Biomedicine on Display

Just learned from Beth how to embed a YouTube video  into a powerpoint slide — see this screencast. You need Powerpoint 2007 (and of curse a live Internet connection). Beth wants to put this trick into the Trainer’s Bag of Social Media Tricks.

We’re just about to announce two new faculty positions here at Medical Museion — which raises the perennial problem of how to select the best candidates from dozens or more written applications. Seeing and hearing a person in live action often says more than thousands of words and an impressive CV. That’s why we interview selected applicants. But interviews are time-consuming and cost travel money for those involved.

The solution may be YouTube. Just read on The Scholarly Kitchen that Tufts University has now embraced the YouTube generation. Tufts’ official admissions criteria read:

Share a one-minute video that says something about you, upload it to YouTube or another easily accessible website, and give us the URL. What you do or say is totally up to you.

The videos are purely optional, but about 6% of 15,000 applicants submitted them.

Well, I’m afraid our university is not prepared to use this method for job applicants yet. But wait another couple of years …

As we watch the political wrangling over healthcare reform in the United States, one key element seems to be left out: consumer demand. For better or worse, Americans expect and even demand high-cost technologically-embodied medicine. A recent article on robotic surgery in the New York Times really drove this point home.

“Results Unproven, Robotic Surgery Wins Converts” (Feb 14, 2010)  by Gina Kolata, found that patients seeking prostrate treatment increasingly preferred robotic surgery over laparoscopic procedures. (Who knew that laparoscopic surgery would be considered “traditional” and low tech?) Eight years ago robotics comprised less than 5000 prostate surgeries; last year, the number reached 73,000, or 86% of prostate surgeries. And yet the benefits remain to be clearly and definitively established.

Despite this, robotic surgery is rapidly eclipsing other prostate surgery protocols in the United States, driven by “a lot of marketing hype,” per one leading urologist. The first thing that prostate surgery patients will ask a urologist is “Do you perform robotic surgery?” If not, they move on to one who does.

This technology doesn’t come cheaply, with a price tag of $1.4 million per unit, not adding technical support and training. Such expenditures (or “investments,” rather) incentivize use, per surgeons interviewed by Kolata. And the numbers involved are significant: one in six men will face prostate cancer in America.

Little wonder that we Americans have the world’s most expensive health care without the corresponding evidence that it necessarily improves our wellness.

I refer those interested in the peculiarities of American medicine to David J. Rothman, Beginnings Count: the technological Imperative in American health care (1998), and the remarkable inquiries of the surgeon Atul Gawande, most especially, “The cost conundrum: What a Texas town can teach us about health care” in The New Yorker.

Jim Edmonson

Jim is Director of the Dittrick Museum in Cleveland, Ohio, and one of our (hopefully growing number of) guest bloggers
Thomas

The most relevant academic question this year is asked by Paul Glasziou (Centre for Evidence-Based medicine, Oxford University), who gives a talk with this title in the Institute of Public Health, University of Copenhagen, on Monday 15 March, at 10am (Øster Farimagsgade 5, room 15.3.15). The talk is based on his and I. Chalmers’s article ‘Avoidable waste in the production and reporting of research evidence’, which was published in Lancet two years ago (vol. 374, 86-89).

Everyone who has spent hours engaged in social networking services may recognise themselves in Irene Angelopoulos’s vitriolic attack on the “depressing daily grind” of virtual life (in Adbusters yesterday):

We toil late into the night, unleashing an endless stream of status updates and tweets in a desperate attempt to keep ourselves relevant, desirable and in [...] Social Networking Sites (SNSs) promise limitless, boundless friendship – a phenomenon that should make us happier than ever. But our optimism over connectivity has gradually morphed into cynicism and resentment. It turns out virtual life is less about connectivity than self-branding [...] Paranoid about how we’ll be perceived, we spend hour after hour trying to avoid the virtual consequences of being deemed uncool. We have more to worry about than our online acquaintances deleting us after we’re tagged in an unflattering photo [...] Bleak, shallow and repetitive, virtual life seems increasingly less worth living. Users are beginning to realize that it’s not leisure, it’s work that borders on servitude.

