The Gods Themselves Contend In Vain

In 1972, as the Cold War chilled the world, Isaac Asimov published The Gods Themselves. Reading it today, I can't help but regard the novel as a powerful allegory for climate change as humanity fails to act on the knowledge that our destruction is an inevitable consequence of continuing to consume energy the way we do. That failure is itself a consequence of the failings of our political institutions, of our scientific and political leaders, and of our reason.

The story is set in 2100AD, after the mysterious 'crises' of the 21st century that led to a depopulation of the planet from six billion to two billion. Asimov does what he does best here, creating a fictitious world inhabited by plausible characters who help him churn through expository passages with the humour and humanity he suffuses into their lively dialogue, and into his science fiction yarns generally.

In the first of the book's three acts (Against stupidity...), we learn of a device called the Electron Pump which can provide an essentially limitless supply of clean energy. The device was developed after the serendipitous discovery of an anomalous radioisotope and its spontaneous decay by a man named Frederick Hallam. The isotope originated in a parallel universe. Because of differences in the physical laws governing the two universes, each race--men and para-men--could take advantage of the energy released by the decaying material being pumped into their own universe by their parallel analog.

Hallam is credited as the Father of the Electron Pump, though it was only through his tenacity not his brilliance that the device was developed. In fact, the matter transfers are initiated entirely by the para-men. Because of the injustice of Hallam's stature and jealousy of a subordinate researcher, the Electron Pump is found to be fatally flawed: the ongoing import of energy from the parallel universe introduces perturbations into our own universe which alter the physical properties of matter and potentially accelerate fusion, conceivably leading to runaway solar fusion and an explosion that could form a solar-system-shattering quasar. If the disruptions have to accumulate across the entire universe to trigger the effect, millions of years would have to pass before the cataclysm could occur, but if the disruptions were localized, a sufficient change to the physical properties in our solar system might lead to its destruction within a few decades.

The hypothesis of the potential danger of continuing to operate the Electron Pump is difficult to confirm. Evidence of the effect would be subtle and expensive to collect. Moreover, the scientists who suggest this threat are discredited and marginalized by the Pump establishment, led by Hallman himself. If the threat is genuine, it may be irreversible by the time it is readily apparent. I think you can see where I'm going with this.

A politician in the novel explains his quandary when faced with the hypothesis this way:

"It is a mistake," he said, "to suppose that the public wants the environment protected or their lives saved and that they will be grateful to any idealist who will fight for such ends. What the public wants is its own individual comfort. [...] Now then, young man, don't ask me to stop the Pumping. The economy and comfort of the entire planet depend on it. Tell me, instead, how to keep the Pumping from exploding the Sun."

I expect this insight applies equally well to our current predicament. There remains an extraordinary amount of fossil fuels in the ground that we can still dig-up and burn for energy, though conventional oil production will likely peak in the next ten to fifteen years. Our comfort, growth, and progress appear to depend on continuing to burn fossil fuels. Yet the evidence has been accumulating for decades that the continued release of greenhouse gases will lead to calamitous changes in our planet. Policymakers are paralyzed by their fear of being ousted by a public unwilling to be painfully weaned from its energy supply, and by serving the established corporate interests that prop up their economies. The public, in its attempt to resolve the cognitive dissonance of its entrenched consumption patterns and the consequent disaster it will bring, denies the looming crisis and carries on.

Though striking in its aptness to climate change, the novel appears not to have been conceived for this reason. Rather it was conceived as a thought experiment by Isaac Asimov when told by a colleague that Plutonium-186 could not exist in this universe. The novel grew out of his conjecture about what sort of universe would permit the existence of this isotope. In fleshing out this possibility, Asimov creates not one world but three: post-apocalyptic Earth, the para-universe, and a Lunar colony.

For the alien para-universe, Asimov creates entirely novel creatures governed by the physical properties of that universe. Though their bodies differ from ours, their stars shine more dimly, and their life cycles are totally unfamiliar, the creatures display familiar psychology of self-interest, doubt, shame, love, chauvinism, and nurturing. He focuses on three of the creatures, a mating triad with the names Odeen, Dua, and Tritt, reminiscent of the Russian words for the first three numbers: один (adeen), два (dva), три (tree). Their story is told in the middle act of the novel (...the gods themselves...), and the chapters are numbered with three parts per chapter, the 'a' parts told from Dua's perspective, 'b' from Odeen's, and 'c' from Tritt's.

I stalled when the novel entered the para-universe. The environment was disorienting and the usual literary tricks Asimov exploited to allow character interactions to drive his plot were lost on me: I could hardly identify with shimmery shape-changing, photosynthesizing, ephemeral blobs. But at the encouragement of a friend, I revisited the para-universe and discovered that in fact I could identify with these creatures, their parental instinct, curiosity, rational detachment, shame, jealousy, anxiety, and sexual politics. We were the same beings, and only the physical constants of the universe were different. The para-men understand the peril to our universe that the Pump may pose, but elect ultimately to keep Pumping because our destruction would not imperil them.

