Cell Phones and Brain Cancer

I was in the living room two nights ago and the NBC (?) network news came on.  I haven’t seen the 6 PM news in memory, recent or otherwise.  It was appalling, the assault of negative perspectives.  I guess that the programming creates such tension that the commercials are an emotional relief, so we develop some association of relaxation or relief when we see the products elsewhere, or some equally compelling marketing ploy.

The ‘teaser’ was some ‘new research’ (and when you read that, substitute the word ‘unsubstantiated’ for ‘new’ and you will have a clearer understanding of what the phrase actually means) about brain cancer and cellphones.  And, as former CSO of a company that makes therapeutic medical devices that use radiofrequencies to stimulate (and current consultant to that company), I was compelled to sit through the ongoing horror until they got to the bitter end, with this:
http://www.hulu.com/watch/218282/nbc-nightly-news-with-brian-williams-cell-phones-trigger-changes-in-brain-activity.  Of course, the research had nothing to do with cancer, unless they were using 'brain cancer' as a metaphor for their thinking in this story.

I loved the way they simply inverted the story and were able to get the principal investigator to say something about using a hands-free device and then prefaced it with their assertion (not hers) that she ‘was changing the way she used her cell phone.”  It was a semiotic maneuver of epic size, to present ‘evidence’ that only supported the lack of relationship between cell phones and any cancer with a commentary that suggested precisely the opposite.  Just an outstanding example of the way in which ‘science’ can be turned to any end, regardless of the actually ‘facts’ within that ‘science.’

The evidence is actually the other way around.  For example, in a large Danish study looking at folks with over 10 years of cell use, they found a significant decrease evidence of dementias, like Alzheimer’s, in users.  So cell phone use may be protective, rather than dangerous.  WHO, in their review of the health status of electromagnetic fields (EMFs) point out that EMFs have been studied (25,000+ studies)more thoroughly than any chemical, for instance, with no known negative health associations.  So if there are any, the risk must be vanishingly small.

That, of course, must not sell cars or detergent.  I wonder if there is a study that supports that....

Dogging it

I have had the privilege of working in many therapeutic markets, including the vet market.  So I learned a lot about all of the marketing in human and vet businesses.  I mean good, bad and ugly.  So the example.  My mom has my dad’s cat, Sambuca (after my dad’s fave closer).  She (the cat) has a wound that would not heal.  So she asked me about what to do.  Sambuca had gone through a round of antibiotics and wasn’t quite healed, so needed more.  But the vet charged $69.73 for the antibiotic.  My mom was torn by the cost and benefit.  So I said to my mom that she should get the prescription directly and fill it for cheap (or free) at the local market.  She had some trepidation, but ask for a prescription, not just paying the vet for the drugs.  When my mom asked, the vet was kind of taken aback (as who asks that sort of thing) and said she didn’t know where her prescription pad was, but my mom insisted and they produced it.  Turned out is wasn’t a free antibiotic, but got it filled at the local Wegmans for $9.00 (but a number of other antibiotics would have been free).  She was livid that her vet did this to her.  Playing on her emotional commitment for profit. 

Well, that’s how it works, pets or people.  There is a business being run that leverages its ‘authority’ to generate income, even if the ‘patient’ pays  a premium.   I don't’ begrudge anyone making a profit (that’s the way we all roll), but gouging folks, because they love their pets and trust their ‘doctors’ is a bad business model.  An evil business model.  Think about that the next time you go to the vet.

Gossip or glory

Oxymoron?

I worked in a children’s psychiatric hospital full time, while I finished my undergrad degree in anthropology.  I picked anthropology because I had accumulated the most credits in that area, as I only took anthro electives in an early stint at Maryland, as there was a human dissection class (Comparative primate anatomy) only open to juniors or better in anthropology (or grad students).  Of course, the year I got to the class there were no cadavers, so had to dissect a macaque I named George.  Fast forward past a couple of years on the road, working off-shore oil and blood banking, and I am finishing an undergraduate degree working on a locked, co-ed adolescent psychiatry unit.  This passage is from my dissertation:

"I was a “milieu therapist” (the local job title for the more ubiquitous “clinical child care worker”.  In that environment it was universally shortened to “MT”, a homophone which figured in many puns), on a locked co-ed 17-bed inpatient unit.  I took care of patients, trained staff, did computer programming work, co-authored a social skills program, conducted in-service training and ran workshops at regional conferences and eventually worked as a research assistant, on a project focused on suicide attempters.  I found myself in an odd place, between the professional staff and the line staff,  affectively (1) more connected to the line staff but intellectually involved with the clinical staff.  My experience as a clinical child care worker drove home the schism between them in a singular fashion, with the issue underscored by my participation in research projects.   As part of that project, for example, I reviewed, at the morgue, the medical examiner’s records on any adolescent committing suicide; some whom had been previously hospitalized our facility.  I had been involved in the clinical care of several of the adolescents and had known them quite well.  I reviewed their records, saw pictures of the “suicide scene,” followed by pictures of their naked mottled bodies on the steel autopsy tables.  I read suicide notes, interviews with family, case histories, and in some cases remembered  things I’d said to them while they were hospitalized.  I’d then carve out of this “data”, using statistical programs, correlations, trends, and connections, between their final act and the clinical residue of their short lives.  No matter how I worked the data, no matter how I interpolated, ANOVA’d or regressed (2) it, every time I looked at the pictures, Johnny was still hanging bugged-eyed from his chin-up bar, belt thickly around his neck creating the illusion of muscular tension in his otherwise limp body.  No matter how persistently I translated all their sadness, fear and self-doubt into Risk/Rescue scores (3), BDI totals (4), or SIQ (5) percentages, Mary’s urine-soaked jeans belied her repose as the permanent Desipramine induced sleep that it really was.  And so it hit me, like Col. Kurtz’s (6)  diamond bullet in the forehead, that much of my activity in this professional research was the conversion of the experiences of these adolescents into homogenized, “useful” data that became the tokens (7) of professionalism in the various associated disciplines." 

What I came to understand was that these apparently competing and even adversarial ‘economies’ were differentiated by the nature of the ‘tokens’ that were considered of value (where value is defined as the indicator of status).

A simple example.  A nuclear physicist is often seen as someone who is breathtakingly intelligent and of very high status in the community. That is evidenced by the very complex mathematics that she uses to communicate and explain her world.  Of course, there are only a small group of people who understand this kind of math and are seen as competent to discuss it.   In the same community, there is someone who is relatively uneducated and engages in menial labor.  His discussions are mostly about the people around him and he may know quite a bit about them and freely passes on anything he thinks interesting, provocative, embarrassing, etc.  Gossip.  This man has relatively low status.  But, if you are new to a community, gossip is a much more useful source of information and nuclear physics completely useless.  But status is almost inversely proportional to utility?  Why?  Because anyone can produce gossip but only a few can enter the formal conversation in the mathematics described.  The latter is a club only open to a select few, so high status, and the former open to all comers, so of no status.  So it is in medicine.  The more complex the analysis, the more sophisticated and high-status the people engaged in it, whereas the actual lives of the children involved are of low status, because they are only slightly different from ordinary.  It is the transformation of the ordinary suffering into high-value tokens of scientific medicine that drives and helps explain much of that activity. 

1: In the sense of outward emotion

2. Statistical methods of data analysis

3: Risk/Rescue: rates lethality by risk of death by chance of rescue

4. Beck Depression Inventory

5. Suicidal Ideation Questionnaire

6. Apocalypse Now, 1981

7. Such psychological testing translates real human experience into numbers, percentages, scales, diagnoses that represent these experiences in such a way that the professional can compare them (the numbers) with other cases and make generalizations.  How this alchemy works is mostly a matter of faith to those outside of it.  Telling a patient that their BDI is normal does not somehow relieve them of, say, a history of sexual abuse.  But it does help generate things like papers which can be exchanged with others in the professional economy of association meetings and journals.

Circles

I am sort of thinking about the critical components one needs to assess the medical apparatus and have introduced a couple of concepts, such as semiotics and the notion of complexity, as in non-linear.  

Recapping, semiotics is a way to understand communication, from bacteria to humans and anything else with a formal system.  What is important here is that the folks who are acting within a system, like medicine can sign (communicate) without express understanding of the system itself.  That’s what anthropologists are for.  Or at least my breed.  There are a whole raft of anthropologists who have adopted western medicine as a truth and try to figure out how to apply the best of that to other cultures.  Think about AIDS prevention in Africa. But we few more critical types are interested in the very nature of that medical culture.