But there’s a resistance movement on its way “among those tired of their virtual subjugation”:

In response to the electronic world’s rising indignation, virtual suicide sites like seppukoo.com and suicidemachine.org have started a countermovement, provoking users to kill their online selves and reclaim their real lives. These programs assist our virtual deaths by hacking into our profiles, completely annihilating our online personas and leaving no trace of our former selves behind. It’s social revolt for the online age: a mass uprising that will shatter the virtual hierarchy and restore order to our actual lives.

A desire for off-line reality! Is this what’s behind Jessica’s (Bioephemera) current blogcation?

The Galaxy Zoo team have just spread the news that the first scientific paper using Zoo 2 data has been submitted (to Monthly Notices of the Royal Astronomical Society). Doesn’t mean it’s published yet, but it’s nevertheless a great step for the Galaxy Zoo citizen science projekt — and an inspiration for other participatory science projects and even for museum 2.0 projects.

Sanjoy Bhattacharya (Reader at the Wellcome Trust Centre for the History of Medicine at UCL) invites us all to participate in a webinar organised in connection with the first event of the 2010 series of the World Health Organization Global Health Histories Seminars (you can see the full list of seminars here).

The topic of the webinar is ‘SARS: Learning from an epidemic of fear’, and it takes place this upcoming Wednesday 17 February, 12:30-2:30 pm (Central European Time):

The 2003 outbreak of SARS, a deadly new infectious disease, sparked worldwide alarm. It caused more than 8 000 cases and almost 800 deaths in at least 25 countries. Its spread was halted only by emergency international action.

In the opening presentation of this new seminar series, health psychologist Professor George Bishop describes his studies of how ordinary people respond to illness threats. He focuses particularly on the impact of SARS in Singapore, public responses to the epidemic, and the lessons learned.

Dr Cathy Roth, a WHO expert on the disease, explains the role of WHO in leading the struggle to contain this unprecedented threat.

The WHO’s webinar system only allows up to a thousand users logged-on simultaneously, so you’d better reserve access now — register here. After registering you will receive a confirmation email containing information about how to join.

Last year we announced the upcoming conference ‘Wissenschaft im Museum – Ausstellung im Labor’ which Anke te Heesen and Margarete Vöhrunger are organising in Tübingen 8-9 April.

Now the final programme has been announced — it includes, among other things, a presentation growing out of our ‘Biomedicine on Display’ project and the exhibition ‘Split + Splice: Fragments from the Age of Biomedicine‘ (Danish: del+hel). The exhibition’s lead curator, Martha Fleming (now at the Natural History Museum in London) and one of the co-curators, Susanne Bauer (now at the Max-Planck-Institut für Wissenschaftsgeschichte in Berlin) will give a paper titled ‘Displaying Observational Practice: Split + Splice as a mirror structure between laboratory and museum’. See the full programme here.

As mentioned in a previous blogpost, I’m currently doing a ph.d.-project here at Medical Museion concerning the history of the concept of successful aging in neuroscience and its relation to ideas on cognitive enhancement.

Part of my work, therefore, is going to conferences like this one, held in Copenhagen last week:

The conference was arranged by the Danish research center GNOSIS, and featured both neuroscientists and philosophers – as an attempt to bridge the disciplinary boundaries and maybe produce some kind of synergy.

The first day especially had that feeling. Themed under the headline ‘Brain Plasticity’ and featuring, among others, the English philosophical-minded neuroscientist Steven Rose, German phenomenological philosopher and psychiatrist Thomas Fuchs, and Danish biologist and anthropologist Andreas Roepstorff, there was a real feel of cross-disciplinary science communication. A science communication which was also a communication of the immense complexity of the brain and of the production of knowledge concerning it.

