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Archive for the ‘health’ Category

Covid 19: hopes, failures, solutions

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under pressure

Covid-19 continues to be devastating, especially in the USA, where there are vastly more cases than anywhere else, and vastly more deaths, though the picture there is complex. The hardest-hit region, the New York area, is seeing devastation in poorer districts such as Queens, where the Elmhurst public hospital is inundated with uninsured, critically ill patients. New York has suffered almost half of US deaths. Some other states and regions, especially physical outliers such as Alaska, Hawaii and the Virgin Islands, have very low numbers, and it would be hard to explain why the spread of cases across the mainland has been so uneven. Of course it’s obvious that there has been no federal leadership on the pandemic.

Here in Australia, where the numbers seem to be improving (we’re 33rd on the list of total cases, down from 18th when I first started paying attention to the list about three weeks ago, and 52nd on the list of total deaths), our conservative federal government is keen to open up the country again, and has released modelling to the effect that the virus will be eliminated from the mainland if we maintain current physical distancing measures, though it’s likely to take weeks rather than months:

The model suggests that every 10 people infected currently spread the virus to five more people, on average. At that level, the virus would eventually be unable to circulate and would die out within Australia.

Sydney Morning Herald, ‘Australia in course to eliminate Covid-19, modelling shows’

Australia’s current reproduction number (R0) is just a little over .5. A maintained R0 of 1 or less will eventually eliminate the virus. Of course, there will be fluctuations in that number, so it will be difficult to project a time when things are ‘all clear’. Another difficulty with modelling is that the number of infected but asymptomatic people is unknown and difficult to estimate. For example, recent Covid-19 testing of the entire crew of the aircraft carrier Theodore Roosevelt found that a substantial majority of those who tested positive were asymptomatic, casting doubt on previous estimates (already worrying for transmission) of one in four cases being asymptomatic.

The asymptomatic/presymptomatic transmission issue was addressed by Bill Gates in this article back in February. It’s what makes SARS-CoV-2 a much more serious threat than the previous SARS and MERS viruses. Gates, in this very important article, also provides an outline of what needs to be done globally to fight this pandemic and to prepare for inevitable future ones. If only…

It’s worth comparing Gates’ call for national and global co-ordination, and more expenditure, in the fields of epidemiology and disease prevention, with another more recent article, also published in the New England Journal of Medicine, which tells a tale of Britain and its NHS, gutted by years, in fact decades of ‘reforms’ and budget cuts:

Thanks to government “reforms” of the NHS, it has become highly decentralized, with over 200 commissioning groups in England that can make independent decisions about staffing and procurement of equipment — far from the monolithic “socialist” health care system it is often assumed to be. The devolved governments in Wales, Scotland, and Northern Ireland have substantial health system autonomy. At a time when central management of staff and resources might be most helpful, the decentralized decision-making structure leads to competition for resources and inconsistent policies.

One can hope that the travesty of this virus, especially in places like the US and the UK, will lead to a rethinking of the importance of a well-funded, centralised, co-ordinating and interventionist government in modern states, with particular emphasis on the healthcare system. But I suspect that, in the USA at least, things will go the other way, and the government-hating and government-blaming will only intensify. I’d love to leave this topic and look at solutions – that’s to say I’d love to focus more on the science, but I’m barely equipped to do so. Still, I like to have a go. A very technical and comprehensive review review of pharmacological treatments has been posted recently on the JAMA website, which includes an account of how SARS-CoV-2 enters host cells and utilises those cells for reproduction.

The review claims that currently the most promising therapy is the antiviral drug remdesivir. So what is it and how does it work? I’ll try to answer that question next time.

References

https://www.news.com.au/world/coronavirus/global/epicentre-of-the-epicentre-this-queens-ny-hospital-is-coronavirus-ground-zero/news-story/6d0213ab9d5dd82fa12339f551be99ce

https://www.theguardian.com/world/ng-interactive/2020/apr/16/coronavirus-map-of-the-us-latest-cases-state-by-state

https://www.smh.com.au/national/australia-on-course-to-eliminate-covid-19-modelling-shows-20200416-p54kjh.html

https://www.nejm.org/doi/full/10.1056/NEJMp2005755?query=recirc_artType_railA_article

https://www.nejm.org/doi/full/10.1056/NEJMp2003762

https://jamanetwork.com/journals/jama/fullarticle/2764727

Written by stewart henderson

April 18, 2020 at 1:18 pm

My current health condition 1: it’s bizarre

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I can bear any pain as long as it has meaning

Haruki Murakami

stuff to learn about

I haven’t written for a while because I have a new health problem which flared up last Saturday, February 29, 2020. I had been feeling mild pain in my shoulder and I was lying on my bed reading when I tried to get up. Shooting pain from my shoulder down my left arm was so excruciating that I fell back on the bed and and lay down for a while before trying to get up again. Again I couldn’t get up because of the pain. I called for help but even with two of us it was difficult. I may have had a panic attack and exaggerated the pain of rising – I was gasping a lot. To cut a long story short Sarah called an ambulance (and the paramedic got me into a sitting position easily enough). I spent the next few hours in emergency at the Royal Adelaide Hospital.

Due to being given Panadol in the ambulance, and a long wait in reception while the painkiller took effect, by the time the friendly, efficient and strikingly beautiful (oh dear) young intern saw me, the pain, my only symptom, had much reduced. She found that, yes, I could move my arm above my shoulder, flex my elbow and my wrist, and no, I couldn’t precisely describe the nature or location of the pain. She checked my arm for swelling or redness (none), and asked about any recent history of injury to the region (none). I was beginning to feel like a fraud, a malingerer, a milquetoast.

So after some more prodding and questioning and advice from higher authorities, I was released with a report for my local doctor.

I’m very left-handed, so this left arm pain is quite a problem for me. I was due to work on the Monday and I needed some pain relief. It would have to be over the counter at first. The report’s only solid conclusion was ‘skeletal-muscular pain’. Since I needed to work on Monday and Tuesday I could only get to the GP on Wednesday. So on Sunday I started doing what research I could. I’ve never taken regular medication for anything, and I’ve never experienced regular pain like this. The only over-the-counter treatments for pain are ibuprofen and paracetamol as far as I know. Only ibuprofens is an anti-inflammatory. Paracetamol works on pain centres in the brain. Which one would work best? Was it all in my mind? But don’t we always feel pain via the brain? Isn’t that how the nervous system works?

I obtained both medicines. Over the next day or so I experimented with both, singly and in combination, and I got through Monday and Tuesday’s work. The pain never went completely away, though the teaching days, when I had to concentrate on and interact with my students and other teachers, helped to distract me from it, which gave me that guilty ‘it’s all in the mind’ feeling.

Even so, on Wednesday (March 4), the pain came roaring back. My subjective sense told me that the paracetamol was much more effective than the ibuprofen, another surprise. I visited my GP, who smiled at the hospital report, saying, ‘yes, they wanted you out of there as soon as possible – they’re there for acute, intensive care stuff, it’s understandable – a GP can refer you to a specialist, and we can go from there’. So he filled out a referral form for St Andrews Hospital, for an x-ray and an ultrascan. I rang them and organised an appointment, for Friday, March 6 at 11am.

I was still in pain, though. The OTC medication had reduced the pain to more bearable levels, but I still hadn’t worked out which worked best. Unlike me, Sarah was on many medications, for pain and other problems, including Prodeine (paracetamol plus codeine) and a set of tablets which combined paracetamol and caffeine. I was taking the tabs at the upper level of what was recommended, and beyond. I was trying to monitor the pain, what it felt like. It was always a low-level throbbing, which increased and became a shooting pain if I used the arm too much. It was a strange delayed pain – I would engage in a flurry of physical activity, such as preparing a quick meal, and then lie down, knowing that the pain would rise up as a result of the activity, then slowly subside. I had difficulty sleeping, and I dreaded dressing myself in the morning. Typing this is giving me an ache, and I’m experimenting with dictation – I find the Apple dictation system a pain (mentally speaking). I have to learn more about how to use it effectively.

