, by eating less cholesterol.

Another relevant study was done by Ancel Keys, who in 1950 compared people’s diet in several different countries. He found that countries with greater amount of fat in peoples’ diet, such as Finland, had higher incidence of heart disease. As such, he was the first person to use the term “heart-healthy diet”, urging Americans to restrict their fat intake. In 1961, the American Heart Association recommended to not eat more than 300 mg of daily cholesterol. There was only one problem with these recommendations: “scientific data on the relationship between fat consumption and human health remained, at best, ambiguous”, in Offit’s own words.

While data weren’t clear for radical interventions, restricting diet fat became government policy. Another crusader against fat was Senator George McGovern, who founded a nutrition committee responsible for a report wrote by politicians, instead of nutrition scientists or specialists.

In the 1980s, a non-governmental company called Center for Science in the Public Interest (CSPI) target restaurants and other food companies that used saturated fat based oils. This was a response to several studies that found saturated fat as the culprit of heart disease and that unsaturated fats were good for health. That’s what led us to the great margarine mistake. Following the push against saturated fat, the public reduced the amount of butter consumed, replacing it with margarine. Restaurants and food supply also made changes. They started using partially hydrogenated vegetable oils. As Offit put it, “In the 1980s, partially hydrogenated vegetable oils became the single most product for all baking and frying”.

Foods containing animal fats, such as butter and those oils previously used by industry, are rich in saturated fat. In contrast, margarine (at the time) and partially hydrogenated vegetable oils have great quantities of trans unsaturated fat, or trans-fat. In the 1980s and 1990s, studies linked partially hydrogenated vegetable oils with heart disease. Offit is crystal clear:
“The Harvard School of public health later estimated that eliminating trans fats from the American diet would prevent 250,000 heart attacks and related deaths every year!

Unlike studies of total fat, total cholesterol and unsaturated fat – where findings had been contradictory or inconclusive – no researcher has ever published a paper showing that trans fats are anything other than one of the most harmful products ever made.”
By trying to make us healthier, we ended up creating a much bigger problem. We didn’t know if trans-fat were safe or not, but our desperation to remove saturated fat from the diet certainly has led us astray: “in 2006, an article in the New England Journal Of Medicine declared ‘On a per calorie basis, trans fat appear to increase the risk of coronary heart disease more than any other macronutrient.’”

If that mistake was not enough, Offit brilliantly remember our desire to cure or treat mental illness was even more tragic. In attempt to understand the function of brain areas related to memory tasks, two researchers removed the frontal lobes of two chimpanzees. After the procedure, both chimps didn't remember how to get food. So, the researchers believed frontal lobes were responsible for creating and storing recent memories. But something else had happened. It seemed that one of the chimps didn't care for her recent memory limitation, as if she had "joined a happiness cult", in the words of one of researchers. They believed they had invented a treatment for anxiety.

It didn't require much time for someone trying this procedure called lobotomies in humans. In the late 1930s, several countries like performed lobotomies. One responsible for the apparent success of lobotomies was the neurologist Egas Moniz, who published a long monograph describing the procedure results in his 20 patients. Moniz reported improvements in more than half of it, even though adverse events like vomiting, diarrhea, nystagmus, and disturbed orientation of time and space happened. Surprisingly, Moniz was awarded the Sweden's Nobel Prize for his invention. The consequence was nothing to be awarded for: within four decades, 40,000 lobotomies were performed in the world.

The United States also had their lobotomy pusher: Walter Freeman. His "insight" was making a much more fast procedure, using electroshock for anesthesia and an ice pick. In 1950, Freeman wrote a book reporting the results of many of his “ice pick lobotomies”. While patients had several adverse events (as had happened with Moniz's patients), Freeman concluded his invention was successful. But Offit is clear about the patients:

"would lie in their bed like 'wax dummies' and have to be turned constantly by visiting nurses or family members to keep from getting bedsores. All were profoundly inddiferent to their surroundings. They didn't seem to care about anything. Worse, they had lost any sense of decorum". 

