July 9th, 2009 by Dr. Val Jones in Book Reviews, Medblogger Shout Outs, Opinion
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Francis Collins, M.D., Ph.D., is probably best known for his leadership of the Human Genome Project, though his discoveries of the Cystic Fibrosis, Huntington’s, and Neurofibromatosis genes are also extraordinary accomplishments. Dr. Collins is a world-renowned scientist and geneticist, and also a committed Christian. In his recent best-selling book, The Language Of God, Dr. Collins attempts to harmonize his commitment to both science and religion.
Some critics (such as Richard Dawkins) have expressed reservations about Dr. Collins’ faith, wondering if it might cloud his scientific judgment. Since Collins was rumored to be the most likely candidate for directorship of the NIH (and he was nominated for the position yesterday, but must be confirmed), and because I wanted to know if Dawkins et al. had any reason for concern, I decided to read The Language Of God.
First of all, Christians are a rather heterogeneous group – with a range of viewpoints on evolution, science, and the interpretation of Biblical texts. On one extreme there are Christians (often referred to as “young earth creationists” or simply “creationists”) who believe in an absolutely literal interpretation of the Genesis story, and see evolution as antithetical to true faith. Dr. Collins suggests that as many as 45% of Christians may actually be in this camp.
On the other end of the spectrum are Christians who embrace evolution, accept and promote scientific thinking, and understand the Bible to be a blend of poetry, allegory, and historical literature. While they see the Genesis account of creation as poetic, the Gospel accounts of Jesus’ life and teachings are considered to be more literal.
Collins’ views are very representative of the scientific end of the Christian spectrum. In fact, he spends several chapters attempting to help creationists embrace evolution. He takes great pains to explain how irrational it is to deny the evidence we have (both from a genetic, and an archeological/basic science perspective) for evolution. He argues that evolution is not an enemy of faith, but rather an enlightening look at how God’s creative process works.
Collins also takes on “Intelligent Design (ID),” exposing it as a PR play, not a true scientific theory. He suggests that ID is an “argument from personal incredulity” expressed in the language of mathematics, biochemistry, and genetics. Furthermore, Collins explains that ID proponents have confused the unknown with the unknowable – there is no current “irreducible complexity” that cannot be explained by evolutionary theory. We don’t need a “God of the gaps” to explain what we’ve yet to learn.
One of the more interesting parts of the book is Dr. Collins’ mathematical review of the incredibly low odds of the right blend of atoms/elements and the correct rate of expansion of the universe to occur by chance. He argues that certain atomic particles needed to be present in unequal and varying amounts at the earliest moment of the Big Bang to produce – eventually – the right conditions for life as we know it. He uses this analogy: it’s possible that a poker player could randomly obtain a straight flush in 50 consecutive hands. However, a more plausible explanation is that he’s cheating. In the same way, the universe could have come into being by coincidence, but it’s more likely that it was a coordinated event.
Collins’ argument for the existence of God is compelling to me. His explanation of why he chose to become a Christian is a little less so. Collins often resorts to lengthy quotes of C.S. Lewis in lieu of his own theological rationale – but I suppose we can forgive him for this. He is first and foremost a scientist, not a theologian, and his book simply reflects that fact. [Those interested in a more compelling theological rationale for Christianity might try Timothy Keller’s, The Reason For God: Belief In An Age Of Skepticism.]
In summary, Collins claims to believe in “theistic evolution.” He says that few people have heard of it because it harmonizes science and religion – and “harmony is boring” and doesn’t have a PR agenda. Nonetheless, he finds it internally consistent and intellectually satisfying. The material world is best understood through scientific inquiry, the spiritual world cannot be tested or understood by science. Matters of conscience, morality, and a yearning for answers to questions that may not be resolved empirically (What happens to us after death? What existed before the Big Bang? Is there a soul?) are matters best left for religion.
After reading The Language Of God, I feel confident that Collins is a reasonable person. He embraces science more successfully than many people of faith, and I didn’t notice anything about his beliefs that would make me question his ability to lead the NIH in true, scientific inquiry. In fact, The Language Of God may embolden other Christians to join the Science-Based Medicine movement by offering them a rational way to allow faith and science to co-exist. I hope that scientists who hold atheist or agnostic religious views will embrace this small group of evolutionary theists as religious moderates who fully support scientific orthodoxy.
