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Human Nature is on vacation and won't be back till after New Year's. In the spirit of the holidays, I'd like to thank each of you for staying in touch as a reader and, I hope, as a correspondent. In fact, I'd like to ask one favor of you: Tell me how you'd like me to do my job differently.
The mission of this column is to explore the ways in which science and technology are changing how we live, what we think, and who we are. It's a huge and growing part of modern life. Traditional media have covered it poorly, I think, because they're too accustomed to the old system of beats. There's the science beat, where you cover the latest studies. There's the health beat, where you cover the human body. And then there are political and cultural beats, which address how we live and govern ourselves.
The problem with the old system is that technology is moving so fast, and transforming society so extensively, that we can no longer adequately cover politics and culture without accounting for science and technology. Nor can we cover science and technology without examining how they're affecting culture and politics. Hence this column.
With that framework in mind, which topics should I be covering more? Which developments am I missing? Which questions am I neglecting to ask? And while you're at it: Which formats do you prefer to read? How often do you want to be updated? Do you prefer the longer pieces of previous years? The quick headline links of last spring? The daily, medium-length blog items of the last month or so? Something else?
Who are your favorite writers on science and technology? Your favorite news sources? Your favorite blogs? Last spring I drew up a list of blogs and news outlets. I'll probably adapt it to run in the right-hand column of this page. Should I add to it? If I narrow it, which links should I keep? Got any good books to recommend?
One thing I've come to admire about science, as opposed to politics, is its humility. Today's proudest theories are always at the mercy of tomorrow's inconvenient data, and today's seemingly straightforward data are always open to being reshuffled by tomorrow's perspective-shifting theories. We have a lot to learn from each other.
So give me your best advice. I can't learn without you. And I'll be back to return the favor in 2009.
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We have a verdict in the premature-organ-harvesting case.
Let's go to the Los Angeles Times for a summary of the case. Two years ago, the patient, Ruben Navarro, lay close to death after a heart attack.
His mother had given permission for organ donation, and a team that included [Dr. Hootan] Roozrokh flew in from San Francisco on behalf of a regional transplant network. Roozrokh ... was to supervise a donation after cardiac death ... In most transplants, the removal of organs occurs only after a patient is declared brain-dead. In donations after cardiac death, a patient's brain is irreversibly damaged but still functioning minimally. With a family's consent, the patient is removed from life support and, once the heart has stopped, the patient is declared dead, and organs may be removed minutes later. Many experts say, however, that organs are usable only if they can be retrieved within 30 minutes after the machines are turned off.
According to prosecutors, Roozrokh ordered up excessive doses of the painkiller morphine and Ativan, an anti-anxiety drug, so that Navarro would die within that crucial half-hour. As it turned out, he died eight hours later and Roozrokh did not remove any organs.
So the basic problem was that Navarro's medical care was being directed by a guy sent to the hospital to get his organs—and that the doctor's actions may have helped the organs but not the patient. The doctor was looking at a felony charge, dependent adult abuse, with a possible sentence of four years.
Verdict: Not guilty. But the jury also issued this statement (handwritten PDF here):
Ruben's case has identified that Donation by Cardiac Death (DCD) is in desperate need for further identification of prescribed policy in order to continue successfully as a viable option for organ donation in this country. Refining the nationwide protocol of DCD organ procurements will be an important part of Ruben's legacy...
In other words, Roozrokh may have crossed the line, but the jury blames the system, or lack thereof, for failing to draw the line clearly in the first place. I think the jury did the right thing. Most of us are selectively pious. We like to single out villains when bad things are done. It's harder to admit that the bad things are extensions of good ideas and that the people behind those ideas include us. What happened to Navarro wasn't a bad doctor. It was a system that has increasingly pushed boundaries to get organs that save lives. As Art Caplan puts it in the Times story:
There's a growing waiting list; there are more centers competing for donors; and it's a very lucrative procedure for hospitals. It's against that backdrop that the story of a doctor being sent out to come back with organs unfolds.
The pressure has reached the point where doctors at one hospital, as noted here,
removed hearts from infants 75 seconds after their hearts stopped. The infants were declared dead of heart failure even as their hearts, in new bodies, resume ticking.
It's a discomfiting new trend of treating people as bags of organs. But the driving force behind this trend isn't Hootan Roozrokh. It's all of us.
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I went to see President Bush's farewell chat with the American Enterprise Institute yesterday. It was an unusually frank conversation: He actually admitted mistakes. In fact, he wandered so far off-message that when he was asked about defense spending, he started talking about specific weapons systems, and pretty soon he said this:
Our soldiers are carrying unbelievably new technologies, using Predators to use over-the-wall intelligence to be able to have better battlefield awareness.
Over-the-wall intelligence? I've searched DefenseLink, and I don't see that term or anything like it. I do, however, see "through-the-wall surveillance," associated with the Air Force Research Laboratory. And the last time I checked, walls tended to be associated with roofs. So one way or another, the Predators have to see through something.
Is Bush possibly blabbing about the technology cryptically described by Bob Woodward and others? The ability of U.S. unmanned aerial vehicles to identify and track human targets "even when they are inside buildings"? If so, the convergence sketched here two months ago—unmanned vehicles that can see through walls—is indeed upon us.
By the way, as of this week's hit in North Waziristan, the number of U.S. drone missile strikes in Pakistan this year is approaching 30, and the body count is over 200.
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From yesterday's piece:
Don't look now, but a woman in Ohio has a new face. And the world has a new kind of medicine: socially necessary surgery.
The operation, announced yesterday at the Cleveland Clinic, was a face transplant from a corpse. ... Doctors replaced 77 square inches of the patient's face, from her eyelids to her chin.