Despite serious adverse events (3% died from bleeding and other 3% faced permanent seizures), no medical society or organization stood up against lobotomies. According to Offit, it was the invention and use of psychoactive drugs that lessen the number lobotomies performed.

In a page-turner way, Offit tell us more five lessons of the past. God’s Own Medicine, or the story about the creation and use of opioid pain-killers, appeared in the latest issue of Skeptical Inquirer. We can learn the lesson from those stories to apply them to the present future.

That's what Offit does in the final chapter, for example discussing the problem of overdiagnosis and overtreatment with cancer screening programs. We must recognize as Offit explains that cancer's definition is changing. Not all of the detected cancers are going to kill us. Screening with PSA-test made prostate cancer the most commonly diagnosed non-skin cancer in the United States. But the risk of death due to prostate cancer remains unchanged in the last ten years. Critically, in men with 60 years or more that died from other causes, autopsies found prostate cancer in half of them. A similar situation is seemed in thyroid cancers, which are found in autopsies in one-third of people that had died from something else. The screening for breast cancer, another that in Brazil has a dedicated month to its promotion and awareness, it’s just a bit better because it saves some lives, but not many lives we’d think or like. Only 8 women of 122 benefit from it. The problem is what happened with the others: mastectomy, radiation therapy, chemotherapy with no evidence of benefit. Alarmingly, it’s estimated that 1.3 million women had been diagnosed with a breast cancer that would never killed them.

One clear lesson is to be cautions of anecdotes. Those pushers for lobotomies believed their procedure was saving lives. That’s why we need careful and controlled studies to evaluate the efficacy and safety of interventions.  So, Pandora’s Lab main lesson is to apply the skepticism even to science’s new inventions. Actually, accepting new inventions coming from science or not with face value is, in fact, not scientifically. The book beautiful reminds us that one of the big lessons of science is the skepticism and the importance in the promotion of science and critical thinking we do in CSI. The conclusion:

we need to approach all scientific advances cautiously and with eyes wide open – and to make sure that we learn from our mistakes and aren’t paralyzed by them.  

Reflections on Krauss’s The Greatest Story Ever Told—So Far

by Felipe Nogueira

published in Skeptical Briefs Volume 27.2, Summer 2017

In the Summer 2016 issue of Skeptical Briefs, this column featured an interview with theoretical physicist Lawrence Krauss, who briefly mentioned his new popular-science book. The Greatest Story Ever Told—So Far was published by Atria Books in the beginning of March. It’s about the greatest intellectual journey ever taken by humans (so far) from Plato to the discovery of the Higgs’s boson.

Krauss begins by reminding us of Plato’s Allegory of the Cave. As the allegory goes, people live imprisoned inside a cave only seeing its blank wall. The only thing those inside the cave see from the outside world is that wall, which is illuminated by a fire behind them, allowing moving shadows to appear. According to Plato, the prisoners of the cave consider the shadows part of the real world to the point of giving names to them.

This Allegory of the Cave brilliantly introduces the book. As Krauss uncovers through the book, a lot of what we learn about the universe, or the greatest story ever told so far, came from humans’ investigation about the nature of light.

Newton’s curiosity about light, Krauss argues, might have been motivated because it was a gift from God. This is not a mischaracterization, since Newton devoted much more time to writing about the “occult, alchemy, and searching for hidden meanings and codes in the Bible—focusing in particular on the Book of Revelation and mysteries associated with the ancient Temple of Solomon—than he did to writing about physics.” So, Krauss thinks it’s also reasonable to conclude that Newton’s primary interest was in theology.

Regarding light, Newton thought that it was made of individual particles he called “corpuscles.” Other natural philosophers, such as Descartes and Robert Hooke, did not share his view, considering that light was a wave. In their support, when passed through a prism, white light splits into the several different colors of rainbow.

Even against it, some of Newtown’s discoveries about light made more sense with the “wave theory of light.” He discovered, for example, that each color of light has a distinct angle at which it bends when passing through a prism. He also showed that colored light does not change its color, regardless of how many times it passes through a prism. All of this could be explained if white light is indeed a collection of different colors, but not if light is made of different-colored particles (as Newton thought).

