Medical scan scam

DRUG BUST Alan Cassels

Seek and ye shall find. We can find disease wherever we look; the question is do we need to be looking? One of the longest-running debates in health care circles involves the dichotomy of “prevention” versus “treatment.” Some people complain that our “health” system has nothing to do with health and basically exists to patch you up once you’re broken. It’s a system that, by design, ignores many of the factors that make us sick in the first place. Many people praise the need for prevention using very compelling arguments, stressing that the bucks need to go towards health promotion and disease prevention in order to save further billions on medical services down the road. This would avoid much needless suffering and engender a healthier, happier society at a fraction of the cost we currently incur.

There’s no doubt that, as a society, we need to do a better job of following the classic triumvirate of health promotion advice: Eat well. Exercise often. Don’t smoke. However, that which passes for prevention is often an exercise in consumerism to get us to part with even more of our dollars. All in the name of health, of course.

We’ve seen many examples of how “prevention” consumerism drives the use of pharmaceutical drugs prescribed to “prevent” all kinds of chronic disease, even when the evidence underlying those treatments really applies to only a small subset of “high risk” people who may benefit. The incessant drumbeat of preventative pharmacology persistently fails to remind us that many of those treatments provide infinitesimally small benefits for relatively healthy people at great costs with unknown risks.

The pharmaceutical industry is not alone in discovering that prevention sells. Others, particularly those that market organ screening with some of the highest tech tools on the planet, such as the CT (computed tomography) or PET (positron emission tomography) scanning machines, have discovered that screening for disease is a cash cow capable of providing a much more lucrative revenue stream than that yielded by simply providing treatments for the sick.

In fact, one way to sell “prevention” is to establish a market for screening for the deadliest diseases lurking in your body – seeking out markers of disease, such as heart disease or cancer, before the disease can get you.

This new generation of scanning devices wouldn’t look out of place in Dr. McCoy’s sickbay on the Starship Enterprise. These space-age devices generate three-dimensional images of your body’s insides and, in terms of diagnosing what is wrong with you, a CT or PET scan might be the best medicine for you. But, at the same time, because these machines are so good at detecting tumours and arterial plaque, entrepreneurs would naturally reason that we should grow that market by expanding the machines’ uses to more and more healthy people. In fact, why not send the whole population to get “screened,” under the guise that it would (like most arguments for prevention) ultimately save the health system money?

It’s not that simple. Population-wide screening of healthy people seems intuitively sound until you look a little closer and realize the costs and potential for harm are considerable, including, in this case, the massive doses of radiation that some of the tests themselves deliver.

What do we really know about the overall screening of the population using these devices? The answer is not much. And it provides no solace that even the screening paradigm about which we know the most – screening mammography for breast cancer – is no slam-dunk. Maryann Napoli, associate director of the Centre for Medical Consumers in Manhattan (www.medicalconsumers.org), has an in-depth consumer’s view of the controversies around mammography. In a recent interview, she shared some of the statistics with me: “For every 2,000 women who have mammography over the course of 10 years, one woman will have her life extended because she was saved from having or dying from breast cancer. Meanwhile, 10 more women will be diagnosed and treated for a cancer that they didn’t need to know about.”

The fact is the more mammography screening you do, the more things you’ll find. And the more stuff you find, the more you will be driven to determine if the lumps are lethal, beginning a cascade of biopsies, surgery, radiation, hormone therapy and so on. Any screening, if pursued too aggressively in well people, will deliver high rates of false positives – the equivalent of crying wolf. One of the surprising findings of mammography screening research, despite our profound belief in its usefulness, is that breast cancer death rates don’t vary, regardless of whether or not you religiously have mammograms or avoid them. The equation tilts in favour of older women being more rigorous about mammography, but then why do we still recommend screening so aggressively for younger women?

Cancers don’t just show up in the breast, and around the world, private entrepreneurs with scanning machines are promoting their high-tech search and destroy missions in hearts, lungs and other organs. In Canada, these scans seem to be currently limited to those who can plunk down the fee of several thousand dollars, unless you’re a CEO and you get the screen as a perk of “executive health” coverage. The promotion of these types of screenings tend to use a predictable technique designed to grab your attention: 1) the hook –sell the size of the problem. 2) the set-up – sell the wonders of the technology. 3) the pitch – and then close the deal by asking the customer to commit to some action.

The following two examples derive from a centre in a large, western Canadian city pitching its screens for lung cancer, heart disease, and other conditions.

Lung cancer screening

1. The hook: “The Lung Scan – The Best Defence is a Good Offence”

2. The setup: The most preventable of all cancers, lung cancer remains the leading cause of cancer death for both men and women.

3. The pitch: After quitting smoking, early detection may be your best defence against lung cancer. Researchers have recently demonstrated that routine CT screening reveals most lung cancers while they are potentially curable.

4. The close: The lung scan is very accurate in detecting small lung cancers before they become symptomatic or before they become visible on standard chest X-rays. Early detection of lung cancers can mean a longer life and, in many cases, a cure.

Heart Disease

1. The hook: “The Heart Scan – Know the Score”

2. The setup: Cardiovascular disease is the single greatest health problem in Canada and the rest of the developed world. Health Canada suggests 37 percent of Canadian men and 41 percent of women will eventually die of some form of cardiovascular disease.

3. The pitch: A heart scan is an “effective, non-invasive way to measure the amount of calcified plaque in blood vessels – your ‘cardiac calcium score.’ Once identified, at-risk patients can be treated for problems such as high blood pressure, cholesterol pathology and borderline diabetes, significantly improving their chances of survival.”

