Saturday, October 3, 2009

My New Philosophy

The 1999 Broadway revival of Clark Gesner's You're a Good Man, Charlie Brown contained two additional songs by Andrew Lippa, one of which is My New Philosophy, sung to great effect by the amazing Kristin Chenoweth, in the character of Sally.

 It is great fun, and captures the spirit of an actively evolving sense of self. A personal philosophy becomes a lens for viewing the world, and a framework for thinking about and responding to events. Also, the true value of a philosophy is found less in the answers it provides than in the questions it asks. Sally's first "new philosophy" is "Why are you telling me?" I like it.

In the spirit of Sally, I've decided that my new philosophy is "Compared to what?" It is a question that is asked far too infrequently. We are faced constantly with assertions by family, friends, neighbors, pundits, politicians, etc. that X is good or Y is bad, or you should do A and shouldn't do B, and so forth. To all of these I reply, "Compared to what?" The proposed new federal controls over health care are good? Compared to what? It is bad to allow large financial institutions to collapse from their mistakes? Compared to what? Surgery is the best treatment for your cancer? Compared to what? I am sure that Winston Churchill felt the "Compared to what?" philosophy in his bones when he famously said, "Democracy is the worst form of government, except for all those other forms that have been tried from time to time." (House of Commons speech, Nov 11, 1947). Once the "compared to what?" philosophy becomes yours, you become empowered to make better choices in life.

But beware. People who want to influence you to choose their interests over yours, have developed a countermeasure to the powerful "compared to what?" philosophy. It is the false dichotomy, or false choice, or straw-man argument. They will say that their proposal is good, and then defend it by comparing it to an obviously bad alternative, as if that alternative were the only option, or by selectively excluding the benefits of an alternative and focusing only on the harms. If you don't judge for yourself what the alternatives are, and let others do it for you, the "compared to what?" philosophy is robbed of its power. "Cheap tires imported from China harm the American tire industry. We should tax them." But if tires are cheaper, fewer people will be tempted to drive on over-worn tires and rear-end your family in a rainstorm. Furthermore, the money saved by millions of consumers will be spent in innumerable other American industries and make them stronger. (credit to Frédéric Bastiat's famous 1848 essay, What is Seen and What is Not Seen.) "We must pass this health care bill, because to do nothing is unacceptable." Who said doing nothing is the only alternative? Whole Foods CEO, John Mackey wrote about eight steps in the right direction, none of which are part of the current proposals before Congress. "Surgery is the only cure for your cancer. You should get an operation." But if the surgery will leave you physically impaired, and cancer is the kind that grows so slowly that it probably will not cause any problems for 10 years and you are already 75 years old, what's the rush? And aren't there medicines that will treat the problems that come up? And might there not be even better medicines in 10 years?

Sometimes people become paralyzed in their decision-making process because they are consciously or subconsciously comparing their choices to some unreasonable ideal. This is the vice of perfectionism and utopianism. It is what the French philosopher, Voltaire, was thinking about in 1772 when he wrote "Le mieux est l'ennemi du bien," usually translated as "The perfect is the enemy of the good." Have you ever spent hours writing and re-writing a letter, e-mail, or yes, even a blog post, trying to say something in just the right way, only to delete it, and miss the opportunity to say something that mattered to you, and maybe to someone else too? Voltaire has your number, and mine. Guilty as charged. So today I am re-energizing myself with the spirit of Sally Brown, and my new philosophy, "compared to what?"

Wednesday, May 6, 2009

Global Warming is NOT People!

Sometimes I feel like Charlton Heston at the end of Soylent Green, but instead of declaring "Soylent Green is People!", I'm saying "Global Warming is NOT People!"

For the past year or so I have been following the science and politics of Anthropogenic Global Warming (AGW), which is now supposed to be called "Climate Change," because those who seek political and economic power based on the control of carbon dioxide, in order to "Save the World", do not want to be impeded by the observation that the world has gotten cooler in recent years. In the process of following this science, I have accumulated and digested and enormous library of literature, some of which I hope to eventually post here.

A competing theory of why the Earth has, on average, warmed over the past century is based in variations in the Sun's activity. Solar-driven climate change has a great deal of evidence and theory behind it, and many well-qualified scientific proponents. I am convinced that it is the far better theory and have been sharing my conclusions with anyone who will listen.

Scientific arguments for the reality of AGW do exist, as exemplified by the IPCC's Fourth Assessment Report. However, most of what passes for argument against carbon dioxide emission in the public sphere is much more a religious or political stand than an assertion of science, especially when Albert Gore, and others, proclaim that the science is "settled," debate should stop, and bold action needs to be taken. This is to be expected, as Mr. Gore comes from the political world where debate is decided by voting, and the purpose of voting is to silence debate. Scientific debate is never decided by voting. It is decided by demonstrating that your theory succeeds where others fail. Even then the debate is not silenced. It is only a provisional truth, susceptible to revision or replacement by something better. Scientists, or anyone with a duty to the truth, do not defend their theories by condemning those who raise questions as counter-revolutionaries.