More here.
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Hey, Detroit! We have a new job for you.
Just in time to bail out the auto parts suppliers, Madeline Drexler heralds the latest cool new (or is it old?) idea: car-parts incubators. Here's her description of them in yesterday's Science Times:
The heat source is a pair of headlights. A car door alarm signals emergencies. An auto air filter and fan provide climate control. ... Unlike the notoriously high-maintenance incubators found in neonatal intensive care units in the United States, it is easily repaired, because all of its operational parts come from cars. And while incubators can cost $40,000 or more, this one can be built for less than $1,000. The creators of the car parts incubator ... say it could prevent millions of newborn deaths in the developing world.
We're so used to incubators these days that we've forgotten how radical they are. Their function, Drexler notes, is "providing a warm, clean, womblike environment in which a baby can mature." In short, they're artificial wombs. They don't replicate every function, of course. But for millions of babies who would otherwise die, they replicate enough.
They also destabilize our notions of abortion and infanticide. U.S. abortion laws are organized around viability, the idea that a fetus is entitled to protection when it can survive outside the womb. That's a technical question, and incubators, by creating a kind of womb outside the womb, influence the answer. The earlier they can sustain preemies, the further the line of viability advances.
But that's the fancy far edge of incubator technology. Drexler is talking about something simpler and more immediate: making basic incubation available and functional around the world. Who cares about the latest million-dollar American baby born at 21 weeks when you live in a country where preemies die at 35 weeks? You can't spend that kind of money. You can't even find somebody local to fix a $20,000 incubator. You need an affordable machine that works for most preemies and can be reliably maintained. That's what the car-parts incubator is designed for: babies born at 32 weeks or later.
In the transition from George W. Bush to Barack Obama, we're going to see a big shift in the politics of biotechnology. The conservative preoccupation with technological frontiers will be replaced, for the time being, by a progressive preoccupation with distributive justice. That means less debate about things like future artificial wombs and more attention to things like car-parts incubators. In some ways, it'll be more boring. But tell that to the woman in Indonesia who gets to keep her baby.
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I'm now going to depict an adult and a minor having sex. The adult is represented by the character on the left. The minor is represented by the character on the right. Here is my depiction:
&i
Have I just committed a crime punishable by 10 years in jail?
Under a ruling issued last week in Australia, it's quite possible that I have. The ruling, issued by the Supreme Court of New South Wales, affirms that a cartoon can be prosecuted as child pornography. Here's the background of the case:
[T]he plaintiff was convicted ... of possessing child pornography contrary to s 91H(3) of the Crimes Act 1900 (the Act) and using his computer to access child pornography material contrary to s 474.19(1)(a)(i) of the Criminal Code Act 1995 (the Code). The alleged pornography comprised a series of cartoons depicting figures modelled on members of the television animated series "The Simpsons". Sexual acts are depicted as being performed, in particular, by the "children" of the family. The male figures have genitalia which is evidently human, as do the mother and the girl.
The Australian laws in question define child pornography as depictions of a "person" or depictions of "a representation of a person." A related memorandum says such definitions "are intended to cover all visual images, both still and motion, including representations of children, such as cartoons or animation." But even without the memorandum, the court says child pornography laws are in part "calculated to deter production of other material—including cartoons—that ... can fuel demand for material that does involve the abuse of children." Accordingly, "The depictions and representations of persons to which the definition refers include a drawing (or, for that matter, a model or sculpture) and, hence a cartoon, of a fictional character."
Does it matter that we're talking about the silly-looking Simpsons? No, says the court: "Even a substantial departure from realism will not necessarily mean that the depiction is not that of a person in this sense." The court upholds the initial ruling that the characters "were indeed depictions of persons" under the law. The convictions stand.
You have got to be kidding me.
Look: If you molest my kid, I'll see that you burn in hell. If you take a picture of my kid and Photoshop it so it looks like a sex act with you, I'll use any law I can find to put you away. If you make a sicko cartoon and digitally alter it so it looks like my kid, I'll throw the book at you. But if what you've made doesn't look like anyone's kid—if it's just a revolting mockery of the Simpsons—I'm supposed to convict you of child pornography? Really?
What's happening to child pornography is what's happening on the Internet and in software generally: Technology is blurring boundaries between action and thought, public and private, real and fake. On this point, the Australian court quotes the Supreme Court of Canada: "With the quality of contemporary technology, it can be very difficult to distinguish a 'real' person from a computer creation or composite." This gray area unnerves us, so we prosecute it. Two years ago, then-Rep. Mark Foley, R-Fla., was forced out of Congress for soliciting teenage boys online, though there's no evidence he ever touched a minor. This year, the U.S. Supreme Court upheld a ban on sexual images of children even if they're computer-generated or nonexistent. Apparently, more people are now arrested for using the Internet to solicit cops posing as kids than for using it to initiate relationships with real kids.
I understand why we do this: We're afraid that if we don't prosecute cyber-perverts, they'll move on to the real thing. But the danger runs both ways. How far will we extend felony prosecution into the realm of the private, the fake, and the abstract? If the Simpsons count as child pornography, what's next?
Actually, the Australian court has answered that question. Under the relevant child pornography laws, says the court, "a stick figure ... might well depict a representation of a person. No bright line of inclusion or exclusion can be sensibly described."
Well, then, come and get me. If there's no boundary between real and fake, between people and "depictions of representations," then prosecute me for my stick figures. Or admit it's ridiculous—and an insult to the real thing.
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The health police have crossed another line. Four months ago, they banned new fast-food restaurants in a 32-square-mile area of Los Angeles. In that case, they crossed the line from restricting food for kids to restricting it for adults. They also extended the practice of health zoning from liquor to food.
