A Pioneer of Personalized Medicine

Genotopia has a terrific thumbnail of the life and work of Barton Childs:

But his most important contributions were his steady, articulate advocacy of the importance of genetics for medicine. Like his mentor Harris, Childs’s passion was variation. He was not interested in finding “the gene for” a disease; he wanted to understand how our genes contribute to variability in disease. What is it that makes us each biochemically and genetically unique? In particular, he was interested in bringing an understanding of the principles of genetics and evolution into medical education. He was fascinated by the challenge of molding physicians’ minds as the most potent way to improve medical care. By influencing how doctors think, he believed, one could have the largest possible effect on how patients are treated.

This post originally and erroneously described Barton Childs as the founder of personalized medicine. Pioneer is more accurate.

"The Struggle for Africa" and the AIDs Epidemic

The Washington Post has a fascinating excerpt from Craig Timberg and Daniel Halperin's forthcoming book Tinderbox. Money quote:

One of the first victims — whether a hunter, a porter or an ivory collector — gave HIV to a sexual partner. There may have been a small outbreak around the trading station before the virus found its way aboard a steamship headed down the Sangha River.

For this fateful journey south, HIV could have ridden in the body of these first victims, or it could have been somebody infected later: a soldier or a laborer. Or it could have been carried by a woman: a concubine, a trader.It’s also possible that the virus moved down the river in a series of steps, maybe from Moloundou to Ouesso, then onward to Bolobo on the Congo River itself.

There might even have been a series of infections at trading towns along the entire route downriver. Yet even within these riverside trading posts HIV would have struggled to create anything more than a short-lived, localized outbreak.

Most of this colonial world didn’t have enough potential victims for such a fragile virus to start a major epidemic. HIV is harder to transmit than many other infections. People can have sex hundreds of times without passing the virus on. To spread widely, HIV requires a population large enough to sustain an outbreak and a sexual culture in which people often have more than one partner, creating networks of interaction that propel the virus onward.

To fulfill its grim destiny, HIV needed a kind of place never before seen in Central Africa but one that now was rising in the heart of the region: a big, thriving, hectic place jammed with people and energy, where old rules were cast aside amid the tumult of new commerce.

It needed Kinshasa. It was here, hundreds of miles downriver from Cameroon, that HIV began to grow beyond a mere outbreak. It was here that AIDS grew into an epidemic.

Book Review: Paul E. Stepansky, The Last Family Doctor: Remembering my Father's Medicine (Montclair, NJ: Keynote Books 2011)

At some point while reading Paul E Stepansky’s memoir (notes here), you are going to think that something has gone terribly wrong. It might be that the fillip for your discovery was that on the way to work, you noticed that another hospital or clinic was being built in your neighborhood. Or perhaps you were reading this book just when you decided to have your eyes tested: at your local eye doctor’s practice you spent twenty minutes filling out forms, twenty minutes awaiting your doctor visit, and between five and ten minutes actually having your vision tested. You wondered when you got home and found out that your HMO wasn’t covering your visit because your deductible had been changed by your HR department: was this visit worth the effort and expense?

Somewhere in his writings Gandhi observes that you can judge the health of a society by the size of its hospitals – the larger the hospitals, the sicker the society. And how can one resist agreeing with his assessment? Drive through Cleveland and you’ll notice that the only viable industry in the city is medicine. Or note, irony of ironies, that in Pittsburgh, the old and grand U.S. Steel Skyscraper is now labeled UPMC – i.e. University of Pittsburgh Medical Center.

Against this increasingly bizarre backdrop of post-industrial apathy and postmodern culture, it is hard to resist the charms of Stepansky’s memoir. Indeed, his book ought to be required reading for everyone, but especially medical professionals. In it readers will encounter memories of a different world, one where, as Stepansky writes, “… medicine was medicine as a calling, not medicine as commerce, however tempered by a caring sensibility and hemmed in by professional ethics the latter may be” (pp. xi-xii). For in the transformation and shift from the small clinic and hospitals of a manufacturing society to the medicalized skyscrapers of the postindustrial order, much Stepansky argues was lost as our doctors stopped caring “for individuals and their families from birth to death." (p. xiii) And one of the most important qualities lost was an attitude of generalism, a  sensibility that many medical practitioners possessed that made them desire to learn as much as possible about as much as possible.