Stupidly, I hadn’t asked my GP about stronger prescription medication. The day after the consult (Thursday, March 5) I had Sarah ring the surgery – I was experiencing bouts of serious pain, and was finding it hard to track what medication was working, or not. The doctor wrote a prescription, which Sarah collected and had made out at the pharmacy around the corner. It was for ibuprofen (200mg) and codeine phosphate hemihydrate (12.8mg). I was skeptical about the efficacy of ibuprofen, and I had been researching anti-inflammatories, and inflammation generally.

What, exactly, is inflammation? There are, supposedly, five signs of it, remembered under the acronym PRISH – pain, redness, immobility, swelling and heat. My only symptom was pain. There was certainly no redness or swelling. Immobility wasn’t a real problem either. I could move my arm above the shoulder, I could flex my elbow, etc, but some pain would come afterwards. Heat wasn’t something I could measure, but it didn’t seem an issue. Only pain. And I hadn’t pinpointed any cause of all this. I remembered what I’d said, quite often (or at least I thought I did – maybe I was mostly saying it to myself) to the intern at emergency: ‘It’s bizarre!’

Anyway, I’ll wind up this piece, and start on a new one, dealing with my time at St Andrews Hospital, the x-ray and the ultrasound.

Written by stewart henderson

March 8, 2020 at 12:43 pm

Covid 19, bird flu, etc – why China?

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Covid 19 under the microscope

The recent coronavirus now has an official name, Covid 19, and the death toll at present is a little under 2000, considerably more than that for the SARS coronavirus of 2003. It has spread to at least two dozen countries according to ABC reporting. I note that the WHO are emphasising how co-operative the Chinese authorities have been, I suspect as an attempt to keep those channels of communication and co-operation open, or to open them wider. The infamously over-controlling Beijing government is faced with a dilemma as its economy is taking a major hit – it desperately wants to get over this epidemic, which means downplaying it as much as possible, but its dependence on international trade means having to co-operate with those over whom it has no control. The Middle Kingdom has always been sensitive about this issue of control and dominance, which clashes with the co-operative spirit of modern global trade relations. 

Having said that, Chinese authorities have certainly learned from the reaction to their fairly disastrous early handling of the SARS coronavirus outbreak in 2002. In terms of the really essential stuff, co-operation and information-sharing have rapidly improved – motivated by the apolitical spirit of research, detection and problem-solving that constitutes science’s unique value.  

Of course, one of the questions being asked, with Covid 19, the SARS virus, and other viruses such as H7N9 avian influenza virus (which had a very high mortality rate), is ‘Why China?’ An article from late 2017 in the Smithsonian magazine provides a plausible if shocking answer. 

It seems imprinted in Chinese culture that freshly killed-birds and other animals are tastier and somehow healthier than anything frozen or otherwise processed. The Chinese government has, in the past, been reluctant to interfere with the demand for freshly slaughtered produce, and it’s likely that, even if it enforced a clamp-down, the market would go underground. Melinda Liu, author of the Smithsonian article, described the scene at one of these markets, in the Sichuan city of Chingzhou:

Half a dozen forlorn ducks, legs tied, lay on a tiled and blood-spattered floor, alongside dozens of caged chickens. Stalls overflowed with graphic evidence of the morning’s brisk trade: boiled bird carcasses, bloodied cleavers, clumps of feathers, poultry organs. Open vats bubbled with a dark oleaginous resin used to remove feathers. Poultry cages were draped with the pelts of freshly skinned rabbits. (“Rabbit meat wholesale,” a sign said). These areas – often poorly ventilated, with multiple species jammed together – create ideal conditions for spreading disease through shared water utensils or airborne droplets of blood and other secretions.

Flu viruses can crop up and mutate anywhere – for example, the H5N2 flu strain which broke out in the USA in 2015 led to the slaughter of 48 million poultry – but China’s mixed farming habits, in which poultry and other livestock live in close proximity with their keepers, together with the taste for freshly slaughtered and disturbingly exotic meat, and the conditions in many markets and slaughter-yards, presents a massive cultural problem for China’s huge and increasingly mobile population. The country will have to come to terms with these issues, sooner rather than later, if it wants to recapture and grow beyond the leading economic role it led before the advent of Covid 19.

References

https://www.smithsonianmag.com/science-nature/china-ground-zero-future-pandemic-180965213/

https://www.who.int/emergencies/diseases/novel-coronavirus-2019

https://www.who.int/influenza/human_animal_interface/influenza_h7n9/en/

Written by stewart henderson

February 19, 2020 at 9:15 pm

Posted in China, covid19, health

Tagged with , ,

coronavirus – a journey begins

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this is an electron micrograph of 2019-nCoV – ref JOHN NICHOLLS, LEO POON AND MALIK PEIRIS/THE UNIVERSITY OF HONG KONG. The cell is infected with the virus (the little black dots), which migrates to the cell surface and is released

Lots of information and disinformation around the recent outbreak of coronavirus, and my own occasional workplace, a college that teaches academic English to overseas, predominantly Chinese students, is naturally affected by the precautionary procedures and the possibly OTT concern.

This is a new strain of coronavirus, first detected late in 2019. It hasn’t been given a specific name, as far as I’m aware (apart from 2019-nCoV,  which I doubt will catch on) so lay people tend to think this is the one and only coronavirus, since most have never heard the term before. These viruses are zoonotic, transmitted between animals, from bats to humans. My interest is most personal, because when I read that the signs are ‘respiratory symptoms, fever, cough, shortness of breath and breathing difficulties’, I recognise my life over the past several years. I wouldn’t go as far as to say I have a fever, but all the other signs are just features of my life I’ve become inured to over time. I’m reluctant to even talk to people lest my voice catch in my throat and I have to give myself up to hideous throat-clearing, which I do scores of times a day. I’m also afraid to get too close as I assume my breath smells like rotten meat. I should probably wear a face mask at all times (hard to get one for love or money at this point). My condition has been diagnosed as bronchiectasis, possibly contracted in childhood, but I’m fairly sure it was exacerbated by a very severe bout of gastro-enteritis in the late eighties, which left me bed-ridden for several days, too weak to even get to the toilet. When I eventually recovered enough to drag myself to the doctor, she arranged for me to go to the hospital next door for blood tests. It was unspoken but obvious to me she thought I might have AIDS, which I knew was impossible given my non-existent sex life and drug habits. It seems to me, but I might be wrong, that my life of coughing, sniffling and raucus throat-clearing took off from that time.

All this by way of explaining why these types of illness catch my attention. WHO advice is for people to, inter alia, wash hands regularly, cook meat and eggs thoroughly, and keep clear of coughy-wheezy-sneezy people like me. 

Coronaviruses are RNA viruses with a long genome, longer than any other RNA virus. According to Sciencealert they’re so called because of the crown-shaped set of sugar-proteins ‘that projects from the envelope surrounding the particle’. This one is causing perhaps a larger panic than is warranted, when you compare its fatalities (and the numbers should be treated with skepticism at this stage) with those associated with regular flu season. Of course, the difference is that this coronavirus is largely unknown, in comparison to seasonal flu, and fear and wariness of the unknown is something naturally ‘programmed’ into us by evolution.  

There’s an awful lot to be said about this topic, biochemically, so I’ll write a number of posts about it. It’s not only of great interest to me personally, but of course it fits with my recent writings on DNA and its relations, including RNA of course, and to a lesser extent epigenetics. I’m becoming increasingly fascinated by biochemistry so it should be an enjoyable, informative journey – for me at least.