Now they've breach another line between paternalism for children and paternalism for adults. The Boston Public Health Commission has just banned the sale of all tobacco products at colleges. Not high schools. Colleges.
Anti-smoking activists are ecstatic. "Boston has taken another step that puts it in the forefront in the United States in protecting people against secondhand smoke," says the president of the Campaign for Tobacco-Free Kids. But the Boston regulations don't just restrict smoking. They forbid the sale of "any substance containing tobacco leaf, including but not limited to cigarettes, cigars, pipe, tobacco, snuff, chewing tobacco and dipping tobacco." Last I heard, there's no secondhand smoke from chewing tobacco. And the tobacco industry is constantly developing new products that confound the equation of tobacco with smoking. That's not because tobacco companies care deeply about public health. It's because secondhand smoke has become a political problem for them—and because, while addicting customers is good business, killing them isn't.
In a press release, the executive director of the Boston commission says the new regulations "will help reduce young people's exposure to tobacco products." Young people? That phrase used to mean minors. Now, apparently, it includes the targets of the new rule: students at "any public or private college, normal school, professional school, scientific or technical institution, university or other institution furnishing a program of higher education."
On what grounds do college students—not to mention students at professional schools—deserve the kind of paternalism previously reserved for minors? The commission offers two reasons. First, "educational institutions in the City of Boston also sell tobacco products to the younger population, which is particularly at risk for becoming smokers." Second, "the sale of tobacco products is also incompatible with the mission of educational institutions which educate the younger population about social, environmental and health risks and harms."
In other words, college students (henceforth known as "the younger population") are so vulnerable to smoking and to deception about the harms of smoking that their access to any tobacco products on campus must be legally forbidden.
It's true that laws across the United States set the legal drinking age at 21. But those laws are based on the argument that alcohol makes people aged 18 to 20 drive dangerously. Where's the evidence that chewing tobacco makes these people drive dangerously?
To repeat: I detest smoking. But if there's no secondhand smoke and no secondhand driving effects, what are the grounds for telling a 20-year-old college student—let alone a 25-year-old professional-school student—that tobacco is off-limits? And if that kind of paternalism can be extended so easily from minors to 25-year-olds, who's next?
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Earlier this year, I criticized Medicare for spending $35,000 on a heart implant for a woman who was about to turn 100. The basic argument was:
Should we means-test people on Medicare not just for wealth, but for age? ... The theory is that just as some people have enough money, others have had enough time. If you make it to 100 and can fund your own surgery, that's terrific. But Medicare should focus its resources on people who haven't been as lucky as you. Living to 99 is no tragedy. It's a blessing.
Several of you chastised me for callousness. And now a report from a recent American Heart Association conference backs you up. Marilynn Marchione of the Associated Press tells the story:
Eighty-year-olds with clogged arteries or leaky heart valves used to be sent home with a pat on the arm from their doctors and pills to try to ease their symptoms. Now more are getting open-heart surgery, with remarkable survival rates rivaling those of much younger people, new studies show. ...
In Florida, Dr. Paul Kurlansky led a study of 1,062 octogenarians who had heart bypass surgery at Mount Sinai Medical Center in Miami Beach from 1989 through 2001. ... Average survival was roughly six years—almost the same as similarly aged people who do not have heart disease. Overall, 90 percent survived their surgery to leave the hospital. This improved dramatically as the study went on, from 85 percent in the early years to 98 percent by its end. Even more impressive: 65 percent survived without surgery-related complications and even more without long-term complications ...
A Yale cardiologist draws exactly the conclusion I rejected: "Age itself shouldn't be an automatic exclusion." Marchione adds: "Not every older person can undergo such a challenging operation, but the great results seen in the new studies show that doctors have gotten good at figuring out who can."
This doesn't settle the underlying question of whether there's such a thing as having lived long enough, regardless of what a new device or surgery will do for you. But it does underscore that age, like race, is a crude basis for making individual projections.
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We saw this coming. More than 1 million procedures every year to implant artificial body parts. Two million patients with heart-regulation implants. And the big question:
You can fix a squeaky bike, but what about a squeaky hip? You can take a bum cell phone back to the store, but what about a heart implant? What do you do when the product you want to return is part of your body?
Latest example: an emerging fight over the interface between your heart implant and your heart. The FDA is on one side; Dr. Robert Hauser an Dr. Adrian Almquist of the Minneapolis Heart Institute, writing in the New England Journal of Medicine, are on the other. Their commentary is behind a subscription wall, so here's a summary of the debate from Barry Meier in the New York Times:
Federal regulators are about to approve use of a critical new electrical component for implantable heart devices without adequately testing for its potential risks, a prominent cardiologist warned Wednesday. The potential problem involves a new way of connecting defibrillators to the wires, or leads, that carry high-voltage electrical jolts between such units and the heart ...
Dr. Hauser argued that manufacturers should perform at least some clinical trials on patients to ensure that the new technology is not prone to short-circuiting, a problem that can prevent a defibrillator from delivering the life-saving electrical jolt ... The Food and Drug Administration, on the rationale that the new wiring connectors are simply a design modification and not a new technology, is not requiring human tests. Instead, it is requiring producers to carry out mechanical stress tests of the new connectors and study their performance in animals.
In other words, the FDA is treating the new technology as a detachable gizmo: You can test it in the lab, or in an animal, or whatever. Then you put in people and assume that since the last version worked, the upgrade will work, too. Hauser is treating it as a human body part: You have to test it in people, since that's where it's going to live, as it were.
