Every so often, some paper happens to grab my attention for various reasons. As I read the paper, often I have questions. Not all of those questions, unfortunately, can be easily submitted for answers. In recent times, one such paper was published earlier this month in PLOS One. The great benefit of the Open-Access model of PLOS is that it allows a reader to ask questions directly of the authors. This level of engagement is very laudable, especially to someone like me who has an interest in the communication of scientific facts.
Science is awesome. But I expect you already knew that, dear readers o’mine. In science laboratories across the world, every day dedicated researchers are testing ideas, generating and evaluating hypotheses, critically analyzing observations, and thereby, making significant contribution to the humanity’s attempts to understand in greater depth and detail the wonderful natural world that surrounds us, of which we, along with other living beings and non-living objects, form a part.
While contemplating the scienciness of homeopathy research and the time, money and effort wasted by misguided homeopathy researchers, I recently came across a paper which represents one such effort; it was published in the Journal of Analytical Methods in Chemistry in 2012, written by two Indian authors, one from the prestigious Indian Institute of Technology in Kharagpur, West Bengal, and the other from a medical college associated with a local district hospital. Intrigued by the title claim of “Medicinally Active Ingredient in Ultradiluted Digitalis purpurea”, I decided to delve in.
The “alternative medicine” modality called homeopathy is popular in some parts of the world, especially some European countries (including Germany, where it was invented in the late 18th century; France; the UK), and in India and its neighbors in the subcontinent. Many Indian homeopaths are well-known amongst the global homeopathy-aficionado community, and there were over 250,000 registered homeopaths in India in 2010 – which is not surprising, considering that homeopathy enjoys official government patronage in India and is recognized as a valid system of medicine in that nation.
My readers may remember a previous post detailing a crisis in animal-based research in Italy. Early this morning I received a note from the Basel Declaration Society alerting me to an urgent situation developing in Belgium. Scientific research with non-human primates appears to be in serious jeopardy in that nation, but it is hardly likely that the fallout from any anti-science policy prohibiting research will remain restricted to Belgium alone. Bioscientists from Belgium are asking for immediate help and support from the world science community; Prof Rufin Vogels, current President of the Belgian Society for Neuroscience, and his colleagues have formulated a petition to the Ministers of the EU and the members of the Belgian parliament. The Basel Declaration Society (to which I am a signatory) is supporting this petition; I am including the text of the petition. Please read it and consider signing.
A Université de Montréal team, studying the quality of care provided to elderly diabetic patients by Quebec practitioners of family medicine, recently released a report on their findings. [NOTE: The link to the report points to the University of Montreal news page in English, detailing the study. However, the reference provided at the end points to a French-language abstract in a Conference book with scant data; therefore, for my comments, I am forced to rely mostly on the Université de Montréal communiqué in English.] The report brought out screaming headlines, “Female doctors are better than male doctors” (EurekAlert) and “Women Make Better Doctors Than Men” (Time Magazine). The sensationalized headline piqued my curiosity enough – by which I suppose the headlines did their job! – for me to take a gander at the report.
The overall objective of the study was to look for two parameters related to the physicians serving the Family Medicine Group (les groupes de médecine de famille, GMF) that Québec had established in 2002 to organize its healthcare delivery: (a) quality of care (as indicated by strict adherence to the practice guidelines of the Canadian Diabetes Association) and (b) the productivity (as measured from billing data; the number of procedures done – and charged for – per year). The specific group of physicians to be scrutinized was comprised of 906 doctors (431 women and 475 men; I don’t know why the English news report kept floating a vague estimate: “over 870 practitioners,” it said) who looked after elderly diabetic patients.
For diabetic patients 65 or older, the CDA recommendations are fairly straightforward: biennial ophthalmic exams, three prescriptions for appropriate medications, and annual medical exams. From the data pulled from the patient records kept under the auspices of Québec’s health-insurance administration (la Régie de l’assurance-maladie du Québec), the researchers found that, apparently, compared to the men physicians, more women physicians emphasized the eye-care visit (73% vs 70% by the men), provided smoking counseling (1.8% vs 1.4% by the men), prescribed the recommended medications (68-70% vs 64-66% by the men, for statins and other drugs), and insisted on the annual review (43% vs 31% by the men).
In contrast, the women physicians apparently charged for only 3100 procedures in a year versus 4920 by the men, and therefore, they were considered to be less productive than their male counterparts.
The abstract and the report both mention that these differences are “Statistically Significant”, although in absence of a clear significance criterion and a definition of variables, it is unclear to me how the Student’s Test (I assume, the t-test) – mentioned in the Methods section of the abstract – was used to compare the difference between these percentages.