References

Cases of the new coronavirus hint at the disease’s severity, symptoms and spread

Updated: Your most urgent questions about the new coronavirus

https://www.who.int/health-topics/coronavirus

Written by stewart henderson

February 8, 2020 at 10:57 am

Posted in coronavirus, health, RNA, viruses

Tagged with , , ,

a brief history of radical mastectomy

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Dr William Halsted

Siddhartha Mukherjee is an oncologist, an academic and an astonishingly gifted writer and story-teller, in the Indian tradition of seemingly effortless, self-effacing wordsmiths. I read, and learned heaps from, his 2016 book The Gene a while back, and now I’m being educated by his first book The Emperor of all Maladies, a history of cancer. 

The book twists together different threads of cancer treatment in the modern era, most notably various forms of chemotherapy, and surgery. I’m focusing solely on surgery here, as it pertains to breast cancer, because it highlights the relation between experts (very predominantly male) and sufferers (exclusively female).


The term mastectomy is a bit of a mystery, at least to me. The suffix –ectomy is clear enough, meaning ‘cutting out’, or surgical removal, and ‘lumpectomy’ is a slightly dismissive term for the surgical removal of lumps (from the days when full-blown excision was king) . Maybe mastectomy refers to the removal of a mass of tissue, though why it wouldn’t be called massectomy or masectomy, and why it refers only to the breast, I don’t know. It has nothing to do with mast cells.


The radical mastectomy – the concept refers to ‘root’ as in rooting out, rather than quasi-political radicalism – is most associated with an American physician, William Halsted, though radical surgery in the treatment of cancer was far from unknown when Halsted began practising in the 1870s. Cancer at the time was recognised as the growth and spread of malignant tissue, at mysteriously varying rates, and the surgical removal of that tissue seemed the obvious response. Nineteenth century developments in anaesthesia helped to make the procedure more bearable for all, but operations in the US were often ad hoc and unsanitary. In the late 1870s Halsted made a trip to Europe, which radically changed his outlook and practice. He encountered and absorbed the ideas of various pioneers in surgery and anatomy, including Joseph Lister, Theodor Billroth, Richard von Volkmann and Hans Chiari, then returned to the US, and in the 1880s he quickly established a reputation for boldness and skill as a surgeon. Having become familiar with cocaine, which he recommended as an anaesthetic, he soon became addicted to the drug, which gave him seemingly boundless energy. He tried using morphine to kick the habit, and then found himself in a struggle with both drugs, but this barely damped his work-rate.

Hasted had become particularly interested in Volkmann’s surgical work on breast cancer, and noted that, though the surgeries became more extensive, the cancers returned. An English surgeon, Charles Moore, was experiencing the same problem. Moore’s painstaking analysis of the operations and the following relapses showed that malignant cells had begun to proliferate around the edges of previous surgeries. It seemed clear to him that the surgeries just weren’t extensive enough, and by limiting the surgery to the clearly evident cancerous tissue, and not widening the margins to ensure that the malignant region was properly cleaned out, surgeons were exercising ‘mistaken kindness’. Of course, the problem with this argument was that more radical surgery could itself be life-threatening as well as permanently disfiguring and debilitating. What was also not known at the time was the detailed mechanism of cancer’s metastatic spread throughout the body via the blood and lymph systems. However, this was a time when medical expertise tended to go unquestioned. Halsted and his surgical followers were considered heroes, and the delayed return of the cancers tended not to be dwelt on. The surgeons certainly did buy time for their patients, but often at great cost. Volkmann, for example, had taken breast surgery further by removing not just the breast but the muscle beneath it, the pectoralis minor, to try to ensure the complete removal of the cancer. Impressed, Halsted took things to the next level, cutting through the more vital pectoralis major, essentially killing off movement of the shoulder and arm. Radical mastectomy had now truly arrived, and was to become even more radical, with the collarbone and the group of lymph nodes beneath it becoming the next target, and it didn’t stop there, as cancer kept recurring. As Mukherjee describes it:

A macabre marathon was in progress. Halsted and his disciples would rather evacuate the entire contents of the body than be faced with cancer recurrences. In Europe, one surgeon evacuated three ribs and other parts of the rib cage and amputated a shoulder and a collarbone from a woman with breast cancer.

Siddhartha Mukherjee, The Emperor of all Maladies, p65

There were, of course, no female surgeons at this time, and precious few female doctors, and the male-female power imbalance was coupled with that of the expert and his suffering if not panicking victim to create a kind of juggernaut of largely unnecessary suffering. It took years to reverse this radicalising trend. Nowadays, radical mastectomies are very rarely performed, but with so many giants in the field – who often controlled the nature of clinical trials related to cancer – having earned their reputations through their surgical expertise, change was slow in coming, in spite of a gradual increase in often heroic dissenting voices. For example, Rachel Carson, the author of Silent Spring, refused to undergo a radical mastectomy, which would in any case have offered only brief respite as the cancer had already spread to her bones. Changing attitudes to experts and their secret and superior knowledge was of course a feature of the sixties and seventies, when the turning point really occurred. Developments in the field of course played their part. The knock-out blow for the procedure is largely associated, according to Mukherjee, with another surgeon, not unlike Halsted in energy and drive.

Bernard Fisher had been analysing the data of Halsted’s critics, notably Geoffrey Keynes in England and George Crile in the US, and became increasingly convinced, for a number of reasons, that radical mastectomy was a wrong-headed approach. In 1967, Fisher became the chair of a national consortium in the US, the National Surgical Adjuvant Breast and Bowel Project (NSABP), and began an uphill battle to run large-scale trials to test the efficacy of different treatments of breast cancer. Patients were reluctant to engage, and most surgeons were hostile. The process took years, but results were finally made public in 1981. Here’s Mukherjee’s summary.

The rates of breast cancer recurrence, relapse, death and distant caner metastasis were statistically identical among all three groups [i.e treated with radical mastectomy, with simple mastectomy, or with surgery followed by radiation]. The group treated with the radical mastectomy had paid heavily in morbidity, but accrued no benefits in survival, recurrence or mortality.

Siddhartha Mukherjee, The Emperor of all Maladies, p201
Dr Bernard Fisher

So. Richard Feynman once famously/notoriously said ‘science is the belief in the ignorance of experts. When someone says science teaches us such and such, s/he’s using the word incorrectly – science doesn’t teach us, experience teaches us.’ I agree. Science isn’t a person, let alone an expert person. Science is, to me, an open-ended set of methods based on experience. Experience creates new methods out of which new experiences are created, and we move on, trying to right the wrongs and to minimise the damage, while always maintaining our skepticism.

Reference

The Emperor of all Maladies: a biography of cancer, by Siddhartha Mukherjee, 2011

Written by stewart henderson

December 22, 2019 at 3:01 pm

The statin controversy

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Never edit your own writing! Brian J Ford.

one thing thing you can be sure of – this claim (posted by a British chiropractor) is meaningless bullshit

I read Ben Goldacre’s quite demanding book Bad pharma some years ago, and that’s where I learned about statins, but I don’t recall much. I do recall that, not long after I read the book, I was at a skeptics meet-up when Dr Goldacre’s name came up. The man next to me started literally spitting chips at the mention – he was eating a massive bowl of chips and was grossly overweight (not that I’m assuming anything from this – just saying, haha). He roolly didn’t like Dr Goldacre. What went through my head was – some people may be really invested in having a magic pill that allows them to live forever and a day no matter what their diet or lifestyle.

I’ve just discovered that Goldacre has a new book out, entirely on this topic, which I intend to read, but my current decision to explore the issue is based on listening to Dr Maryanne Demasi’s talk, ‘statin wars – have we been misled by the evidence?’, available on YouTube. I very much recall the massive Catalyst controversy a few years ago, when a two-part special they did on statins led finally to the demise of the program. Without knowing any details, I thought this was a bit OTT, but when I heard Dr Norman Swann, a valued health professional and presenter of the ABC’s Health report, railing about the irresponsibility of the statin special, I frankly didn’t know what to think.