4. The close: “Starting at age 45 for men and 55 for women, individuals should consider a heart scan to determine their calcified plaque levels.”

So there you have it – all the reasons why you should be proactive. There is this disease – lung cancer or heart disease – that is a huge killer. You could be at risk. The technology could save you. And luckily for you, you can act now (and pay the thousands of dollars your scan will cost you). And the narrative flows to the point where you are willing to part with your money.

By now, you would probably like to ask me, “So what’s wrong with paying a few thousand dollars to find out if your body is harbouring any latent disease?” One way to answer this question is by asking yourself what matters to you.

Does it matter that a single CT scan could expose you to as much radiation as 300 chest x-rays, which, statistically, will cause cancer in a small number of patients thus exposed?

Does it matter to you if the World Health Organization, as well as almost every federal agency in Canada and the US and many radiology societies and associations around the world, gives the thumbs down to population screening of asymptomatic (healthy people) for coronary artery disease or lung cancer using CT scans? In other words, for a variety of reasons, the experts don’t recommend it.

Does it matter that the language used to sell many types of population screening is prone to many forms of bias? Three types of bias – lead-time, length time and overdiagnosis bias – collectively conspire to make the screening appear to improve your chances of survival when it actually doesn’t? (Check Wikipedia for a good explanation of the types of possible bias.)

Does it matter that many of us who are healthy are harbouring slow-growing tumours and other moles, lumps and bits inside our bodies that we don’t know about and which may never bother us, yet, if those things were to be discovered, the medical cascade of investigations, biopsies and surgeries (as well as complications arising from hospitalization and surgery) would tend to follow?

Let me conclude by saying that while we all hope that high tech, such as CT or PET screening, saves lives, it’s worth waiting for the evidence to back up that hope. In the meantime, it’s buyer beware; watch for the hook and beware of those ready to “close” the deal.

Alan Cassels is a pharmaceutical policy researcher at the University of Victoria and is the author of The ABCs of Disease Mongering. He is currently studying the marketing and regulation of private scanning in Canada. Have you been scanned? Do you have a story to tell? Contact him:cassels@uivic.ca

Think for yourself

by Joseph Roberts

“This above all, to thine own self be true, and it must follow, as the night the day, thou canst not then be false to any man.”

– Shakespeare, Hamlet

The Conservative government launched a huge AMEND Bill 51 campaign in the wake of the hostile reception it received. People are now in place, hired by tax-payers dollars, to inform the manufactures, retailers, and consumer of the benefits of the new improved AMEND position. The Conservatives would like to just pass the bill and have all this noise die down before the next, possibly very soon, election. The Amend promoters stand ready to ridicule anyone who doesn’t agree with them as ‘fear-mongers’, as ‘misunderstanding the intent of what they’re trying to say’, etc.  So, a smear, not necessarily directed at any one person, but at everyone in general who has a different opinion. Grassroots folks will be accused as people who “don’t want regulations at all!” Another smear strategy, implying that, well, those low lifes are a bunch of hicks that don’t know better. Whatever.  

If Health Canada had been so sharp, Listeria at the luncheon meat counter and mad cow disease would have been prevented, or at least announced earlier. Walkerton and SARS would have been discussed when “different” opinions first appeared. 

Health Canada certainly does not have a monopoly disliking whistle blowers or heretics. Atomic Energy of Canada (AECL) was slow to announce their screw-ups in the supply of medical isotopes, and, that homes in Elliot Lake were polluted by radon gas hence uninhabitable. So many wonder which side some governments agents are really on. To some these may be inconvenient comments. But let us not forget that regular people need to be represented, the voice of the consumer, and not just industry.  Not government, but the consumer.  People need to be protected and it seems that the people most likely to do this are the people themselves. Because, as Jacques Cousteau said, “you will only protect that which you love”.  Corporations, though granted the status of person under law, are not known to be bastions of compassion.

Those that prefer to limit debate in order to push through their agenda have a familiar refrain. Benito Mussolini declared “O con noi o contro di noi”–You’re either with us or against us. President George W. Bush in September 20, 2001 voiced, “Either you are with us, or you are with the terrorists.” Gaston in the movie Beauty and the Beast tells citizens, “You’re either with us, or against us,” and then proceeds to locks up Belle and her father so he can kill the Beast.

One needs to welcome, not stiffle civil debate in order to find common ground. 

Eat the light – the fourth age of solar is on the way…

by Geoff Olson

In a 2000 interview on CBC Radio’s Ideas, ethnobotanist Wade Davis recalled a “horrific book that came out called The Secret Life of Plants.” One of Davis’ plant-gathering colleagues, Tim Ploughman, was “infuriated” with the book’s thesis that houseplants respond emotionally to human voices and the music of Mozart. “I remember Tim saying to me, ‘Why would a plant give a shit about Mozart?’ And then he said, ‘And even if it did, why should that impress us? They can eat light. Isn’t that enough?’”

Whatever the merit of the slab of compressed pulp that so annoyed the two ethnobotanists, there’s no denying that light-eating is a very impressive trick. In fact, it’s evolution’s greatest routine, the foundation for the pyramid of life. Every cell of algae and every humble weed chows down on photons, as a matter of course.

That’s real magic. Let’s see David Copperfield and Kris Angel sit down for a tray of rays.