And complexity?  Well, interesting you should ask.  Most of what we take for granted about medicine was decided way before we really had any notion of how biology might work.  The body was a machine and medicine was about repair.  Of course, that is all wrong, but lots of notions about the body as a machine persist in both popular culture (whatever that means) and in medicine.  So being schooled in understanding the inherent non-linear nature of biology makes it easier to understand why folks in medicine don’t understand it (mostly, it is not useful, relative to the stories medicine tells about people).

So the last leg on the stool (I hear this from business types all the time, when constructing a pitch for funding.  Need at least ‘three legs on a stool,”  meaning your pitch has to have three compelling components) is rhythm.  Huh?  Yeah, rhythm.  Turns out that not only is biology strictly complex, it is always rhythmic.  Why?  Well, to communicate information in a biochemical system, one great way is using ‘difference.’

So the relative ‘amount’ of a biochemical is information.  Turns out that all of our biochemical (and all other behaviors) are rhythmic, meaning that there are normal and necessary oscillations in all of our basic biological activities.

Medicine knows this to be true, but the very way that data is collected and reported, say in clinical trials, assumes this to be untrue.  Take something like body temperature.  It follows, in healthy folks, a 24-hour cycle (called a circadian rhythm).   



 

But what many, many studies will report, is an average temperature for a human, without noting the time of day.  Virtually all studies commit the same profound mistake, as if it didn’t matter.  Here is the analogy.  If someone asked you to tell that what the average time of day is, you’d likely look at them as if they were nuts, since the time is cyclic and therefore a term like “average” isn’t really meaningful.  Or what if someone asked you the average temperature where you lived.  Would you give them the annual average temperature (say 61 Degrees F in Omaha, NE or 76 in Cairo).  Not very useful if you want to know what to wear.  You might ask what time of year, day or night, etc.  Well, our biology, like all biology, is identical.  Variations daily, weekly, monthly, and at least yearly.  But the ‘average’ hides all of that.  Most folks in medicine I talk with don’t even know this is true, but certainly are not interested.  Almost everyone.

So the stool has three legs. Semiotics, complexity and rhythm.  I’ll go on about each as time goes on and will give lots of examples from the business of medicine. because it determines what kind of medical care we have, from the disease itself to the treatments.

An example from the field

I know this is a slog, but I am trying to compress about a zillion years (or that’s what it felt like) of graduate school and industry training into something that might be palatable (as it might be), but more important, useful, to anyone who wants to slog through it.  I am a poor example of what should be a good product, considering the training I had.  The errors in this endeavor all all mine and the good parts (if any) are because of lots of much more interesting people.

The freedom in that is I know already I cannot due justice to the phenomenal exeriences I was granted, though serendipity and outright good luck.  This blog is just my outlet for saying thanks.  

But you don’t get off the hook that easily, as I have to push on with the thinking and the examination of what it is that we do, as a culture, in persisting in the kind of involution described below.  

If you think about the nature of our medical system, I think I am on fairly safe ground in asserting that on of the underlying aspects can be reduced to an economic argument, that therapies that converge on the suppression of symptoms, without addressing the underlying pathology, create an annuity for the industry of medicine.  Hmmm.  

Every chronic disease state becomes an annuity for the industry.  Could that be true?  An example?  Okay.  Here is just one.  

FDA approves a technology of use on treating pain and edema after surgery.  But so effective that technology is in other areas, Medicare (CMS) approves it for use in treating chronic wounds.
As an aside, even though Medicare says it is effective, the FDA precludes the companies from advertising it for that use.  

Unfortunately, not an unusual position for companies to find themselves it, but that isn’t as important as what happens on the ground.  I was one of the founders of such a company and we began to drive the therapy into places were it could help patients with chronic wounds, which often require special beds, pressure relieving surfaces, which help those patients as well.

One of our early users added the therapy to his program of renting these beds to nursing homes.  As the therapy proved effective, he angrily accused us of reducing his ability to rent the beds, as the chronic wounds healed more quickly, so folks didn’t need the beds as long.  He actually asked if we could make it ‘less effective.’  So maybe this is just a story, because it doesn’t have the names and the dates (oh, which it could).  But doesn’t the whole idea make ‘economic’ sense?  I’ll offer more objective examples as I go on.  But just think about it.  It isn’t a conspiracy, or a plan that anyone person has, but it is the outcome of the incentives.  That’s what an anthropologist behind the curtain can see.