Who's right? I don't know. Hauser has a better track record than the FDA does in assessing the safety of heart implants. But the key question, from what I can tell, is which standard of testing to apply. Should we let implant makers upgrade their devices just like other technology companies, or not? Think carefully. Because if you don't have an artificial body part today, there's a good chance you'll have one tomorrow.
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The latest encroachment of DNA testing: No conviction, or even prosecution, necessary. From Spencer Hsu in the Washington Post:
Immigration and civil liberties groups condemned a new U.S. government policy to collect DNA samples from all noncitizens detained by authorities and all people arrested for federal crimes. The new Justice Department rule, published Wednesday and effective Jan. 9, dramatically expands a federal law enforcement database of genetic identifiers, which is now limited to storing information about convicted criminals and arrestees from 13 states.
This comes after the U.K. launched a similar plan and got smacked down by European judges:
This month, the European Court of Human Rights unanimously ruled that a British policy to collect fingerprints and DNA of all criminal suspects, including those later deemed innocent, violated privacy rights.
If anyone here thinks the U.S. Supreme Court will take a similar line, I've got a few large automobile manufacturers to sell you.
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From today's piece:
I remember the day my first child was born. He lay sleeping, swaddled, in a plastic bin at the hospital. That's when I finally understood what it meant to be a parent. "If we leave this hospital without this baby," I told my wife, "we'll be arrested."
It was a joke, but it was also true. You arrive at the hospital as two people, and you leave as three. You can't just make a baby and walk away. It's yours forever.
Unless, that is, you make a baby through in vitro fertilization. In that case, you can put the embryo away in a freezer and decide what to do about it later. Or never. ...
More here.
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We have a late-breaking frontrunner for dumbest policy idea of 2008: defunding Planned Parenthood in the name of fighting abortion.
Stephanie Simon reports the latest developments in the Wall Street Journal:
Abortion opponents are pressing state and local governments to stop sending taxpayer dollars to Planned Parenthood, arguing that the nonprofit group has plenty of cash and shouldn't be granted scarce public funds at a time of economic crisis. ...
In recent weeks, Planned Parenthood chapters have lost public funds in two states as elected officials juggled tight budgets. Fulton County, Ga., which includes Atlanta, canceled a $420,000 contract as part of statewide cuts in health care. The move ended a teen-pregnancy prevention program and prompted a local Planned Parenthood clinic to raise fees to make up lost revenue. Sarasota County, Fla., ended years of subsidizing Planned Parenthood's sex-education programs with annual grants of as much as $30,000. ... The Family Research Council is developing a kit to help grass-roots activists dig through financial reports so they can make detailed presentations to elected officials about the assets and revenue of local Planned Parenthood chapters. The council has sent letters to 1,200 state legislators describing Planned Parenthood's strong financial position and urging "a second look" at public funding.
Defunding Planned Parenthood is hardly a new idea. What's new is the fiscal-responsibility angle. And from a pure cost-cutting perspective, you can make the case that Planned Parenthood brings in plenty of private funding and doesn't need public money. I think the pure cost-cutting perspective is a mistake, given the enormous social and economic benefits of preventing unintended pregnancies. But you can make that case, if you really believe in fiscal austerity.
What's insane, however, is the real motivation behind this push. The Family Research Council doesn't really care about economics. That's why, as you might have noticed, it's called the Family Research Council. The campaign to defund Planned Parenthood is really about abortions. FRC would like to see fewer of them. So would I. And that's the crux of the idiocy: The single best thing you can spend money on to reduce the number of abortions, not just in this country but around the world, is Planned Parenthood.
I'll say that again: If you define pro-life as preventing abortions, Planned Parenthood is the most effective pro-life organization in the history of the world. No, it doesn't give teenagers the idea of having sex. That idea comes to them quite naturally, thank you very much. What Planned Parenthood does, more comprehensively than anyone else, is to distribute the means and knowledge to control your risk of getting pregnant when you don't want to be pregnant. And those two things, combined with pressure to exercise that control assiduously, are the surest way to prevent abortions. If you wait till women are already unhappily pregnant, you're too late.
If you think Planned Parenthood is sufficiently funded, fine. Write your check or award your grant to some other, smaller organization that does similar work. But don't imagine that defunding birth control will buy you fewer abortions. It will buy you more.
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Looking for some extra income to make ends meet during the recession? Try selling eggs. Not chicken eggs. Your eggs.
Melinda Beck has the story in today's Wall Street Journal:
Here's another sign of the tough economic times: Some clinics are reporting a surge in the number of women applying to donate eggs or serve as surrogate mothers for infertile couples.
"Whenever the employment rate is down, we get more calls," says Robin von Halle, president of Alternative Reproductive Resources, an agency in Chicago where inquiries from would-be egg donors are up 30% in recent weeks—to about 60 calls a day. "We're even getting men offering up their wives. It's pretty scary." James Liu, a reproductive endocrinologist at University Hospitals, Case Medical Center, in Cleveland, says there is no waiting now for egg donors since his roster has swelled from the usual 4 to 17. Andrew Vorzimer, an attorney who represents prospective parents in Los Angeles, says the usual six-month wait for a surrogate in California has vanished as well. "Many of these women have college loans to pay off or they want to help buy a house or provide for their own kids' education," says Mr. Vorzimer, who is also CEO of Egg Donation Inc., a recruiting agency.
So the good news is, you have an exploitable asset in your ovaries. The bad news is, you have to compete with all the other young women—and apparently their husbands—who have realized the same thing. Did I mention the daily hormone shots? The prohibition on intercourse? The needle extraction?
