Tuesday, August 23, 2016

Is Bioscience Spinning Its Wheels?

Each year, the U. S. National Institutes of Health (NIH) alone spends over $30 billion on medical research.  The people who decide which scientists get this money are, unsurprisingly, scientists.  Daniel Sarewitz, a professor of science and society at Arizona State University, thinks that we are no longer getting the bangs we should get for all these bucks.  In an article in the spring/summer 2016 issue of The New Atlantis, he explains why.

First off, he admits that spending lots of money on scientific research and development has historically been a great idea.  If you compare how most people in the U. S. lived in 1900 with the way things are done in 2000, most of the good differences—modern medicine, jet aircraft, cars, air conditioning, the Internet, wireless devices, computers, down to electric toothbrushes—are due to technological innovations that grew out of research directed at certain goals.  And Sarewitz has no problem with that.  The federal government was not a big player in research prior to World War II, but the lessons we learned then about how heavy investments in military technologies such as radar and nuclear weapons could pay off led to the creation of the National Science Foundation (NSF). 

The NSF was the brainchild of MIT engineer Vannevar Bush, who directed most government-funded research during the war.  Sarewitz says that in order to get his idea enacted, Bush told "a beautiful lie," and summarizes the lie this way:  "Scientific progress on a broad front results from the free play of free intellects, working on subjects of their own choice, in the manner dictated by their curiosity for exploration of the unknown."  Sarewitz spends the rest of his article showing just what was wrong about this "lie," and how it has led to inefficient and often simply incorrect research that taxpayers (and corporations too, for that matter) are paying billions for today.

In support of his thesis, he cites studies showing the increasing rate of retractions from peer-reviewed research journal in recent years.  Another source indicates that between 75 and 90 percent of all basic and preclinical biomedical studies are not reproducible. 

These are indicators of a general trend or pattern that goes something like this.  A newly minted Ph. D. in one of the softer sciences (economics, sociology, psychology, biology) gets an academic job and has to produce new and original results that are published in peer-reviewed journals or get fired in five or six years.  (That part I'm very familiar with.)  So he writes tons of proposals to NIH or wherever he can get funding, gets ten to fifteen percent of his proposals funded, and sets to work being novel.  Novel about what?  Well, that almost doesn't matter.  As long as you can show you did something that nobody's done before, and it has some remote tenuous connection with reality, you can find a journal and willing referees to publish it.  There's more Internet-based journals popping up every year, and it's almost to the point that you can get anything published if you send it to enough journals.  Multiply this picture by the thousands of Ph. D.'s we produce every year, and bear in mind that their proposals and papers are being reviewed by people who went through the very same system, and you can see how the situation described by Sarewitz can happen. 

So what should we be doing with all that money?  Sarewitz says it should be spent on highly directed research targeted at specific time-limited goals.  He cites several examples of the way it ought to be done, including a program in the 1990s directed by the U. S. Department of Defense (DOD) to develop a new treatment for breast cancer.  It led to the development of the drug herceptin, one of the most important treatment innovations in years.  The point here is that useful innovations based on science typically happen not when some isolated scientist pursues his or her private dream, but when a team of smart people use both existing and new science and engineering to pursue a specific socially profitable goal. 

Sarewitz congratulates the DOD for its no-nonsense approach to getting such things done, and for including in its project planning people without academic qualifications, but with a strong interest in the goal.  One of the sparkplugs that got the herceptin project going was an activist named Fran Visco, herself a breast cancer survivor, who founded the National Breast Cancer Coalition to do something about better treatments.  She was a lawyer, not a biologist, but the DOD welcomed her as a participant and her vision was essential in getting things done. 

In pointing out that much research today, especially in the biomedical area, doesn't seem to accomplish much more than paying for a lot of expensive professors, postdocs, grad students, and equipment, I think Sarewitz is on the money, so to speak.  However, I disagree with him that Vannevar Bush told "a beautiful lie" to get the NSF going. 

If you genuinely believe that what you say at the time is true, it isn't a lie, morally speaking.  You may be guilty of self-deception or not informing yourself sufficiently, but not of lying.  Bush was a creature of his time, and most of the people he had hired to develop things like radar and nuclear bombs had in fact spent most of their careers indulging the "free play of their free intellects," because that was the main way basic science was pursued before huge amounts of federal dollars showed up after World War II.  Most scientists before 1941 operated more or less in the style of Albert Einstein, who single-handedly revolutionized physics in his spare time that his job at the Swiss patent office provided him.  Back then, the exception was a scientist who did good science while working for industry, such as Irving Langmuir, the first industrial scientist to win a Nobel Prize.  So although the phrase "beautiful lie" is an attention-getting rhetorical device, I think Sarewitz is a little anachronistic in his accusation that Bush was lying at the time.

