Saturday, April 26, 2008

Hypocritic Oath

In December 2004, I interviewed with Merck for a position. I was flown out for an interview to their research division in New Jersey. I spent the whole day meeting various individuals. I had finished my doctorate earlier that year and I thought I would be a good fit in a pharmaceutical research department doing medical research and publishing.

I got asked how important publishing was to me. I said I enjoyed research and publishing was another step in the process of disseminating findings to the larger academic and lay community- so yes, it was important. Great, said they. Unlike academia, I was told, the process of getting research funded was not a big issue at Merck. As long as I worked up an idea well and could show justification for it, the money could always be found- I wouldn't have to go through the kind of onerous process that grant-writing in academia usually involves.

But how important, I was asked, was it to me that I get credit for the research I carried out. I must have looked a little non-plussed as it is not a question one prepares for. I said well, in collaborative research, all contributors should be acknowledged. Someone must have realized that I was quite clueless where all this was heading and laid it out for me in two ways.

1. I was told that most Merck studies were carried out in-house but then suitable medical doctors were found to be added on as main authors. They may have helped in, say, recruiting their patients or maybe contributed in some other indirect way or maybe were an acknowledged area expert in that topic who did not contribute in anyway. It was a quid-pro-quo. The doctor (usually an academic) got their name on a publication, always a good thing, and the Merck employees got the satisfaction of knowing it was their study as well as plenty of financial remuneration- certainly more than any academic job could provide.

2. I was told that one way to tell who the real author of a study is to phone all the authors from the top, one by one. Only one of them, perhaps listed toward the end, could give you details of the study design, the statistical analysis and the results. That was the real lead of the study and that person would be a bona fide Merck employee (in other words, that person would be on the books as an employee of Merck). The first author (the medical doctor) may have contributed to the editing of the final paper but doesn't have any role in running the study or writing up the results; and they certainly were not listed on Merck's payroll.

I was told that while the research itself was top-notch, due to the nature of the industry and the research environment, it was expedient to find more credible authors as the venues for publication were the world's top medical journals. A few weeks after the interview, I got a job offer. It paid better than my two other options- a post-doctoral fellowship and a tenure-track position at a state university. While a part of me knew that it would be a career-path that would mean fewer worries about finances, another part of me doubted whether I could actually be happy in a position where I would have to be "flexible" to justify the ethicality of what I was doing.
I ended up deciding against it and having other options was probably a key factor in that decision. There have been recent "revelatory" pieces in the news which have "outed" Merck as having written studies for doctors. The pharmaceutical industry is a huge money-making machine with scarce concern for the consumers of the medicines being churned out. Bad drugs put on the market; studies showing ill-effects cut short or scraped under the carpet; doctors invited to "educational" cruises...and now this. Why are we even surprised at this chicanery after all that has already transpired in the last few years?

[Click on picture for credits.]

Friday, April 25, 2008

The Real Victim of Propaganda

On the 18th of April, 2008, a couple of Dutch soldiers were killed and a couple more were injured by a roadside bomb in Afghanistan. One of the soldiers killed was Lt. Dennis van Uhm who was the son of Gen. Peter van Uhm, who took over command of the Dutch forces the day before. The Taliban claimed to have specifically targeted the young soldier with a mine according to their spokesperson. The Dutch government dismissed the claims the same day saying that they doubted the Taliban even knew before hand who the young soldier was. Link to story.

China claims Tibet as part of one-China and says that the "splittist" Dalai clique had been behind the recent violent demonstrations by Tibetans resulting in many mainland Chinese losing their lives and property. It says that it found evidence to show that the Dalai Lama instigated the protests. The Dalai Lama denies that he played any part in inciting the riots and condemned China's heavy-handed crackdown. According to Tibetan sources, more than a hundred Tibetans lost their lives but according to the Chinese this figure is about 20 or fewer. Link to story.