Stepansky’s story is about a recollection of his father’s medicine – a medicine that was sometimes “literally strong” as in the case of an elixir that he mixed and proffered his sick patients and was sometimes ‘figuratively strong’ in the way it adopted – Hercules-like – its commitment to intellectualism, artistry, and professionalism.  A musician trained in pharmacy, a veteran of the Second World War who travelled with War and Peace in his backpack across war-torn Europe, a Jewish Romanian-born son of Ukrainian peasants in a medical world with great antipathy to Jewish students, Stepansky’s father entered Jefferson Medical College in 1947 and eventually became a generalist physician:-

Upcoming Talk: 13 March 2012, Rhodri Hayward (Queen Mary) "Ulcers, Cortisol and the Remaking of Modern Britain"

Dr Rhodri Hayward

Institute of Historical Research

Gordon Room G34, South Block, Senate House London WC1E 7HU

Tuesday, 13 March, 5.15 p.m

From the early 1930s psychology, psychiatry and neurophysiology populated the world with a novel collection of concepts and objects - such as the 'anxiety neuroses', the 'unconscious', 'nervous ulcers', 'cortisol', 'stress' and 'lifestyle' - that allowed emotions, selfhood and social relationships to be described in new ways. Concentrating upon the uptake of the language of stress from the late 1930s this paper will show the concept disrupted traditional ideas of causality, temporality and influence while at the same time providing a new point of reference point for political intervention and a new landscape for government action. In particular I want to look how the language of stress was used to bring together two different orders of time - the evolutionary inheritance of the Pleistocene environment and the lived experience of post-war Britain - and then consider how this bifurcated understanding of emotions and temporality made possible new forms of political action. Examining the rhetorical function of stress in events such Coronation Bus Strike of 1937 or the planning of Harlow New Town should allow us to critically interrogate the turn to evolutionary neuroscience in contemporary historiography and the adoption of a 'happiness agenda' in modern government.

Note: Dr Rhodri Hayward is an extremely good historian of science and medicine. If anyone would like to send a reaction to his talk, I will publish it for regular readers unable to attend his lecture but interested in Dr Hayward's ideas.

DNA, Epigenetics & Identity

Discover Magazine has a terrific essay on epigenetics and environmental influences on individual development. Money quote:    

The even greater surprise is the recent discovery that epigenetic signals from the environment can be passed on from one generation to the next, sometimes for several generations, without changing a single gene sequence. It's well established, of course, that environmental effects like radiation, which alter the genetic sequences in a sex cell's DNA, can leave a mark on subsequent generations. Likewise, it's known that the environment in a mother's womb can alter the development of a fetus. What's eye-opening is a growing body of evidence suggesting that the epigenetic changes wrought by one's diet, behavior, or surroundings can work their way into the germ line and echo far into the future. Put simply, and as bizarre as it may sound, what you eat or smoke today could affect the health and behavior of your great-grandchildren.

All of these discoveries are shaking the modern biological and social certainties about genetics and identity. We commonly accept the notion that through our DNA we are destined to have particular body shapes, personalities, and diseases. Some scholars even contend that the genetic code predetermines intelligence and is the root cause of many social ills, including poverty, crime, and violence. "Gene as fate" has become conventional wisdom. Through the study of epigenetics, that notion at last may be proved outdated. Suddenly, for better or worse, we appear to have a measure of control over our genetic legacy.

On some level, these findings should not surprise us. Plant physiologists, for example, have long known that transcription changes in plants situated in nitrogen rich or nitrogen poor environments. That these changes should be expressed in progeny seems a likely - if somewhat Lamarck-ian - thesis. But notice the really important point: these changes in the environment lead to behavioral changes in the mammal's offspring. The implication is that the underlying neurobiological mechanisms are themselves highly plastic.