On the other hand, Sarewitz is probably right in pointing out that the foxes-guarding-the-henhouse pattern of handing money over to scientists who give it to other scientists may not be the right way to do things anymore, at least with the majority of federal research funds.  There's a reason that government funding for science is declining as a percent of GNP, and the public may be right in thinking that their federal research dollars are not being spent as wisely as they could be.  If the powers that are or will be listen to Sarewitz's advice, maybe things will be reorganized so that even fewer dollars can accomplish more, both in the way of pure basic science and in practical applications that improve the lives of millions.

Sources:  Daniel Sarewitz's article "Saving Science" appeared in the Spring/Summer issue of The New Atlantis, and online at http://www.thenewatlantis.com/publications/saving-science.  For the statistic on NIH spending, I referred to the NIH website at https://www.nih.gov/about-nih/what-we-do/budget.  Full disclosure:  my wife had breast cancer over a decade ago, and is now cancer-free

Monday, August 15, 2016

The Spirit of Engineering: Ulysses Cephas

Some years ago, probably in the late 1940s—the news clipping has no date on it—an 18-year-old woman attending what was then called  Southwest Texas State Teachers' College in San Marcos was seriously injured in an automobile accident, suffering a broken pelvis.  She was taken to a hospital, but became despondent, and her attending doctor decided she should spend her long recovery at home in Hico, 150 miles away.  But the jarring of a long road trip might cause further injuries.  Some sort of rigid custom-made frame to hold her bones in place was needed, but where could such a thing be found?

The photo accompanying the article shows the solution:  a sort of cage made of three or four steel straps attached to a stretcher.  The article gives the names of the young woman and the doctor, but identifies the craftsman who designed and fabricated the frame only as "the village blacksmith."  Thus encased, she was able to be transported safely to Hico, thanks to the village blacksmith.  Probably everyone who read the article in the San Marcos local paper knew who the village blacksmith was.  He lived in a house he built himself, worked in a shop he owned, and had the skills to construct a custom medical device that today would cost many thousands of dollars to make.  Why, then, was the newspaper so reticent about giving his name?  We can only speculate at this point, but I can think of one good reason.  Ulysses Cephas was black.

Mr. Cephas was born in San Marcos in 1884 to Joe and Elizabeth Cephas, both former slaves.  Joe was a blacksmith, and Ulysses followed in his father's footsteps.  Around 1909, Ulysses had acquired enough skills to obtain a certificate in Artistic Horseshoeing, and that was the extent of his formal education.  He married and built a small, sturdy house in the black section of San Marcos.  San Marcos, along with the rest of Texas back then, was a segregated society.  Blacks could live only in the black section of town.  Blacks could sit only in the black section of movie theaters, if the theater happened to have such a section.  It was a common sight to see hotels, restrooms, and even water fountains labeled with signs such as "For Whites Only" or the less direct but just as effective "We Reserve The Right To Refuse Service To Anyone." 

Mr. Cephas, if he did not embrace these restrictions, at any rate lived within them.  He, along with the rest of the black community, endured the rise of the white-supremacist Ku Klux Klan in the 1920s.  After some Klan doings that were so bad they drew the attention of the local law authorities, the police asked Mr. Cephas if he could identify certain horseshoe prints left at the scene.  Mr. Cephas was able to connect the prints with one of his own customers, which led to an arrest of the culprit.  Even the Klan came to "Boots" Cephas for horseshoes.

By 1933, Mr. Cephas had saved enough to buy the blacksmith shop he worked in, while supporting his five children.  As if that wasn't enough, he became active in the First Missionary Baptist Church and helped found the San Marcos Independent Band.  But he kept busy working in his shop, as pages from his account book from 1944 attest.  They include things like repairing wagon wheels, drilling holes in iron plates, welding a battery box for the local phone company, and renovating pieces of farm equipment for local farmers.  By that time, his shop was what we would term today a general metal fabrication facility, and his reputation for being able to deal with almost any problem was what led the young woman's doctor to him when the special frame was needed.

There is a photo of Mr. Cephas at work:  a sturdy, overalls-clad man caught in the midst of swinging a heavy hammer—an engineer's hammer, is the technical term.  Along with the photo, another news article quotes him as saying that when he passes from the scene, there won't be anyone to replace him.  Young people these days aren't interested in the hot, heavy work of blacksmithing, he says.  This was well before air conditioning was installed in most small-town businesses, let alone residences or blacksmith shops. 

Mr. Cephas died in 1952, with $10,000 in the bank, rental property in hand, and owing only a keg of nails.  His house stood vacant for years until the City of San Marcos, prompted by those interested in black history, used federal funds to renovate it and turn it into a multi-use space for things like art classes, which is how I found out about the house and Mr. Cephas's story—my wife was attending an art class that I visited last Friday.  Artifacts from his life and work are on display there, and the house itself is a testimony to the skill he brought to his work—the original door and doorknob from the 1920s are still in use. 