Human beings may not be able to “eat light” as directly as plants do, but our fossil-fuel addicted civilization is beginning to taste the possibility of reducing its steady diet of dirty energy sources like coal, oil and nuclear. With the explosive growth of renewable energy, we are now on the cusp of the fourth age of solar (see sidebar).

Tavis Bradford, an industry analyst for The Prometheus Institute, predicts that within a short time, production of solar panels will double each year. The price per volume savings will inevitably follow, as production scales-up and becomes more efficient. The price of solar panels could drop as much as 50 percent from 2006 to 2010, Bradford adds.

According to futurist and inventor Ray Kurzweil, solar power will be the dominant form of energy source within the next 20 years. With the use of solar power doubling every two years, it is following the exponential growth of previous technologies, Kurzweil says. The futurist has seen similar kinds of patterns in the past and has correctly predicted the outcomes. He foresaw the explosive growth of the Internet and wireless systems and also predicted the downfall of the Soviet Union.

With wind factored in, the possibilities are even sunnier. The Pacific Northwest National Laboratory in Richland, Washington – one of the U.S. Department of Energy’s 10 national laboratories – estimates that, as wind power drops to competitive levels, it could quickly supply 20 percent of the US’ electrical needs. With the proper infrastructure implemented, some researchers put the figure at 30 percent. (For the purposes of this article, I include wind power as a subset of solar power because the sun’s electromagnetic energy is the prime driver of the atmosphere’s thermal engine.)

The pace of research is tracking the pace of production. It seems that a week can’t pass without another technical or market breakthrough. Passive solar heating, solar ovens, solar-powered trash compactors, solar-powered UV water treatment, hyper-efficient LED lights and building-integrated photovoltaics – the present state of the art has dizzying possibilities for social change, even without the projected technical advances and plunging costs.

The entry of big players like Wal-Mart into solar power indicates energy security is as much of an issue as good business practice. Corporations aren’t going to wait to take their cue from the Jurassic oil dynasty counting out its last few months in the White House. Geneticist and entrepreneur Joel Bellenson points out that the founder of Wal-Mart has invested $250M in First Solar, which now has a market capitalization larger than GM and Ford combined. The founders of Google funded NanoSolar, which just shipped solar panels at $1/W, making it cheaper than coal. And while General Electric is losing its appliance division, it’s going big time into renewable energy via wind and LED lighting.

Other big players include Phillips, Sharp Electronics, Boeing, Peterbilt, Intel, Hewlitt-Packard and IBM.

“Silicon Valley/Stanford on one coast and MIT on the other coast are driving solar advancements at breakneck speed,” Bellenson notes in an email exchange. “Clearly, the principal countries and their industrial capitalists in the EU are hell bent to switch to renewables. The United Kingdom plans to get all of their residential electricity from wind by 2020.”

The game has gone global and North America is playing catch-up. Germany and Denmark are far ahead of us in working renewable technology into their infrastructure. One of the largest wind companies, India-based Suzlon, is going gangbusters; China-based SunTech, one of the largest solar panel companies, is doing the same. At current rates of production, the solar industry worldwide will be producing enough solar panels in 2009 to power nine Vancouvers, Bellenson claims.

Nonetheless, there have been two persistent bugaboos of solar power: it doesn’t work when the sun goes down and storing power is expensive. This is why solar still supplies only a small percentage of the world’s electricity. Off-the-shelf batteries are still too big and expensive to compete with other options. In comparison, fossil or renewable fuels act as their own storage, making for ease of use and transport.

That nut may finally have been cracked, however. In August, researchers at the Massachusetts Institute of Technology (MIT) claimed to have found a radically inexpensive way to store solar power. Eoin O’Carroll described the feat in an article published in the Christian Science Monitor: “Daniel Nocera, a chemistry professor at MIT, and Matthew Kanan, a postdoctoral fellow in Mr. Nocera’s lab, have developed a catalyst made from cobalt and phosphate that can split water into oxygen and hydrogen gas. When used in conjunction with a photovoltaic solar panel, their system can use water to store the sun’s energy.”

Cobalt replaces electrodes made of platinum, which is more expensive than gold, thereby reducing costs by a huge margin. Nocera describes his catalyst discovery as a solar power “Nirvana,” with the inference that we can now “seriously think about solar power as unlimited and soon.”

In a Forbes magazine interview, Nocera enthuses about his battery’s replication of photosynthesis. “Once you put a photovoltaic on it, you’ve got an inorganic leaf,” he says. The chem prof figures he’s managed to match wits with Gaia. “For six months now, I’ve been looking at the leaves and saying, ‘I own you guys!’”

The MIT press release includes a sanguine estimate from James Barber, a biochemist at the Imperial College London in the UK. “This is a major discovery with enormous implications for the future prosperity of humankind,” Barber says. (That was so last month! As this magazine goes to press, Green Car Congress (greencongress.com) announces that Australia researchers have developed a “bio-inspired, photo-oxidizing catalyst for solar water-splitting to produce hydrogen.” The researchers use manganese, as plants do – and thereby may have gone a step further in replicating photosynthesis.)

This all may sound too good to be true. Are Kurzweil’s prognostications too sunny? Is Nocera’s leaf-mimicry a revolutionary turn for alternative technology or just a minor riff on nature’s grand banquet of light? Besides, the MIT battery still has a long way to go before market testing. And weren’t there promises in the past from the press about some new technology that would liberate us all, from the rotary telephone to the Internet?

