Reflections on “Mountains Beyond Mountains”

Yesterday (Thursday) was the Share the Vision part of the orientation program for the new Case students. This year’s theme was based on the biography Mountains Beyond Mountains: The quest of Dr. Paul Farmer, a man who would cure the world by Tracy Kidder, which the incoming class had read over the summer. This is a truly inspiring book about a man who is driven to bring quality health care to the poorest of the poor, mainly in remote regions of Haiti. Severance Hall was almost full with students and faculty and I was one of the panel of speakers. Below is the text of the talk I gave to the group.
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The ethical dilemma of faith healing – 2

There were some very thought provoking comments (some of them sent privately) in response to my posting on the ethics of faith healing. In one of the comments, Erin made a very telling observation that I’ve been thinking about and which prompted me to revisit the topic.

Those of us who do not believe in a god who intervenes in daily life tend to think of faith healing (if it works at all) as purely a placebo effect whose success depends on people believing that there is something real going on. As I said before, I have a real problem with how to deal with this.

On the one hand, the rationalist/skeptic in me wants to actively debunk all faith healers as, at worst, cynical con artists who are preying on the gullible for monetary gain or for fame and glory, or at best as self-deluding people who genuinely believe that they have some sort of gift. Even if a few people are of the latter kind, allowing them to propagate the belief that faith can heal allows the charlatans amongst them a greater chance of swindling others.

On the other hand, the humanist in me wants to keep out of the issue since I don’t want to jeopardize the chances of a “cure” for a few people, even if it is placebo induced.

In these types of discussions, we tend to contrast the placebo effect (which is based on an illusion) with the effects produce by modern medicine, which is assumed to be based on science and is thus real. But Erin points out that the medicine-as-science versus placebo-as-quackery distinction isn’t as clear-cut as one might imagine.

On the third floor of Allen building (where my office is) is the Dittrick Medical History Museum. It consists of just two rooms but contains enough devices and descriptions of past treatments to make me glad that we live in the current age. If one goes back in medical history, one finds all kinds of treatments that were once fully endorsed by the medical establishment and are now discredited. Some of them (such as bleeding using leeches) are pretty bizarre. The museum is free and open 10:00 am-4:30 pm Monday through Friday, and well worth a quick visit.

So what are we to make of these past treatments? Based on current science, we have no reason now to think that they should work, so any success they had must have been due to the placebo effect. But since the medical establishment believed in those treatments then, they must also have been considered science at that time. One assumes that the physicians of that time recommended these treatments with complete sincerity and achieved some “cures”. What distinguishes them from the sincere faith healers of the current times?

Can we maintain the distinction between science and the placebo? Some argue that we cannot. I have heard it said that: “The history of medicine is the history of the placebo.” This may be a little strong but it has enough truth in it to be disquieting. What if current medical treatments are also placebos? It could be that a few generations from now, people will marvel that bodies were once cut open with sharp knives or that strong chemicals were introduced into the bloodstream, all in the name of medicine-as-science.

One way to get around the problem is to think that past generations of medical scientists were simply wrong and that we are fortunate to happen to live in an era when science has come into its own, producing real cures, and that our current successful treatments are permanent. Some science triumphalists extend this argument across the board, arguing that current scientific knowledge, unlike that of its predecessors, is right in its essentials and that all that awaits us in the future are minor improvements, tinkering at the boundaries.

I am always a little wary of assuming that we live in a special time in history, whether it is a high point (as asserted by the science triumphalists) or an especially low point (as asserted by those Christian fundamentalists who think the country has gone to the dogs and want to return it to a previous era by putting religious symbols in the public sphere and overthrowing evolutionary theory). While changes have undoubtedly occurred and in some cases for the better, we may not be too different from our predecessors in our ability to distinguish good science from bad, or science from non-science.

One thing that has definitely improved is our research protocol methods. At least with double-blind clinical trials, we can have some confidence that some of the medical treatments we use are truly beneficial. But that still does not solve our problem of the ethics of faith healing and whether we should try and debunk them, whether the practitioners are sincere or not.

That’s the trouble with true ethical dilemmas. There is no obvious right answer.

POST SCRIPT 1

Tom Tomorrow spells out how supporters of the Iraq war avoid reality.