The debate persisted for many years involving discoveries that seem unconnected to the nature of light, such as the connection between electricity and magnetism. As Krauss points out, “These two forces seem quite different, yet have odd similarities. Electric charges can attract or repel. So can magnets. Yet magnets always seem to have two poles, north and south, which cannot be isolated, while electric charges can individually be positive or negative.” To connect these forces required the work of Michael Faraday, the greatest experimental physicist of the nineteenth century. Faraday worked for years trying to see if magnetism could induce electricity, which he showed in 1831, allowing us to use electricity the way we do today, changing the world forever:

It is hard to imagine any discovery that is more deeply ingrained in the workings of modern society. But more deeply, what makes his contribution to our story so remarkable is that he discovered a missing piece of the puzzle that changed the way we think about virtually everything in the physical world today, starting with light itself. If Newton was the last of the magicians, Faraday was the last of the modern scientists to live in the dark, regarding light

The mystery of the connection between electricity and magnetism continued until 1865, when Maxwell published his complete set of equations, connecting these two apparently unconnected phenomena together in a formal theory. He also showed that oscillating charges produce an electromagnetic wave. Then, critically, Maxwell calculated the speed of the electromagnetic wave and he found out what was almost identical to the already known speed of light. Light is an electromagnetic wave.

There was a problem, however. Maxwell’s results concerning electromagnetic waves contradicted the properties of motion already established by Galileo many years before. If a ball is thrown with a speed of 10 mph inside a car moving at 15 mph, someone outside the car would measure the speed of the ball to be 25 mph (10 mph plus 15 mph). But what if instead of a ball inside the car, we have an oscillating charge? Maxwell calculated the speed of electromagnetic waves produced by oscillated charges measuring the strength of electricity and magnetism. Then, would someone outside the car measure the speed of electromagnetic waves from the oscillating charge to be different than what someone inside the car observes? If that’s the case, the observers would measure the strength of electricity and magnetism to be different from the other’s, allowing us to tell who is moving and who is not. But Galileo had shown this is impossible; there is no experiment anyone could perform that could tell if one is at rest or moving at a constant speed. Even though it’s a profound implication, Einstein was the one who realized it. The inconsistency is not just a thought experiment or between simple suppositions; both Galileo’s and Maxwell’s results have been verified by experiment. As Krauss remind us all, “rules that have been established on the bases of experiment cannot easily be tossed aside.” That’s why we needed Einstein’s genius to reconcile those notions.

Einstein’s great solution was that, as Krauss explains, “the two different observers must both measure distances and/or times differently from each other in just such a way that light, at least, would traverse that same measured distance in the same measured time for both observers.” In Einstein’s theory of relativity, space and time measurements are observer dependent.

Motion, electricity, magnetism, and relativity are all connected. That is just the beginning. The book continues to detail those hidden realities of our world, connecting in interesting ways many other physical phenomena, from the double-slit experiment and the rise of quantum mechanics (which uncovered the individual particles that light is made of) to unification of electromagnetism and weak force to superconductivity and the Higgs’s boson.

Were it not for the progress of science—reason and experiment, instead of Plato’s pure thought—we would not uncover many parts of the hidden realties; we would still be inside of a Plato’s cave. And the job of scientists, as Krauss argues, is to see what is behind the shadows, separating illusion from reality.

As the title suggests, the story is not finished: “Every day that we discover something new and surprising, the story gets even better,” says Krauss. Every page of the book you turn, it gets better. Krauss certainly has made a great contribution by describing the hidden realities in his fascinating book.

Reflections on Sean Carroll’s The Big Picture

by Felipe Nogueira

published in Skeptical Briefs Volume 26, number 3, Fall 2016

Sean Carroll is a theoretical physicist at the California Institute of Technologies. He has also dedicated a considerable amount of time to science popularization through his books, such as From Eternity to Here and The Particle at the End of the Universe, and debates, for example with theologian William Lane Craig.