The difference this time around is that the enthusiasm isn’t limited to journalists and public relations flacks. It’s rare for scientists to speak in superlatives, but solar seems to have lit a fire under the thinking class.

Joel Bellenson is convinced solar will introduce massive changes into society, on a global scale. A typical conversation with the 43-year-old polymath ranges from the genetics of human scent to Big Bang cosmology to the politics of sub-Saharan Africa. It’s like talking to a bipedal Library of Congress or a jovial Wikipedia. The Vancouver resident describes himself as a “serial entrepreneur at the intersection of life sciences and information technology.”

Bellenson co-founded Pangea Systems/DoubleTwist, which in 1999 was the first to annotate the human genome and make it available to academics for free to prevent it from being patented by Celera. He is currently the CEO of Upstream Biosciences, which investigates new drugs for Global South infectious diseases, such as Malaria, Black Fever, Sleeping Sickness, Chagas and TB, utilizing artificial intelligence and chemical data.

The Stanford graduate relates the current thinking among solar power researchers: “Based on a mid range of 25 percent efficiency, solar panels generating 90 Terawatts of power – ~6X the planet’s current energy consumption of all types: electricity, heat, transportation – would require no more than 360,000 square kilometers.”

The whole planet, including the projected population growth by 2050, could be powered at North American levels for electricity, heat and transportation by sunny land smaller than the state of Montana, he says. “One hectare of sunlit land surface area, covered with a 15 level, LED-lit, hydroponic greenhouse with solar panels on top, will produce the equivalent of 150 outdoor, arable hectares of food, assuming LED and solar panel efficiencies expected within the next five to 10 years. Costs of sufficient solar panels and, most importantly, LED lights will cross over with the price of arable farm land in five years.”

Bellenson isn’t troubled by concerns of a shortage of wild spaces given over to solar power collectors. He believes the main impact “…will be on enabling more rational economic organization,” which includes rational use of the landbase and freshwater.

Who will be the big losers in this? The big oil companies, for sure. “In general, we are already entering a period where the King CONG – coal, oil, nukes, gas – companies are nervous about investing in any step in the process, since the payback is over 20 to 30 years. They are not stupid, and see that the complete triumph of renewables will occur in about 10 to 15 years, with almost 100 percent of all electricity converted over and probably 50 percent of transport to plug in hybrids by then. Even oil rich Middle East countries from Algeria to United Arab Emirates are jumping on the solar bandwagon,” Bellenson states.

The geneticist notes that the primary material that goes into producing solar panels is silicon. The Earth’s crust is one-quarter silicon, the seventh most abundant element in the universe. You could say the cosmos is just about screaming at the clever monkey to crank out solar panels.

It all makes for a wonderful vision of civilization turning its face to the sun. Anyone who can work an Excel spreadsheet can drag the simple formula of 45 percent compound annual growth rate for solar down 20 years of rows and see what happens, Bellenson insists. Last year, worldwide solar investment grew 92 percent. A mix of lower solar prices, higher oil prices and geopolitical tension will drive solar power further up Kurzwell’s exponential growth curve.

Bellenson foresees a time when solar generates enough power that all agriculture can be brought indoors into “multilevel urban greenhouses,” thus saving 90 percent of the 70 percent of the world’s freshwater devoted to agriculture, while also radically reducing the amount of herbicides, pesticides, fertilizers and associated runoff.

Solar is already being produced at $1 to $1.25 a watt, and in the past few months there have been announcements noting solar panel production prices dropping to $0.40 a watt. Coal plants cost $1 to $2 a watt to build. Engineers working on quantum dots are claiming that it will cost on the order of $0.05 a watt by 2017. “In other words, it would cost $200 to build solar capacity – roof or on large solar farms – for a big single family home (4kW),” Bellenson says. “At that price, the Global South’s pent-up, desperate need for electricity will be able to be addressed quite easily.”

Some of the sunniest places on Earth, including Africa for example, are also the places with the greatest need for electricity. Bellenson’s interest in Africa and the Global South is more than academic. He recently founded the AfricaFreeMAN project to set up free wireless broadband intranets with free local telephony in metropolitan area networks. He is also involved with the Presidential Investment Roundtable of the President of Uganda, an initiative focused on biotechnology, forestry, agriculture, IT/telecom and renewable energy.

Solar power is truly empowering for the Global South, the geneticist insists: “The power source, the Sun, is plentiful and democratically distributed. No geopolitical games. No need to sell cheap labour intensive agro products on unfair global markets to purchase expensive petroleum. No ability for the oil curse to corrupt social, economic, political and military life…For those motivated to improve the environment to prevent horrors from climate change, subsidizing solar panels in Africa and other places in the Global South not only makes for a better future, but radically improves people’s lives right now, far, far more than adding renewable power sources in rich countries. Affordable electricity is the core necessity of modern civilization. Without it, life is a needless nightmare of suffering.”

Solar and wind have long been the bastard children of energy production, dismissed as bit players in petroleum and coal’s rich pageant. There’s little doubt that the oil lobby has kept alternative energy research and development on the fringe for years. But with the horses out, there is little point in trying to shut the barn door. The question is not how widespread renewable power will be in our future. The question is will its reign arrive in time? With resource wars raging in the Near East, and the planet in the midst of its sixth great extinction period, one expression comes to mind: the power of now.

Bellenson believes a transformation is already in the works, as humanity moves away from its obsessive dependency on non-renewables: “This shift will occur over the next 15 – 20 years and will be more massive than the development of agriculture itself 10,000 years ago.”