Still, it's a better deal than lots of people in the developing world are getting. They're selling kidneys; you're only selling eggs. And you can make a lot more money than they can. Beck lays out the numbers:
The going rate for a surrogate is about $25,000. Egg donors generally receive $3,000 to $8,000. But a few agencies advertise that they'll pay much more for specific characteristics. One ad running in campus newspapers promises $25,000 for a donor who is "100% Jewish with ... High SAT Scores... Attractive, at Healthy Body Weight and Free of Genetic Diseases." ... "Now that we have more donors, it's become a buyer's market," Ms. von Halle says. "Some people are looking for a 6-foot Swedish volleyball player with 39 ACTs, and they'll take their time." ... Darlene Pinkerton, executive director of A Perfect Match in San Diego, which offers up to $50,000 for egg donors with high SATs ... [has] seen a doubling of inquiries recently. The American Society for Reproductive Medicine considers compensation above $10,000 to be inappropriate; Ms. Pinkerton argues that the offer brings in donors who might not otherwise be interested.
In other words, the egg market is working like any other market. A Perfect Match is offering big bucks for exactly the same reason the ASRM opposes this practice—because money can persuade people to do things they otherwise wouldn't do. Actually, the 50 grand supplies only half the persuasion. The other half comes from the recession. You need money; you're running out of options; here's a way to get it.
But ordinary eggs won't get you the 50 grand. For that, you'll need the SAT scores, and the face, and maybe a bit more height. You'll need to be tested for the wrong genes—and maybe for the right ones, now that we can project athletic potential from specific variants.
Do you find this scrutiny degrading? Does the whole tiered pricing system offend you? Then go look in the mirror. Catering to buyers' tastes is part of selling. I know it's a lousy economy out there. But if you don't want others treating your eggs as a commodity, don't treat them that way yourself.
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I've promised to make this page a reliable headquarters for anyone who wants a single URL or RSS for all the Human Nature stuff. So here's a link to yesterday's piece on the Indian woman who just broke the world record for being the oldest woman ever to deliver a child. Excerpt:
There will be mothers at 71 and 72. It will be done because it can be done, and because doctors such as Bishnoi see themselves as liberators. They're not just defeating society's strictures. They're defeating nature's.
More here.
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In case you missed it, here's an excerpt from Friday's piece:
I've had my share of arguments with people who deny that race is biologically meaningful. Many of them are dedicated to the proposition that all humans are created equal, not just in the sense of moral worth or treating each person on his merits, but literally, in the sense that no genetically based difference can be admitted in average ability between populations. That kind of egalitarian literalism—I call it liberal creationism—becomes harder and harder to sustain in the face of evidence such as the data on ACTN3.
More here.
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Good news for U.S. national security! We're finally flying surveillance drones over the treacherous border ... between us and Canada.
You're kidding me, right? William Arkin and Peter Feaver of the Washington Post have the same question I do: Why are we posting drones in North Dakota when we need them in Pakistan?
This weekend's national coverage of the first drone's arrival (courtesy of the AP and NYT) didn't really explain. So I moseyed over to the Grand Forks Herald (before I saw the same link at Danger Room, I swear) to see what I could find.
Answer: Pork. Here's the Herald:
At 2:28 p.m. Saturday, the unmanned aircraft touched down at the Grand Forks Air Force Base ... The Saturday landing's significance is about the new mission of the base, which has lost planes and people in large numbers in recent years. The Unmanned Aircraft System mission allows the base to continue, although in a reduced capacity. [Base commander Col. John] Michel said the base will be home to more than 20 UAVs in a few years. The Air Force portion of the 20 will be six Global Hawks, a bigger and higher-flying version of the Predator, by early 2011. "Our manpower will be shored up by 843 people by those Global Hawks," Michel said. "The UAS is the fastest growing part of the (Air Force) business."
How's that for irony? Drones, a technology we're fast-tracking and fast-deploying in the name of replacing personnel, are becoming a jobs program. Though I guess that's consistent with the current economic meltdown and the new emphasis on finding work for people instead of the other way around.
Among other things, it raises the question: What's the future of Air Force bases? How many will fly old-fashioned manned aircraft? How many will be more like NASA's mission-control facilities? That's one of the nice things about drones: You can operate them from anywhere. Which means we should be able to create drone-operation jobs in North Dakota while flying the drones over Pakistan, Afghanistan, or India, not Canada.
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Be careful how you justify a war on drugs. Drugs can be modified so that your arguments no longer apply.
That's what the anti-tobacco movement is now learning. In state after state and country after country, smoking has been banned in public places: bars, restaurants, even apartment buildings. Everywhere, the rallying cry for these measures is that other people have a right not to breathe your smoke. Smoking is harmful to them, so you have to stop.
Except now you don't have to. You can keep using tobacco, but in a way that doesn't get into other people's eyes, throats, and lungs. The Associated Press reports:
[T]he folks who created Joe Camel are hoping Camel Snus will become a hit with tobacco lovers tired of being forced outside for a smoke. ... Snus—Swedish for tobacco, rhymes with "noose—is a tiny, tea bag-like pouch of steam-pasteurized, smokeless tobacco to tuck between the cheek and gum. Aromatic to the user and undetectable to anyone else, it promises a hit of nicotine without the messy spitting associated with chewing tobacco. ... With more public bans on puffing, [tobacco companies] say smokers need socially acceptable alternatives. ... "There's no secondhand smoke. There's no spitting. We see it as a win-win," says [an R.J.] Reynolds spokesman.
Undetectable to anyone else. No secondhand smoke. There goes your rationale for ordering people to stop using tobacco. "At least two tobacco companies besides Reynolds are also test-marketing snus," says the AP. What are you going to about it? What can you say?