POST SCRIPT 2

As usual, Jon Stewart of The Daily Show has the best take on Pat Robertson’s latest idiocy and the coverage of it (via onegoodmove).

Science and trust – 2

As I discussed in an earlier posting, trust plays an important role in science. It is hard to imagine science functioning as well as it does if everyone started being suspicious of each other. I see disturbing signs of this recently in the field of medicine. Increasingly, academic research on new drugs is being funded by private pharmaceutical companies that have a vested interest in the results coming out in favor of whatever drugs they are trying to market. Thus they can exert subtle and not-so-subtle pressure on the researchers to manipulate the results, since they are controlling the flow of money. This can raise suspicions about the credibility of the scientists who do this kind of sponsored research.
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The college rankings game

I was walking around the campus yesterday and it was wonderful. The day was cool and sunny and the campus was green and inviting, reinforcing my feeling that over the last fifteen years Case has transformed itself from an ugly-building and surface-parking-lot dominated landscape to one of the most attractive urban campuses in the nation. This is especially so this year with the new dorms that have opened up (I went on the tour last week and was really impressed by their spaciousness and tastefulness) and the new playing fields.
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Science and trust

My first scientific paper involved correcting an error made by others in an earlier paper published on the same topic. The error was a very simple one (a plus sign had been replaced by a minus sign) but had been buried in a complicated calculation that made it hard to detect. However, the consequences of the error were quite significant and had caused some puzzlement amongst the physicists in that subfield.

Ironically, some years later I too made a sign error in a published paper and my error was pointed out by someone else.

This kind of mistake and correction happens in science. Scientists are generally cautious and careful (otherwise they cease to be taken seriously by their peers) but are not infallible. And when they make a mistake, they are corrected by their peers, either in print or in private, and they move on. It is almost invariably assumed that the error was an honest mistake, not an attempt to cheat. Scientists trust each other.

In fact, the whole enterprise of science is based on trust and could not function otherwise. This does not mean that there are no checks in the process but those checks are not designed to catch fraud.

The process of peer review is one such measure. In this process, once the editors of a journal receive a submission, they send it out to (usually) two or more scientists who work in the same field to review the paper and recommend one of three actions to the editors – accept, reject, or make revisions.

I have had my papers reviewed by anonymous peers and have reviewed the papers of others. The point of the review is to check for clarity and completeness and proper methodology. The reviewer does not usually try to reproduce the paper’s results but instead tries to get a feel for whether the paper’s conclusions make sense and are consistent with other information. The reviewer assumes that the authors are honest, that the data given is correct, and that the calculations the authors say they made using the data have been done with due care.

So how do errors and fraud get caught? The way this usually happens is when another scientist wants to build on the previous published work and extend it or take it in a new direction. Then that scientist usually begins by trying to reproduce the results of the earlier work, and it is because of this that errors usually get detected. This is why reviewers try to make sure that all the information necessary to reproduce the results is present in a paper, even if they do not actually check the results themselves, so that future work can be built on it. (This is how the two errors that I was personally involved in got detected.) Clearly the chances of errors being detected become greater if the original work has major significance since then many people want to take advantage of that work and try to reproduce the results.

An example of this process at work occurred just this month with the important issue of global warming. While there is an emerging scientific consensus that it is occurring, there are disagreements over details. As the website What’s New reports: “One detail was records that were interpreted by a group at the U. Alabama in Huntsville as showing that the troposphere had not warmed in two decades and the tropics had cooled. However, three papers in Science this week report errors in the Alabama-Huntsville calculations. It seems that warming of the troposphere agrees with surface measurements and recent computer predictions. The group at Alabama-Huntsville concedes the error, but says the effect is not that large. That’s the way it’s supposed to work.”

If no one else cares about the work or is unaware of it, errors can remain undetected. Since trust is assumed, it is possible for an unscrupulous author to abuse that trust and to falsify and fabricate data and results and get their work published. But to remain undetected over an extended period of time usually means that the work was not considered of much use to begin with and was ignored by the scientific community.

Another way in which trust manifests itself in science is that unless there is some reason to suspect otherwise, scientists assume that whatever gets published in a journal (especially one that is peer-reviewed) is correct, even if they do not know the authors personally or even know the field. So scientists quote each other’s work freely, and often base their own papers on the work of others without knowing for sure whether that work is correct or not.