The fourth age of solar

The story of life on Earth is ultimately about a long-term relationship between light and matter. In the first age of solar, plants evolved the capacity to transfer the electromagnetic energy of sunlight into the high-energy chemical bonds of sugars and carbohydrates.

In the second age of solar, a few hundred million years later, the monochrome, brownish-green world of the late Jurassic gave way to an explosion of colour with the emergence of the angiosperms – the flowering plants. The plants directed some of the photosynthetic energies of their green-coloured tissues into the production of lurid landing pads, alerting insects through their brilliant hues. With the symbiosis of insect pollination, evolution took a whole new direction, giving the wilderness a coat of many colours in the process. (Charles Darwin called flowers an “abominable mystery” because they appeared so suddenly, and spread so quickly, in geological time.)

The third age of solar began 10 thousand years ago, when several populations in the Near East abandoned their nomadic way of life for year-round settlements. These small settlements, the seeds of future city-states, were made possible through the use of domesticated animals and seasonal stockpiles of grain. The energy of the sun, bound up in the chemical bonds of plant carbohydrates, was deposited in silos and granaries like money in a bank. A cascade of cultural consequences followed, with institutional mechanisms for measuring, allocating and protecting the stockpiles: cuneiform script, local governance, taxation and standing armies. We are still in the third age of light, but now the vast bulk of our energy comes from fossil fuels. These fuels also began as organic material and they hold the energy of ancient sunlight in their chemical bonds.

Civilization is now on the cusp of the fourth age of solar. We now have the opportunity to abandon the unsustainable, finite resources of fossil fuels for a truly abundant, freely available form of energy. We’re doing it by following the evolutionary example of the plants.

www.geoffolson.com

Caesar’s last breath

by Geoff Olson

Breathe in. Breathe out. Now consider this: every breath you take contains at least one air molecule exhaled by Julius Caesar in his last breath. With your every breath, at least one of these molecules makes its way into your lungs. This pop-science factoid may sound dubious, but it actually began as a thought experiment by nuclear physicist Enrico Fermi. It’s been a chem class standard ever since.

Mathematician John Allen Paulos took another look at the numbers for his 1988 book Innumeracy. He began from the assumption that two thousand years have been enough time for the carbon dioxide molecules in Caesar’s last breath to mix evenly in the atmosphere. “Thus there is a 1.8% chance that none of the molecules you are (still) holding in your lungs came from Caesar’s last breath. And there is a 98.2% chance that at least one of the molecules in your lungs came from Caesar’s last breath,” Paulos noted.

This counterintuitive calculation strikingly illustrates how interconnected our lives are, across vast stretches of time. The traffic of molecules between our bodies and the environment is the ultimate in “free trade.” As Zen philosopher Alan Watts once observed, human beings are like the whirlpools and eddies seen at the edge of running streams. We’re dynamical systems that maintain recognizable form while exchanging matter and energy with our environment.

We are inseparable from the larger patterns in which we’re embedded. The great lesson of twentieth century science, from quantum physics to ecology, is that we cannot understand the separate components apart from the whole. Yet there are places in the world where they apparently haven’t heard the news yet, and I don’t mean the refugee camps of Sudan or the jungles of Borneo; I mean the university faculty clubs in the First World.

Post-Keynesian economic theory is stuck in a Newtonian era rut – a push-pull paradigm – and it’s about to hit a wall, both intellectually and practically, in Earth’s carrying capacity.

It’s not as if there hasn’t been plenty of time to catch up with the non-reductionist worldview. In 1866, German biologist Ernst Haeckel coined the term oekologie, or “ecology,” defining it as “…the comprehensive science of the relationship of the organism to the environment.” By the early twentieth century, poverty-stricken New York collector of scientific oddities Charles Fort had a grasp of where the new sciences were heading. “If there is an underlying oneness of all things, it does not matter where we begin, whether with stars, or laws of supply and demand, or frogs, or Napoleon Bonaparte. One measures a circle, beginning anywhere,” Fort stated.

In 1961, when weather scientist Edward Lorenz was programming a computer to predict weather patterns, he entered the decimal .506 as a shortcut, rather than the full sequence of .506127. The result was a radically different weather scenario. Lorenz remarked on this finding in a 1963 paper: “One meteorologist remarked that if the theory were correct, one flap of a seagull’s wings could change the course of weather forever.” Appearing before the American Association for the Advancement of Science, Lorenz gave a talk entitled, Does the Flap of a Butterfly’s Wings in Brazil Set off a Tornado in Texas? The title has since become a shorthand expression for nature’s interconnectedness.

Lorenz’s findings kick-started the 1980s academic cottage industry of “chaos theory.” Aided by the personal computing explosion, scientists plumbed the bizarre, psychedelic landscapes of fractals and “strange attractors,” mathematical forms that appeared to underlie some of nature’s most persistent themes. Suddenly, it became possible to see links between seemingly unrelated things. From dripping taps to the collapse of caribou populations, from the whirlpool of cream in your coffee cup to the pinwheel of stars in a galaxy millions of light years away, chaos theory supplied the connections. Charles Fort was right: you could measure a circle beginning anywhere.

The disciplines of chaos theory and complexity theory have both had a strong influence on the physical sciences and in some of the life sciences, as well. Urban planners and social scientists have also seized upon the new ideas. Yet, as far as neoclassical economics is concerned, it’s as if the discoveries of Lorenz and his colleagues never occurred. The disconnect between rhetoric and reality has alerted some of the silverbacks within the financial-speculative complex that something is very wrong with their profession. Among them are Joseph Steiglitz, former senior vice president and chief economist of the World Bank, former hedge fund financier George Soros and University of Bologna professor of political economics Stefano Zamagni.

