Science, lies, evidence, knowledge

In so many fields, owing to the Internet-driven democratization of knowledge, we learn that that the power associated with hoarded knowledge has been abused, and the position of leadership – the priesthood – associated with the acquisition of knowledge has been leveraged to manipulate and deceive. “Everything you know is wrong!”

David Freedman has a great article in the Atlantic about medical deception, called “Lies, Damned Lies, and Medical Science,” which focuses on Dr. John Ioanniddis’ dedication to exposing bad science in medicine.

He’s what’s known as a meta-researcher, and he’s become one of the world’s foremost experts on the credibility of medical research. He and his team have shown, again and again, and in many different ways, that much of what biomedical researchers conclude in published studies—conclusions that doctors keep in mind when they prescribe antibiotics or blood-pressure medication, or when they advise us to consume more fiber or less meat, or when they recommend surgery for heart disease or back pain—is misleading, exaggerated, and often flat-out wrong. He charges that as much as 90 percent of the published medical information that doctors rely on is flawed. His work has been widely accepted by the medical community; it has been published in the field’s top journals, where it is heavily cited; and he is a big draw at conferences. Given this exposure, and the fact that his work broadly targets everyone else’s work in medicine, as well as everything that physicians do and all the health advice we get, Ioannidis may be one of the most influential scientists alive. Yet for all his influence, he worries that the field of medical research is so pervasively flawed, and so riddled with conflicts of interest, that it might be chronically resistant to change—or even to publicly admitting that there’s a problem.

At e-Patients.net, Peter Frishauf writes a response to the Atlantic article, called “Fixing those Damn Lies.” How do we fix them? The Atlantic piece discusses Ioannidis’ suggestions to change the culture of medical research, and reset expectations. It’s okay to be wrong in science – in fact, it’s almost a requirement. The scientific method is about testing and proving hypotheses – proving can be “proving wrong” as well as “proving right.” Either way, you’re learning, and extending science.

Frishauf also mentions how medicine and science should embrace the Internet “and figure out a way to better incorporate patient self-reported and retrospective data in trials,” which is one goal of participatory medicine. He also suggests “giving up on tenure-tied-to-the-peer-reviewed-literature, and embracing a moderated form of pre and post-publication peer review,” something that came up in discussion when I spoke at the Central Texas World Future Society Tuesday evening. (More about this in an earlier e-Patients.net post by Frishauf.)

Knowledge is not a citadel or ivory tower, but a network that we could all be working, challenging, and improving.

TEDx Austin notes

Here are some notes from my TEDx Austin experience yesterday at the Austin City Limits studios on the campus of the University of Texas, hanging out with 300 or so people, listening to a series of very interesting talks. This was an independently organized TED event, limited by TED policy to 300 people. Licensee Nancy Giordano, who moved to Austin eighteen months ago from Los Angeles, pulled together a local team of volunteers to produce the event. For something put together on a wing and a prayer and a bit of donated time, the results were very good.

TED is about “the power of ideas” or “ideas worth spreading. ” Some think it’s a tech event, but tech is only the “t” in the acro, there’s also Entertainment and Design. Also, per Nancy’s opening, it’s about giving people ideas for a future they can believe in. Overriding theme of this particular TEDx: PLAY BIG.

My notes:

  • Rip Esselstyn talked about his Engine 2 Diet, which is plant-based and excludes any animal products as well as oil. His intro was about the nutritional bases for many common diseases – heart disease, cancer, diabetes. We work hard to find ways to cure or prevent these diseases without looking at the obvious source of the problem, which is the American diet, very heavy on animal products, processed foods, fats. Rip, a former firefighter, noted that 80% of all fire department calls are not about fire at all, but about fighting Western disease. He thinks it’s time for the USA to acknowledge the nutritional problem and make a change, for which he’s evangelizing. Quoted Winston Churchill: “America always gets it right, but only after they have tried everything else.”
  • Doug Ulman said “small is the new big” and talked about changing the label “nonprofit” to something else.
  • Many thought Steven Tomlinson was the best speaker. Coincidentally, my friend Rob Matney was telling me about Steven earlier in the week – “this is somebody you really have to meet.” Indeed. He talked about deciding what you want to do and be and, even if you want diverse things, finding a way to engage wholeheartedly with all of them, as he has done (he teaches business, writes and performs plays, and has attended seminary). We don’t need careers, we need callings. A calling is where your deep passion meets the world’s deep need. We need to stare at things until they inspire us and inform us – “until it becomes in us what it needs to be.” Our fantasies are a first offer of what might be. In summary, practice, pay attention, don’t discard. Show up. Lead with what you love.
  • Chris Mueller of Life Technologies gave a fascinating overview of gene sequencing. As we understand the human genome better we can approach personal genomics which is a foundation for personalized medicine. [I’ve always felt a core flaw with the healthcare system as it is today is in a generalized approach to the human system, whereas each of us is unique – I hear that organ shape, size, and arrangement can vary quite a bit from one human to the next, and we all have a unique cellular code with general similarities. Something to think about.]
  • Chris Shipley said we should rethink how to be big in business – by staying small. She used the analogy of the Sumo wrestler, who is big and powerful but not particularly agile, and the Peloton in a bicycle race, which is agile and collaborative. Small companies do more with less, are more innovative, and the customers of small companies are engaged (because scale creates barriers). The value creation by all small businesses is kind of a long tail – far greater than the value creation the the Fortune 500. She’s an organizer of Innovate 2010, which is sponsoring global “pitch slams.”
  • My friends Suzanne and Dave Armistead did a short version of the much longer “Moving Love” performance, which celebrates their son Davis’s short life. It’s also about their grief over his death, and how responding to that grief brought them to a greater awareness and appreciation of life, and a deeper connection to Davis. Very powerful.
  • Dr. Bill Merrill talked about the devastation of Galveston by Hurricane Ike, and his proposal to build a $3 billion Ike Dike to prevent further disasters. Significant hurricanes like Ike strike the Galveston coast at least once every fifteen years, and with climate change there could be more strong hurricanes than usual. Merrill borrowed his idea from the Dutch, who’ve build a system of “gates” for protection. He said that you can’t really quantify the loss from Ike in dollars – 40,000 monarch oaks were destroyed, and historic iron-front buildings were devastated, probably beyond recovery. Evacuation doesn’t really work – the Rita evacuation was impossibly chaotic, 30 people died as a result.
  • Mark Rolston of Frog Design talked about user experience, the increasing degree to which computerized devices are embedded in our environment. He showed the “Santa Claus of the subconscious” clip of Ralph Fiennes in the film “Strange Days,” the point being that “jack into the matrix” and download experiences. He didn’t really pursue that, burt got into the transformation of objectsin the environment, and made a distinction of first life (physical) vs second life (digital). I don’t know that it’s valid to make the distinction, but it enabled his point that “second life” is grwoing in fidelity and frequency, and starting to compete for mindshare with first life (physical) experience. There’s an entangling of the two, which we see in location-based augmented reality applications that are starting to appear. Human computer interface (his field) is evolving quickly, and touch is an important step (think how so much of the iPhone experience is organized around touch). 3D controls are coming, too, as on the Wii. The computer is learning to interact with our world – he suggests that computers are beginning to “understand.” I’ve always argued that this claim is somewhat bogus – computers intelligence is simulation, I haven’t seen anything to suggest otherwise though brilliant scientists like Ray Kurzweil and Hans Moravec suggest the possibility. Rolston went on to say that computer experience is no longer tied to devices, that we can tag our world, create map overlays with citizen notes, etc. We are beginning to get embedded or peripheral devices attached to our bodies – “your heartbeat becomes a conversation.” This was probably the talk I resonated with least, because it was a rehash of old thinking with very little that seemed innovative – but for many in the audience, it might have seemed new and stimulating.