The lesson that I take away from this - this is totally conjecture - is that epigenetics will underpin a more devastating critique of many fMRI studies (and thus function implicitly as a larger critique of the widespread neuromania of the last few years). Largely the issue is going to be that fMRI studies will increasingly be seen as naive structural-functionalist accounts. They will be described as unable to account for changes over time, for failing to recognize that changes across generations are not uniform, and seen as classic examples of circular reasoning.        

Who loves the most? A Competition in the Age of Functional MRI. A Video

The Love Competition from Brent Hoff on Vimeo.

Talking Philosophy's Interview with Alex Rosenberg

A worthwhile twenty minutes of reading and the comments section should not be missed. A taste from the interview:

Ultimately what would the success of your arguments mean for the importance of history, the social sciences, literature and the humanities? And what would it mean for philosophy? 

My arguments turn the humanities and the interpretative social sciences, especially history, into entertainments. They can’t be knowledge, but they don’t have to be in order to have the greatest importance—emotional, artistic, but not epistemic—in our lives. As for philosophy, done right it’s just very abstract and very general science.

I have not yet read Rosenberg's book. I certainly shall and will review it here. I can't resist wondering, however, if something vaguely like an historical method will show up in it occasionally. Indeed, I'll probably review it with that specific question in mind.

A Passage from Mary Lee's "It's a Great War!"

A truly beautiful book:

I'm no hero, you know, Anne. You don't want to forget that for one second." His dark eyes met hers. Anne looked straight at him. Whatever he had done, he wasn't ashamed.... Men's eyes, sometimes shifted.... His stayed... "If you know that the coin's comin' down tails some day," he said, "you, - you try to suck the orange dry before they knock it out of your hand. You've got to, to keep your mind off, - There's two things you can't think about: one's the fighting that you did today. The other's the fighting that you're goin' to do tomorrow. If you do, you get jumpy. You have to just live in the minute you're in, try to plunge into life up to the hilt in every minute. Get every smell and sound and taste and feel that's in it ... The beauty of it, and the extraordinary sweetness. Life's a sort of splendid stream of good things flowing past you, and you're a fly that can buzz round and taste 'em. Till Someone swats you. You know that Life's goin' on, - all the good things, - after you've been swatted.... That's the irritating part of it. That's why you feel so extraordinarily keen to be alive now." He took a sip of wine. (p. 163-164)

Nervous Structure: A Film

Nervous Structure (field) (2012) from Cristobal Mendoza on Vimeo.

Identifying Academic History Journals; Ranking Them Too!

Scholars in the Humanities & Social Sciences are often loath to discuss questions of the relative merit of academic journals or the impact factor of the places we publish. Rightly or wrongly, such discussions hint at a managerialist odor. We tend to think little of claims that scholarship should possess value-added. But whether we like it or not, these merit-based measures of scholarly activity are becoming more commonplace as a means of assessing academic work, judging scholars for promotion, teaching quality, and arbitrating merit-based raises. I think we can only resist these indicators so far. But I would add that one of the other problems we confront is that we are often not aware of how just many potential peer-reviewer forums are available for our work. Meet the European Reference Index:

The European Reference Index for the Humanities (ERIH) is the only reference index created and developed by European researchers both for their own purposes and in order to present their ongoing research achievements systematically to the rest of the world. It is also a unique project because, in the context of a world dominated by publication in English, it highlights the vast range of world-class research published by humanities researchers in the European languages.

Among the fields covered by this Index are: Anthropology, Gender Studies, History, History at Philosophy of science, Linguistics, Literature, Musicology, Pedagogical and educational research, Philosophy, Psychology, Archeology, Art and Art history, Classical Studies, and Religious Studies. And they provide a complete list of journals for each of those fields! While they eschew the "impact factor" as a means of ranking the journals, they do produce a perhaps less detrimental means of assessing their value. They offer: National, International I, and International II. In this scale, its clear that their committee see International I as most the likely to reach a wide audience and be cited by a wide audience. There is no other evaluative judgment implied by this designation. I believe this tool is very valuable. I hope it helps. Information, after all, is power.