Muslim scientists and clerics, at a 2008 conference in Qatar, have called for the adoption of "Mecca time" to replace the GMT. The conference was titled Mecca, the Center of the Earth, Theory and Practice and is representative of a growing trend in some muslim societies where it is claimed that all scientific knowledge is already in the Quran and it only needs unearthing (pun intended) by the scholars and clerics. A certain geologist at the conference held that unlike other longitudes, Mecca was in perfect alignment with the magnetic north. Link to story.

All the stories presented above have elements which test our credulity. One comes across many instances of such stories in the news or information put out by various organizations, groups or nations (I have selected the above 3 due to their recency and exemplary nature). Some of the claims made in these stories seem outrageous to those of us exposed to multiple viewpoints through multiple media sources (some of which may be biased, making "multiple" the crucial word in that sentence). We wonder whether the person, group or government claiming something, which seems extraordinary, really expect us to believe what seems questionable to begin with. Why does their evidence seem so one-sided? Why do they never entertain any other view-point? Why is their claim never subject to outside examination? Why is their claim seldom, if ever, falsifiable? And ultimately, do they really believe what they say, even when it sounds like an outright lie?

The claims in these stories would fit nicely under the sobriquet of propaganda. They are especially formulated statements to present a world-view that furthers a particular agenda of the entity that presents them. But you think, "Sheesh, this is pathetic! I would never believe this drivel..." In fact, I have thought this for years. But, we are missing the real aim of those who create and disseminate these statements. The purpose of propaganda is not to convince those outside of a regime, religion, system or group. If anyone outside buys into propaganda that is a bonus for the creators of the propaganda. Propaganda is, in fact, aimed at in-group members who are provided these strident and unbalanced views, as if there were none other, in order to bolster their conviction in and support of the system they may be exposed to.

In the examples above, the Taliban claim is meant to portray the Taliban (see picture for some members) as being more coordinated and powerful than the forces of the west fighting them. It may not be believed by most in the west but, for those in Afghanistan whose allegiance is being vied for by the administration of Afghanistan, this statement may serve as further evidence that the Taliban is indeed a force to be reckoned and one that might actually be more than a match for the forces of the west.

A friend who was in China recently attested to the stridency of the Chinese media in whipping up the masses against the Dalai Lama. The Nobel Peace Prize winner is portrayed as being a devious person who is against Chinese peace and prosperity. The media makes no mention of the Dalai's call for non-violence or his requests for Tibetan autonomy rather than independence, leaving the Chinese people to draw the conclusion that the Dalai Lama wants to break up China violently. As to China's claim that very few Tibetans lost their lives, it is a claim that can only be met with dubiousness given all the other evidence of Chinese activists who disappear or are thrown in jail. It is unthinkable that the nation of the Tienanmen debacle would let the demonstrators in Tibet escape even as it accused them of killing Han Chinese and destroying their property. But sadly, many of the Han Chinese who claim Tibetans as their countrymen, do believe it.

For the Mecca story, oh where to begin! Anyone with the most rudimentary geometry lessons should be able to tell that one line passing through a certain point cannot be more "perfectly aligned" with that point than all the other lines passing through it. The Mecca longitude is no more perfect than any other longitude passing through the magnetic north of the planet earth. Yes, the GMT is a relic of the colonial past but it is a standard that is adopted by most of the world at the present time. (India is on an offset time zone but that is another story which predates colonialism and doesn't dispute science or geometry.)

This Mecca news item brings to mind an incident. Last summer when I was taking a train between Belgium and the Netherlands, I sat across from a person who turned out to be a muslim of (most likely) north African descent. He was a manager at McDonalds. He was dutch. The conversation at some point turned to belief systems and he believed in Allah and Mohammad and how Allah created earth and mankind etc. etc. I asked him why this planet under this sun was chosen by Allah of all the millions of other sun/stars in the universe? He said, "What other sun?" I thought he was joking but it eventually dawned on me that he really could not comprehend the existence of other suns and planets; a star was just a twinkle in the sky.