In the AP article, public health advocates try to make a case against snus. It's "a second addiction," they argue. It can cause cancers of the mouth and pancreas. It's just an industry scheme to find "replacement smokers" for the millions of customers its death sticks have killed.
Well, good luck with those arguments. Of course snus is addictive, but that alone isn't sufficient grounds for banning things. As for its health effects, even the top scientist at the American Cancer Society tells AP, "If all smokers switched to snus tomorrow, in a few years we'd certainly see less heart disease, less lung disease and fewer cancers." And why exactly should we be upset if the tobacco industry has figured out a way to keep itself alive by keeping its customers alive?
I'm not endorsing snus. It's carcinogenic, addictive, and gross. I'm just not sure those are good reasons for restricting it the way we've restricted cigarettes. And I say this as a lockstep fascist for laws against smoking in public. If you aren't smoking—if you're just sucking, or whatever it is—I don't really see what basis I have for making you take your bad habit elsewhere.
If, on the other hand, you're a nonsmoker who's aggressive enough to wage a cigarette-like war on snus, where will you stop? Do you imagine that tobacco and its core product, nicotine, won't be engineered into new forms? Already, AP reports that Reynolds is "developing dissolvable tobacco strips, orbs and sticks that it will start test-marketing early next year in Portland, Indianapolis and Columbus, Ohio." Are you going to ban strips and orbs?
Look, I'm no fan of drugs. I don't even drink coffee. My advice is to stay away from all tobacco products. But if you choose a tobacco product that basically leaves me alone, I'll show you the same courtesy.
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Eight months ago, I thought I saw a silver lining in this recession. Now it's looking more like scar tissue.
The silver lining, I thought, was that cosmetic surgery was taking a financial hit:
A breast implant company disclosed a decline in surgeries late last year; a laser eye-surgery firm has lowered its forecast based on a similar trend early this year. A professional breast augmenter frets that in January and February, business for some of his colleagues was off 30 percent to 40 percent. ... More effectively than any bioethicist, the recession is reminding people that cosmetic work isn't medicine. "While healthcare spending as a whole has traditionally moved independently of the economy—a safe haven—that really isn't the case with plastic surgery," a financial analyst tells the Times. In the new, sobered economy, the paper reports, some cosmetic doctors are diversifying into "reconstructive surgery for cancer patients and others that is covered by insurance." Insurance!
Say what you will about coverage-denying bean counters, but they do enforce the essential priority of urgent procedures over elective ones. In a health-care industry controlled by tight budgets and insurers, you might even see the cream of the med-school crop shift back to the kind of work that keeps people alive.
That was then. This is now: The Associated Press reports,
Johnson & Johnson said [Dec. 1] it would buy Mentor, a maker of cosmetic products and breast implants, for $1.07 billion, a move that would help the drug maker become a major player in cosmetic and reconstructive surgery. Analysts said Johnson & Johnson was paying "a giant premium" for Mentor, which makes MemoryGel breast implants, liposuction equipment and skin repair products. ... "It's a good space for J.& J. to get bigger in because it's a space with the least cost-control pricing pressures," as patients, rather than insurers or government health programs, generally pay for cosmetic surgery, said Erik Gordon, associate dean and head of biomedical industry programs at Stevens Institute of Technology.
In other words, the increasing power of insurance gatekeepers and cost controls, driven by the recession, might drive some companies out of health-oriented medicine and into cosmetic procedures. The inability of middle-class people to pay for boob jobs doesn't mean providers have to shift their focus to real medicine for the middle class. Maybe they'll shift their focus instead to boob jobs for the rich.
True, the rich are a smaller market than the middle class. But if the cost controls in real medicine are too tight, providers can make up in profit margins what they lose in volume. So, as we're revising our health-care system, let's try not to drive too many doctors and health companies out of real medicine. They might have something less important to do.
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Solar power is good for the environment, right? Eh, sort of. Marla Dickerson reports in the Los Angeles Times:
Rows of gigantic mirrors covering an area bigger than two football fields have sprouted alongside almond groves near California 99. This is a power plant that uses the sun's heat to produce electricity ... At least 80 large solar projects are on the drawing board in California ...
Critics fear that massive solar farms would create as many environmental problems as they purport to solve. This new-age electricity still requires old-fashioned power towers and high-voltage lines to get it to people's homes. A proposed 150-mile transmission line known as the Sunrise Powerlink that would carry renewable power from Imperial County to San Diego has run into stiff resistance from grass-roots groups and environmentalists. Solar plants require staggering amounts of land, which could threaten fragile ecosystems and mar the stark beauty of America's deserts.
No problem. We just need to put these huge arrays on the moon.
Now, about the energy cost of getting them there ...
Over to you, John Tierney.
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David Savage, one of my favorite legal writers, has a good story in the L.A. Times about President Bush's plan to protect medical employees from punishment when they refuse to violate their consciences. The idea sounds good till you read the details: The rule bars "any entity" that gets federal money (e.g., private companies that happen to be funded in part by a grant) from disciplining any employee, including one "whose task it is to clean the instruments." Savage reports:
Proponents, including the Christian Medical Assn. and the U.S. Conference of Catholic Bishops, say the rule is not limited to abortion. It will protect doctors who do not wish to prescribe birth control or to provide artificial insemination, said Dr. David Stevens, president of CMA. "The real battle line is the morning-after pill," he said. "This prevents the embryo from implanting. This involves moral complicity. Doctors should not be required to dispense a medication they have a moral objection to."
Hey, I'm all for respecting moral objections. Doctors are entitled to their own ethical judgments, regardless of what the medical establishment says. But they're not entitled to such defiance when the judgments in question are scientific. And what Dr. Stevens says about the morning-after pill—that it "prevents the embryo from implanting"—is such a gross misrepresentation that it's amazing he's in charge of any medical association.