Ethical exemplars are people whose professional conduct goes beyond the call of duty to the point where they can be held up as examples of how to do it right.  Mr. Cephas's skin color and birth date barred him from any realistic hopes of gaining an engineering education.  Most of the few colleges open to blacks back then had no engineering schools, and even if they had, the need for tuition money was an obstacle that few black students could overcome.  So he took his certificate in artistic horseshoeing and taught himself everything else he needed to know to serve the community of his birth, even when it turned on him viciously as the KKK did.  His unique skills allowed him to be prosperous in a modest way, and he gave back in terms of service to his church and to the citizens at large who enjoyed the music he and his friends played at special events.  In his life of integrity and service, he showed how a professional—one with specialized knowledge—can use this knowledge responsibly to make the world a better place.  That is what engineering should be all about, and though he lacked the usual academic credentials, I salute Ulysses Cephas as one who embodied in his life and work the true spirit of engineering. 

Sources:  There is a historical marker in front of Mr. Cephas' former home, and a photograph thereof can be seen at http://smmercury.com/tag/ulysses-cephas/.  I also used information from news articles at http://www.statesman.com/news/news/local/san-marcos-seeks-to-rent-cephas-house-for-commun-1/nRfFM/ and http://www.austinchronicle.com/arts/2003-06-20/164554/.  Some of the information in the above post is from my memory of artifacts, and may be slightly inaccurate in a few details.

Monday, August 08, 2016

Hacked At The Polls

Last month we learned that computer systems used by both the U. S. Democratic National Committee (DNC) and the Democratic Congressional Campaign Committee (DCCC) were hacked into, possibly by Russia.  The initial news reports were confirmed by the FBI, which is investigating the breaches.  While no actual damage appears to have been done—yet—it is not clear what the hackers might have learned, and what they might do with the information.  At a minimum, it is a chilling reminder that foreign powers can now remotely meddle with systems vital to our democratic process:  a political party's internal analytical tools, not to mention electronic voting machines themselves.

A recent article on the Politico website enlarges on the latter possibility:  that hackers, either foreign or domestic, could diddle with electronic voting machines and the associated systems enough to throw an election.  Some computer scientists at Princeton have made a career out of showing how various brands of electronic voting machines can be hacked using simple methods that are accessible to clever teenagers.  Usually, the hacks require physical access to the machines for a time, but if polling-place workers are not quite vigilant enough, one can imagine this happening.  And then anything can happen, from blatant count manipulation to subtle effects that would be hard to catch in an audit.  The most vulnerable machines appear to be the touchscreen types that produce no paper audit trail.  Many states and counties have recognized this vulnerability and have switched to optically-scanned paper ballots which automatically produce a paper trail, but even these systems can be hacked into at the count-totalling level where laptops and computer networks are used to add up the results.  But there are still a lot of old vulnerable touchscreen systems in use.

The Politico article decries the inconsistent patchwork nature of our voting technology in the U. S., but fails to note that this can also be regarded as a strength.  For offshore hackers to arrange a major hijack of a national election and be fairly sure it would work, they would have to target up-for-grabs states (several of them), get detailed information on the wide variety of systems being used, and devise sub-hacks for each one.  While this kind of operation could be carried out, it's hard to see how, unless the foreign power had spies on the ground in the various states to provide information that would not be available any other way.  Nevertheless, huge elections can come down to a few critical votes in a few critical states, or even one, as the "hanging-chad" adventures of the Florida vote count of 2000 proved, leaving the whole nation in suspense for weeks and making the U. S. Supreme Court an unwilling participant in the election as well. 

While I normally eschew discussions of politics in this blog, I will limit my comments on the current Presidential contest to a phrase I heard from someone whose position prevented him from venting a more frank opinion about the candidates:  "It's a pity." 

Pitiful or not, national electons are a vital part of the way the U. S. government is made beholden to the people, and it is in the interest of every citizen to see that the process is as fair and transparent as possible.  If a foreign country manages to put its thumb on the scales, so to speak, it would betray the election's whole purpose and be tantamount to invasion by a foreign power.  For the same reason, contributions to domestic political campaigns by foreign entities are generally prohibited by law.

Voting in elections is an odd mix of the highly traditional and the cutting-edge high-tech.  Most applications of engineering have fairly clearcut goals:  build a bridge here to carry so much traffic and cost this much and take that long to build, for instance.  But in voting, it's not always clear what problems engineers are being called upon to solve. 