Carroll’s latest book is The Big Picture: On the Origins of Life, Meaning and the Universe Itself. Published by Dutton, the book came out in May 2016. With that title, it’s right to assume that Carroll covered many topics in the book. A look at the table of contents finds six parts, with topics such as “The Funda­mental Nature of Real­ity,” “Interpreting Quan­­tum Mechanics,” and “The Origin and Pur­pose of Life.” But in short, the book is about poetic naturalism.

Naturalism asserts, as Carroll puts it, that “there is only one world, the natural world, exhibiting patterns we call “the laws of nature,” which are “discoverable by the methods of science and empirical investigation.” He makes it crystal clear that within naturalism there is no space for the supernatural: “There is no separate realm of the supernatural, spiritual, or divine; nor is there any cosmic teleology or transcendent purpose inherent in the nature of the universe or in human life.”

And what is the natural world made of? Our deepest understanding of reality, or in other words, our fundamental ontology is The Core Theory, a better term coined by physicist Nobel Prize winner Frank Wilczek for the Standard Model of particle physics. “It’s the quantum field theory of the quarks, electrons, neutrinos, all the families of fermions, electromagnetism, gravity, the nuclear forces, and the Higgs,” Carroll explains. So on our most fundamental level we have a sparse ontology, containing several different entities.

The Core Theory also 
tells us something very im­portant about the world: there is no such thing as astrology and life after death. Carroll had written about this on his blog [1], and he repeats this spectacular argument again in the book. Using our fundamental ontology, the world, including our bodies, is made of particles interacting according to equations of the Core Theory. The important point here is what kind of particles is the soul made of? If souls are made of the same ordinary particles as human bodies, there is no afterlife. On the other hand, if they are made of a different particle, this certainly would require a new physics to describe the interaction between our bodies—collections of ordinary Core Theory particles—with the soul. But every experiment ever performed says the Core Theory provides the correct description of how its particles behave at everyday energies. We know it’s not a complete description of everything that exists in the world—for example, dark matter is not included in it—but it describes everything related to human beings. If it exists, an immaterial soul that interacts with our bodies would prove the Core Theory is not right at everyday energies; the Core Theory would then need to be modified to include how its particles interact with the soul. One cannot believe in the existence of the soul and also believe the Core Theory is the correct description of how particles behave at everyday energies. “There is no life after death. We each have a finite time as living creatures, and when it’s over, it’s over.” Carroll blows the hope for the soul away.

The same line of reasoning can be applied to astrology. The Core Theory particles make human beings interact with a few forces of nature: gravity, electromagnetism, and strong and weak nuclear forces. But the nuclear forces do not reach macroscopic scales, and gravity is too weak—gravitational force from other planets might be equivalent or even weaker than that of a person nearby. We’re left with electromagnetism, but it’s not difficult to think that any electromagnetic signal coming from other planets will be interfered with signals originated here on Earth.

This brings another important question: What about things that are not part of the Core Theory? Are they just illusions? No! These can be useful ideas to describe real phenomena that manifest at higher scales. Temperature and entropy, for example, are not part of our fundamental ontology, but they’re real; they are emergent phenomena.

This is why Carroll is a poetic naturalist, and he does a great job throughout the book of differentiating fundamental from emergent phenomena, highlighting that both are real. But poetic naturalism is bigger than that; it has space from moral values, even if they’re part of our deepest ontology and not emergent. For Carroll (although Sam Harris certainly disagrees [2]), morality is not something out there to be found and cannot be discovered by science, but it is not less important. Poetic naturalism embraces all these “views” together. In Carroll’s own words:

Within poetic naturalism we can distinguish among three different kinds of stories we can tell about the world. There is the deepest, most fundamental description we can imagine—the whole universe, exactly described in every microscopic detail. Modern science doesn’t know what that description actually is right now, but we presume that there at least is such an underlying reality. Then there are “emergent” or “effective” descriptions, valid within some limited domain. That’s where we talk about ships and people, macroscopic collections of stuff that we group into individual entities as part of this higher level vocabulary. Finally, there are values: concepts of right and wrong, purpose and duty, or beauty and ugliness. Unlike higher level scientific descriptions, these are not determined by the scientific goal of fitting the data. We have other goals: we want to be good people, get along with others, and find meaning in our lives. Figuring out the best way to talk about the world is an important part of working toward those goals.