This might seem to be a risky thing to do but it is this very interconnected nature of science that keeps the system functioning. If at some point a result shows up that is plainly wrong or does not make sense, people can sometimes trace through the network of connections and find the original error that triggered the problem. Thus even errors that have remained undetected for a long time can suddenly surface because of research done in a seemingly distant area.

Given this feeling of openness and trust, it is possible to manipulate the system and get fraudulent results published. This can be for bad reasons such a deliberate fraud for personal gain (say because the authors are trying to pad their resumes or are trying for fame and hoping not to get caught). These are clearly wrong. But there are reasons for faking that, at least on the surface, may be good and these raise ethical issues that I will examine in a the next few postings.

The ethical dilemma of faith healing

Those people who read the Plain Dealer would be aware of the sudden rise to fame as a faith healer of Dr. Issam Nemeh, a general practitioner (and Catholic) in the Cleveland area who also practices faith healing, in the form of using heated acupuncture-type needles, the passing of hands, and prayer.

The Plain Dealer has given him considerable coverage in the past, leading up to well-attended faith healing services held earlier this year in a Catholic Church and at the HealthSpace Cleveland Museum. He is now said to be the area’s most sought after physician, booked through 2006, and patients often wait until midnight to get to see him, paying $250 for appointments.

But not everyone is happy and a recent article reports on those who feel they have been had. They say that he made claims about their cures that were not substantiated, and that his assistants seemed to be overly concerned with getting their money and made outlandish claims that angels visited him regularly.

Is Nemeh a fraud? It is tempting for those of us who are not religious to think so, since we do not believe that supernatural forces exist. After all, a recent study in the medical journal The Lancet (free registration required) finds that prayer and touch have no effect and Bob Harris argues on other grounds why such claims are unlikely to be true.

This is not the first time that claims that prayer leads to successful healing have been found to be wanting. The December 3, 2004 issue of the newsletter What’s New said:

PRAYER STUDY: COLUMBIA PROFESSOR REMOVES HIS NAME FROM PAPER. We have been tracking the sordid story of the Columbia prayer study for three years (WN 05 Oct 01). It claimed that women for whom total strangers prayed were twice as likely to become pregnant from in-vitro fertilization as others; it was published in the Journal of Reproductive Medicine. At the time we were unaware of the background of the study, but knew it had to be wrong; the first assumption of science is that events result from natural causes. The lead author, Rugerio Lobo, who at the time was Chair of Obstetrics, now says he had no role in the study. The author who set up the study is doing five years for fraud in a separate case, and his partner hanged himself in jail. Another author left Columbia and isn’t talking. The Journal has never acknowledged any responsibility, and after withdrawing the paper for “scrutiny,” has put it back on the web. Nor has the Journal published letters critical of the study. Columbia has never acknowledged any responsibility. All of this has come out due to the persistence of Bruce Flamm, MD. The science community should flatly refuse all proposals or papers that invoke any supernatural explanation for physical phenomena.

While it is natural for religious believers to think there could be some healing effect of prayer, it is possible for non-believers in a supernatural power to accept it too. Even if there is no god, the mind-body connection makes it possible that a person’s will and attitude can influence the biochemical processes in the brain and body and produce actual physical effects. As the Plain Dealer article on Nemeh states “Even skeptics agree that faith and prayer can improve one’s mental state, which can in turn promote physical health. Some also suggest that people who report being cured by faith healers are probably experiencing a placebo effect, a powerful phenomenon in which symptoms improve on the mere belief that a remedy is at hand.”

And it is this possibility that causes the ethical problem. Here is a hypothetical situation. Suppose that a small number of people (say about 1% of those who are sick) respond favorably to “faith healing” this way via the mind-body connection or placebo effect. The catch is that we do not know a priori which ones will do so. Since it seems essential that people have faith in order for this method to work on them, everyone has to maintain the illusion that god is acting through prayer.

So here is the dilemma. If someone believed that there was no god but still wanted to help people, is it unethical for them to pretend to be a faith healer and treat people? After all, even if just 1% get better and nothing bad happens to the rest, isn’t that still a positive result? I am assuming that everyone is acting on the best of motives and that the “faith healers” are not con artists preying on desperate and gullible people and swindling them out of their money. Let us assume they are pretending to be faith healers for purely altruistic reasons.