So statins are lipid-lowering medications that come in various flavours, including atorvastatin, fluvastatin, lovastatin and rosuvastatin. Lipitor, a brand name for atorvastatin manufactured by Pfizer, is the most profitable drug in the history of medicine. I’ve never taken statins myself, and I’m starting this piece as a more or less total beginner on the topic. I’ve read the Wikipedia entry on statins, which is quite comprehensive, with a very long reference list. Of course it’s not entirely comprehensible to a lay person, but that’s not a criticism – immunobiology and related research fields are complex. It’s also clearly pro-statin. It includes this interesting sentence:

 A systematic review co-authored by Ben Goldacre concluded that only a small fraction of side effects reported by people on statins are actually attributable to the statin.[63]

It’s interesting that Goldacre, and nobody else, is mentioned here as a co-author. It makes me wonder…

My only quibble, as a lay person, is that the positive effects of these statins, and their relatively few side-effects, seems almost too good to be true. I speak, admittedly, as a person who’s always been ultra-skeptical of ‘magic bullets’.

Which brings me to issues raised in Dr Demasi’s talk, and not addressed in the Wikipedia article. They include the idea, promoted by an ‘influential group’, that statin use should be prescribed for everyone over 50, regardless of cholesterol levels. Children with high cholesterol levels are being screened for statin use and Pfizer has apparently designed fruit-flavoured statis for use by children and adolescents. Others have suggested using statins as condiments in fast-food burgers, and even adding statins to the public water supply. It’s easy to see how such ‘innovations’ involve making scads of money, but this isn’t to deny that statins are effective in many if not most instances, and we should undoubtedly celebrate the work of the Japanese biochemist Akiro Endo, who pioneered the work on enzyme inhibitors that led to the discovery of mevastatin, produced by the fungus Penicillium citrinum.

But Demasi made some other interesting points, firstly about how drug companies like Pfizer might seek to maximise their profits. One obvious way is to widen the market – for example by lobbying for a lowering of the standard level of cholesterol in the blood considered dangerous. From the early 2000s in the US, ‘high cholesterol’ was officially shifted down from as high as 6.5 down to below 5, moving vast numbers of people onto having a ‘need’ for these cholesterol-lowering drugs. Demasi points out that this lowering wasn’t based on any new science, and that the body responsible for these decisions, the National Cholesterol Education Program (NCEP), was loaded with people with financial ties to the statin industry. To be fair, though, one might expect that doctors and specialists concerned with cholesterol to be invested, financially or otherwise, in ways of lowering it. They might also have felt, for purely scientific reasons, that the level of cholesterol considered dangerous was long overdue for adjustment.

Another change occurred in 2013 when two major heart health associations in the US decided to abandon a single number in terms of risk factors for heart disease/failure. Instead they looked at cholesterol, blood pressure, weight, diabetes and other factors to calculate ‘percentage risk’ of cardiovascular problems. They evaluated this risk so that if it was over 7.5% in the next 10 years, you should be prescribed a statin. A similar percentage risk system was used in the UK, but the statin prescription started at 20%. Why the huge discrepancy? Six months later, the Brits brought their threshold down to 10%. The US change brought almost 13 million people, mostly elderly, onto the radar for immediate statin prescription. The method of calculation in the US was independently analysed, and it was found that they over-estimated the risk, sometimes by over 100%. Erring on the side of caution? Or was there a lot of self-interest involved? It could fairly be a combination. The term for all this is ‘statinisation’, apparently. It’s attributed to John Ioannidis, a Stanford professor of medicine and a noted ‘scourge of sloppy science’. If you look up statinisation, you’ll find a storm of online articles of varying quality and temper on the issue – though most, I notice, are five years old or more. I’m not sure what that signifies, but I will say that, while we’ll always get the anti-science crowd baying against big pharma, vaccinations and GM poison, there’s a clear issue here about vested interests, and the need to, as Demasi says, ‘follow the money’.

This brings up the issue of how trials of these drugs are conducted, who pays for them, and who reviews them. According to Demasi, the vast majority of statin trials are funded by manufacturers. Clearly this is a vested interest, so trial results would need to be independently verified. But, again according to Demasi (and others such as Ioannidis and Peter Gotzsche, founder of the nordic Cochrane Collaboration) this is not happening, and ‘the raw data on statin side-effects has never been released to the public’ (Demasi, 2018). This data is held by the Cholesterol Treatment Triallists’ (CTT) collaboration, under the Clinical Trial Service Unit (CTSU) at Oxford Uni. According to Demasi, who takes a dim view of the CTT collaboration, they regularly release meta-analyses of data on statins which advocate for a widening of their use, and they’ve signed agreements with drug companies to prevent independent examination of research findings. All of this is described as egregious, which might seem fair enough, but Elizabeth Finkel, in a long-form article for Cosmos magazine in December 2014, takes a different view:

.. [the CTT] are a collaboration of academics and they do have access to the raw data. It is true that they do not share that data outside their collaboration and are criticised by other researchers who would like to be able to check their calculations. But the trialists fear mischief, especially from drug companies seeking to discredit the data of their rivals or from other people with vested interests. Explains [Professor Anthony] Keech, “the problem with ad hoc analyses are that they can use methods to produce a particular result. The most reliable analyses are the ones done using the methods we published in 1995. The rules were set out before we started.” And he points out these analyses are cross-checked by the academic collaborators: “Everything is replicated.”

As a regular reader of Cosmos I’m familiar with Finkel’s writings and find her eminently reliable, which of course leaves me more nonplussed than ever. I’m particularly disturbed that anyone would seriously claim that everyone over fifty (and will it be over forty in the future?) should be on these medications. I’m 63 and I take no medications at all, which I find a great relief, especially when I look at others my age who have mini-pharmacies in their homes. But then I’m one of those males who doesn’t visit doctors much and I have little idea about my cholesterol levels (well yes, they’ve been checked and doctors haven’t raised them to me as an issue). When you get examined, they usually find something wrong….

In her talk, Demasi made a comparison with the research on Tamiflu a few years ago, when Cochrane Collaboration researchers lobbied hard to be allowed to review trial data, and it was finally revealed, apparently, that it was certainly not as effective and side-effect free as its makers, Roche, claimed it to be. The jury is still out on Tamiflu, apparently. Whether it’s fair to compare the Tamiflu issue with the statin issue is a matter I can’t really adjudicate on, but if Finkel is to be believed, the CTT data is more solid.

There’s also an issue about more side effects being complained of by general users of statins – complaints made to their doctors – than side effects found in trials. This has already been referred to above, and is also described in Finkel’s article. Many of these complaints of side-effects haven’t been able to be sheeted home to statins, which suggests there’s possibly/probably a nocebo effect at play here. But Demasi suggests something more disturbing – that many subjects are eliminated from trials during a run-in period precisely because the drug disagrees with them, and so the trial proper begins only when many people suffering from side-effects are excluded. She also notes, I think effectively, that there is a lot of play with statistics in the advertising of statins (and other drugs of course) – for example a study which found that the risk of having a heart attack on statins was about 2% compared to 3% on placebos was being advertised as proving that your heart-attack risk on statins is reduced by a third. This appears to be dodgy – the absolute percentage difference is very small, and how is risk actually assessed? By the number of actual heart attacks over period x? I don’t know. And how many subjects were in the study? Were there other side-effects? But of course we shouldn’t judge the value of statins by advertising guff.

Another interesting attack on those expressing doubts about the mass prescription of statins has been to call them grossly irresponsible and even murderers. This seems strange to me. Of course doctors should be all about saving lives, but they should first of all be looking at prevention before cure as the best way of saving lives. Exercise (mental and physical) really is a great form of medicine, though of course not a cure-all, and diet comes second after exercise. Why the rush to medicalise? And none of the writers and clinicians supporting statins are willing to mention the financial bonanza accruing to their manufacturers and those who invest in them. Skepticism is the lifeblood of science, and the cheerleaders for statins should be willing to accept that.

Having said that, consider all the life-saving medications and procedures that have preceded statins, from antibiotics to vaccines to all the procedures that have made childbirth vastly safer for women – who cares now about the pharmaceutical and other companies and patentees who’ve made their fortunes from them? They’re surely more deserving of their wealth than the Donnie Trumps of the world.