Some readers may know that Thomas Edison's first patent was for an electric vote recorder that received votes made by pushing buttons, and printed out a paper tally of the results.  He patented it in 1869 and a colleague tried to get the U. S. Congress to adopt it.  But getting through a roll-call vote faster by machine was not something that the committee evaluating the machine wanted to do.  As the committee chairman reportedly said, "If there is any invention on earth that we don't want down here, that is it."  It wasn't until the 1880s that any kind of voting machine was used in the U. S. in a general election, and legislatures were among the last entities to adopt them for their own voting process.  So even the great inventive genius himself misjudged what highly political organizations really want in the way of automated voting.

Increasingly today, politics is about power.  Power has always been a factor, but as other cultural forces—tradition, religion, courtesy, even fairness—wane in influence, the vacuum tends to be filled by the raw lust for power.  So it is understandable that regimes and individuals who see power as the mainspring and goal of politics will stop at nothing to attain their aims.  Just as our military has to exercise constant vigilance to keep armed threats at bay, we now have to defend the integrity of our elections from foreign interference, which is a new thing to a lot of local officials whose worst concern used to be finding enough volunteers to man the polls. 

One of the best ideas for safeguarding election integrity was proposed by a Princeton cybersecurity expert quoted in the Politico article.  If each lowly precinct simply posts its results in real time, on paper (and I would add, on the Internet too), allowing independent vote-checking agencies to compile vote totals, this step essentially eliminates any chance of an outside entity hacking into the vote-totaling systems, because the multiple independent tallies would agree and call into question the "official" total.  To some extent, news agencies already do this, but the exact data paths by which they obtain their vote totals is not obvious to the viewer, and making it so would both raise their credibility and help ensure the integrity of the whole system.

Casting a meaningful ballot is one of the most important privileges of living in a democratic society.  It is up to engineers and programmers to make sure that the voting systems this fall will allow every qualified citizen to do that.  But it is up to the citizens to use that power wisely.

Sources:  I thank my wife for drawing my attention to the Politico article, "How to Hack an Election in 7 Minutes" by Ben Wofford, published online on Aug. 5, 2016 at http://www.politico.com/magazine/story/2016/08/2016-elections-russia-hack-how-to-hack-an-election-in-seven-minutes-214144.  I also referred to a July 30 NBC News article about the hacking of the Democratic Party systems at http://www.nbcnews.com/news/us-news/clinton-campaign-computer-system-was-hacked-report-n620051.  Details of Edison's first patented invention, the vote recorder that nobody wanted, can be found at http://www.techtimes.com/articles/132791/20160211/thomas-edisons-first-patented-invention-could-have-drastically-changed-u-s-history.htm.

Monday, August 01, 2016

Readers Respond: tDCS ($) Versus TMS ($$$$)

Last week I devoted this space to discussing transcranial direct-current stimulation (tDCS), a much milder form of brain-zapping than electroconvulsive therapy (ECT), but nevertheless in the same category.  Because there are not a lot of studies on tDCS, we do not have extensive statistical evidence that it does much good for conditions such as depression, but I asked readers who might have had experience with tDCS to respond, and two did:  one amateur tDCS user and one doctor who trains and supervises patients to use tDCS.  For reasons of medical confidentiality, their real names will not appear here, but for the purposes of this article I will call them Mr. P. and Dr. D.

Mr. P., a sufferer from depression, has been using a tDCS setup he built himself for about six months to help him during a transition from one drug regime to another.  As to whether it works, he says, "I did experience a slight lightening of mood and a little more energy, and perhaps a more regular sleep pattern."  But he admits that this is not a scientific controlled experiment, as he was also taking his medication at the time and could not therefore separate the effects of tDCS from what the drug was doing for him.

Dr. D. has assisted "patients using tDCS protocols intermittently with supervision to treat pathological conditions," including depression.  He says it seems to be helpful in cases of depression that have proved to be resistant to other treatments.  He "can't disagree when someone with this condition attempts tDCS.  Considering the compromised quality of life, the potential improvement is worth the risk.  Medical supervision would increase the success rate and make the procedure even safer."

Why isn't tDCS used more widely or studied more extensively?  Dr. D. believes that "tDCS is not utilized primarily because of profitability. Transcranial magnetic stimulation (TMS) produces effects and results similar to tDCS. The cost of a 30-treatment protocol for depression costs $15,000 and re-treatments would need to be done at least yearly. And insurance is beginning to cover TMS."  On the other hand, Dr. D. charges only $3,000 for a tDCS stimulator, training, and three years of supervision—a lifetime cost for tDCS, in other words, as opposed to the $15,000 each time a protocol of TMS is administered.

TMS uses a much more complicated piece of machinery than tDCS, a pulse generator that produces powerful magnetic fields which induce currents in the brain without the need for direct contact to the skin.  From an engineering point of view, assuming the end result of small currents in the brain are more or less the same, the difference between tDCS and TMS is the difference between the old wired telephones ("POTS" or "plain old telephone service"), and wireless cellphones.  Cellphones are a lot more complicated, but they have genuine advantages over wired phones.  Whereas it may be that the only advantage TMS has over tDCS is that the machinery costs a lot more and the medical profession, speaking generally, can profit more from a treatment that involves an expensive machine or patented drug, than it can from a gizmo you can build with $30 of parts or a medication you can buy for ten bucks at a drug store without a prescription. 