For many passionate anti-carbon dioxide activists, anthropogenic global warming is nothing less than the theology of original sin, with a church that regards the breath of human life itself as a taint on a fallen Eden, and a theocracy that would sell indulgences in the form of carbon credits, and tax all production.

The debate has taken on a new significance and urgency, because just as the governments of the world seem to be on the verge of capitulating to the global anti-carbon jihad, the world is cooling and the Sun is going through a lull in sunspot activity that is unprecedented in modern times. The current solar cycle's long slide to an ever-lower minimum resembles nothing more than the end of Solar Cycle 4, which led into the Dalton Minimum, a period of cooler temperatures punctuated by the disastrous "Year Without Summer" in 1816, following the eruption of Tambora. Several blogs have taken up the discussion of the controversy. I highly recommend ScienceBits by Israeli physicist, Nir J. Shaviv.

The popular science press has noted the recent drop in sunspot activity, and occasionally connected it to past solar minima and the associated cooling periods. Some have even raised the question of whether the decrease in the sun's activity will "offset" global warming, as if the overall increase in solar activity from 1850 to 2001 were a completely separate phenomenon.

The central controversy, in broad terms, is over how sensitive the climate is to small changes in heat flux. Increased greenhouse gases that trap solar heat contribute a positive heat flux. Increased clouds that reflect light contribute a negative heat flux. Variation in CO2 by itself, at relevant concentrations, traps far too little heat to account for the change that IPCC attributes to it. It requires a "multiplier" and water vapor is offered as the principal multiplier. Working Group 1 of the IPCC's Fourth Assessment Report adopts a model with high sensitivity, based on the fact that the most significant greenhouse gas is not CO2, but rather H2O, and that warmer air contains more moisture, providing a source of positive feedback. Variation in CO2 by itself, at relevant concentrations, traps far too little heat directly to account for the change that IPCC attributes to it.

One criticism of the IPCC's model it that it is unstable, being so sensitive to fluctuations in temperature that past CO2 fluctuations would have "run away" in a positive feedback loop many thousands of years ago, which is obviously not seen in the record. Another criticism is one that the IPCC itself calls the largest uncertainty in their model, which is the potential negative feedback effects of low clouds.

Since 1997, Henrik Svensmark has been arguing that most of the historical climate record, both ancient and recent, is explainable in terms of the modulating effects of the solar cycle on cosmic ray flux in the atmosphere. (See Svensmark H. Cosmoclimatology: a new theory emerges. Astronomy & Geophysics 48 (1): 1.18–1.24. A number of scientists, including Willie Soon of the Harvard-Smithsonian center for astrophysics, have produced research that confirms the solar cycle, particularly as it is recorded in proxies for cosmic ray flux, like Beryllium-10 and Carbon-14, is statistically a far better explanation for global temperature changes than is carbon dioxide.

As with carbon dioxide, the variation in the total solar irradiance by itself is far too small to directly explain the observed temperature changes. It too needs a "multiplier", which according to Svensmark comes in the form of the portion of the sun's output that deflects cosmic rays away from Earth. This varies by much more than the 0.1% of total solar irradiance. The part of the atmosphere that would be most sensitive to cloud formation due to increased cosmic ray ionization of the air is exactly the part to which the IPCC uses to amplify the small effects of man-made carbon dioxide, namely the moisture-laden air over warm tropical oceans. But for lack of nucleii for droplet formation, clouds would readily form. Ions produced by cosmic rays are said to form these nuclei.

Arnold Wolfendale of Durham University was recently quoted under the headline "Natural causes" not responsible for global warming, as stating that solar variation could not be responsible for more than 14% of the warming seen since 1956. As can bee seen in some of the attached figures, there is mischief in the choice of 1956 as the baseline, which was one year before the modern solar maximum's crescendo. 1956, 1957, 1958, and 1959 were the 12th, 1st, 2nd and 3rd most active solar years in the last 260 years of records. It is a little like saying that New Orleans is not sinking, because the average water level has not risen when compared to the peak of Hurricane Katrina.

The view of the man-made global warming skeptics, which appears sensible, is that the climate is less sensitive, and more stable than the IPCC models, and that this stability is manifest in the historical record, which includes periods that are both much warmer and much colder, and with much more CO2 than today. However, this relative stability can still be powerfully influenced by solar modulation of cosmic-ray seeded cloud formation.

The cruel joke that Nature appears to have played on climate scientists is that the Sun has been in a period of very high activity that rose from the Dalton minimum in the 1800s to a great crescendo in 1957, and has only recently started to subside. That this rising solar activity almost exactly parallels the Industrial Revolution and the increasing burning of fossil fuels has probably led many people astray in ascribing cause and effect. It is looking more and more like the sun is the driver, carbon dioxide is mostly just an effect of warming oceans (as warm soda goes flat), and anthropogenic global warming will join cold fusion and Lysenkoism on the ash heap of scientific history.