Medical Involution

The social history of US, especially ‘science-based’ medicine is perfectly enthralling already, but I can’t help heap a bit more into the hopper, even if my points are less than that.

One of the great ‘exposes’ that helped catapult ‘scientific medicine’ (such as it was) into prominence was the interesting confluence of social movements (specifically the temperance movement) and phenomenal power of the ‘patent medicine’ trade groups (among other things).

Collier’s Magazine did a great expose on the whole patent medicine business in a series of articles (click to download)  that was a fine example of investigative journalism.  The fabulous connection to the temperance movement was that folks who were rabid temperance (redundant, I know) believers were free to consume ‘patent medicines,’ of which many were largely alcohol, with very liberal doses (several glass or even bottles a day).  There were plenty of other goodies, cocaine, heroin, codeine, etc., in the wide variety of ‘patent medicines.’  Obviously, the temperance folks held tightly to their patent medicines, the only thing that gave them the fortitude to combat evil. The manufacturers were free to make any claim they liked (see right) and also collected testimonials as the principal ‘support’ for their effectiveness.  So important were the testimonials, there was an active trade in them, with companies simply in the business of collecting testimonials around a patent cure and a specific complaint and then selling them is lots, like 1000 testimonials on catarrh (which, of course, we don’t today, but was quite popular in the late 1800s.  But don’t feel neglected, we found plenty of other disorders to fill in the slot) for $10.

Eventually this was all legislated away (or so folks thought) by the establishment of the Pure Food and Drug Act in 1906, then later the FDA in 1938.

Okay, fast forward.  So scientific medicine and the FDA are established to both produce ‘evidence-based medicine’ (‘evidence’ the key word, much like trying to understand what the meaning of ‘is’ is) and the FDA running herd on the whole deal. 

“Patent,” in patent medications meant that the ingredients were proprietary and the notion of proprietary medicine was foreign to clinical medicine at the time and suggested that someone was concealing something because of commercial interests.  So they were banned.  But wait, aren’t ‘patented’ medicines today the basis of the pharmaceutical industry?  Did we forget history?
Maybe.  Fast forward to today.  Hormone replacement therapy for post-menopausal women.  In the first incarnation, lots of ovarian cancer.  So a new version is put into widespread use, without that effect.  But it has others, from heart disease to increased breast cancer.  But a vast campaign to buffer the market came from the pharmaceutical giant who was making all the money, in the form of academic articles, with prominent clinicians as authors, but actually written by a company contracted to manage publications.  Until, of course, the whole apparatus was revealed.  This phenomenon has been quite common and widespread, called ghost writing, but interest never really took hold until the NYT and PLoS got there hands on the internal communications between the contract company, Wyeth and the clinicians.  It is pretty well laid out in “The Haunting of Medical Journals: How Ghostwriting Sold “HRT”  (Fugh-Berman, PloS 2010).

This is the sort of thing we find commonly in cultures, where the ‘paradigm’ has been established, like an aesthetic or artistic form that has to be maintained.  Since real creativity, meaning new methods, are not ‘sanctioned’ or ‘legitimate,’  the current forms just get iterated and iterated, more complex, but at the core, always the same.  That, BTW, is called ‘involution.’

Anthropological gaze...or is it haze?

I often explain that, to my idiosyncratic anthropological thinking (a gaze of sorts), the work of medical scientists and, say,  the indigenous healer among the Bongo-Bongo (mythical tribal group) is that the Bongo-Bongo healer shakes his chicken at the moon with his left hand and US medical scientists use their right  hand.

 

Sometimes folks think I am being critical here (to one or the other group here), but I am only pointing to the underlying cultural contexts within which all their activities take place. And within those cultural contexts, each is as meaningful as the other (culture = “that which goes without saying because it comes without saying.” P. Bourdieu, 1977)

One of the reasons an anthropologist might make that claim is on the basis of looking at the kinds of communication and interaction that take place through a common framework.  Not all anthropologist share the same one, so makes for a better range of opinions.  I am very interested in the nature of ‘signs,’ defined as ‘something that means something to someone in some context’ and, for the most part, function as a semiotician sorting through the kinds of signs that are meaningful in medicine and science at developing navigational tools, a kind of map making, for folks who want to get from one place to another (think of a salesperson trying to talk to a clinician).   I will get back to that last point, somewhere in this bricolage.  