I told him that scientists have seen other suns and planetary bodies through telescopes and science conjectures a lot about celestial bodies (and I didn't mean angels). He flatly refused to believe in what I was saying. I had no way to show him anything then so I got his email address to send him the evidence. I have still not done it because I don't know where to begin and why anyone whose world view had been so constricted by agenda-driven information (such as that propagated by imams the world over) should believe some random websites about the existence of stars and planets out there in space. And even if they did believe me, I am sure it could also be attributed to Allah the magnificent and munificent. There is no science other than the science already revealed in the Quran it would seem.

Propaganda isn't half as hurtful to you and me as it is to those whom it is truly aimed at.

[Click on picture to see credits.]

Tuesday, April 22, 2008

Another Bloody Olympics...

... and another exercise in jingoism. Here's a link to an op-ed piece in the NYT about how the games have deteriorated in spirit. The graphics below arrived in my mail-box and I thought I would add it here for maximum dispersion. I don't have the names of the creator to credit. Feel free to copy and email.

Saturday, April 05, 2008

Washing Hands and Creating Killers

When I was working at the Med School in Birmingham, UK, all the clinicians and researchers I ever spoke with were aware of the anti-biotic resistance that is now prevalent around the world because of a misuse and overuse of antibiotics. Indeed, NHS trusts have received recommendations to try and reduce unnecessary prescriptions of anti-biotics for short illnesses of unknown origin. Most such illnesses are self-limiting anyway as the doctors will point out, when asked. They are all aware of the epidemic of prescription-led multi-drug-resistant strains that have sprouted. And yet, when I walked into the ladies room, everyday I was faced with the soap we were to use- Triclosan. At a medical school where medical research is being carried out and medical policy being created, how can another soldier in the war to create resistant bacteria be deployed so wantonly?

My puzzlement may be a sign of my frustration. I still have conversations with my neighbors and friends (here in the United States) that judge a doctor's efficacy and "caring-ness" by how quickly anti-biotics are dispensed. But instead of fighting back with education and information, these doctors do not "first do no harm". They cave in. I know that it is not so hard to talk to lay people about this issue because I do it all the time. And while my background and education give me some credibility, it is far less than that wielded by a family physician. In the absence of their physicians backing up what they have heard or read on the outside, these people (my friends and neighbors, for instance) go right on believing that anti-biotics in general are harmless and helpful- and I end up having these conversations again and again, appearing like the quintessential pushy person, or giving up.

How many people have you seen carrying those little anti-bacterial washes for their hands? They are even advertised on TV (well they used to be till recently, though I must admit, I haven't seen one recently). They are sold everywhere, not just at pharmacists'. We treat medicine quite cavalierly without recognizing its true benefits and costs of use. And let's not delude ourselves- even the anti-bacterial hand wash is medicine. I am reminded of an experiment narrated to me by Jurriaan who went to medical school in the Netherlands. Students are asked to rub a finger in a petri dish, then wash their hands with soap and rub the same finger in another petri dish. Which dish do you think had a denser bacterial population after a day?

In India, you can buy prescription drugs (such as anti-biotics) at pharmacies without prescriptions. People store them in their first-aid kits for years and use them as needed (the need is self-determined). In the US, many doctors will hand out prescriptions if you complain of a flu-like cold or throat pain, etc. And if you are (un)lucky enough to end up with one who doesn't follow this practice you can try brow-beating them with your conviction of a need for anti-biotics or threaten to go to a doctor who will comply. In some cases, you may actually have to go to a different doctor, but this doesn't happen very often. In the UK, it depends on your luck generally but doctors are less prone to being brow-beaten because in the NHS, your choices are more limited than in a private health care system. But as we saw, the anti-bacterial hand wash are somehow not even being considered as another culprit in the development of drug-resistance bacterial strains in the UK. How self-defeating!

The fact is we humans, just like most other animals, are prone to getting sick from time to time. Most illnesses are self-limiting in that even untreated they will eventually resolve themselves while leaving you a little worse for the wear. It is not easy to tell, especially early in an illness, what causes it- the two major outside causes being a viral or a bacterial infection. This is especially true of the kinds of occasional flus, colds, stomach upsets, inflammation, etc., that we seem to catch at work, play,... life.