As Steven Rose pointed out, neuroscience is ‘data rich, but theory poor’, needing some theorizing on how best to manage the complexities of the huge amount of collected data. One common perspective to most of the talks at the conference were that the brain’s workings can best be understood viewed as a complex, irreducible and indeterminate, continuously developing process. This was conceptualized from both phenomenology, developmental systems theory (or autopoiesis, as Rose termed it), and biosemiotics – all in one way or the other emphasizing the brain as embodied (or the body as ‘embrained’, as someone smartly put it), and emphasizing the body’s embeddedness in the world (emworlded). Dichotomies and dualisms, determinacy and reductionism were (with maybe one exception) not only forcibly opposed, they were long left behind, it seemed.

But still there was a sense that, despite agreement on the general perspective, this did not solve the concrete methodological challenge of, for instance, going from correlates to causality, inducing from the particular to the common, or explaining the relationship between brain and mind/consciousness/awareness/attention etc. Neuroscience, it seems, brings new attention to a lot of old philosophical problems. The multidisciplinary collaborations within the field of neuroscience, and the demand for new theoretical developments and new conceptualizations, may not find a solution to these problems, but it sure sets the stage for interesting theoretical developments in the years to come.

As for the link to my project on successful aging, this development in neuroscience seems to run almost parallel to the overall development of the field of gerontology and aging research in the last couple of decades from around the time that the concept of successful aging was introduced. Many of the same philosophical problems are also seen in other parts of aging research than the parts including the neurosciences.

Aging research (as well as maybe most other fields in the health sciences?) is becoming a multidisciplinary field where dichotomies and dualisms between brain-mind, body-world, and individual-society are being tested and challenged.

[This is a guest blog post by Martin Fenner, who normally blogs at Gobbledygook. It raises a problem of great importance for the preservation of the contemporary medical heritage]

The first email was sent in 1964, but that first email has been lost forever. - Lucy Nowell

As we have moved to digital formats both for primary research data and scientific publications, digital preservation has become critical to secure permanent access to scientific information. Digital preservation turned out to be much more difficult than creating digital content, as preservation requires long-term thinking about many issues including file formats, storage solutions and funding. Digital preservation turned out to be too big for individual libraries, publishers or research disciplines, and large collaborative efforts were started in the last five years.

Alliance for Permanent Access
The Alliance for Permanent Access is a European strategic framework for digital preservation of scientific information. The alliance coordinates the efforts of different funders, research support organizations and major european research laboratories (e.g. CERN or ESA).

Sustainable Digital Data Preservation and Access Network Partners (DataNet)
Sustainable Digital Data Preservation and Access Network Partners is a digital preservation project by the National Science Foundation. The deadline for proposals was May 2009, and $100 million will be awarded over the next five years. Wow.

Portico
Portico is a not-for-profit digital preservation service for scholarly content. Portico was launched in 2005 with initial support by JSTOR, Ithaka, the Library of Congress, and the Andrew W. Mellon Foundation. The Portico archive currently contains close to 15 million papers and is archiving journal content for many publishers and libraries for a fee. Portico steps in (a so-called trigger event) when a publisher

• stops operations
• ceases to publish a title
• no longer offers back issues
• has a castastrophic failure of the delivery platform

File formats
PDF/A was approved as an ISO standard for long-term archiving of electronic documents in 2005. Before PDF/A, many organizations (including our institution) used the raster graphics format TIFF. The major advantage of the PDF format is the handling text and vector graphics in addition to raster images, allowing full-text search and smaller file sizes. Because the PDFformat is constantly changing, PDF/A was based on a specific PDF version (1.4) with the following specifications:

• self-contained, no external images or fonts
• no sound or movies
• metadata in the XMP format
• no password protection

Most scientific papers are now produced in XML, usually using the NLM DTD. The Archiving and Interchange Tag Set is a flavor of the NLM DTD that is intented for archiving.

Storage solutions
Hard disks, tape and optical media are possible storage solutions. Tape is the ideal solution for long-term storage of research papers, but the digital preservation of research data in many areas (e.g. sequencing, high-energy physics) can’t be done with tape because of the exponential growth of these data. Hard disk storage has another problem: the energy requirements of data centers.

We live in a digital world, and this of course includes how we do and communicate science. It is surprising that we have barely started to think about digital preservation.

This is the last part of my project description for the Ph.D.-project called “A genealogical study of the concept of ’successful aging’ and its relation to the idea of ‘human enhancement”. See the first two parts here and here.