Complexity, in the best way.

When I described the complexity of medicine, I did mean it in the technical way, that the issues we face, whether in our own health or in the health care system are really, irreducibly complex.  But that isn't a bad thing.  What it does require is for folks to actually learn a bit about these kinds of systems, so they then can apply that knowledge when faced with the simplifying shorthand of science and medicine that we consume through popular media.

A neat start, explaining how apparently complex behavior emerges from simple rules is here.

A bit more detail here, where the underlying complexity of nature gets greatly simplified (and some neat special effects:

If nothing else, you can go around disturbing the assumptions of your friends and colleagues.  That is the real credo of an anthropologist, making people stub their toes on what they used to take for granted.

Marketing Hope

A week ago, one of my great sister-in-laws asked me about an interview she had seen around a Rett Syndrome, as a friend has a daughter with the disorder.  The interview was on the View.  She asked whether the statements about the expectation that ‘there is every reason to be hopeful’ and the cure was ‘not if, but when.’  The basis being that there has been a study in a where the gene associated with Rett was knocked-out in some mice and treatment with a growth factor improved (not cured) the mice.   I suggested that a cure was not imminent, as there are lots of things between that work and treatment, from the simple differences in the mouse response to both the deficiency and treatment and humans, not too mention the vast array of clinical and regulatory issues should there be some possibility of a treatment emerging from this work.  To her further question as to why someone would talk about a cure as a ‘when not if,’ I responded that it was really about marketing.  There are finite resources and a surplus of diseases and disorders.  People will trade money for hope.  Not necessarily a bad thing, but I don’t think folks often think about the daily ‘breakthroughs’ as marketing.  
The other notion that rests under this discussion is that our bodies are somehow simple machines that move in a pretty straight-forward manner, from one ‘biological task’ to another.  If one of those tasks is not being completed well enough, some therapy can be developed to improve that one task.

That very ancient cultural imperative around biology and medicine is appealing, but not congruent with what is really going on.  Think about all the activity in your body as the traffic in Manhattan, or Atlanta, Chicago or Los Angeles.  Your physician determines that your cholesterol is too high, so puts you on a statin.  The city equivalent is a back up on 7th Street, at 42nd Avenue.  The traffic cop standing there  has a remedy, think of it as the statin, to leave the light 7th green longer.  Soon, traffic flow seems to improve.  But that means the light for 42nd Street is now red longer, so all the people trying to turn west on 42nd are slowing down.  And that means the Avenues they are on, waiting to turn, are slowing down.  Soon, there are many new traffic jams.  Too each one, a local ‘solution’ is applied.  And things just get worse.  
We seem to apply the same reductionist ideas at every scale in medicine, from individual treatment to the whole health-care system.  Of course, none of those are really reducible to some independent set of parts.  It is strictly complex.  Nothing more, or less.

A face that toils so close to stones is already stone itself! (Albert Camus)

Anthropologists commonly will seek to be trained as indigenous experts.  So I have colleagues trained as Mayan day keepers and Culina shaman.  Me, I got trained as a medical scientist (Brown University Medical School, Dept of Community Medicine).  That post-doc gave me a window into how we produce medical scientists and the credentials to function as one.  And so I have.  From a Brown-affiliated start-up in the decision sciences to Chief Science Officer at a public (AMEX and NASDAQ) company, and interesting stops in between.  But the other day I was on the phone with some goofs (chief of surgery and a exercise physiologist) who were quizzing me about statistical validity in a research trial I ran and realized I, too, had become stone.  Rather than laugh at their phenomenally naive questions about p-values, I engaged them.

That’s when I realize I was losing my perspective as a critical thinker.  


But, after a couple of drinks (and reading some Foucault out loud), I came to the few senses I have left.  I know a bit about the medical industry, from the basic ‘science’ perspective, to what it takes to convince investors to join a company and what it can mean to patients who benefit (I have spend many years directly in clinical settings with pretty sick folks).  And all of it is with an anthropologist’s eye to the culture that drives the machine.  You are welcome to take objection with it all, as I am not the best anthropologist, scientist, nor executive.  But I am at least all of them.  Oh, and I am my daughter’s basketball coach, which trumps all that noise.