Fortunately, there are doctors such as Dr. D. around who help patients use less expensive and possibly more effective treatments, but you have to hunt for them.  And as I noted in last week's article, the medical profession, at least that portion of it represented by the Annals of Neurology, has extended something of an olive branch to those who are using tDCS, rather than doing something obstructive such as calling for legislation to stop non-professionals from fooling with it.

Perhaps we can gain a little perspective on this matter if we ask a more basic question:  what if the criteria by which we judge medical care are missing something important?  Here's what I mean.

When we see two kinds of treatment being used for a class of medical conditions, and one costs mucho buckos and the other one is comparatively cheap, and they seem to do about the same amount of good, it's almost a no-brainer to ask, "Why don't we drop the expensive treatment and go to the cheaper one?"  The answer comes back from the medical-scientific establishment:  "Because we have studies that show the expensive treatment is effective, and we don't have anything like that for the cheap treatment."  What is not stated in this interchange are the underlying assumptions shared by doctors, patients, researchers, and medical organizations. 

One of these unstated assumptions is that for every perceived problem, there is a solution that can be discovered, researched, quantified, tested, and implemented efficiently and promptly.  The unconscious image is that of a person in a supermarket, making a consumer's decision as to which technology to use.  The philosopher George Parkin Grant, who made an appearance in this blog not too long ago, recognized that this technological outlook or perspective has become an almost automatic mode of thinking.  In fact, it's hard not to think this way.  He puts it succinctly:  "Technology is the ontology of the age."  And "ontology" is the study of being:  what things really, fundamentally are. 

What he's saying is that we tend to approach the world as though it were a big parts warehouse, or electronics showroom.  Everything is there to be used, and everything is analyzed in terms of its parts and how they can be assembled to do something we want.  Here's a person with depression.  We treat him like a machine in need of repair.  What will fix him?  Certain chemicals?  Expensive TMS treatments?  Or inexpensive tDCS treatments?  We don't stop to ask why he's depressed in the first place. 

It's hard to imagine thinking in some other way, but in the space remaining I'll try.  What if we look at a society in which more than one out of every ten adolescents in the U. S. suffer at least one episode of major depression per year?  The technological fix is to look around for repair parts.  But what if we looked into why being a teenager in this society is so gosh-awful depressing for so many?  And the older they get, the more depressed they become, often.  Try getting funding for that. 

I'm glad Mr. P. is happy with his tDCS, and Dr. D. is helping others like him to get treatment at less cost than alternative treaments.  But as for why so many people are depressed, well, that is, as they say in the technical journals, "outside the scope of this article."

Sources:  I thank Mr. P. and Dr. D. for permission to quote from their emails.  I was clued to the words of George Parkin Grant by a comment made by philosopher Antonio López on Vol. 130 of Ken Myers' excellent Mars Hill Audio Journal, a by-subscription podcast about which more can be found at https://marshillaudio.org.  The Grant quotation itself is from his article "Thinking About Technology," Technology and Justice (Notre Dame Press, 1987), pp. 11-34, and can be downloaded at http://www.communio-icr.com/files/grant28-3.pdf.  The statistic about the incidence of depression among adolescents is from the National Institute of Mental Health at http://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adolescents.shtml.

Monday, July 25, 2016

Do-It-Yourself Brain Zapping

An unfriendly nurse orders the gown-clothed patient to climb onto the gurney.  Beside the gurney on a table stands an ominous-looking black box with dials and switches, and a cable running from it to a two-armed thing that looks like the doctor's end of a stethoscope.  Only instead of earplugs, it's got two cloth-covered steel electrodes.  The patient lies on the table and two other nurses stand next to her, ready to hold her down.  You see a closeup of a jar of greasy stuff that the head nurse applies to the patient's temples.  Then the scene cuts to the black box as the nurse throws the switch.

The film "The Snake Pit" (1948) stars Olivia DeHavilland as Virginia Cunningham, a patient in a mental hospital, and was based on memoirs by a former mental patient.  The black box, of course, is an electroconvulsive therapy (ECT) machine, which was one of the few effective treatments known in 1948 for severe depression.  A current passes through the brain that is large enough to induce an epileptic seizure, and in enough cases to be useful, the resulting massive reorganizing of neural behavior can improve the patient's condition.  But the treatment has frequent and serious side effects, including confusion and memory loss.