 ’Successful aging’ in the neurosciences and the link to ‘cognitive enhancement’
In order to narrow the problem field, the project will look closely at how the notion of ‘successful aging’ has been understood and defined in the field of neuroscience in the last decades, and how ‘successful cognitive aging’ has played together with discussions — both in the scientific literature, in science policy documents and in general public discourse — about the possibility for so called ‘cognitive enhancement’ (‘neuro-enhancement’) [12][13][14][17]. Both in the scientific literature and in policy documents on ‘successful aging’ and ‘human enhancement’, the neurosciences are considered as the primary field of research; neuroscience also figures prominently in the corresponding public discourse [7][21][23], cf. [25]. The brain and cognition are ascribed significant cultural value in the emerging ‘knowledge society’; healthy cognitive abilities are considered necessary for a life-long contribution to the labour market and for well-being in everyday life, and not surprisingly some of the exponents for the notion of ‘knowledge society’ are also exponents for ‘converging technologies’ [17][21].

Current developments in the field of aging research also have strong discursive links to cognitive enhancement. As the aforementioned EU parliament study argues: “The growing problem of neurodegenerative diseases in ageing societies has turned research and development in therapeutic cognitive enhancers into a very dynamic field with significant resources” [21:26]. Likewise, in enhancement discussions special attention is being ascribed to cognitive enhancement: “’neuro/ brain enhancement’ as a research field stands at the centre of the CT [converging technologies] debate. It attracts the largest share of attention due to its plans to simulate and manipulate brain processes, which – if realized successfully – could directly affect our concepts of the human self and identity” [17:382], cf. [21][23][25]. Also here there may be a significant aspect of user-driven innovation: medications developed in research into age related diseases like Alzheimer’s disease is already being used by young, healthy individuals to (presumably) enhance their cognitive abilities [14][17][21], and, conversely, one could therefore expect that the market for cognitive enhancement may stimulate research in the prevention and treatment of age-related neurodegenerative diseases.

These interconnected arenas of aging research, enhancement discourse and general ideas about successful aging will be the focus point of this project. The point of departure is that the connection between the discussion about successful aging and the discussion about human enhancement has been overlooked in the scientific literature and that the two discourses are more closely related than usually presumed. Shedding light on the historical relation between the two notions both in the scientific and popular discourses will potentially have significant consequences for future research, for research politics and for the public understanding of successful aging.

References:
7. Kirk, H. (2008). Med hjernen i behold – Kognition, træning og seniorkompetencer. København: Akademisk Forlag.
12. Balling, G. (2002) (ed.). Homo Sapiens 2.0. Når teknologien kryber ind under huden. København: Gads Forlag.
13. Balling, G og Lippert-Rasmussen, K. (2006). Det menneskelige eksperiment. København: Museum Tusculanums Forlag.
14. Greely et al. (2008). Towards responsible use of cognitive-enhancing drugs by the healthy. Nature, 456, 702-705.
17. Beckert, B., Blümel, C and Friedewald, M (2007). Visions and realities in converging technologies. Innovation: The European Journal of Social Science Research, 20(4), 375-395.
21. European Parliament Science and Technology Options Assessment (2009). Human Enhancement Study. Awailable at http://www.europarl.europa.eu/stoa/publications/studies/stoa2007-13_en.pdf (14.08.09)
23. http://www.humanityplus.org/read/2009/07/human-enhancement-what-should-be-permitted-geneva-october-20-21-2009/ (14.08.09)
25. Dumit, Joseph (2004). Picturing Personhood. Brain Scans and Biomedical Identity. Princeton: Princeton University Press

This is the second part of my project description for the Ph.D.-project called ‘A genealogical study of the concept of ’successful aging’ and its relation to the idea of ‘human enhancement’. See the first part here.

The relation between ’successful aging’ and ‘human enhancement’
The project will particularly focus on an analysis of the possible connection between ideas about the prevention and treatment of age-related diseases, on the one hand, and the current merging discourse on ‘human enhancement’, on the other. Like ‘successful aging’, the notion of ‘human enhancement’ — including a large variety of different ideas about the future possibilities for technological improvements of human bodies — became widely spread in the 1980’s and 1990’s [11][12][13][14].