To conclude, it’s a great book, covering a wide range of interesting topics. In fact, it’s impossible to fairly account for all the good stuff in the book in a short review like this. Go read it!

Notes

1. http://www.preposterousuniverse.com/blog/2011/05/23/physics-and-the-immortality-of-the-soul/
2. http://www.preposterousuniverse.com/blog/2010/03/29/sam-harris-responds/

Reflections of a A Scientist in Wonderland

published in Skeptical Briefs volume 25 number, Summer 2016.

by Felipe Nogueira

Edzard Ernst is a medical doctor and the world’s first professor of alternative medicine. I always thought that his story is quite interesting. For years, Ernst has been a strong skeptical and critical voice of the often extraordinary claims done by alternative medicine proponents. In his blog he posts in a daily basis critical analysis of alternative medicine studies. In his 2008 book Trick or Treatment, co-authored with Simon Singh, Ernst had explained the history and evidence about different alternative medicine therapies, from acupuncture to homeopathy to chiropractic. However, this skeptical scientist had started his medical career as a homeopath. How that happened? How did he change his mind?  

The answers to those questions and other interesting details of Ernst’s career are written in his latest and excellent book. A Scientist in Wonderland was published in January and is “a memoir of searching for the truth and finding trouble”, as the subtitle says.

Ernst went to medical school in Germany. I was amazed to know that he actually wanted to be a musician, rather than a doctor. Even after he finished medical school he recognized this passion: "I still felt much more like a musician than a doctor". Around 1970, Ernst had difficulties when he was looking for a job as junior doctor, but he found in the only homeopathic hospital in Germany.

He worked in different places in Germany, including in the University of Munich, but it was in London that he had his first job as researcher, in a blood rheology laboratory at St George's Hospital. For the first time, he felt in the right job, because he was working with several intelligent people, going to conferences and publishing papers. Medical school was focused on clinical medicine; he didn't learn to be a scientist there. Working in that laboratory, he begun to realize that science of medicine was really important. With enough time to think, read, and learn, for the first time he questioned clinicians' most basic assumption that if a patient feels better, the cause is the treatment. Differently, a medical scientist is trained to be skeptical, to doubt, and to question this kind of assumption. In Ernst's own words, "An uncritical scientist is a contradiction in terms: if you meet one, chances are that you have encountered a charlatan. By contrast, a critical clinician is a true rarity, in my experience. If you meet one, chances are that you have found a good and responsible doctor".

The job as a researcher was good, but Ernst missed clinical activities. He changed jobs a couple of times, until he found a place where he could do research and clinical activities, in Munich. The research was so productive that he achieved a PhD without difficulties. At that time, around 1981, he published his first paper on alternative medicine.

It was in 1992 that his life was about to change dramatically as he saw an advertisement of the chair of complementary medicine at the University of Exeter. After one year, he was nominated for that task.  The mission of his research team was to conduct rigorous research into the efficacy, safety and cost of complementary medicine. However, as one can expect, alternative therapists don't want that. Enrst wrote, "Some offered the opinion that alternative medicine should not be scientifically scrutinized at all."

Ernst promised he would investigate the most popular alternative therapies in UK. For his surprise - and to my own as I read the book - spiritual healing was a common alternative therapy. At that time, there were more healers than chiropractors, osteopaths, acupuncturists, homeopaths and herbalists combined and almost the same number of mainstream physicians. Ernst and the healers agreed with the experimental methods to be used and the trial would test healers’ efficacy for chronic pain.