Let's get clear on two important points. First, "morning-after" does not mean "after-fertilization." To repeat what I wrote about this two years ago:
An egg loses its fertility within 12 to 24 hours. It takes sperm about 10 hours to reach the egg, and sperm can survive in the female reproductive tract for up to five days. If you want to get pregnant, you'd better send in the sperm before the egg shows up. But if you don't want to get pregnant, and the sperm are on their way or already there, you still have time to stop the egg.
Second, of all the ways in which a morning-after pill might block pregnancy, preventing implantation is the least plausible. Chemically, a morning-after pill is a form of oral contraception. Here are the facts:
The risk that oral contraception will prevent implantation of an embryo is purely theoretical. There is no documented case of such a tragedy, since we have no way to verify conception inside a woman's body prior to implantation without causing the embryo's death. Even theoretically, the risk is vanishingly small, since the primary effect of oral contraception is to prevent ovulation, and the secondary effect is to prevent fertilization. To classify oral contraception as abortifacient, one would have to posit a scenario in which the drug fails to block ovulation, then fails to block fertilization, and yet somehow, having proved impotent at every other task, manages to prevent implantation.
So what Stevens says is, at a minimum, a gross distortion. And it's a particularly evil distortion because it steers women away, not from abortion, but from the measure that is at that moment most likely to prevent them from later resorting to an abortion. If I ran a medical facility and found out one of my doctors was feeding patients that kind of propaganda, I'd fire him. And the government, particularly a government that calls itself conservative, has no business standing in my way.
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Good front-page article in today's New York Times on Britain's National Institute for Health and Clinical Excellence (NICE), which, among other things, decides whether a few more months of your life are worth the expense. The article begins with a guy named Bruce Hardy who needs a drug that might give him an extra half-year of life but would cost $54,000. NICE said no. The agency comes off as heartless. "Everybody should be allowed to have as much life as they can," Hardy's wife pleads. The article concludes: "Meanwhile, Mr. Hardy waits. In recent weeks his growing tumor has pressed on a nerve that governs his voice. He can barely speak and is increasingly out of breath."
Aw, hell. It'd be great if we could buy an extra half-year for everybody. But we can't. We have unmet needs everywhere. People die every day from being uninsured and unattended. They just don't make the front page.
There's a cruel bias built into our minds that makes you feel more for the person who's suffering in front of you than for people whose suffering appears only in statistical form. (I can't remember what the psychologists or economists call this bias. If you do, please share it with the class.) So now you know all about Bruce Hardy, and you probably regard the bureaucrats at NICE as cads for stiffing him. It's harder to remind yourself of all the health and added life that $54,000 could buy for others. For example: Where does the Gates Foundation send its medical dollars for maximum efficiency? Childhood vaccines.
As far as I can tell, NICE is doing good work. Its refusal to pay any amount for life-prolonging drugs has forced drug companies to cut prices. And by drawing a line against paying too much in some tragic cases, NICE preserves money for other cases where the money can do more good. If anything, NICE is a bit soft. For instance, the Times reports: "After consulting a citizens group, the institute decided that the nation should spend the same amount saving or improving the life of a 75-year-old smoker as it would a 5-year-old." If I ran NICE, the 5-year-old would take priority. And I'm irked to see that NICE is already backing off from its rejection of cases such as Hardy's. According to the Times, this comes after NICE was "flooded with anguished comments." I'm sorry, but anguish is everywhere. If patients like Hardy get funded at $9,000 per month, which other patients won't be funded? What about their anguish? Or does your anguish count only if you have the means and know-how to lobby the government?
Yes, everybody deserves as much life as possible. But that means the person in front of you can't take an undue share of limited public funds when others are in need.
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I forgot to do something Monday that I need to start doing from now on: posting an item here each time I write a longer essay in Slate. The item here will just link to the essay and summarize it. Or maybe it'll just be the opening paragraph or something. The reason I'm doing this is to simplify things so you don't have to go to two different places, or subscribe to two different RSS feeds, to get the latest Human Nature whatever. Last spring I set up a network of separate HN pages. Result: The more clicks readers had to go through to find each page, the lamer the traffic got. My tentative conclusion: You're busy, and you don't have time to go poking around looking for a lot of stuff, and my job is to make it easier for you to find what interests you in one place. So: Here it is. You can read the short stuff here, and the longer stuff, and eventually we'll have blog software that will let me post more links to outside pieces, in case you're into that.
If you want to RSS this page, you can use the RSS or Atom links on the right. Or you can bookmark it using the URL at the top: http://www.slate.com/blogs/blogs/humannature/default.aspx. Or, for those of you who prefer a URL that's easier to remember and type (as I do), I just bought humanature.com (one N—all the double-N humannatures were taken), so you can just type "humanature" in your browser window, hit control-enter, and it'll bring you here.
Now, here's the link to Monday's piece. It's about a test that's being marketed to parents to tell them which version of a "sports gene" their kid has. I called this an early version of environmental eugenics or "envireugenics." The language guardians at Commentary have already criticized this as a misnomer and an "ugly Greco-Latin hodgepodge"—the sort of response that, when I've delivered it, has prompted my wife to dismiss me as a "usage pedant." So clearly I'm among friends.