David Suzuki is another skeptic and he offers a great anecdote about economic thinking. While at the University of British Columbia, he figured it would be a good idea to supplement his academic background in biology with an understanding of economics. When he attended his first class, the instructor stood at the blackboard, drawing lines in chalk to show the flow from the resource base into the market, with subsidiary industries adding value and creating wealth for investors.

Suzuki pointed to the side of the blackboard that was empty of equations, the resource base, and asked whether the calculations took into account the effect of human activity on the environment, the diminishing reserves and growing waste that Suzuki reasonably regarded as a cost mortgaged into the future. “That’s an externality,” the instructor responded dryly. In other words, the environment is something external to the grand human workings of the market and not worth factoring in. Suzuki left the class on the spot.

According to Stefano Zamagni, prior to the 1900s, economics was referred to as “the science of happiness.” By the late twentieth century, it bore the ignominious title, “the dismal science.” In a lecture in Vancouver in 2004, Zamagni described the crisis facing economic science. Economists identify the common good with the sum total of individual goods, the professor says, which doesn’t work, as it ignores “the good of every individual in all the dimensions of a human being.” What Zamagni calls the “original sin of economics” is the reductionist idea that economic relations are reducible to the exchange of equivalence: I give or do something for you and you give or do something for me of the same value.

Yet there is another dimension to exchange, based on the principle of reciprocity, and as Zamagni noted, “…the principle of reciprocity is completely different from the exchange of goods.” Reciprocity is closely tied to trust and both variables are entirely missing from economic equations. In fact, they are extremely difficult or impossible to quantify, yet immensely important for sustaining fair economic relations. Enron, anyone?

Zamagni connects several decades of materialistic economic philosophy, with its reductionistic disconnect from the real word, to the deterioration of North American civic and family life. The “instrumental rationality” of economic thinking, he says, has ventured far beyond its sphere of applicability, justifying a dog-eat-dog paradigm for both interpersonal and international relations.

Steve Keen, associate professor of economics and finance at the University of Western Sydney, describes conventional economic theory as “autistic.” “What passes for ‘normal’ in economics barely deserves the appellation ‘science,’ he asserts in his 2001 paper Economists Don’t Have Ears.

Keen writes: “Most introductory economics textbooks present a sanitized, uncritical rendition of conventional economic theory…the courses in which these textbooks are used do little to counter this mendacious presentation. Students might learn, for example, that ‘externalities’ reduce the efficiency of the market mechanism. However, they will not learn that the ‘proof’ that markets are efficient is itself flawed.” Keen also assails the economics, as taught at an undergraduate level, as “profoundly boring,” and those who move from the discipline into accountancy, finance or management learn just enough to walk away from the classroom with a warped view of the world.

Although there is a vast body of literature critical of economic thinking, the students aren’t exposed to any of it. Most students end up swallowing the axioms of economic science because, as Keen notes, “…their training leaves them both insufficiently literate and insufficiently numerate.” Neither are they given the historical context for economic thinking, making it seem as if some bearded prof had delivered it from on high, reading from inscribed tablets.

Economics has persevered with mathematical methods that professional mathematicians have long ago transcended, Keen writes. “This dated version of mathematics shields students from new developments in mathematics that, incidentally, undermine much of neoclassical economic theory.”

In particular, applying the findings of chaos theory to real-world market behaviour involves an understanding of “ordinary differential equations.” Yet this topic is taught in very few courses on mathematical economics, notes Keen, and where it is taught, it is not covered in sufficient depth.

“Economics students therefore graduate from Masters and PhD programs with an effectively vacuous understanding of economics, no appreciation of the intellectual history of their discipline and an approach to mathematics, which hobbles both their critical understanding of economics and their ability to appreciate the latest advances in mathematics and other sciences.

“A minority of these ill-informed students themselves go on to be academic economists, and then repeat the process. Ignorance is perpetuated,” Keen claims.

Bill Rees, professor at the School of Community and Regional Planning at the University of British Columbia, is best known for his concept of the “ecological footprint.” He received a PhD from the University of Toronto in population ecology in 1969 and when UBC’s forward-thinking School of Planning went looking for someone with a background in the biological science, Rees fit the bill. He began to ponder the relationship between the carrying capacity of the environment and economic activity, subsequently developing “a simple little model” showing that the human carrying capacity of the Lower Mainland was less than half of the population of the time. In a 2006 article by Robert Alsted in the Vancouver Courier, Rees discussed the response from colleagues:

“One of them, a prominent Canadian resource economist, took him to lunch and with genuine concern told him that if he continued to pursue his research interests as expressed in that little paper, his career at UBC would be ‘nasty, brutish and short.’ Didn’t he know? Carrying capacity as a concept had been demolished long since –trade, technology and human ingenuity could make up for any regional resource shortfalls.”

In recent years, there has been some noodling with “the economics of happiness” along with the emerging new science of “behavourial economics.” But as long as GDP calculations can factor a heart attack, a divorce or an oil tanker spill as economic pluses, the rot goes to the core of the discipline.