Somehow I don't think too many people who currently practice a much milder version of the same thing—transcranial direct current stimulation, or tDCS—have seen "The Snake Pit."  The process of tDCS consists of sending no more than a couple of milliamperes of current through one's head with electrodes that can be placed in different areas, depending on what you want to do to your brain.  The simplicity of the equipment (the whole thing can run on a nine-volt battery) and the expense of conventional medical treatment for conditions such as depression, anxiety, or ADHD (attention-deficit hyperactivity disorder) has created a small but active cadre of do-it-yourself tDCS users.  And a market for commercially made devices has come about to serve them as well.  

In a recent New York Times article, Anna Wexler, a Ph. D. student at MIT, noted that the medical journal Annals of Neurology published an open letter addressed to tDCS "amateurs," as you might call them.  Somewhat surprisingly, the medical folks didn't come out with guns blazing and condemn all non-professionally-authorized use.  Instead, they rather mildly warned about some of the known hazards (mainly skin irritation) and said that the effects of tDCS can be long-lasting and unpredictable. 

I have a confession to make.  One day in my garage lab back when I was in high school, I made a pulse circuit that put out about 10 volts, and out of curiosity more than anything else, I took the two wires coming out of the circuit and touched them to my sweaty temples (the room wasn't air conditioned and this was summertime in Fort Worth, Texas).  I was rewarded with what is called a "phosphene" flashing in time with the pulses.  A phosphene is a kind of visual hallucination arising from direct stimulation of nerves associated with vision.  After that, I decided I liked my brain the way it was, and didn't fool with tDCS anymore.  But I can vouch for the simplicity of the equipment, at any rate. 

In her editorial, Wexler praises the doctors for extending an olive branch, as it were, to the do-it-yourselfers, at least those who happen to read Annals of Neurology.  Somehow I don't expect that's too many people.  But speaking more generally, there is a moral issue here about the high cost of medical care and the things people will do who simply can't afford conventional treatments. 

People who are ill are by definition vulnerable, and deserve to be treated with respect, in both senses of the word:  treated medically, and treated as a fellow human being in need.  Before the age of modern scientific medicine, everyone was pretty much in the same leaky boat medically.  Hardly any medical treatments did any good, and so even the rich folks who could afford expensive so-called doctors didn't get much in the way of real help from the medical profession.  But with the huge advances that scientific medicine has made in the last century, we can now defeat entire diseases such as smallpox and do a great deal to prevent or alleviate others.  All these advances come at a price, however.  And the big question now is, who pays the price?

There are two extremes in the approach to funding medical care, and most countries fall somewhere in between the two extremes.  At one extreme is the on-your-own approach.  Countries that are too dysfunctional to have anything resembling a government fall into this category.  If you have enough money and can afford to travel and pay for medical care, you get it.  Otherwise, you're out of luck.  At the other extreme is the single-payer government-does-it-all approach.  I am told that Cuba does something along these lines.  Maybe a few people have made a trip to Cuba just for the medical care, but not many.  Less extreme and more functional is the government-run medical system in Canada, which treats medical care as simply something that every Canadian has a right to.  In the nature of things, this leads to some sort of rationing.  Even if Canadians had a lot of gripes about their system, they are probably too polite to air them in public so that we in the U. S. can hear. 

And then there is our crazy patchwork of Federal, state, local, private, and charity-provided medical care here in the U. S., augmented  since 2010 by the Affordable Care Act.  I have seen some reports that some of the "exchanges" set up by ACA are in deep financial trouble.  But believing that our present Congress will pull itself together long enough to make sensible improvements to that legislation takes an act of imagination that I am presently incapable of—without tDCS, anyway. 

If anybody reading this blog gets the idea to try tDCS, please don't do it on my account.  My brief encounter with it all those years ago made me decide to leave it alone, and I don't want to be responsible for any negative consequences arising from reading an ethics blog.  On the other hand, if anyone reading this has used tDCS and think it works, it would be interesting to hear from you.  Bearing in mind, of course, that it affects everybody differently, so if someone writes in saying their headaches were cured by tDCS, don't the rest of you headache sufferers get your hopes up. 

Sources:  Anna Wexler's article "Zapping Their Brains At Home" appeared on the New York Times website on July 22 at http://www.nytimes.com/2016/07/24/opinion/sunday/zapping-their-brains-at-home.html.  I also referred to the open letter posted by Annals of Neurology at http://onlinelibrary.wiley.com/doi/10.1002/ana.24689/full and the Wikipedia articles on transcranial direct current stimulation and electroconvulsive therapy.  A recent report on one healthcare exchange in financial trouble is at http://www.foxnews.com/politics/2016/05/06/obamacare-exchange-problems-add-to-marketplace-woes.html.  You can read more about "The Snake Pit" at its IMDB site at www.imdb.com/title/tt0040806/.  