I have no choice but to disregard the questions of study methodology (since those answers cannot be found in a Conference abstract). However, I heartily disagree with the way these research questions have been framed. Let me clarify.
I have a specific and abiding distrust of these men vs women narratives; in fact, I think they are deeply divisive and reprehensible, because they tend to enforce certain assumptions or memes about women being more caring than men. Régis Blais, Professor at the Department of Health Administration and co-supervisor of the study, even commented, “People assume that women doctors spend more time with their patients, but it is difficult to observe in a scientific study. This study does just that.” This may not be an incorrect observation per se, but formalizing that via a research question would, in turn, tend to bring in certain other memes about men (‘less caring’, ‘more aggressive’, et cetera, including the execrable ‘boys would be boys’). These memes are at best counter-productive, and at worst end up being eventually harmful for all concerned, in terms of engendering and enabling certain widely-prevalent anti-woman biases. Valérie Martel, the lead author, said, “[…] women temporarily leave the network to start a family. They work fewer hours to spend more time at home when they have children. Inevitably, this change has an effect on the management of resources […]” I don’t know how much of a problem this is in Canada as a whole (see Ontario Human Rights Commission statement) and Québec in particular, but in the US, pregnant workers are known to face workplace discrimination on a routine basis. This is why gender segregation, especially gender segregation in caregiving, is a nasty concept.
Anecdotally, if one looks at any hospital across the US, one may always find a certain subsection of patients who’d not prefer to be treated by African American, Jewish, or Latino physicians or caregivers. (More mind-bogglingly, sometimes hospitals do pander to these racist requests. For a more comprehensive treatment of this issue, see here.) Gender segregation is no less objectionable or disgraceful than racial or ethnic segregation in healthcare. If, in the above study, one substitutes gender with race/ethnicity and makes a cohort with such physicians, I can almost guarantee that one would come up with a similar sort of differential observation. Because of a priori separations, conclusions drawn about groups from such observations would be meaningless.
Note that I am not disregarding the observations of this study. The authors have already commented upon the need to redefine and expand the concept of ‘productivity’ in healthcare delivery in a way that takes into account the overall experience of the patient. In addition – in my opinion – what this sort of study should focus on – and the data are there if one reads between the lines – is how compliance to existing patient care guidelines improves the standard of care and the outcome for patients, regardless of whether women or men are doing it. Also, as an important corollary, these studies should try to discern why women doctors seem to be more compliant with the guidelines than the men doctors are, despite receiving the same or similar training. Divvying up patient care between men and women doesn’t serve at all the main purpose of this enterprise, the care of patients.
Roxane Borgès Da Silva, Valérie Martel, & Régis Blais (2013). Qualité et productivité dans les groupes de médecine de famille: qui sont les meilleurs? Les hommes ou les femmes? Revue d’Épidémiologie et de Santé Publique, 61 (Supplement 4) DOI: 10.1016/j.respe.2013.07.021
I have written earlier about the peril that Italian Biomedical research finds itself in, due to extreme, immoderate and unreasonable restrictions on animal experimentation that the Italian Parliament approved recently. Via a missive from the Basel Declaration society (Disclaimer: I am an individual signatory to and supporter of the Basel Declaration), I learnt this morning about a PETITION (in Italian, and in English) that several prominent Italian Biomedical Scientists have launched, directed at European Commission officials and copied to several relevant ministers in Italy.
I am including here the text of the English version of the petition. Please read, support and share it. The place to put your name, email, and optionally, location and degree, is to the right side of the petition text (see the petition page link above). The field-names are unfortunately written in Italian even in the English page, but they are not difficult to understand. Upon signing the petition, you’d receive an email with a validation link which you must remember to click in order for your signature to be registered.
Please stand with these scientists for the sake of not only saving Italian scientific research, but also maintaining the integrity and continuity of biological research as a whole throughout the world.
Dr. Janez Potočnik
European Commissioner for the Environment
Directorate General for the Environment
Dr. Susanna Louhimies
Policy Officer- Use of animals for scientific purposes
Directorate General for the Environment
B- 1049 Bruxelles
Minister of Health of Italy
On. Beatrice Lorenzini
Minister of EU Affairs of Italy
On. Enzo Moavero Milanesi
Minister of the University and Scientific Research of Italy
On. Maria Chiara Carrozza
Subject: Implementation in Italy of EU Directive 63-2010 on the protection of animals used for scientific research in Italy. Art. 13, Law n. 96/2013.