“The mad rantings of men in authority often have their origins in the jottings of some forgotten professor of economics,” said John Maynard Keynes, himself a largely forgotten professor of economics. As journalist Naomi Klein demonstrates in her most recent book The Shock Doctrine, the economic theories of Milton Friedman were put into practice in Chile immediately following the 1972 coup. Friedman’s dangerous, destructive ideas became the intellectual foundation for the subsequent neocolonial domination of Latin America, under the so-called “Washington consensus.”

From the corporate-backed war of attrition on the pubic sector, to Canada’s proxy war in Afghanistan, with its perpetually-undefined “mission,” to the Iraqi debacle and the American’s current sabre-rattling with Iran, surely part of the problem resides in the education of the advisors and handlers who surround our leaders. These people suffer from a serious thinking problem. Their blinkered, one-size fits all vision of a world monoculture, of democracy at gunpoint, is about what you’d expect from anyone whose worldview is post-Enlightenment, but pre-Einsteinian.

I’m sure many of these highly educated sorts would fail to see the full relevance of the anecdote about Caesar’s last breath. But I’d like to think a few of them would be stirred by the words of the late Italian author Primo Levi. In his book The Periodic Table, Levi tracks the path of a carbon atom as it escapes from a block of limestone and travels into the airways of a falcon. It fails to penetrate the bird’s bloodstream and continues whirling about in the atmosphere for another eight years, before being inhaled by the author himself. The carbon atom makes its way into Levi’s bloodstream and into a brain cell that, as he says, “…guides this hand of mine to make this dot upon the page: this one.”

Levi’s scientific lyricism underscores the message of Caesar’s last breath. Our lives are intimately interwoven with all things, living and nonliving. It’s hardly a radical notion: most of us get it by now. “The Butterfly Effect” is well known enough that it became the title of a Hollywood film. Yet the idea that human beings are rational free agents, with no allegiance to anyone or anything other than their own self-interest, remains a given in neoclassical economics. It’s not a workable recipe for dealing with a finite planet with real-world limits, but it works just fine as a philosophy for psychopaths.

Like former chemist and Auschwitz survivor Primo Levi, we’re all co-authors in the universal process of creation. This is demonstrably true in market economics. Our collective capacity for reality construction is demonstrated by the gyrations of stock exchanges. The value of stocks are no more than what we collectively believe them to be, arguably making market economics a branch of social psychology.

The world as we experience it is a weird amalgam of world and worldview, of expectation and external relations. Werner Heisenberg, one of the architects of quantum theory, held that “…what we observe is not nature itself, but nature exposed to our method of questioning.” As scientists penetrate nature to smaller and smaller scales, all they find are ghostlike entities that evaporate into abstract clouds of probabilities. And the deeper they go, they find only the relationships between things, which themselves are only relationships between other things, whether we call them quarks, strings, “virtual particles” or some other conceptual will-o’-the-wisp.

Recent physics experiments in Vienna on “non-locality” have confirmed that all parts of the universe appear to be in instantaneous connection with all other parts. This is reminiscent of the Buddhist notion of “mutual arising” or the Vedic myth of Indra’s net, composed of an endless web of jewels that reflect one another.

Through its recursive retreat into endless layers of pattern, it seems the universe forever hides its face from us, hinting that our self-image as independent beings isn’t the whole story. It’s more like a game of hide and seek between observer and observed.

Ultimately, we are no more “rational utility maximizers” in a “free market” than we are sacks of chemicals disconnected from the air we breathe. We are creative patterns, whirlpools and turbulent flows, inseparable from all the other patterns in the river of being. This is what ecology and the sciences of connectedness have been telling us for decades. And as the frogs, songbirds and honeybees continue with their vanishing acts, the time is running short for the wizards of the dismal science to get it.

www.geoffolson.com

Health Canada takes baby steps toward drug safety

DRUG BUST Alan Cassels

If you thought we could get through these lazy days of summer without another major drug warning from Health Canada for a class of drugs taken by thousands of Canadians, think again.

The most recent advisory is among the more mystifying of the “adverse drug reactions” warnings I’ve seen lately; it warns of tendonitis and even tendon rupture linked to a commonly prescribed, relatively new class of antibiotics. And while the warning threatens to make me riff, for the umpteenth time, on the variety of ways in which drug regulators around the world – Health Canada not excepted – seem to go through the motions of monitoring and ensuring drug safety, there was also some good news. In a separate announcement, Health Canada advised it would provide some new seed money to help establish a drug safety research network in Canada.

This is very good news, but first, about the warning. The fluoroquinolone antibiotics, which include ciprofloxacin (Cipro) and other drugs whose generic names end in floxacin, have been under a dark cloud for a while now. More than two years ago, the drug watchdog group Public Citizen petitioned the US FDA to strengthen the warnings, stating, “…tendon ruptures associated with these drugs continue to occur at a disturbing rate, but could be prevented if doctors and patients were more aware of early warning signals.”

Last month, Health Canada was seemingly spurred into action by the US FDA’s ruling that makers of fluoroquinolone drugs had to issue a “black box” warning – the FDA’s strongest safety warning – on these drugs. Black box warnings don’t come along all that frequently and they usually emerge after much negotiation between the manufacturers and the regulator. A “black box” often precedes the removal of a drug from the market and it is a serious signal that the regulators are concerned about the drug’s toxicity.

For all you active individuals out enjoying the summer sunshine, the phrase “tendon rupture” is likely to strike fear in your heart. Tendon damage and perhaps a torn Achilles tendon could wreck anyone’s day. And this due to a drug you took for a simple infection? While the potential effects on your tendons from these drugs have been known for some time, what isn’t entirely clear is why any physician would prescribe the drug, being fully aware of the risk it carries when other antibiotics carry no such risk. As far as I can tell, there is no valid evidence that the fluoroquinolones are any better at treating most infections compared to the alternatives, such as older penicillin-type antibiotics.