So, that’s my initial foray into statins, and I’m sure the story has a way to go. In my next post I want to look at how statins work. I’ve read a couple of pieces on the subject, and they’ve made my head hurt, so in order to prevent Alzheimer’s I’m going to try an explanation in my own words – to teach myself. George Bernard Shaw wrote ‘those who can, do, those who can’t teach (it’s in Man and Superman). It’s one of those irritating memes, but I prefer the idea that people teach to learn, and learn to teach. That’s why I love teaching, and learning…

By the way, the quote at the top of this post seems irrelevant, but I keep meaning to begin my posts with quotes (it looks cool), so I’m starting now. To explain the quote – it was from a semi-rant by Ford in his introduction to the controversial dinosaur book Too big to walk (I’ve just started reading it), about writers not getting their work edited, peer reviewed and the like, and being proud or happy about this situation. This, he argues, helps account for all the rubbish on the net. It tickled me. I, of course, have no editor. It’s hard enough getting readers, let alone anyone willing to trawl through my dribblings for faults of fact or expression. Of course, I’m acutely aware of this, being at least as aware of my ignorance as Socrates, so I’ve tried to highlight my dilettantism and my indebtedness to others. I’m only here to learn. So Mr Ford, guilty as charged.

References

Dr Maryanne Demasi – Statin wars: Have we been misled by the evidence?

https://en.wikipedia.org/wiki/Statin

https://cosmosmagazine.com/society/will-statin-day-really-keep-doctor-away

https://en.wikipedia.org/wiki/John_Ioannidis

https://www.smithsonianmag.com/science-nature/what-is-the-nocebo-effect-5451823/

http://www.center4research.org/tamiflu-not-tamiflu/

Written by stewart henderson

September 9, 2019 at 9:44 pm

On cramp, sensation and pain

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hard to find a non-athletic-looking image of leg cramp

In recent times I’ve been suffering from cramp, usually in bed in the early mornings, almost always in the calf but sometimes in the foot, around the toes but sometimes at the back of the foot, and invariably on the left leg. So all of this leads to a great variety of thoughts and anxieties. What is cramp? What causes it? Can it be cured or prevented? Why only on the left side? Why now and not in the past? Will it keep getting worse? How to describe the sensation? What’s the difference between a description of a sensation and the sensation itself?  Can pain be measured? Can it be distinguished from pain response?

The cramps I suffer from are clearly not the same thing as those experienced by footballers near the end of a go-for-broke cup final, when they crumple in a heap of agony and have to be massaged back to life by a team-mate, an exercise which also seems to involve a stretching of the afflicted muscle. I’ve heard this has to do with a lack of oxygen getting to the muscle when it’s being strenuously exercised. I don’t know if I’ve ever experienced that kind of cramp (does it feel different?) but I do recall getting a sharp pain in the abdominal region, referred to by others as ‘the stitch’, when, either during a football game or a school run, I exercised myself beyond my level of fitness – which was very easily done. That pain, however, was qualitatively different from the cramps of today. It didn’t feel muscular.

 So now to what the pundits say. First, on ‘stitch’, this BBC health and fitness website has it that ‘most scientists believe the pain is caused by a reduction of blood supply to the diaphragm, causing it to cramp’. It’s certainly common in long-distance runners, but as I recall – and it’s been a long time since I’ve been silly enough to bring on that particular pain – it felt very different from the leg cramps, more like an organ pain, of the stomach perhaps, or the duodenum (I’ve no idea). If it is a muscular cramp, it’s an indication that these cramps can feel very different from each other.

It hasn’t taken me long to realise that the science of cramps isn’t particularly well-developed. Though perhaps that’s a bit unfair – better to say that it’s not settled, due largely to its complexity. Some cramps, though surely not mine, are caused by muscle fatigue, while others are caused by a lack of electrolytes, or it could be a combo.

So what are these electrolytes? Salts, acids and bases mostly, which become ionised in solution when an electric current passes through it. The major electrolytes in our body are calcium, sodium, magnesium, potassium, phosphate and chloride.

Okay, I’ve got it slightly wrong. These electrolytes, or ‘lytes’ as the pundits call them, dissolve in any ‘polar solvent’, such as water, and separate into cations and anions. I learned a bit about this at school but I’ve forgotten. Basically the dissolved lytes become ionised, I don’t know why, becoming either positively charged (having fewer electrons than protons, making them cations), or negatively charged anions (with more electrons than protons). These anions and cations disperse more or less uniformly through the fluid, making it electrically neutral. But when an electric potential (something very complicated, but I think it basically means an electric charge) is applied to the fluid, the cations gravitate (surely the wrong word!) to the electron-rich electrode, the anions to the … other one.

What does this mean for cramp sufferers? Fuck knows, but I think it means that if you don’t have enough of these lytes, for whatever reason, you don’t get this ionisation happening and that’s bad for your body. Anyway, we’ve all presumably heard of these probably bogus electrolyte-bearing drinks that are advertised as a salvation for athletes, of which I’m very obviously not one, but it does seem possible that I’m a bit light on my lytes. What I’m doing here is engaging in a bit of deductive reasoning a la Sherlock Holmes. If you eliminate all the impossibles, whatever’s left, however improbable, is probably true, or something like that.

So… my cramps are definitely not caused by hyperflexion (flexing of a muscle beyond normal limits), or by hypoxia (deprivation of oxygen at the tissue level). Nor is it likely to be a complication of pregnancy (I wish). I don’t want to think about it being symptomatic of kidney or thyroid disease (I feel otherwise healthy), but they’re extreme improbabilities that might need to be looked at later. Three other conditions are highlighted on the fabulous Wikipedia: hypokalemia, hypomagnesemia and hypocalcaemia. Careful inspection from the astute reader should render these terms intelligible. They refer, bien entendu, to a, presumably chronic, lack of potassium, magnesium and calcium, respectively (the aforementioned lytes). A quick glance at the symptoms of these three conditions suggests to me that they can be relegated to the bottom section of the list of probable causes. Often they result from the use or overuse of prescription medication. I don’t take any.

Now I’m starting to run out of possible causes, and I don’t want to complicate the problem too much. Actually the best advice I’ve read so far on the Wikipedia website is this: Stretching, massage and drinking plenty of fluid, such as water, may be helpful in treating simple muscle cramps. Obviously they don’t include wine as a useful fluid in these circs. That may be my downfall – alcohol tends to dehydrate, which is negative in itself but also seems implicated in cramping. It narrows the blood vessels (hypoxia enfin? the blood vessels oxygenate the muscles don’t they?), which is probably what gives that headachey hungover feeling I sometimes have in the morning. It also causes a build-up of lactic acid, another probable cause of cramping. I’m beginning to feel that a few small adjustments, such as drinking some water before bed-time, avoiding excessive alcohol intake, and keeping the muscles of the lower leg warm (cramping always seems more excruciating in winter) might be enough to solve my problems, which are only minor after all.

So that’ll do me, all that philosophical stuff about the nature of pain will have to wait for another day. I need to hydrate and keep warm, firstly, and I’ll see how that helps as winter is coming.

Written by stewart henderson

April 29, 2017 at 5:53 pm

Posted in fitness, health, pain

Tagged with , ,

Recalling romance: the incomparable Ha Ji-won

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a young Ha Ji-won looking determined, in the 2002 comedy/drama Sex is Zero

Canto: Okay, so we’ve been so busy pretending to be sciency savants that we’ve forgotten about the romantic side of this blog…

Jacinta: You’re right, the Urbane Society for Skeptical Romantics must be a confusing name for some, unless they can find some romance in our scientific interests, which would be nice…

Canto: So we’re changing all that by doing occasional pieces on heroines around the world, since we’re both into female supremacy, right?