Dear Dr. Potočnik:
We are writing to share our concerns on the criteria approved by the Italian Parliament concerning the implementation of the European Directive 2010/63 on the protection of laboratory animals in Italy.
As a scientific community we have approved and supported the decision to generate an harmonized approach shared by the whole Community. The European discussion has lasted almost a decade and has led to a well-balanced compromise between the demands of animal welfare and the interests of research.
This well balanced compromise has been challenged by the Italian Parliament with
severe risks for the future of biomedical research in the country.
We ask you to help re-balance the discussion by warning the Italian Government that the Parliament has approved decisions is in violation of art. 2 of Directive EU 63-2010. If transformed into a legislative decree by the Government, those decisions will make the Italian law much more severe and restrictive than the EU Directive.
Specifically we ask you to convince the Italian Government to implement in Italy the EU Directive 63-2010 as the UE Parliament and Commission have licensed it. This will require the rejection of the Art. 13 of the national law of implementation of the EU Directives for 2013 (Legge di delegazione europea 2013, n. 96, published in the Gazzetta Ufficiale, Serie generale n. 194, 20/08/2013, into force since 04/09/2013).
The different paragraphs of art. 13 of the above mentioned law contains a severe limitation to the use of cats, dogs and non-human primates for basic research, limitations in the re-use of animals of any nature previously employed in procedures classified as of “moderate” severity, prohibition of research on non-anaesthetized animals, limitation in the use of genetically modified animals, a ban of animal experiments on xenotransplantation and drug addiction, a ban of animal breeding centers in the national territory.
We trust that the strict control and ethical review mechanisms proposed by the EU Directive are the most effective mechanisms to prevent unnecessary and unjustified pain and suffering for animals. The Italian scientific community is very supportive of this strict review process but opposes any total bans, as fully inappropriate to regulate the complexity of biomedical research, and liable to damage it severely without adding significant benefits to animal welfare.
In the interest of biomedical research in Italy, we ask you to follow our recommendations and help us obtain a new and well balanced Italian animal welfare legislation, in line with the European directive.
Fabio Benfenati, Professor of Physiology, University of Genova
Giovanni Berlucchi, Professor Emeritus of Physiology, University of Verona
Roberto Caminiti, Professor of Physiology, University of Rome SAPIENZA, Chair, Committee of Animals in Research (CARE), Federation of the European Neuroscience Societies (FENS)
Enrico Cherubini, Professor of Physiology, SISSA, Trieste, President of the Italian Society of Neuroscience (SINS)
Francesco Clementi, Professor Emeritus of Pharmacology, University of Milan, and National Council of Research, Milan
Gaetano Di Chiara, Professor of Pharmacology, University of Cagliari
Silvio Garattini, Director, Institute for Pharmacological Research Mario Negri, Milan
Jacopo Meldolesi, Professor Emeritus of Pharmacology, University Vita-Salute San Raffaele, Milan, past President of the Italian Federation of Life Sciences
Giacomo Rizzolatti, Professor Emeritus of Physiology, University of Parma
Carlo Reggiani, Professor of Physiology, University of Padua, President of the Italian Physiological Society
Piergiorgio Strata, Professor Emeritus of Physiology, University of Turin
The science-associated blogosphere and Twitterverse were abuzz today with the news of a Gotcha! story published in today’s Science, the premier science publication from the American Association for Advancement of Science. Reporter John Bohannon, working for Science, fabricated a completely fictitious research paper detailing the purported “anti-cancer properties of a substance extracted from a lichen”, and submitted it under an assumed name to no less than 304 Open Access journals all over the world, over a course of 10 months.
“The most beautiful thing we can experience is the mysterious. It is the source of all true art and science. He to whom this emotion is a stranger, who can no longer pause to wonder and stand rapt in awe, is as good as dead: his eyes are closed.” — Albert Einstein, Living Philosophies (Simon and Schuster, New York, 1931).
“They (Science and Art) ask the same questions… really what it (Science) does at its best is force us to reassess our place in the cosmos. Where do we come from? Who are we? Where are we going? And those are the very same questions that you get in art, literature, music. Every time you read a wonderful book or see a wonderful film, you come out of it with a different perspective of yourself, and too often, it seems to me, we forget that cultural aspect of science…” — Lawrence Krauss, Interview on the National Public Radio, 2011.