Monday, July 18, 2016

Watch Where You're Pokémon Go-ing

The Japanese megacorporation Nintendo was founded way back in 1889 to sell playing cards, and when I hear the word "Pokémon" I think of the collection of cards one of my nephews accumulated when he was about eight years old.  They showed bizarre-looking fantasy creatures that had complicated made-up genealogies and quirks that he committed to memory.  I figured Pokémon was one of those things that kids go through like a phase, and while it seemed important to him at the time, I couldn't imagine him, or anyone else, taking such things seriously as an adult.

Well, I was wrong, and not for the first time.  On July 6, Nintendo released a smart-app aspect of their Pokémon universe called Pokémon Go.  From what I can tell from Wikipedia and other sources, the idea is this.  You pick an avatar to represent you, and show up on a map of your vicinity, courtesy of the GPS function of your phone.  Then if you choose the augmented-reality mode, you can scan around certain special places shown on the map where the Pokémon critters typically hang out.  Spotting one, you can throw a (digital) Poké Ball at it, and if you hit it, you get points or go to bed happy or something good happens in the game, I'm not sure quite what.  There are good things and not so good things about this game, which has proved to be one of the instant hits of the smart-phone app world, allegedly being loaded onto 5% of all Android devices within two days of its release.

The nice thing I like about this game is that it encourages people to get off the couch and outside the house.  Nintendo is using the GPS database of another game company called Niantic, whose augmented-reality game Ingress did other things with the long list of physical sites that somebody had to compile manually.  There are apparently enough special spots in Pokémon Go to keep most players happy, at least in larger cities.  I'm not sure how many Pokémon Go enthusiasts live in Wyoming, for example, or Alaska.  But a number of national parks are included, as well as museums, city parks, lakes, and other publicly accessible sites, including the U. S. Holocaust Memorial Museum, which is reportedly not amused at the crowds of people with cellphones around their entrance shooting imaginary balls at imaginary beings. 

Anyway, that aspect of the game looks like an improvement over the usual zone-out-into-cyberspace effect that happens to millions of kids (and adults) when they play the usual type of electronic game. 

Now for the bad news.  Not everyone who plays Pokémon Go exercises good judgment in the old-fashioned real world that we all live in by default.  Maybe the most spectacular example of this problem came when two twenty-something guys near San Diego, California (one of whom might have been drinking) chased a Pokémon that appeared to be on the other side of a fence between them and the unstable edge of a cliff.  They climbed the fence anyway and fell off the cliff, landing 50 feet and 90 feet below.  Both survived, but with injuries.  Other reports include that of a girl who chased a Pokémon critter into busy traffic and got hit by a car, fortunately suffering only minor injuries, and numerous people walking into trees, driving into trees, or even driving into a police car while chasing a Pokémon in a parking lot.  Driving while chasing an augmented-reality Pokémon is bad judgment, but that apparently doesn't stop some people, until hitting something hard and unyielding in old-fashioned real reality does.

People have played games ever since there were people, and it's not for me to say how much time any individual should spend working versus burning calories and gasoline on chasing down fictional digital animals.  It's a little troubling that so many accidents have been reported in less than two weeks since the game's release.  Maybe it's just a startup glitch, and as those who haven't got the sense to put down their Pokémon Go games at appropriate times either wise up or possibly eliminate themselves from the gene pool, we will hear less about such accidents.  Something similar happened when the first smart phones came out, folks walking into swimming pools while watching the Weather Channel and so on, and we've somehow adapted to those hazards. 

I do expect that Nintendo is under a lot of pressure to make Pokémon beings show up at places that would like more people traffic, which is namely every retail business with walk-in outlets in the world.  So far, you mainly hunt the critters at parks, memorials, and other non-profit places.  If Nintendo caves to this temptation , you'll be finding Pokémon gyms at the nearest shopping mall, McDonald's, or Home Depot.  There would be nothing wrong with that, I suppose, as long as the game players know that certain Pokémon hangouts are "sponsored," I guess you'd call it.

What is of more concern is the accident aspect.  I'm not that coordinated, so I'm not sure what would happen if I was looking at a smart phone screen and trying to track some animated whatever-it-is and throw a digital ball at it.  The whole operation requires a kind of interaction with reality that is really a novel thing for most people, which is why it's so popular.  But it can be dangerous to the user and people nearby, too.  Maybe some fairly minor changes in the way the augmented-reality feature works will minimize the chance that you'll walk into a tree or a manhole or something while in hot pursuit of your extra ten points in the game. 

All in all, it seems like Nintendo has scored a hit with their latest variation on Pokémon.  If it gives millions an excuse to get outside among other people, that's a good thing, and if they can work out a way to minimize the occasional safety problems, that's even better.  While you won't be seeing yours truly watching a smart phone and following an imaginary critter around (first I'd have to buy a smart phone), I will understand what's going on if I see people glued to their phones while crowding around certain locales from now on.  But I'll also know to stay out of their way.