Jacinta: Okay and you’ve chosen a very romantic heroine first up, and I must say I approve of her wholeheartedly, though I may play devil’s advocate during this dialogue.

Canto: Fine, well I’ve chosen a real people’s heroine, the dazzling Ha Ji-won, from Korea. She’s a hugely successful star of film and television drama, a household name over there, but I’ve picked her for, inter alia, her many portrayals of strong women – from teenage misfits to action heroes to royalty to suburban divorcées, she’s one of those actors who dominate the screen and inspire women everywhere – at least everywhere in Korea – to be feisty and independent, and that’s a fine thing.

Jacinta: Actually I like her because she comes across mostly as a warm and sensitive person, a sort of ‘what the world needs now’ sort of person, but admit it, what’s the real reason you’ve chosen her?

Canto: Ah well, of course it’s purely a romantic one, I’m totally besotted with her and I’m sure my usual razor-sharp judgment has been blunted by my adoration, so you’ll have to provide the skepticism I’m afraid.

Jacinta: Well I’m quite attracted myself I have to say, though I definitely get the impression that girl-girl love, or lust, is much more frowned upon in South Korea than it is here.

Canto: Yes it does strike me as a rather buttoned-up, conservative, class-oriented and overly materialistic society by Australian standards, judging by their movies and dramas, but it’s a dynamic society, and a little more open, I think, than, say, Japanese society, so hopefully this obsession with the ‘right’ education and ‘pedigree’ instead of evident talent will be blown away by outside influences. Actually I think women like Ha Ji-won are contributors to this sort of levelling process. From her various bios I’ve not discovered whether she comes from a privileged background or not – she seems to have made it on ability, hard work and, okay, extreme good looks.

Jacinta: To those in the west who might not be familiar with her, I’d describe her as a sort of blend of Angelina Jolie action figure and a slightly more boyish version of Emma Watson. What do you think?

Canto: Mmmm no, neither of those women come to mind. For a start she’s no statuesque figure, she’s quite slim and slightly built. I don’t really compare her to any western actors – she’s incomparable. She’s definitely a sporty type with energy to burn, and with an independent nature…. It’s fascinating to me that she’s never married, though she’s approaching forty, and still absolutely stunning.

Jacinta: Well, we’ve been doing some background checks, via Google haha, and her private life, at least regarding relationships, is a completely closed book. I get the impression she’s something of a workaholic, with an extraordinary list of performances over twenty years, and a very healthy bank balance with her star having risen so much over the last decade. So what’s she doing with all that loot?

Canto: Are you being skeptical of her outwardly sweet character or just genuinely questioning? Let me first describe her in the most positive light. I doubt that she’s a fitness fanatic or anything, but I think that especially in her earlier roles, once she got established enough to pick and choose, she relished roles that were physically active and often beautiful, I mean physically, in terms of movement and grace. For example in Sex is Zero (2002) she played an aspiring national aerobics champion and went into full training for the role. For the drama Damo (2003) and the film Duellist (2005) she learned how to wield a sword, and for the ultra-energetic sci-fi action flick Sector 7 (2011) she learned scuba diving and other fancy stuff. But perhaps the most impressive thing I’ve read about her dedication to her craft was her months of boxing training for Miracle on First Street (2007), during which she actually got knocked out. There’s a description here of the filming by the director Yoon JeGyoon, which is essentially a heart-felt tribute to Ji-won. It brought tears to my eyes. And so it goes…

duelling with spirits

Jacinta: I can see you’re getting emotional again, mate. I agree with you she’s amazing in that way. And it wasn’t just in her early roles that she was doing all that physical stuff. In Sector 7 and and in the hugely successful Secret Garden (2010), in which she played a stunt-woman, she challenged herself to the utmost. And don’t forget the film As One (2012), in which Ji-won played South Korean table tennis champ Hyun Jung-hwa. We haven’t seen that one but it recreates a very touching event in recent Korean history, when the two Koreas united to form a single table tennis team in 1991, an act of reconciliation after the downing of a passenger plane by North Korea in 1987. It’s a movie all about women and friendship and I’m really really keen to see it. Ji-won had never played table tennis before and trained intensively for four months, though she was recovering from an ankle injury sustained while shooting Sector 7.  She was under the tutorship of Hyun Jung-hwa herself, and was determined to imitate the details of her playing style.

Canto: Yes, that’s a must-see movie. Now, I’m sure that all good actors throw themselves whole-heartedly into their roles, but I’ve never encountered anyone so determined about it as Ha Ji-won. And what I get from all the sources I’ve read is that she virtually never complains and is always smiling and happy on set, always lifting the spirits of those around her. Everyone seems to love working with her, it’s almost sickening.

Jacinta: She’s very demanding of herself, though. She actually tried to drop out of As One because she felt her table tennis ability wasn’t up to scratch and she’d let the whole film down.

Canto: I could talk about her forever, it’s such sheer pleasure. Also I think it’s because contemplating her keeps me young and frisky….

Jacinta: You’re only as young as the one you love. Shame she doesn’t speak your language. Do you think she’d be into science?

Canto: Mmmm. An important question. I note from her bios  that she’s not religious, that’s a good start. I’m sure she’d be open to it. It’s not just wishful thinking to believe she’s a very smart cookie…

Jacinta: I agree with you there – she’s been very smart about her career, having the foresight to see, once established, the kind of roles that would challenge her and excite an audience. Even though that foresight may well be largely unconscious…

Canto: I think she scores very high on EQ, emotional quotient, if that’s a thing. That’s what gives her the rapport she has with the team around her, and with her fans. She knows how to deal with people without even knowing how she knows how. She’s just a natural. Here’s an example. In this café interview (I can’t find it now – she’s done so many!), she’s asked by a young paparazzi type ‘There’s one question I need to ask you: when did you start to be so pretty?’. So Ha Ji-won’s face turns serious as this question begins to unfold: she’s expecting something heavy, then when it turns out to be frivolous, you can see her serious face registering it, after which she falls forward with a laugh, putting her hand over her face. Totally spontaneous and endearing, and much better than how I might’ve been tempted to react, i.e. with scorn. Then, quickly recovering, she answers with disarming truthfulness, ‘when I was born’, after which she breaks into embarrassed laughter again, as if she’d been immodest. But of course she was correct, she was born pretty, that’s to say very lucky, and she knows it. And she managed to convey that, and yet to keep everything good-humoured and light. Maybe it’s nothing, but I think it’s a kind of genius she has.

Jacinta: You’re in a bad way, mate. Tell me when they ask her some more interesting questions. So do you recommend any of her work?

Canto: Well I’m just exploring what’s available on YouTube, some of which is of poor film quality, and some of which is either poorly translated or not translated at all, especially her earliest stuff – and I want to trace her career from the beginning. So, yes, I’ve become addicted to Ha Ji-won, I’ve chosen her as my guardian angel and guiding spirit – I’ve even thought of dedicating a new blog just to her – but that might be a bit excessive….

Jacinta: Maybe a bit, but whatever floats your boat. Back to my question – any work you would recommend?

Canto: I’m not sure I’ve seen her best work yet, but the film ‘Miracle of a giving fool’ (2008), also known as ‘BA:BO’, has a lovely understated performance from her. A nice intro, though maybe not, as it doesn’t give much indication of her capabilities. The TV series ‘Damo’ (2003) might be better, but I’m having trouble finding a fully translated version. Horse-riding and swordplay aplenty. Anyway, she’s a wonderful woman, an inspiration, and I think you need to see a lot of her work – depth in diversity is her greatest achievement.

spreading the love

 

Written by stewart henderson

April 14, 2017 at 12:41 pm

Posted in feminism, health, modesty, power, romance

Tagged with , ,

no jab no pay starts now

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actually, a fairly unsystematic campaign to protect kids, often from their own parents

Jacinta: I believe the federal government is bringing in new rules penalising parents who choose not to vaccinate their children. Do you know the details, and how do you think the anti-vaccination movement, which is quite strong in Australia, is going to react?