My knee-jerk reaction is to suspect that the fluoroquinolone antibiotics have been widely prescribed – both mis-prescribed and over-prescribed – and only a little research confirms those suspicions. There is that perennial, but misapplied, axiom “newer equals better,” which has likely driven much of the marketing and subsequent prescribing of these drugs, and as with any newer treatment, the drug roars onto the scene with bells and whistles while the vital safety signals are spoken in whispers years later.

It is obvious to me that these drugs are marketed as being useful for indications for which they would, at best, be someone’s second choice. At least one manufacturer of this type of antibiotic has been slapped on the wrist by the US FDA for “…making false and misleading statements regarding the safety and efficacy” of the treatment in its advertising.

In terms of how well the drugs are being prescribed, one study involving 100 patients in two academic medical centres in the US found that 81 percent of the patients taking fluoroquinolone antibiotics had been given them for an inappropriate indication. In that same study, 43 percent of the patients received these antibiotics as a first-line treatment and 27 percent of recipients had no evidence of an infection. If this study, which was small and perhaps not applicable to the wider population, comes even close to representing the actual use of these drugs in the “real world,” it is a damning indictment of a serious failure in prescribing, made all the more serious because the drugs have the inconvenient capacity to cause “tendon rupture.”

Should we not expect Health Canada, as our drug regulator, to ensure that proper and timely prescribing information, especially safety information, is made available to guide our physicians? Sadly “too little and too late” seems to characterize the safety signals reaching physicians. After a new drug is approved, the marketers jump into action putting the new drug front and centre of our doctors, our hospitals and health clinics, plying them with free samples and glowing literature.

So what can we do to ensure that new drugs are used properly, rather than inadvertently inflicting tendon damage on the population?

Essentially, we need better “real world” data. It is slowly being recognized that Canada lacks the capacity to properly ensure that “real world” data is generated for new drugs, and that vital safety information about how drugs work in the world in which you and I live must be delivered to physicians in a timely manner. We hope that our physicians are acting in the most prudent manner possible when it comes to treating our infections. We also hope they will reserve newer drugs for patients for whom the older, more established classes of drugs clearly don’t work. Although hope is a pretty frail framework upon which to build a drug safety system.

The demand for “Real World Safety and Effectiveness” research around pharmaceuticals is a topic I’ve written about in the past (Common Ground, August, 2007). This need was initially enshrined in the National Pharmaceutical Strategy (NPS), a federal-provincial initiative boldly launched in September 2004, with the goal of providing Canadians with more equitable, sustainable and safer access to new drugs.

Almost four years later, I’m not the only one to notice that the NPS is largely a dud. Some have said that the “new” Conservative government’s mighty tendency to jettison those Liberal initiatives sounded the death knell for the NPS. Others have noted that provincial-federal wrangling over drug issues – the provinces want help to stanch the bleeding of red ink on the provincial drug file while the feds want to please the drug industry – means the NPS is going nowhere fast.

One of the things buried in the NPS’s objectives was a desire to “strengthen evaluation of real-world drug safety and effectiveness” and this recent announcement seems like it’s about to happen, albeit with baby steps.

With prescription drug spending now in excess of $22 billion per year, and a strong public appetite for more rigorous drug safety in Canada, Health Canada announced in mid-July it would provide the seed money needed to set up an independent research network to study the real world safety and effectiveness of prescription drugs in Canada. The business plan behind this network called for about $20 million per year, but Health Canada announced an immediate five percent of that ($1 million dollars) to get things up and running.

The hope is that the provinces will jump in with their own money and make the network a reality, a network that will likely link researchers in Canada, who are already doing “post-market” surveillance work, and allow them to cooperate in tracking real world drug use issues across the country.

No one can argue that Canadians must be protected from the unanticipated, adverse effects of prescription drugs, as the recent drug safety warning related to the fluoroquinolones has highlighted. Some, however, are insulted with the measly five percent Health Canada is kicking in, as it barely represents a down payment on the initiative.

Some have said that regardless of what form Bill C-51 ultimately takes, if it even survives, any promise of a “cradle-to-grave” surveillance of drugs in Canada will have to be bankrolled by “real world” drug data, and this money will ensure that Canadian researchers are organized and funded to use those data.

I say we give credit where credit is due. Health Canada has anted up so let’s wait and see if the provinces will come on board. Only time will tell if they will do their part to make this network fly. Or perhaps this initiative, like so many other important initiatives in the past, is destined to die from the lack of political will.

My strategy? I’m going to say a little prayer for those who are suffering needless Achilles damage this summer and I’ll feel a little guilty as I continue to enjoy running, jumping, hiking and walking. Because of our collective ignorance about a particular class of drugs, many Canadians won’t be enjoying the summer as I will.

It doesn’t have to be this way. Let’s make drug safety a priority this year and put the money behind that decision.

Alan Cassels is a pharmaceutical policy researcher at the University of Victoria and can be reached at; cassels@uivic.ca

If you think you have been injured by a prescription drug, you should call the Canada Vigilance Program at 1-866-234-2345. You can also submit an adverse reaction report on the Med Effect Canada website (www.hc-sc.gc.ca/dhp-mps/medeff/index_e.html).