  • Carrie Contey, who focuses on prenatal and perinatal psychology, talked about “the power of the pause.” Her studies suggest that the brain reaches a kind of saturation point, and at that point it’s important to pause in some way. She talked about a baby turning away at some point, shutting off attention in order to process. She talked about “big being in a small body.” Development is doing and being. The brain lights up, then pauses to integrate, at which point what happens is 1) orientation, 2) regulation, 3) integration, and 4) inspiration. In stillness, there’s room for creativity to bubble up and pop. In being, there is more room for our authentic self. In modern life, with so many sources of stimulation, it’s important to pause – pausing should be a priority for us. Creativity requires space; do less and be more. This meant a lot to me – I’ve been dealing with a lack of creative space.
  • Turk and Christy Pipkin showed their more recent work via the Nobelity project. They have a new film near release, “One Peace at a Time.” “You can’t build a wall by starting at the top.” They’re reading out to people, trying to get many small donations. They’ve been working in a particular African village to bring clean water and nutrition – which should both be considered a human right.
  • Bob Hunt is a former nuclear engineer who, disenchanted after Three Mile Island and Chernobyl, left that industry and became an entrepreneur and inventor. He created a wind turbine that was inspired by the way a wind chime works. He realized you could integrate gravity and thermodynamics to get more power. He developed a Gravity Assisted Airplane, and a Gravity Assisted Wave Energy Device. More recently he’s been developing a gravity-assisted way to extract geothermal energy from existing dormant wells. Others who have attempted to do this got undramatic output, but his system should be more effective. It occurred to me that this would mean shifting the wells from production of transportation energy to production of energy for the build environment. (Though in fact the wells are inactive, so the real shift is from inactive to active in a different context).
  • Richard Garriot talked about the new space race. Many of us were disappointed that the Kubrick/Clarke vision of space travel by 2001 never came to be, and on February 1st, President Obama ended funding for planned manned space projects. However private industry will step in, and the government and others can contract manned missions and space development, as they currently contract satellite launches. He talked about major players in the field, and how the “NASA primes” (those who were part of the original government space efforts) are getting involved with the private efforts. In a conversation between sessions, Richard told Derek Woodgate, Brandi Clark, and I a bit about his own space mission, how seeing the earth from space, it was clear to him that we’re more resource-constrained than we realized. He’s retooled his home and cars to conserve energy, and has taken an interest in sustainability projects.
  • John Phillip Santos, formerly a poet, brought up DNA again, and talked about genealogical genetics. We’re learning more about our ancestral code. E.O. Wilson talks about reinventing an ethic of our origins. What are we becomgin? What is our true origin? Advocating a mestizo world view. Shows a partially-erased (by the subject) image of Carlos Castaneda. Brown is the new white? Yellow is the new brown? Actually, mixed is the new white. We have mixed cultures that have emerged through patterns of migration. Borders are less meaningful. “No borders will stand.” How will genetics be encoded into personal devices? Into persons? Genetics will change from read only to read/write.
  • Philip Berber: every three seconds a child dies because they’re too poor to live. One in five in the third world will not reach their fifth birthday. Every year we give three billion to charity in the U.S., but only 5% of that to international causes, because we don’t trust that the money will be used as intended. Fears of mismanagement. Berber left business, has created a nonprofit with his wife called A Glimmer of Hope Foundation. Focusing on projects in Ethiopia. Asked locals what they need and want: clean drinking water, a place to go to the bathroom, classrooms for their children. Empower them to lift themselves out of poverty – they have the motivation, but they need funding. Partnership: “We buy the bricks, they build the walls. We buy the pump, they dig the hole.” Giving a hand up and a handout. The way out of poverty is to have money via microloans. Funding women in Ethiopia, who are very good at putting small businesses into operation. Donors just need to be able to make informed choices about where their money goes.
  • Final talk was by Mark McKinnon, who talked about how his wife’s bout with cancer taught him to value her and to value life. He has a jar full of beads, as many as he’s estimated he has days left in his life. Each day he takes a bead from that jar, and drops it into another, and thinks how thankful he is to be alive.

One last note – via my good friend Honoria Starbuck as we talked… she said her advice to people how are down is this: “Save your pessimism for the good times.”

Complete speaker list with links. Watch the TEDx Austin site for videos!

Another set of notes from my friend John McElhenney provide another perspective – and more about Doug Ulman’s talk. (For some reason I took few notes while Doug was speaking.)

Here’s another account by Carla Thompson at Guidewire Group.