Canto: Well, first I’ll note that when looking up this issue on the net I found a disproportionate number of anti-vaccination or ‘vaccination skeptic’ sites cropping up on Google. It’s very disheartening that the ‘AVN‘, formally deceitfully titled the Australian Vaccination Network, now forced by law to call itself the Australian Vaccination-skeptics Network, comes up first all the time. Other depressing sites that come up include nocompulsoryvaccination and ‘natural society‘. These appear to be US sites promoting the ‘nature is better’ fallacy or some dubious form of libertarianism, and I suppose they have ways of maintaining a high internet profile.

Jacinta: Well, this is the thing, they have a ’cause’ to rally around, whereas the immunologists and doctors who know the science don’t see what the fuss is about, and just assume that everybody respects scientific methods and results. Which is obviously far from the case.

Canto: Well anyway yes the federal government, and the Victorian state government, have created bills to better enforce vaccination, and the Australian government’s measure came into force on January 1. Child care payments and family tax benefit part A supplement will only be paid for children who’ve been immunised or have an approved immunisation exemption.

Jacinta: So, can you get an exemption easily, due to your firm belief that vaccinations cause diabetes, or autism or whatever?

Canto: Only on religious grounds.

Jacinta: Ahh, but can’t the refuseniks claim to be religious, since they have very strong beliefs based on no evidence?

Canto: Ha, well, I’m sure they’ll try. And actually I think it’s going to be difficult for the government to enforce this one.

Jacinta: Why should it be? Surely they have immunisation records through Medicare, it would be easy enough to check.

Canto: And what if the child spent the first few years of life overseas? And what if a parent insists the child was immunised but there’s no record?

Jacinta: Mmmm, I think these are minor difficulties, and I belief it has a support level of over 80%.

Canto: Yes so we’ll have to wait and see what plans the AVN have to try and sabotage it. Other state governments, in Victoria, Queensland and possibly elsewhere, are introducing measures in harmony with this, so it does seem to deal a serious blow to the refuseniks. And of course it’s hoped, or expected, that it’ll bounce the fence-sitters off the fence and so increase community immunity.

Jacinta: And that reminds me, I was reading somewhere about anti-vaccination hotspots. Any info on that?

Canto: Well yes, they’re the places to look to for trouble. The low-down on all that can be found at this slightly unlikely source, Mamamia, an entertainment and lifestyle website – and good on them. It also has a graphic from the Department of Health that reveals the alarming rise in ‘conscientious objectors’ to vaccination in Australia over the last 15 years, from 4000-odd in 1999 to over 36,000 in 2013.

Jacinta: So does it mention anywhere in South Australia?

Canto: Yes, and I’ve noticed that these hotspots are often in quite affluent regions…

Jacinta: Depressing.

Canto: Yes, the Adelaide Hills region, which I would think is generally quite affluent, has one of the highest objection rates, with 86% of children under 5 vaccinated compared with the state average of 91.5%. But then they say that many other areas are under 85%, including Port Adelaide, Holdfast Bay – that’s the Glenelg region, and Playford. So a mix of semi-affluent and relatively disadvantaged regions. Hard to make sense of it, but I think there’s a distinction to made here between the refuseniks and those who just don’t get round to vaccinating their kids.

Jacinta: Right, and that wouldn’t necessarily come out in the data.

Canto: Yes, some are slackers and some are refuseniks.

Jacinta: And some might be fence-sitters who might be spurred into getting their kids vaccinated by this stick approach.

Canto: Yeah we’ll have to wait and see whether the unvaccinated numbers go down over the next few years.

Jacinta: Which makes me wonder, how do they know that those figures you quoted before – some 36,000 – were ‘conscientious objectors’?

Canto: Well they probably don’t for sure, but it’s highly unlikely that those numbers have gone up by almost a factor of 10 in fifteen years due to sheer complacency. I mean, is it plausible that in the last 15 years or so we’ve become 10 times more slack as a nation about our children’s health? No, there’s something much more disturbing going on. Mamamia quotes a Melbourne virologist, who claims that in some pockets of the nation our immunisation rates are lower than South Sudan.

Jacinta: Oh well done. I’m guessing they enforce vaccination in South Sudan, or I might be suffering from the delusion that most African governments are brutal dictatorships. Anyway, what are the biggest or worst hotspots nationally? I’m thinking Nimbin.

Canto: Yes, that area – Nimbin, Byron Bay, Mullumbimby, that whole northern New South Wales coastal area has vaccination rates down between 60% and 70%. Mullumbimby is the town with the highest objection rate in Australia, and the lowest immunisation rate, at under 50%. Steiner schools are popular in this region, unsurprisingly, and they’re openly promoting refusenik behaviour. But there are many other problem regions, such as Queensland’s Gold Coast and Sunshine coast. Noosa on the Sunshine coast also has very high objection rates.

Jacinta: These are quite wealthy areas I suppose. Any idea why this is happening?

Canto: Well, I can only speculate, but I think, with wealthy people, there’s a greater degree of resistance to government measures, obviously in the case of taxation, but also with health matters. They’re rich, they’re healthy, they feel they’re already immune, and that if they just maintain a healthy lifestyle they’ll be fine. Clearly they’re not particularly informed about the benefits of vaccination, or choose to believe those benefits are exaggerated. I suspect that the further we remove ourselves from the bad days of TB, diphtheria, mumps and measles, the more we’ll get this creeping belief that vaccines are over-rated. The positive thing, though, is that we still have some 83% of parents in favour of some kind of punitive measure for those who don’t or won’t vaccinate their kids. But I do suspect that percentage will reduce over time. We humans have short memories and an over-supply of hubris, it seems to me. Or perhaps we’re just a bit over-confident with respect to our survival mechanisms. We’re like teenagers, we rarely listen to our parents – they’re history, after all. We need a few life-blows to counter our cockiness.

Jacinta: Hmmm, grim but probably true. Anyway, the government has acted and that might reduce the number of fence-sitters, even if it polarises the issue a bit more.

Written by stewart henderson

January 3, 2016 at 9:09 am

does this change everything? Paris, Naomi Klein, extractivism and blockadia

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Canto: Well I’ve just managed to finish reading Naomi Klein’s great big book about the politics of climate change, This changes everything, and since this more or less coincides with the recent political decisions made about tackling climate in Paris, I thought we might spend this session, or even a few sessions, on the future of clean energy, the fossil fuel industry and so forth.

Jacinta: Ah yes, the Paris conference, can you fill me in on that? All I know is that the outcome is being touted as a turning point, a watershed moment, but I presume none of it is enforceable, and I can’t really see the fossil fuel giants giving up the ghost, or considering anything much beyond business as usual…

Canto: Okay, the UN climate change conference in Paris ended on December 12 2015, having run for about 3 weeks. The principal outcome has been the Paris agreement, which was a more substantive agreement on emissions reduction than has been achieved in the past. It apparently represents a consensus drawn from some 196 national representatives.

Jacinta: And I seem to recall the figure of 2% being bandied about. What was that about?

Canto: Ummm, I think you might be referring to the plan, or hope, to limit global warming to 2 degrees, through zero net greenhouse gas emissions in the second half of the 21st century, globally.

Jacinta: Wow, that’s some hope.

Canto: Well the hope is to keep the warming to well under 2 degrees C, preferably aiming for 1.5, which would entail substantial reductions well before 2050, but of course this is all promises, promises.

Jacinta: So what about enforcement, and how is this going to be achieved nation by nation, considering that some nations are huge emitters, and some nations, like India, are still developing and industrialising?

Canto: Right so there are all these semi-commitments and promises, but crunch time starts in April 2016, from which time the relevant parties are asked to sign up to the agreement – that’s 197 parties in all, including all member nations of the UN, the European Union and some not-quite-nations like Palestine and the Cook Islands. They have a year to sign up, and the agreement will only come into force if 55 countries that produce 55% of global greenhouse emissions sign up.