A preliminary survey of the literature indicates that the notions of ‘successful aging’ and ‘human enhancement’ often seem to appear together in the scientific literature and in medical and health policy documents. For example both the European Union (EU) and the National Science Foundation (NSF) have published reports that deal with so called ‘converging technologies’, usually defined as a convergence of nano-, bio-, info-, and cogno-sciences and technologies (NBIC). In such reports, the notion of ‘human enhancement’ is a central concept, around which the discussion of the aging population in the developed countries revolves [15][16][21], cf. also [17][18][19][20]. As a study commissioned by the EU Parliament says, “it is safe to say that a side effect of the fast-growing research and development into pharmaceuticals for age-related neurodegenerative diseases will be a number of new drugs which can be used for the enhancement of performance of young, healthy people.” [21:7]

Similarly, in a large number of websites and blogs published by organisations and individuals that support and promote the notion of ‘human enhancement’, the possibility for using such technologies as life extension devices and for delaying age-related physical and/or cognitive decline constitutes one of the central arguments for developing enhancement technologies [11][22]. Websites that express the opinions of the so called transhumanist (posthumanist) movement is one of the most vociferous exponents of this argument. Both these pro-enhancement advocates and science policy reports (like the EU parliament study and the NSF reports) emphasize the fact that the biomedical sciences, biotechnologies and medicotechnical technologies are increasingly producing new technologies capable of simultaneously enhancing the capacities of healthy people and treating diseases, especially age-related diseases [16][21][23]. Thus the discourse about ‘human enhancement’ and ‘successful aging’ are discursively intimately connected.

In addition, this integration of the ‘human enhancement’ and ‘successful aging’ discourses seem to have a strong element of user involvement. The strong ideological commitment to the integration between the two notions among individuals that view themselves as members of a loose ‘transhumanist’ intellectual movement is probably the best example of user involvement. It is unclear, however, to what extent the scientific community, the ‘transhumanist’ intellectual movement and the public at large differ with respect to an active commitment to integrating the two notions. However, I will suggest that the increasing use of performance-enhancing drugs in the general population (especially among young people) and the increasing dissemination of pro-enhancement policies and visions that challenge traditional views of the use of medicine both work in favour of a similar integration between the two notions.

Furthermore one might expect that the general and widely spread popular attitude to performance-enhancing drugs in Western cultures is an underlying Zeitgeist which supports the current political, scientific (and ethical) discussions about the integration of the two notions in the ‘transhumanist’ movement and among scientists. Finally, one might also expect that such popular attitudes will effect strategic market evaluations in the pharmaceutical industry and thus spill over to strategies for future drug pipelines. In all these respects, the integration of the notions of ‘human enhancement’ and ‘successful ageing’ may well be framed with reference to broader user involvement and user driven innovation (cf. [14][15][16][21][24]). These are preliminary hypotheses only, however, which need further empirical substantiation.