A Scientist in Wonderland explains why the best way to evaluate the efficacy of treatments is through a randomized controlled trial. In this kind of experiment, participants are separate randomly at least in two groups: the intervention group (the therapy to be tested) and the control group. If the therapy to be tested is a drug, the control group is given a pill that doesn't have any effect, a placebo. However, when a non-drug therapy is being tested, the "placebo" isn't that straightforward. We can't simply do nothing in the control group, patients need to be given something that looks like the therapy being tested but with no effects. Thus, when the trial is done, scientists use statistics in order to compare the difference between the groups. "Any effective treatment - effective beyond placebo that is - will generate a specific effect plus a placebo effect", Ernst explains.  

The spiritual healing trial ended up with four groups: healing by one spiritual healer; placebo-healing by a trained actor; healing by a healer in a cubicle hidden from the patient's view; and, placebo-healing with no human present in the cubicle. During the study, Ernst witnessed a pain relief so intense that one of the patients stopped using his wheelchair. Remarkably, the pain reduction was due to placebo effect, since the results showed that all groups have considerable pain reduction with no statistically significant difference between them. Ernst and his colleagues published the paper trial with a clear conclusion: "a specific effect of face-to-face or distant healing on chronic pain could not be demonstrated".

Readers will also learn in Ernst book that the importance to investigate alternative treatment is not only to know if it works or not, but also to know if it's safe or not. The patient might be harmed by the treatment directly, which can happen, for example, with acupuncture when the therapist causes a pneumothorax. Every treatment has its risks, even homeopathy that has no active substance in its pill. Why? Because patients might seek a not established treatments rather than an effective one. Moreover, one of Ernst' research showed that half of homeopaths would recommend against MMR vaccine. Thus, alternative therapists might produce considerable harms and we must not neglect that. 

Ernst has received several awards due to the quality of his research. However, for alternative medicine proponents, quality of research is not important. What is important is to defend alternative medicine, even in the absence of evidence. Speaking out the truth about the available evidence, Ernst criticized statements from alternative medicine promoters, such as the famous Prince Charles. At the time, the Dean of Exeter University questioned Ernst: “do you always have to be undiplomatic?” It certainly appears, for this question alone, that the Dean is more worried with being political rather concerned with the truth and possible harms of alternative medicine. What if the evidence from alternative medicine research is undiplomatic itself? It turns out to be case, as Ernst put it, “our critical analyses of alternative medicine, once acclaimed locally, nationally and internationally, seemed no longer wanted.”

What about ethics? Ernst doesn’t let anyone forget that this is critically important in medicine. Doctors occupy a position with authority and power, and patients are vulnerable and often they’re suffering. Ernst is brilliant as he wrote: 

when science is abused, hijacked or distorted in order to serve political or ideological belief systems, ethical standards will inevitably slip. The resulting pseudoscience is a deceit perpetrated on the weak and the vulnerable. We owe it to ourselves, and to those who come after us, to stand up for the truth, no matter how much trouble this might bring.

In fact, the fight with Prince Charles generated much trouble. Despite the fact that Ernst and his team had published more papers in peer-review medical literature than the rest of the Exeter University together, disagreements with Prince Charles culminated with Ernst’s team being isolated and with no funding. Eventually, the situation became so terrible that the team was disbanded and Ernst had to take retirement. He wrote, “The doctor and scientist may still be full of questions, but the musician in me breathes a sigh of relief that the performance, with all its impossible demands and fiendishly difficult passages, is finally over”.

Ernst closes the book with a brief summary of the most important conclusions from his research regarding the efficacy of acupuncture, chiropractic, herbal medicine, and homeopathy. A Scientist in Wonderland must be given to anyone that promotes alternative medicine. The book mentions important principles regarding treatments evaluations. The book shows the amount of trouble a team of scientists can face when their research findings contradicts beliefs and opinions of people with power. Moreover, it shows the importance of the truth.

I’d like to thank Edzard Ernst for having written this fascinating book about his career, but also for having the courage to stand up for the truth and for being the example of a scientist we need in all fields, especially in alternative medicine. Ernst is, as Harriet Hall has said in her review of the book on the Science-Based Medicine blog, “a true hero. He continues to be one of our leading warriors in the battle to defend science and conquer unreason.”