Jacinta: Wait, does that mean all of the top 55 greenhouse gas emitters, or any 55 that together emit 55% of the greenhouse gases emitted by humans?

Canto: Uhhh, I’m not sure but I think it’s the latter.

Jacinta: Great, so Australia doesn’t have to sign. Quel soulagement!

Canto: Funny that, because the Wikipedia article on the Paris agreement, specifically mentions the climate change ‘skepticism’ of our conservative government…

Jacinta: Wow, what an honour.

Canto: Time to lobby our environment minister. Of course there are a lot of people protesting that this agreement doesn’t go far enough – not so much in the targets as in the voluntary nature of it all. I mean, it may not even come into voluntary force if nations don’t sign up to it, and of course there’s no enforcement mechanism. Here’s how Wikipedia describes the situation:

The Agreement will not become binding on its member states until 55 parties who produce over 55% of the world’s greenhouse gas have ratified the Agreement. There is doubt whether some countries will agree to do so. Each country that ratifies the agreement will be required to set a target for emission reduction, but the amount will be voluntary. There will be [no] mechanism to force a country to set a target by a specific date and no enforcement if a set target is not met. There will be only a “name and shame” system or as Janos Pasztor, the U.N. assistant secretary-general on climate change, told CBS News (US), a “name and encourage” plan.

Jacinta: Well I think it’s definitely a positive development, which will add pressure to the fossil fuel industries and their supporters. I notice that one of our green pollies was castigating the government the other day about the expansion of the Abbott Point coal terminal, citing the Paris agreement. That’s going to be a much repeated dagger-thrust into the future. So how does this all connect with Naomi Klein’s book?

Canto: Well I think you’re right to accentuate the positives. I mean, how can you seriously police or enforce such an agreement without interfering with the ‘national sovereignty’ that so many nations bellow about – especially when there’s a hint of criticism from the UN? So the first real positive coming from this confab is that all the parties are in agreement about the imminent threat of AGW, and they’ve actually managed to come to a broad agreement over a target and a goal. That’s a big deal. The second positive is, as you say, the impact of that consensus on the battle against the cashed-up fossil fuel industries, and the mostly conservative governments around the world that are still into science denialism, including our own government. As to This changes everything, Klein sees the AGW issue as a possible game-changer for the politics of global capitalism and free marketeering, which is rather ambitious, but she puts her faith in the protest movements, the indigenous rights movements and other grassroots movements who are, as she sees it, rising up more than ever before to create headaches for the business-as-usual model. She calls this grassroots approach ‘blockadia’, probably not an original coinage.

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Jacinta: So she sees it as an issue to fight global capitalism, to replace it with… what? Surely the renewable energy industries are capitalist industries too?

Cant: Well yes, I think there’s a certain amount of idealism in her view, an old-fashioned back-to-nature ethic, and I don’t think she emphasises the solutions and the science as much as she emphasises the problems and the politics, but if you take the view that the fossil fuel industries need to be phased out, sooner rather than later, you’ll perhaps be as much inspired by the heroic and hard-working efforts to prevent mining and drilling – which, let’s face it, have caused huge devastation in many areas – as you will by the innovations and improvements in clean energy. Which brings me to the other term used a lot in Klein’s book – extractivism.

Jacinta: Which presumably stands not just for the fossil fuel industry but the whole mentality of ‘what can we extract from this entity?’, be it animal vegetable or mineral.

Canto: The ancient Greeks did it with their slaves, the British did it with their colonies…

Jacinta: And their slaves..

Canto: The tobacco industry are doing it with the resource of willing smokers in non-western countries, poachers are doing it with elephants in Africa, the porn industry is doing it with pretty and mostly impoverished girls in the US and Europe, multinational companies are doing it with cheap labour worldwide. Extractivism has always been with us…

Jacinta: Point taken but I think we’re getting a bit carried away here. I presume Klein was using the term in a more limited sense, though perhaps with a nod to broader extractivist tendencies. And I have to say, quite apart from the devastation caused by tailings and disasters like Deepwater Horizon, I’ve always felt there’s something not quite right about our recent cavalier exploitation of a process of incredibly slow transformation of once-living and evolving entities – our ancestors in a sense – into coal and oil. Doesn’t it seem somehow sacrilegious?

Canto: Well perhaps, but I’m not sure if ‘exploitation’ is the right word. People get exploited. Okay animals can get exploited. But dead matter turning into coal? All species do what they can to survive and thrive, and they don’t worry about the cost to others or to historical processes. Right now parrots are feasting on my neighbour’s fruit trees. They’re extracting what they can in one go, and they’ll be back for more unless someone stops them. My neighbours might consider the parrots a pest, but that’s only because they want to extract as much as they can from those trees, to make jam, or to add fibre and other nutritional elements to their diet. As to the fossil fuels I’m all for keeping them in the ground, but more because of the damage they do to our atmosphere than because it’s ‘nice’ and ‘respectful’ not to extract them.

Jacinta: Spoken like a true instrumental scientist, but I can’t help feeling there’s more to it than you say. But what do you think about the view that this is a game-changer for global politics? Klein subtitles her book ‘capitalism v the climate’, as if one or the other has to come out on top. Do you think that’s really the choice?

Canto: No I don’t, but I doubt that Klein really imagines, or even wants this to spell the end of capitalism. I’m no anti-capitalist of course, but then I see capitalism in much broader terms. Those parrots are capitalising on a resource previously unavailable to them, and they’ll continue to do so unless prevented, by netting or something worse. Fossil fuel companies have learned to capitalise on a resource previously unavailable to them, before we learned how to process and extract energy from such material, and they’ll continue to do so unless they’re prevented, by legislation, by blockadia, or by the availability of more attractive alternatives, such as the more effective exploitation of the sun. Or capitalising on the solar resource.

Jacinta: So you believe that all humans, or rather, all creatures are capitalists? Isn’t that a bit of a narrow view?

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                                                                                  the capitalist menace

Canto: Well no, as I say, I think it’s a broad view of the capitalist concept. But of course you might say that this hardly accounts for blockadia. If we’re all capitalists at heart, how do we account for the amount of energy so many citizens put into blocking capitalist exploitation? But that’s easily explained by the parrots and fruit example. The parrots’ gain is the neighbours’ loss. The neighbours have gone to a lot of trouble cultivating the ground, planting the trees, watering and fertilising, and these pesky parrots have come along without so much as a by your leave, and devastated the crop. Similarly farmers who have put a lot of time and energy into cultivating their land, and indigenous people who have learned over generations how to fish and hunt in an area in such a way that stocks can still be replenished rather than devastated, are naturally outraged that these fossil fuel companies have come along and ‘poisoned the well’. The farmers and the indigenes are also capitalists, very effective capitalists for their own needs, but they’re faced with different types of capitalists with different needs. So, to me, it’s a matter of resources, needs, diversity and negotiation.

Jacinta: Hmmm, well I’m inclined to agree with you. Of course indigenous people, such as our Aborigines, like to talk of spiritual connections to the land and its bird and animal life, but I’m not much into spirituality. But I like the idea that even though they’re into hunting and killing those creatures in order to survive, they tell stories about them, and exhibit a great deal of respect and fondness for them. That seems healthy to me.

Canto: I agree completely. I’m not trying to say ‘all is capitalism’. There’s much more to life than that. The beauty of that story-telling and that affection for the land and its inhabitants and their ways is that it’s not a kind of master-race view. The Judeo-Christian view has been that all things, including all creatures, have been put here for our benefit. Of course modern Christianity has largely re-interpreted this as custodianship, which is an improvement, but I prefer the perspective that we’re all in this together, and we should look out for each other. Birds have to eat, and they like to eat fruit, and birds are fantastic creatures. They deserve our consideration.

Jacinta: Well that’s a nice note to end on. And what about the fossil fuel industry?

Canto: I think it’s had its day. It’s time to move beyond it.

Written by stewart henderson

December 31, 2015 at 8:45 am