July 9th, 2009 by Harriet Hall, M.D. in Better Health Network
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It’s easy to think of medical tests as black and white. If the test is positive, you have the disease; if it’s negative, you don’t. Even good clinicians sometimes fall into that trap. Based on the pre-test probability of the disease, a positive test result only increases the probability by a variable amount. An example: if the probability that a patient has a pulmonary embolus (based on symptoms and physical findings) is 10% and you do a D-dimer test, a positive result raises the probability of PE to 17% and a negative result lowers it to 0.2%.
Even something as simple as a throat culture for strep throat can be misleading. It’s possible to have a positive culture because you happen to be an asymptomatic strep carrier, while your current symptoms of fever and sore throat are actually due to a virus. Not to mention all the things that might have gone wrong in the lab: a mix-up of specimens, contamination, inaccurate recording…
Mammography is widely used to screen for breast cancer. Most patients and even some doctors think that if you have a positive mammogram you almost certainly have breast cancer. Not true. A positive result actually means the patient has about a 10% chance of cancer. 9 out of 10 positives are false positives.
But women don’t just get one mammogram. They get them every year or two. After 3 mammograms, 18% of women will have had a false positive. After ten exams, the rate rises to 49.1%. In a study of 2400 women who had an average of 4 mammograms over a 10 year period, the false positive tests led to 870 outpatient appointments, 539 diagnostic mammograms, 186 ultrasound examinations, 188 biopsies, and 1 hospitalization. There are also concerns about changes in behavior and psychological wellbeing following false positives.
Until recently, no one had looked at the cumulative incidence of false positives from other cancer screening tests. A new study in the Annals of Family Medicine has done just that.
They took advantage of the ongoing Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial to gather their data. In this large controlled trial (over 150,000 subjects), men randomized to screening were offered chest x-rays, flexible sigmoidoscopies, digital rectal examinations and PSA blood tests. Women were offered CA-125 blood tests for cancer antigen, transvaginal sonograms, chest x-rays, and flexible sigmoidoscopies. During the 3-year study period, a total of 14 screening tests were possible for each sex. The subjects didn’t all get every test.
By the 4th screening test, the risk of false positives was 37% for men and 26% for women. By the 14th screening test, 60% of men and 49% of women had had false positives. This led to invasive diagnostic procedures in 29% of men and 22% of women. 3% were minimally invasive (like endoscopy), 15.8% were moderately invasive (like biopsy) and 1.6% involved major surgical procedures (like hysterectomy). The rate of invasive procedures varied by screening test: 3% of screened women underwent a major surgical procedure for false-positive findings on a transvaginal sonogram.
These numbers do not include non-invasive diagnostic procedures, imaging studies, office visits. They do not address the psychological impact of false positives. And they do not address the cost of further testing.
These data should not be over-interpreted. They don’t represent the average patient undergoing typical cancer screening in the typical clinic. But they do serve as a wake-up call. Screening tests should be chosen to maximize benefit and minimize harm. Organizations like the U.S. Preventive Services Task Force try to do just that; they frequently re-evaluate any new evidence and offer new recommendations. Data like these on cumulative false positive risks will help them make better decisions than they could make based on previously available single-test false positive rates.
“In a post earlier this year, I discussed the pros and cons of PSA screening. Last year, I discussed screening ultrasound exams offered direct to the public to bypass medical judgment). If you do 20 lab tests on a normal person, statistically one will come back false positive just because of the way normal lab results are determined. Figuring out which tests to do on a given patient, either for screening or for diagnosis, is far from straightforward.
This new information doesn’t mean we should abandon cancer screening tests. It does mean we should use them judiciously and be careful not to mislead our patients into thinking they offer more certainty and less risk than they really do.
*This blog post was originally published at Science-Based Medicine*
July 8th, 2009 by Nancy Brown, Ph.D. in Better Health Network
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Just a friendly reminder to parents that dating does not equal sex. I cannot tell you how many teens have shared with me that the first lecture they got from their parents when they started dating was about sexually transmitted infections, including HIV and unwanted pregnancy. Their reactions were “what?”