Enjoy Some Neurosatire

Fisher and Student have a laugh (pdf here):

Although mostly abandoned over the years, we hope the present study breathes new life into psychoanalysis. If you’re like us, you’ve probably been thinking that Social Neuroscience, Neuroeconomics, and Developmental Social Cognitive Affective Clinical Neuroscience are just not cutting edge enough anymore. Do not despair. This study represents the first of what is likely to be a productive and active new field of Psychoanalytic Neuroscience.

Of Astrolabes and Other Things

PACHSmörgåsbord is always an enjoyable read - their audience is serious, engaged, and discerning. They have a terrific post on the history of astrolabes. Go check them out; a taste:-

The astrolabe was the most widely used scientific instrument in the middle ages. Nevertheless, its origins remain uncertain. The earliest surviving instruments date from medieval Islam. However, Greek and Syriac texts testify to a long theoretical and practical development that extends back to the second century BCE. The underlying mathematical principle of stereographic projection was described by Hipparchus of Nicaea (fl. 150 BCE). Less than two centuries later, Vitruvius (died post 27 CE) described a type of clock that depended on a similar stereographic projection. His suggestion that Eudoxus of Cnidos (ca. 408-355 BCE) or Apollonius of Perga (ca. 265-170 BCE) invented the rete or spider—the network of stars—almost certainly refers to the sundials he was discussing in the passage. Claudius Ptolemy (fl. 150 CE), the most famous astronomer from antiquity, wrote an extensive theoretical treatment of stereographic projection in his Planisphaerium, which included a short discussion of a horoscopic instrument. Although he described an instrument that resembles an astrolabe, including both a rete and the stereographic projection of a coordinate system, Ptolemy’s instrument does not seem to have included the apparatus needed to make direct observations and thus to measure the altitude of the sun or stars.

Nervous Idioms: Brainwash

The Manchurian Candidate (1962), the most famous cinematographic example of 'brainwashing.'

Brainwash (someone): to force (a person) to obey, conform, confess etc by putting enormous psychological pressure on them. To control a person's thinking through psychological or physical torture, disorientation, or coercion. As a verb, the Oxford English Dictionary first finds this familiar usage appearing in Publisher's Weekly  in 1951 as in "the communists are 'brain washing' the minds of the educated Chinese". As a noun, however, the phrase appears to mean an instance of brainwashing - literally. As, for instance, a usage in the Manchester Guardian in 1950: "A school teacher who was summoned to a 'brain-wash' before a large audience partly consisting of his pupils."

Save Rutgers Camden; Sign this Petition

Word has reached The Neuro Times of New Jersey Governor Chris Christie's decision to hand over Rutgers Camden to the administrative control of Rowan University. Rutgers Camden has offered thousands of individuals, including the many residents of Camden, the opportunity to attend a flagship university with an internationally recognized brand. Various organizations, including the AAUP-AFT have publicly defended the faculty, students, and residents. People from across the world have signed this petition. Faculty and concerned citizens have written editorials, given interviews, and contacted the Governor and legislative leadership. All have argued that severing Rutgers Camden from Rutgers will weaken the Rutgers University system, it will cost the taxpayers millions and it will deprive the residents of Southern New Jersey the opportunity to get an education from a top quality university that carries a name known around the world. Please spread the word.

Water doesn't boil at 100 Degrees

The consistently excellent history of science blog Ether Wave Propaganda directs our attention to Cambridge Professor Hasok Chang's brief discussion of the boiling point of water:

We all learn at school that pure water always boils at 100°C (212°F), under normal atmospheric pressure. Like surprisingly many things that "everybody knows", this is a myth. We ought to stop perpetuating this myth in schools and universities and in everyday life: not only is it incorrect, but it also conveys misleading ideas about the nature of scientific knowledge. And unlike some other myths, it does not serve sufficiently useful functions.

So what do you mean by socialism?

Over at Medicine, Health and History, Paul E Stepansky engages in a bit of historical conjecture and begins to 'unthink' the 'socialism' thing that has fed the beast of American medicine:-  

If we’re going to turn back the clock and recreate a Jacksonian medical universe free of intrusive, expensive, innovation-stifling, rights-abrogating big government, let’s go the full nine yards.  Let’s repudiate the Pure Food and Drugs Act of 1906, which compelled drug companies to list the ingredients of drugs on the drug labels.  Sure, prior to the act most remedies aimed at children were laced with alcohol, cocaine, opium, and/or heroin, but was this so bad?  At least these tonics, unlike Elixir Sulfanilamide, didn’t kill the kids, and the 1906 Actdid put us on the path to government overregulation.  And, anyway, it’s up to parents, not the federal government, to figure out what their kids ingest.  Let them do their own chemical analyses (or better yet, contract unregulated for-profit labs to do the analyses for them) and slug it out with the drug companies.