References:
11. Bostrom, N. (2005). A History of Transhumanist Thought. Journal of Evolution and Technology, 14(1).
12. Balling, G. (2002) (ed.). Homo Sapiens 2.0. Når teknologien kryber ind under huden. København: Gads Forlag.
13. Balling, G og Lippert-Rasmussen, K. (2006). Det menneskelige eksperiment. København: Museum Tusculanums Forlag.
14. Greely et al. (2008). Towards responsible use of cognitive-enhancing drugs by the healthy. Nature, 456, 702-705.
15. Roco, M and Bainbridge, W (2002) (eds.). Converging Technologies for Improving Human Performance. NSF/DOC-sponsored report. Awailable at http://www.wtec.org/ConvergingTechnologies/Report/NBIC_report.pdf. (29.05.2009)
16. Innovation: The European Journal of Social Science Research, 20(4) (December 2007). Special Issue: Converging Science and Technologies: Research Trajectories and Institutional Settings.
17. Beckert, B., Blümel, C and Friedewald, M (2007). Visions and realities in converging technologies. Innovation: The European Journal of Social Science Research, 20(4), 375-395.
18. Det Strategiske Forskningsråd (2006). Det aldrende samfund 2030 – Rapport fra Styregruppen for det strategiske fremsyn om det aldrende samfund 2030. Awailable at http://fi.dk/publikationer/2006/det-aldrende-samfund-2030-rapport-fra-styregruppen/det-aldrende-samfund-2030.pdf (29.05.2009)
19. Murphy, T. F.(1986). A cure for aging? The Journal of Medicine and Philosophy, 11(3): 237-255
20. Veatch, R.M. (1979). Life Span: the Hastings Center report on values and life-extending technologies. New York: Harper and Row.
21. European Parliament Science and Technology Options Assessment (2009). Human Enhancement Study. Awailable at http://www.europarl.europa.eu/stoa/publications/studies/stoa2007-13_en.pdf (14.08.09)
22. http://www.humanityplus.org/learn/philosophy/transhumanist-values (14.08.09)
23. http://www.humanityplus.org/read/2009/07/human-enhancement-what-should-be-permitted-geneva-october-20-21-2009/ (14.08.09)
24. Maher, Brendan (2008). Poll results: Look who’s doping. Nature, 452, 674-675

If you happen to be near or in Philadelphia the weekend after next, you may consider attending the upcoming Medical Film Symposium. A awesome lot of film-makers, -theoreticians, and -historians will watch and discuss films that explore “the relationship between moving images and medical science”.

The Mütter Museum (no link provided, they have a malicious virus on their website right now!!, no kidding) will host the well-rounded Saturday program and the Friday night screening will take place in the Pennsylvania Hospital Surgical Theatre, which (Joanna says) is the oldest surgical theatre in the United States).

See the screening and academic program here. Register before Friday, 15 January. Joanna will attend the symposium in the role of “official blogger” for the event, so we can all expect to read well-written accounts about what went on — for example, whether the Saturday night party will turn into a symposium in the original meaning of the word, or not.

Musician John Boswell has just released the third part (called ‘The Unbroken Thread’) in his Symphony of Science series of music videos — the explicit goal of which is

to bring scientific knowledge and philosophy to the masses, in a novel way, through the medium of music.

Boswell’s thing is to remix and tune the spoken words of famous scientists like Jane Goodall, Stephen Hawking etc. with high-profiled popularizers (David Attenborough, Carl Sagan, Richard Dawkin, etc.) and combine them with footage and his own electronic music compositions.

I really don’t know what to say. One side of me just loves to watch and hear the four secular gospels of the creation of the world — i.e., the history of the Universe, the history of the Earth, the history of Life, and the history of Humankind — after all, we atheists too need mind-expanding narratives we can live by:-). One of the most awesome narratives (combining the last three secular gospels into one) I’ve seen is Claire L. Evans’ ‘Evolution in 60 seconds’.

On the other hand, there are limits to what my aesthetic sensibilities can cope with. And even though ‘The Unbroken Thread’ is occasionally able to raise the right feelings of secular sublimity, Boswell’s re-mixing of pretentious voices, his outdated electronic tunes and the use of worn-out molecular animations combines into a major artistic flop. How can he for a moment believe that he will be able to bring scientific knowledge and philosophy “to the masses” (what a phrase to use!) with this kind of music video production?

I’m sure The Knife together with Korb would be able to create a much more sophisticated musical and visual rendering of the four secular gospels of creation.

I seem to have acquired a strange interest in therapies involving animals. Especially if they trigger ‘the yuck factor‘. Leeches and maggots have been used for centuries and are also used in biomedicine today. Whereas these tiny crawling creatures are used externally (fixed on or in the skin), parasitic worms are used internally — the patient drinks a cocktail of worm eggs.

Why? Well, most people have heard of MS (see here), but how many have heard of this particular experimental treatment:

Once the eggs are inside the body, they will hatch into worms that live in the gut. It is hoped they will then stimulate the release of a certain type of immune system cell that will allow the body to heal the damage done by MS

 Interesting but also … yuck!