When young teens start dating it is because they have found themselves twitterpated (which is apparently not a real word), and attracted to someone. Chances are good it is more of an emotional attraction than a sexual one, and one that will wax and wane, usually end with tears, but not kill them.
It is easy to understand why parents panic and worry about sexuality and the risks associated with that sexuality – we live in an extremely over-sexualized culture that can make us believe that everyone is having sex – which is not true. Please remember that only half of teens start being sexual before they are 18, but most fall in love at least once before leaving high school.
Dating is about learning how to be in a relationship, and you will be doing your children a great service if you talk with them about relationships, not sex. It is a good idea to make the difference really clear for them, and make your expectations very clear, too! If you expect your teen to not become sexual, tell them that, and why. Ask them to tell you what there limits and expectations about relationships and sex are. Here are some topic suggestions:
- What do they think dating includes?
- What does sexual pressure look and feel like?
- How would your child resist sexual pressure?
- How long do they think people should date before the topic of sex even comes up?
- How will they know if someone is the “one?”
- What would have to happen before they did think about sexual behavior?
If the possibility exists that they will be sexual, then, you can have the conversation about sex – but not if they tell you they will not be swayed and are not interested – you have to trust them.
Many teens are afraid of dating or choose not to date because a partner may expect sex, so they find a friend or pseudo partner to attend events with and protect them from having to resist sexual pressure – which is a great strategy, but keeps them from trying on relationships.
Oh the conversations that we might have … keep talking and make sure they know you are open to talking – even about things that make you squirm.
This post, Teen Dating Does Not Mean They’re Having Sex, was originally published on
Healthine.com by Nancy Brown, Ph.D..
July 8th, 2009 by Gwenn Schurgin O'Keeffe, M.D. in Better Health Network, Health Tips
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I used to feel guilty when I would say “no thanks” but not any more. I no longer by the line: “Ok…but you do know she might get behind…many of the other kids do continue for the summer.”
I’m ok with it…and so are my kids. And, you know what, not once have they “fallen behind” in any of their activities, even the ones they are at the top of their game on, in sports or in the arts.
It’s a myth that the sports world is the only world with year ‘round pressure. The music and arts worlds have it, too. Those worlds, in fact, can be more insidious about it because it’s done under the guise of “enrichment” and “culture”. The 24/7 wear and tear on our kids bodies, minds, and souls is, nonetheless, the same as with a ‘year round sport and it’s time music, dance and other fine arts parents recognize that their kids, too, need an off season.
The way to look at it is that any school year after school activity that occupies a great deal of time and focus and goes on for most of the school year, or more than 1 celestial season, requires an off season. The model is in the pro worlds. Pro athletes get off seasons and professional dancers and musicians do take breaks from the intense rigor of their professional season.
Our children have 1 childhood and only so much time in it to explore themselves and pursue activities that interest them. Given how much of the school year’s schedule is dictated by adults, the summer is the best time to hand over the reins to our kids and find out what they want to do and make it happen. The summer is the most perfect time to spread wings and try on something new, something that they may have had to shelve by necessity during the school year.
So, don’t buy into the “she’ll get behind” line – in sports or in the arts. Give your kids the off season this summer they deserve. Just like the off season in the pro worlds, kids use the time so productively that by the time they return to their beloved passions, they have a new found energy, zeal and focus. The rust will come off amazingly quickly and they’ll surge ahead again as if the summer never occurred.
Why not just keep on going, you ask? You could…but you may end up turning an activity your kids love into a complete grind and burn them out entirely. Plus, injury rates increase dramatically in sports and the arts when kids don’t have a break. Musicians and dancers put wear and tear on their bodies just like athletes, but with different muscle groups. Those areas of their bodies need to rest and rehab, in addition to their minds and souls having a chance to not focus so intensely for a while.
Childhood isn’t about specialization, it’s about variety. We’ve forgotten that along the way, and our kids’ bodies and spirits are paying a steep price.