And as for the rest of us who have no ambitions to be faith healers but are simply skeptical observers, should we go all out to debunk faith healers in the name of truth and because we feel it is bogus or should we just stay out of the whole thing because of the benefits it might be having on a few people? If you were the faith healer’s friend and knew that he/she was faking belief, would you feel obliged to expose him/her in the cause of truth?

One negative that immediately comes to mind is that people who believe in faith healers might neglect taking conventional treatments that might help them. Another is that the disillusionment that comes with failed faith healing efforts might make these people despair and think that god either does not care for them or wants them to die, creating a negative mindset that surely cannot be helpful.

I think this question illustrates the dilemmas that often occur when abstract principles of truth and honesty come into collision with the needs of real people in desperate need.

How governments lie-2: The London killing

In a previous post titled How governments lie, I warned about how early accounts that official sources put out in the wake of some major event often have only the remotest connection to the facts and are usually designed to imprint in the public mind what the governments want the public to believe.

It looks like the killing on July 22 of an innocent Brazilian electrician Jean Charles de Menezes man in a London subway station is following the same pattern. If you recall, in that case the official story put out was that the man was directly linked to a terrorist investigation and had been under surveillance, was wearing a bulky jacket on a very hot day, refused to obey a police order to stop, ran away from the police, vaulted over the ticket barrier, and was shot when he tripped and fell. His highly suspicious behavior seemed to make the shooting excusable.

Now on August 14 the London Observer newspaper has a long story that says that all these assertions were false. Here are items from the story:

Initial claims that de Menezes was targeted because he was wearing a bulky coat, refused to stop when challenged and then vaulted the ticket barriers have all turned out to be false. He was wearing a denim jacket, used a standard Oyster electronic card to get into the station and simply walked towards the platform unchallenged…..

One witness, Chris Wells, 28, a company manager, said he saw about 20 police officers, some armed, rushing into the station before a man jumped over the barriers with police giving chase.

In fact, by the time the armed officers arrived de Menezes was already heading down towards the train. It now seems certain that the man seen vaulting the barrier was one of the armed officers in hot pursuit. (my emphasis)

Some events in de Menezes’ life shed further light on his behavior.

For de Menezes life in London was for the most part uneventful. He had been stopped by police a few times as part of routine stop and search inquiries, once having his bag examined by officers outside Brixton tube station.

On each occasion the police had asked him to stop and he did so. However, on each occasion the officers concerned were in full uniform.

Two weeks before he was killed, de Menezes had been attacked by a gang of white youths, seemingly at random. According to friends this experience left him shaken and nervous….

No one knows what went through the young man’s mind in the last moments of his life. Having been attacked just weeks earlier, he may have believed the casually dressed white men chasing him were part of the same gang. He may have been thinking of the experience of his cousin who was caught by immigration officers in America and deported before he had the chance to finish saving for his dream home. Now de Menezes is dead and no one will ever know.

A subsequent Guardian story on August 17 says that secret leaked reports say that he had been seated in the train and was not even running when he was shot, and had been overpowered by the security forces and in their grip when he was shot.

The young Brazilian shot dead by police on a London tube train in mistake for a suicide bomber had already been overpowered by a surveillance officer before he was killed, according to secret documents revealed last night.

It also emerged in the leaked documents that early allegations that he was running away from police at the time of the shooting were untrue and that he appeared unaware that he was being followed….

CCTV footage shows Mr de Menezes was not wearing a padded jacket, as originally claimed, and that he walked calmly through the barriers at Stockwell station, collecting a free newspaper before going down the escalator. Only then did he run to catch the train.

A man sitting opposite him is quoted as saying: “Within a few seconds I saw a man coming into the double doors to my left. He was pointing a small black handgun towards a person sitting opposite me. He pointed the gun at the right hand side of the man’s head. The gun was within 12 inches of the man’s head when the first shot was fired.”….

The documents reveal that a member of the surveillance team, who sat nearby, grabbed Mr de Menezes before he was shot: “I heard shouting which included the word ‘police’ and turned to face the male in the denim jacket. He immediately stood up and advanced towards me and the CO19 [firearms squad] officers … I grabbed the male in the denim jacket by wrapping both my arms around his torso, pinning his arms to his side. I then pushed him back on to the seat where he had been previously sitting … I then heard a gun shot very close to my left ear and was dragged away on to the floor of the carriage.”