As many accomplished scientists agree, there is a profound and enduring relationship between science and art. In a lecture, Robert Eskridge, Executive Director of Museum Education, at the Art Institute of Chicago, pointed out the nature of this relationship:
Science and art naturally overlap. Both are a means of investigation. Both involve ideas, theories, and hypotheses that are tested in places where mind and hand come together—the laboratory and studio. Artists, like scientists, study—materials, people, culture, history, religion, mythology— and learn to transform information into something else. In ancient Greece, the word for art was techne, from which technique and technology are derived—terms that are aptly applied to both scientific and artistic practices.
Today I learnt about a scientist, whose unusual art-form fascinated me and I wanted to share it with all. He is Professor Eshel Ben-Jacob, a theoretical and experimental physicist at the Raymond and Beverly Sackler School of Physics and Astronomy, and the Sagol School of Neuroscience, Tel Aviv University. He holds the Maguy-Glass Chair in Physics of Complex Systems, and is a Fellow of the National Science Foundation (NSF) Frontier Center for Theoretical Biological Physics (CTBP) at the University of California at San Diego (UCSD). He is an acclaimed expert in the field of self-organization and pattern formation in open and complex systems.
In the late 1980s and early 1990s, Professor Ben-Jacob began to study of bacterial self-organization and pattern formation, using two strains of soil bacteria, the Paenibacillus dendritiformis and the Paenibacillus vortex; he pioneered the study of the adaptive intelligence and social cooperation that these bacteria demonstrate in complex, hostile environments. Under laboratory-induced stress, these bacteria employ chemical mediators to communicate amongst themselves and cooperate in order to adapt to the stress, facilitating survival. Ben-Jacob, in collaboration with Professor Herbert Levine of the NSF Frontier CTBP, applied biophysical principles, advanced modeling, and molecular biology to unravel the mechanisms behind the bacterial cooperativity, task allocation, learning and decision-making that lead to the generation of complex patterns on artificial media – all of which have significance for both beneficial and harmful bacteria that living beings encounter.
Once these complexly patterned colonies are formed, Ben-Jacob uses simple stains, such as Coomassie Brilliant Blue, and digital color modification to produce absolutely stunning, artistic images of these bacteria. Some of these fascinating images can be seen on his gallery pages (1, 2 and 3), or as a slide show.
All Images from Wikimedia Commons, deposited by Prof. Eshel Ben-Jacob via his laboratory at the Tel Aviv university, licensed under the Creative Commons Attribution-ShareAlike 3.0 License. A. Colony organization of Paenibacillus vortex; B. Colony generated by the Chiral morphotype of P. dendritiformis; C. Morphotype transition between the branching and chiral morphotypes of P. dendritiformis; D. colony generated by the Branching (Tip splitting) morphotype bacteria of P. dendritiformis.
Let me finish with the video of a lecture that Professor Ben-Jacob presented at Google in 2011, in which he talks about how social networks can be informed by bacterial colony morphology patterns and the cooperative information processing undertaken by them.
A quick post this morning. In the Guardian, I came across (courtesy my friend and erstwhile NatureBlogs colleague, Dr. Austin Eliott) this Open Letter to the Spanish Prime Minister from a Spanish researcher, an Astrophysicist no less, whom the current circumstances have forced to leave Spain and take her trade elsewhere. Dr. Amaya Moro-Martín’s letter (translated English text in the Guardian), written with brilliant, acerbic wit, paints a tragic picture of the status of scientific research in that country and how it is mired in countless bureaucratic impediments. She contends that this, along with an egregious lack of funding, is what has forced her and many others (link in the published essay) to abandon Spain in search of better futures elsewhere.
It is, indeed, a sad, sad situation. Dr. Moro-Martín’s position at the Spanish National Research Council bore the name of Ramón y Cajal (1852-1934), a Nobel Laureate pathologist and neuroscientist from Spain, who had transformed the study of the nervous system. I am sure he would have been devastated by this turn of events. As Dr. Moro-Martín wrote, what is even more galling is the resounding silence from the Mariano Rajoy government on this predicament of the Spanish scientists.
In the comments, at least two individuals have pointed out that a very similar situation exists in Portugal and Greece. Needless to say, this doesn’t bode well at all for the future of science in the EU.
I wish Dr. Moro-Martín all the very best for her transition to NASA. A transcontinental move, with family, isn’t the easiest thing to do, and having to start a professional life almost from scratch and rebuild relationships can be a daunting task. A distinguished researcher of her stature should be welcomed with open arms in any scientific community. In that respect, one niggling question that continues to bother me: is the situation with science funding much better in the US currently? I hope Dr. Moro-Martín is not stepping from the proverbial frying pan into the fire.