*This blog post was originally published at Dr. Gwenn Is In*
July 8th, 2009 by KerriSparling in Better Health Network, Patient Interviews, True Stories
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After a hectic week with the conference in Philly and then Chris’s great news, I need to spend some time today catching up on everything. Thankfully, Jessica Phillips has offered to guest post today, writing about marking 500 days with type 1 diabetes. She’s come a long way, and I’m proud to host her words here on SUM.
Heeeeeeere’s Jessica!
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As I was injecting myself with insulin on a lunch break at work, a co-worker walked by and exclaimed, “I could
never do that! EW! I hate needles!” Less than two years ago I might have agreed. I never had a strong phobia of needles, but that is not to say that I particularly liked them either. I was known in my childhood to run out of doctor’s offices into the parking lot at the first mention of “shot”. Now when I hear such a strong and callous remark to my now normal routine of insulin injections, I struggle with trying not to angrily reply, “Well you would have to give yourself shots if you had to in order to live!” or, “How do you think I feel? You think I want to do this?” I’ve learned as of late to simply smile and say, “It’s not easy.”
Reactions like this are commonplace for those of you who have experienced Type One Diabetes for many years, and even some for the majority of your life. For me, June 9th, 2009 marked my 500th day with type 1 diabetes. I was diagnosed in my hometown of San Diego, California on January 25th, 2008 at 26 years-old. For a couple months prior to diagnosis I had been experiencing the typical signs of hyperglycemia and a failing pancreas as I was constantly dehydrated, urinating, and tired. Being a college student and in a constant state of stress, I quickly attributed the majority of my symptoms, from dizziness to infections, to be solely related to my immune system’s battle with my constant stress. After many weeks of procrastinating, I finally urged my doctor to order a blood test. I went in to the lab on January 23rd and was called by my doctor 24 hours later while I was driving to school. The tone in her voice immediately caught my attention and set me in a state of alarm. She informed me that my blood sugar the day before was above 300 mg/dL and I was to avoid sugar and be referred to an endocrinologist immediately.
Luckily I was able to see an experienced endocrinologist the next day, and he diagnosed me with type 1 within minutes of being seated in the exam room. I was in complete shock, and felt confused, angry, and overwhelmingly sad all at the same time. I felt a struggle between trying to remain alert to the bombardment of information he was feeding me, and trying desperately not to cry. The doctor left the room to retrieve my new meter and insulin pens, and I lost it. Luckily I had some moral support with me, but I have never felt so alone and lost. I kept thinking, “how did this happen?” and, “what did I do wrong?” To have gone many years without having anything major occur medically, not even a broken bone, it was a major shock to hear I had something irreversibly wrong with me. I not only had something wrong, but I could not do anything to change it.
The next few days were extremely challenging to say the least. I was unable to give myself insulin and had to have someone else do it for me for the first couple days. I would sit and look at the needle and could not conceive of how this tiny piece of metal was going to go through my skin. I just kept thinking it was so wrong, and foreign. I also cried. A lot. And I researched online and in books so much that I felt as though I could speak at a lecture on the biology of diabetes. I found the knowledge empowering, and the more I grasped what my body was actually doing, and not doing, I became more confident in my ability to control my state.
Now, 500 days later, this diabetic routine is normal to me. I can hardly even remember a time when diabetes wasn’t on my mind. The memories have faded of when my blood sugar was not a concern, and when I was able to look at food as just food. The last year and a half has been a giant emotional roller coaster, full of ups and downs, but they have changed me. Sometimes I get the look of sympathy from others when I detail my hardships with this disease, anywhere from medical costs to just the simple annoyance of pricking myself all the time, and I have found myself realizing that although I would not choose to have this disease, I consider myself lucky. I am lucky of course to not have something worse, but having gone through this change has made me look at my life through a new and clearer lens. My bottom-line now is a cliché idea, but it is so true … life is short, and you only get one shot, so make it worth it, no matter what.
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Thanks for sharing your story, Jessica. (And for the record, Jessica is the one with the fantastic hair on the right in that photo. Also for the record, I just realized that today is my 8,209th day with diabetes. Holy crap, my pancreas is lazy.)
*This blog post was originally published at Six Until Me.*