Monday, July 11, 2016

Cornfield Meet Near Panhandle, Texas: How?

On Tuesday morning, June 28, the stretch of U. S. 60 leading east from Amarillo, Texas past the small town of Panhandle was quiet in the early morning sun.  The flat horizon was broken only by the spinning blades of a wind farm in the distance and a towering grain elevator near the double BNSF tracks, which run straight as an arrow from Amarillo east-northeast for many miles.  U. S. 60 parallels the tracks until the road nears the grain elevator, where it takes a bend southward for a quarter mile or so around the elevator and rejoins the tracks on the other side.
At about 8:25 AM, a BNSF intermodal freight train was heading west on one of the pair of tracks.  At the same time, a few miles west of that train, another train was heading east—on the same track. 

Railroads have faced this kind of problem ever since there were railroads.  In England, the main customers of an early form of electric telegraph were railroads, who saw in it a way of coordinating train movements on single tracks carrying two-way traffic.  Later, block signals were developed that turned red any time a train entered a section of track (or "block"), warning other trains to slow down or stop.  The main idea of double tracks is to allow only one-way traffic on each track, eliminating any chance of head-on collisions.  And most recently, a new communications and control system called Positive Train Control (PTC) has been adopted by most U. S. railways, but its implementation has been slowed by problems with radio-channel allocations and hardware issues.  On June 28, PTC was not implemented in the section of tracks that run past the grain elevator near Panhandle.

So it was that the two trains that morning, each with a crew of two, met in a fiery head-on collision that is known in railroad circles as a "cornfield meet."  One person managed to jump from the train before the collision.  Two bodies were recovered after the accident, and as of July 10, the fourth person's body had not yet been found. 

A passerby on nearby U. S. 60 made a phone video of the wreck even as it was occurring.  You can see cars flying off the track, and eyewitnesses testified to the horrific noise that seemed to go on forever.  A train running at speed can take up to a mile to stop after the brakes are applied, and it is not clear at this point when, if at all, the brakes were applied on either train.  Many trains, including those involved in the wreck, are equipped with digital video cameras and recorders at the front and rear, but the National Traffic Safety Board spokesman in charge of the NTSB investigation said that some of these were heavily damaged.  However, other data recorders on board the trains may have survived to help understand how this accident happened.

It will probably be some months before the NTSB has time to sift through the wreckage and other evidence that could show why, in 2016, it's still possible to have such an accident.  As in other railroad accidents involving fatalities in the last few years, PTC could very well have prevented this one.  If operating properly, the system calculates a safe maximum speed for the train at each point in its travels, and if another train is heading for yours, presumably it would put on the brakes in time to prevent a wreck. 

Trains are dispatched these days by means of centralized train-traffic control centers linked to the individual trains by microwave radio.  One of the dispatch centers for trains in Texas is in Fort Worth, so investigators will probably be reviewing all communications between the controllers and the two trains involved.  Like air-traffic controllers, the dispatcher's word is law as far as the in-train operator is concerned.  So if both trains were told they had a clear track ahead, and saw something that looked like a train in the distance, each might have thought the other one was on the other track instead of the same track.  With radio control, it's not clear to me how much significance the operators attach to block signals, which should have indicated a problem in this case soon enough to prevent the accident.

As train wrecks go in the last few years, this accident was not the worst in terms of fatalities.  In this space in 2013 I wrote about a commuter-train wreck in New York that killed four, and in Philadelphia in 2015 another commuter train derailed, killing eight passengers and injuring over 200.  But the Panhandle wreck is disturbing because it seems to reveal a systemic problem, either with the dispatching system or training or both.  Those trains never should have been on the same track heading toward each other in the first place.  And once they were, it sure seems like block signals should have let the drivers know something was seriously amiss.  It is likely that this accident was the product of a combination of unlikely events, each one of which by itself does not typically lead to a major tragedy. 

But to know for sure, we'll have to wait for the results of the investigation.  And hope that BNSF and the other railways can speed up their implementation of PTC, which promises to make cornfield meets as rare in the future as deaths due to runaway horse-drawn buggies. 

Sources:  I used reports on the accident from KFDA-TV in Amarillo at http://www.newschannel10.com/story/32408347/search-ends-for-body-of-conductor-killed-in-train-wreck and a video of the NTSB news conference held after the wreck at https://www.youtube.com/watch?v=mCBTmxKx2vA.  A video of the wreck itself can be viewed at https://www.youtube.com/watch?v=YiPE8e-fqKU.  I blogged about PTC and train wrecks at http://engineeringethicsblog.blogspot.com/2013/12/positive-train-control-and-commuter.html on Dec. 9, 2013 and at http://engineeringethicsblog.blogspot.com/2015/05/for-want-of-spectrum-allocation.html on May 25, 2015.