Misha Angrist, the delightfully acerbic "Genome Boy," has also posted in response, which completes our mutual name-check, since in part I was responding to him in the first place. I wrote in Monday's piece that the company behind the new gene-testing pitch, Atlas Sports Genetics, was peddling "national greatness." Angrist replies, "I suspect these companies are more interested in making a killing than they are in 'national greatness.' " (He also says he'd write to me if Slate were "less covetous of its reporters' email addresses." This I have to take from a guy who doesn't put his name on his site? Misha, the least I can do is trade you my e-mail address for your genome. The reason I don't post it is that I once gave it out to a newsletter for PR companies, and now I spend 10 minutes a day fending off e-mails from PR companies. It's in the mail.)
The problem I keep having with Angrist is that I want to quibble with his interpretations, but I can't find fault with his facts. I'm sure he's right that Atlas is in this for the money. I guess what I'm arguing is that in a situation like this, there are two motives: the private one and the public one. Here, the private motive is profit. The public motive is national greatness. The public motive is the one the company presents to potential customers who visit its Web site. This is literally the only message on its home page: "Finding any great Olympic champion normally takes years to determine. What if we knew a part of the answer when we were born?"
Olympic champ? That's a pretty extreme standard to throw at parents up front. Maybe the company thinks there are a lot of parents who seriously envision their kids winning Olympic events. (I envision my kid's soccer team winning more than one game next spring.) But my guess is that the company also feels some obligation to make its public pitch fit the scientific evidence behind the test. And the evidence doesn't show genetic differences in athletic performance at childhood or even ordinary adult levels. It shows such differences at the level of international meets.
I'm not saying the public motive excludes the private one. It's already clear from Sunday's New York Times story that funneling kids toward national greatness is part of Atlas' business plan. I'm just saying that the two motives can operate in tandem, or at least side by side.
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I've been meaning to get back to this Cornelia Dean piece from last week's NYT Science Times. It's about one of my favorite topics: military robots. Except it confounds some of my assumptions, which makes it all the more worth thinking about.
First off: The "killing machines" I keep writing about are just drones. They're fully controlled (except for malfunctions and weather) by human pilots. Dean is talking about something way more unnerving: machines that make their own killing decisions. I had assumed that for safety reasons, this kind of technology was still confined to the computer equivalent of drawing boards. Wrong. Army software contractor Ronald Arkin tells Dean that armed mechanical border guards are already on the job in Israel and South Korea. Here in the United States, the Army is paying Arkin and others to explore, among other things, how to design such robots to "operate within the bounds imposed by the warfighter." In other words, before we give them guns, we'd better figure out how to keep them from screwing up royally or turning on us.
What's really interesting about Arkin is that he directly contradicts my paranoid prejudice. It's not the armed robots I should worry about. It's the armed humans. Dean summarizes his argument:
In a report to the Army last year, Dr. Arkin described some of the potential benefits of autonomous fighting robots. For one thing, they can be designed without an instinct for self-preservation and, as a result, no tendency to lash out in fear. They can be built without anger or recklessness, Dr. Arkin wrote, and they can be made invulnerable to what he called "the psychological problem of ‘scenario fulfillment,' " which causes people to absorb new information more easily if it agrees with their pre-existing ideas.
His report drew on a 2006 survey by the surgeon general of the Army, which found that fewer than half of soldiers and marines serving in Iraq said that noncombatants should be treated with dignity and respect, and 17 percent said all civilians should be treated as insurgents. More than one-third said torture was acceptable under some conditions, and fewer than half said they would report a colleague for unethical battlefield behavior. Troops who were stressed, angry, anxious or mourning lost colleagues or who had handled dead bodies were more likely to say they had mistreated civilian noncombatants, the survey said.
That makes sense: In war, emotion is more hindrance than help. Same goes for my previous speculation that pilots will become more brutal as they're insulated from physical risk. Arkin's data suggest that in fact, exposure to physical risk makes troops more aggressive, not less. Again, the theory makes sense: You shoot first and ask questions later when failure to shoot jeopardizes your safety. Take the ego out of it—make you a robot instead of a person—and the self-protective instinct to shoot first disappears.
That leaves the problem of ethics. Hormones, mirror neurons, socialization, and love, among other things, make most people reluctant to kill one another. Robots lack these inputs. Will they be ruthless? Arkin's answer, as related by Dean, is that "because rules like the Geneva Conventions are based on humane principles, building them into the machine's mental architecture endows it with a kind of empathy."
Well, I wouldn't go that far. It's not empathy, exactly. But maybe empathy isn't so hot as a guide to behavior in combat. Maybe one lesson of the Army's Iraq survey is that empathy too easily morphs into tribalism. Maybe mechanical soldiers programmed with ethical rules, like the machines of I, Robot, are more likely to behave decently.
But then comes the hitch: What happens when the grainy realities of war defy the simplicity of the robot's program? What happens when the hard part isn't restraining yourself from firing on civilians, but distinguishing them from enemy forces in the first place? That's where Arkin's dream bogs down. He admits it would be hard for robots to recognize physical changes that entail moral changes, such as an enemy fighter with a wound or a white flag. And that's basic stuff compared to the multiplying subtleties of modern counterinsurgency. It's not as though al-Qaida hands out uniforms. Is the guy with the backpack a student or a terrorist? Is the woman across the street chubby or wearing a belt full of explosives?
Here's my preliminary take on Arkin's idea: He's right that we can and should substitute robots for humans in some lethal jobs. Where the categories are clear and cold reason is crucial, let the robots do the guarding and killing. But don't give the early generations of robots any jobs that require nuanced judgments about who's a bad guy and who isn't. And be prepared for the bad guys to learn the loopholes in the robots' algorithms. If the robots respect white flags, the terrorists will use white flags. If the robots presume women are civilians, the terrorists will use women. That's what terrorists do: They study our habits and exploit them. It's a human skill. And it will take humans, not robots, to defeat them.