Meanwhile - the topic appears to be in the air - Martin Klingst has a bone to pick about this 'socialism' thing too, especially how it translates into anti-European screed:

It is not necessary here to define socialism or to detail the many distinctions between a state-run economy and a social democracy based on a ­free-market system. But those who seek to be president of a global superpower — and may perhaps one day sit at a table with leaders of the Old World — should know a few things: All 27 E.U. members believe, more or less, in mandatory health-care insurance and public education. They believe that government should offer a helping hand to struggling businesses and people during economic downturns. That is why we pay high taxes. It is also true that a number of E.U. countries have irresponsibly expanded their welfare systems and can no longer afford their bills.

However, I think Theda Skocpol has really figured out the definition:-

Initially, we assumed that government spending is the chief irritant for the tea party, but we soon realized that anger about illegal immigrants rivals that concern. With many older men and women (including retirees) making up the movement, its members do not usually point to immigration as a threat against U.S. workers; rather, they are upset at the thought of undocumented children overburdening public schools or illegal immigrants crowding emergency rooms. 

Should Tax Payer Funded Research Be Free to Tax Payers?

The White House's Office of Science and Technology Policy recently requested public comment on long-term preservation and public access to "the results of federally funded research, including peer-reviewed scholarly publications". As part of this request, they published letters from over three hundred individuals representing editorial boards of scholarly journals, scholarly societies, university libraries, philanthropies, publishing companies, and private companies, as well as individual scholars. (Link here.) 

Shocking Discovery: Arguments about Biologically Determined Political Values are Stupid

Why - why? - does The Guardian persist in publishing this kind of nonsense?

But this research also suggests that when David Cameron and his ministers sit in the House of Commons and look over at the faces of the opposition they are more likely to experience a sense of threat and disgust than their political rivals do when looking back at them. It is going to be far harder for conservatives to bury the hatchet and cooperate for the good of the country than it is for the exasperated socialists on the other side of the chamber.

It is often alleged, falsely it turns out, that Winston Churchill once said: "If you're not a liberal when you're 25, you have no heart. If you're not a conservative by the time you're 35, you have no brain." As the Churchill Centre notes:

There is no record of anyone hearing Churchill say this. Paul Addison of Edinburgh University makes this comment: "Surely Churchill can't have used the words attributed to him. He'd been a Conservative at 15 and a Liberal at 35!

The surprising point, of course, that we may derive from these "Churchill-ian" facts, is that people change. Apparently The Guardian has trouble recognizing that people change their political values over time. I know: its shocking, shocking to discover that people change their minds about things.

"The Last Family Doctor": Notes to Paul E. Stepansky's Excellent Book

Paul E Stepansky's memoir of his "father's medicine" is a beautiful book that has really helped me think through the implications of the specialization of medicine. As I was reading it, I took fairly extensive notes from the work. These may well interest regular readers. Where appropriate, I provide a bit of context. My comments below are in bold italics.

A Morality Pill?

Peter Singer and Agata Sagan ask the question:

If continuing brain research does in fact show biochemical differences between the brains of those who help others and the brains of those who do not, could this lead to a “morality pill” — a drug that makes us more likely to help? Given the many other studies linking biochemical conditions to mood and behavior, and the proliferation of drugs to modify them that have followed, the idea is not far-fetched. If so, would people choose to take it? Could criminals be given the option, as an alternative to prison, of a drug-releasing implant that would make them less likely to harm others? Might governments begin screening people to discover those most likely to commit crimes? Those who are at much greater risk of committing a crime might be offered the morality pill; if they refused, they might be required to wear a tracking device that would show where they had been at any given time, so that they would know that if they did commit a crime, they would be detected.