Anti-biotics and anti-bacterial hand washes kill bacteria- the latter is weaker and widely-used, and thus, even more dangerous as it leaves stronger bacteria alive to reproduce. Anti-biotics do nothing to viruses. A progressive viral illness can eventually leave your immunity weakened enough so that you will then be open to some other opportunistic bacterial infection (this is what happens with AIDS). But starting all treatment for any illness with anti-biotics makes as much sense as starting the treatment for AIDS with anti-biotics. All it will do is deplete the existing bacterial reserves in your body which protect you in many ways and also serve a vital function (such as in digestion). In most healthy people (and animals) the occasional viral or bacterial infection will resolve itself. This is good for your immune system as well as for your body in general since it does not have to recuperate from anti-biotic use. That diarrhea, the mal-absorption, weakness, dehydration & the occasional pregnancy after anti-biotic use despite being on a pill... can usually be attributed to the medicine.

Now admittedly, some (viral or bacterial) infections can be quite severe and in the immuno-compromised (such as sick or older people and young children) there is a place for responsible anti-biotic therapy where the benefits outweigh the costs; but, make no mistakes, there are still costs. To ignore these, as we have done, is to ask for trouble.

But this still does not justify the use of anti-bacterial hand washes. Anti-bacterial washes and sprays only create a greater problem for immuno-compromised individuals as well as the general populace by wiping out benign bacteria and allowing virulent strains to become more common. You are helping no one and harming many individuals by using these products. It is irresponsible public health policy that allows these products to be widely available to the public.

It was the second petri dish that had more bacteria, in case you were wondering.

[This post is dedicated to my friend Teresa.]
[The first picture shows MRSA and the second Salmonella. Both were found without attributions on different websites. The MRSA picture was found on & the Salmonella picture was found on]

Thursday, April 03, 2008

A Torch that Inflames a Stepped-On People Reveals a Hero in its Shadows

The Olympic torch is expected to arrive in India around the end of April. India is home to a huge Tibetan expatriate population along with their spiritual leaders, the Dalai Lama as well as the Karmapa (both contenders). Many Tibetans have been born in India and have never been to Tibet. India, which is tentative in its dealing with China, has tried to walk a fine line between offering refuge to those in need and at the same time curtailing them from voicing dissent with China openly. More on India's tightrope walk in another post.

Many were hoping that one of the reigning stars of Bollywood, Amir Khan- a man who is less conventional than most of the other top actors, would take a stand against the violent crackdown in Tibet by refusing to carry the torch as formerly agreed upon. Well, so far, Khan has said that he will be carrying the torch with a prayer for the Tibetans in his heart. Perhaps, he will still see fit to make a stronger gesture of support than this. Or maybe not.

Meantime another hero has emerged. He is the Captain of the Indian football team- Baichung "The Scorpion" Bhutia. Bhutia hails from the state of Sikkim*. Bhutia is a Buddhist and his refusal to carry the oppressive torch (yes, it is an Olympic torch but it also shines the light brightly on China's actions) is not only symbolic but a much needed shot in the arm for the Tibetan struggle even as the Indian government has prevented any marches or demonstrations against China. The Indians even detained about 100 Tibetans to prevent them from marching to the Chinese border. Bhutia was quick to point out that he was not asked by any group or person to pull out. "I sympathise with the Tibetan cause. This is my way of standing by the people of Tibet and their struggle. I abhor violence in any form. I feel what is happening in Tibet is not right and in my small way I should show my solidarity." Go Baichung!!

[* China used to claim Sikkim but agreed to recognize it as a part of India in return for India recognizing Tibet as a part of China (how long this recognition on China's part lasts will determine how long India will continue to suppress overt anti-China demonstrations within its boundaries). What is surprising is that the Indian government even feels that it needs China's recognition. After all the Sikkimese chose to be part of the Indian union in a referendum in 1975 by a vote of 97.5% in favor! Last I heard, no such referendum had been held in Tibet. India's stance seems to show how keen it is to avoid a direct confrontation with China. In the last such confrontation, fomented by the Chinese, India took a drubbing.]