Now that we are in a period of very unusual solar quiet, the solar wind is at its lowest recorded level, and cosmic ray flux is at its highest. This not only has significance for climate, but also space exploration, as manned missions outside the Earth's protective magnetic field will be exposed to radiation from galactic cosmic rays at an all-time high, as will electronic components which can not be effectively shielded from these super-high energy particles.

I expect the coming decade will sort out who is right about climate, especially if the Sun persists in its current quiet ways. I hope our politicians don't cripple the global economy further in the name of reducing the output carbon dioxide, which is not a pollutant, and only weakly influential on climate. Although it is less than 0.05% of the atmosphere, carbon dioxide is a most precious resource. Every bit of carbon in our bodies was once CO2 in the atmosphere which nourished a plant, and then eventually us.

Monday, April 6, 2009

Why "Unfrozen Caveman?"

I've long been a fan of the late comedian Phil Hartman, and in particular his character Cirroc, the Unfrozen Caveman Lawyer, which was written by Jack Handey. So I've adopted this nickname partly as a tribute to the comic genius of these very funny men, but it is more that that.

Before becoming a physician specializing in oncology, I was a teenage "computer wiz", who got an education in applied physics, played at being an FM rock DJ and broadcast engineer in college, and a had 20 year career in computer-aided design software. Along the way I also practiced and taught martial arts, which gave me a kind of informal education in first aid, anatomy and exercise physiology (partly from my own minor injuries).

Most of my medical school classmates were 20 years younger than I was, and while we got along great there was this generation gap. The news of John Lennon's murder, which I saw during a late-night bull session in the basement TV lounge of a Cornell dorm, was still a vivid and painful memory for me that coincided for many of them with the year they were born. When I jokingly described my heavy five-o-clock shadow at the end of a very long day as "Nixonian," I got these blank looks. When I first took chemistry, a slide rule was required. For them, the 1960's and 70's were abstractions, whereas I had lived them. I also had the life experience of having three children, and a wife with type-1 diabetes, so when it came to obstetrics, pediatrics and endocrinology, I had a huge head start, mostly in simple comfort level, but in both formal and informal knowledge as well.

I think that part of the reason I came to medicine so late is that I became involved with computer programming so early, and so intensely. The other facets of my nature became "frozen" while that early adventure ran its course. Eventually I thawed myself out to become a little more well-rounded, and to discover my true calling.

So I called myself Unfrozen Caveman Medical Student, like Cirroc, a sort of noble savage from another time with an uncanny folk wisdom that I could bring to bear to solve the problem. Eventually, I became Unfrozen Caveman Intern, then Unfrozen Caveman Resident, etc.

Now, as Unfrozen Caveman MD, I find I still bring an "out of the box" perspective to problem-solving, which I hope will continue to be valuable resource on behalf of patients both in the lab and in the clinic.

Conflicts of Interest in Science and Medicine

There has been a small uproar in the medical community over how the editors of JAMA responded to a criticism of one of their articles. (For details see the WSJ Health Blog from 13-Mar-09 ).

The JAMA editors behaved shamefully when Dr. Jonathan Leo revealed in a letter to the BMJ not only the analytical weaknesses of a Lexapro study, but that these weaknesses were in the context of the author's undisclosed conflict of interest. Incredibly, rather than using the incident to improve their editorial process, the JAMA editors are seeking as a matter of policy to silence those who would publicly reveal their lapses.

They feel justified because they are mistakenly applying the model of the Protected Forum which facilitates discovery, and whereby physicians and hospitals seek causes and remedies for medical errors. However, an international, weekly publication is the opposite of a protected forum. Suppose a reporter publicized a story that a local hospital had removed the wrong kidney from a patient, and that witnesses believed the surgeon to be impaired. Should the hospital respond by telling the reporter that his family can no longer get care there? Should the hospital administrator call the publisher and ask that the reporter be disciplined or fired? No, the hospital should call the paper first, explain that there has been an incident, explain their internal procedures, and inform the public that the surgeon's privileges are suspended pending a complete review to determine where their patient safety procedures failed and how to improve them. There should be an apology to those harmed. They also have a duty to explain how hospitals that are transparent about their quality measures make patients safer. These actions by the JAMA editors are an affront to all of us in the truth-telling professions, physicians and journalists in particular.

However, I think people become confused when they elevate the absence of conflicts of interest to the status of a "purity test" that substitutes for the genuine scientific quality of a work. In scientific circles, legitimate disagreement over the merits of one treatment over another should not devolve into ad hominem attacks in the form of an accusation of some real or perceived conflict of interest. Plenty of good science is done with integrity by people with financial, academic, or emotional stakes in the outcome, and patients are harmed if this work is dismissed thoughtlessly. Conversely, plenty of bad science is done by people with little to gain or lose.

In some quarters there is an obsessive concern over conflicts of interest, however defined, that can become distorted into a cult of scientific asceticism. The truth is that in all fields of human creativity, money, power and sex have proven to be great motivators, both for good and ill. We should be open about this. I want the people who make major medical advances to accrue wealth, authority and emotional satisfaction. They've earned it. We should sleep much less soundly if those with the ability to improve our lives somehow had these motivations taken away.