There is an interesting sidelight about the closed circuit televisions (CCTV) that are everywhere on the London underground system and would have provided footage from dozens of cameras covering the Stockwell ticket hall, escalators, platforms and train carriages. Pictures from those cameras were widely shown by the police in their investigation of the earlier (July 7) bombings.

But in the initial report, police said most of the cameras were not working. The secret report revealed, however, that it was the CCTV that showed de Menezes walking slowly and not vaulting the turnstile. It is always interesting how evidence seems to “disappear” when the information it could provide might be embarrassing for the government. Could it be possible that the official authorities put out the story that the CCTV was not working hoping that they thus would not have to show them to the public and reveal that they contradicted the official story?

I ended my earlier post by saying that this is why I always take initial news reports of such events with a grain of salt. I believe that all governments, without exception, lie to their people, routinely and without shame. This event only confirms my view.

POST SCRIPT

If “Intelligent Design” is to be put on a par with evolution, surely the theory of “Intelligent Falling” (IF) as a competitor to gravity must be close behind? The editors of The Onion think so. (Thanks to Nicole for the link.)

The article quotes IF spokespersons who say: “Things fall not because they are acted upon by some gravitational force, but because a higher intelligence, ‘God’ if you will, is pushing them down….Gravity – which is taught to our children as a law – is founded on great gaps in understanding. The laws predict the mutual force between all bodies of mass, but they cannot explain that force.”

IF advocates “insist they are not asking that the theory of gravity be banned from schools, but only that students be offered both sides of the issue so they can make an informed decision.”

The article also points out that scientists admit that “Einstein’s ideas about gravity are mathematically irreconcilable with quantum mechanics. This fact, Intelligent Falling proponents say, proves that gravity is a theory in crisis.”

Sounds convincing to me. I never liked gravity anyway. It was always bringing me down.

Should atheists “come out”?

In a previous essay, I suggested that people tend to have a negative view of atheism. In his blog essay Sam Harris provides support for this view, saying that “More than 50 percent of Americans have a “negative” or “highly negative” view of people who do not believe in God.”

Possible reasons for this dislike were discussed earlier but here I want to focus on what, if anything, should be done about it.

One option is to just ignore it. After all, why should atheists care what other people think of them? But this ignores the fact that if atheists allow themselves to be defined by others in negative terms and do nothing about it, they allow the negative portrayals of them to dominate public consciousness.

Another option is for atheists to learn from the steady way that gay people have won increasing acceptance. This has partly come about because gays are “coming out” more to their families and friends and co-workers. They are becoming more visible in everyday life and are being seen as ordinary people. Famous actors are revealing themselves as gay without it being career suicide and gay characters are appearing in films and plays and on television, without their gayness being necessary to the storyline. The fact that they are gay is just incidental.

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Should all scientists try to accommodate religion?

Within the scientific community, there are two groups, those who are religious and who hold to the minimal scientific requirement of methodological naturalism, and those who go beyond that and are also philosophical naturalists, and thus atheists/agnostics or more generally “shafars”. (For definitions of the two kinds of naturalism, see here).

As I have said earlier, as far as the scientific community goes, no one really cares whether their colleagues are religious or not when it comes to evaluating their science. But clearly this question matters when science spills into the political-religious arena, as is the case with the teaching of so-called intelligent design (ID).
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Has the ID movement jumped the shark?

Some time ago, I wrote that I was not worried in the long term about the so-called intelligent design (ID) movement because it would ultimately lose, sharing the fate of all previous faith-based theories in their disputes with science.

The reason is that science has no place for useless ideas. Theories that do not have mechanisms or make predictions or which can be used for some purpose simply do not make it in science. And ID strikes out on all three of those requirements, thus fitting perfectly the description of a useless theory. All it does is provide a story that meets the needs of those who want to think that god intervenes in the world. And that’s fine as far as it goes. But what good are such stories for science? Science even prefers demonstrably false theories as long as they are useful. Excellent examples of such latter theories are Newton’s laws of motion and gravitation.
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