Back on Earth, Lamont, the dissenting scientist of the novel whines, "The best proof [...] is to have the Sun explode." It is to this standard that our scientists seem to be held. The title of the novel is inspired by a phrase written by Friedrich Schiller, a nineteenth century German dramatist and poet. The line appeared in his Maid of Orleans: Against stupidity the gods themselves contend in vain. It is not stupidity we must contend with so much as ignorance, denial, and self-interest. Another passage late in the novel:

"Earthmen want the Pump; they want the free energy; they want it enough to refuse to believe they can't have it."
"But why should they want it, if it means death?"

"All they have to do is refuse to believe it means death. The easiest way to solve a problem is to deny it exists."

On the moon, research confirming the threat posed by Pumping is uncovered. Here we encounter the third world conceived by Asimov. This section of the book sparkles with insightful flourishes about low gravity, conservation, politics, design, diet, and physiology that fully render life on the moon: The discomfiture of an Earthie adapting to his awkwardness and sagging fleshiness on the Moon. The repulsion of a Lunarite to stories of pastures, beaches, and even air. The quest for independence of the Earth-governed colonists. Asimov nails so many details, and evokes them plausibly and subtly.

Ultimately, the underlying problem with the Electron Pump is overcome by more technology. Rather than dissuading people from continuing to rely on a device that endangers them, science prevails by offering a solution that involves creating a channel to another parallel universe, this one capable of offsetting the perturbations caused by the first.

I suspect that we will not be so lucky. Geoengineering is a dangerous prospect. It has a long history in human culture but on a localized scale. What else would one call the razing of land, diverting of waters, and colonization with foreign plant and animal species but geoengineering?

When, in our past, cultures rose beyond the carrying capacity of their environment, they invaded their neighbours and expanded the pool of resources they could tap. When their expansion stretched beyond their ability to harvest, expropriate, and govern their territory, the cultures collapsed. Jared Diamond's book Collapse details several fascinating case studies of cultures that, as he puts it, "choose to fail."

With an integrated global network of commerce, transportation, extraction, agriculture, and manufacture, we are able to exploit the abundance that the entire planet has on offer. Our voracity is unprecedented, and the scale of our impact is not regional but global. When we outstrip our surroundings this time, the world will be spent and reeling, and ultimately billions could suffer.

Those of us who consume the most are, for the most part, unrepentant about it, continuing to elect governments committed to propping up the status quo, to fly for our vacations, to drive almost everywhere and alone, to clog landfills with waste, to pave over arable land with sprawling development, and to pat ourselves on the back for installing a few compact fluorescent lights in our homes. We are the most responsible and at the same time the most insulated from the impact of human-mediated climate change. When the die-off comes, it will visit other shores first.

Here's to Looking Out For Number One.


BBC: 'Inflicting' Cancer on Your Children

A news item out of Britian is being widely reported today. It concerns the preimplantation evaluation of an embryo for the presence of a mutated BRCA1 gene. Mutations of this gene can dramatically increase the risk of breast and ovarian cancers.

The women in the family of the 'cancer-free' infant's father had been diagnosed with breast cancer in their 20's for three generations. And while the fertility expert, Paul Serhal, who cared for the couple is right in saying, "The lasting legacy is the eradication of the transmission of this form of cancer that has blighted these families for generations," this legacy comes at a cost.

In general, prenatal genetic testing poses a risk to the pregnancy and to the health of the fetus. Then there is the issue of what to do with the information if the fetus tested positive. Abortion? Prophylactic mastectomy and oopherectomy (precautionary removal of undiseased breasts and ovaries) when the girl completes adolescence? These maneuvres carry their own health risks.

In this case, preimplantation evaluation was done. Multiple embryos were created from the parents' gametes (sperm and eggs) in a lab, and then tested for the mutation. The winning embryo of the implantation lottery gets the privilege of gestating. This technique has the advantage of avoiding a decision about abortion or later decisions on prophylactic surgery.

I considered becoming a medical geneticist when I started my medical career. The science is fascinating, and builds upon my undergraduate genetics degree. But I did a summer as a student working in a medical genetics clinic and found the profession profoundly frustrating. Here were people of all ages for whom you could diagnose a condition that you could rarely do anything about.

Conditions like phenylketonuria and other inherited disorders of metabolism notwithstanding, medical genetics is essentially a diagnostic specialty with virtually no opportunity for treatment. You can tell people that they will develop Huntington disease, a debilitating progressive neurologic disorder, but you can't prevent or forestall it. You can diagnose them with Marfan syndrome and warn them of the possibility of a fatal aortic dissection. Can't correct the problem. You can diagnose them with BRCA1 or 2 mutations and advise them of the near certainty that if they live long enough, they will develop breast or ovarian cancer. The solution? Mastectomy and oopherectomy.

The really egregious thing about the BBC report that prompted me to start this post in the first place was Serhal stating, "The parents will have been spared the risk of inflicting this disease on their daughter." Serhal's biases are exposed here. He appears to feel that carriers who do not take the precaution of screening their embryos are deliberately causing them harm. If he had used the word "transmitting" instead of "inflicting," I would have no quarrel. But he didn't. He implies the recklessness of parents without the scruples of his clients, if not outright maliciousness.

Is he right? Are parents with the mutation who don't get their embryos tested "inflicting" the condition on their children?

While Serhal eagerly accepts the accolades of his accomplishment, consider the implications of this innovation, good and bad. The world is imperfect, and any interested observer can see that our solutions often lead to new problems. What about the cost, risk, and invasiveness of the procedure? What about choosing not to conceive? What about adoption? What about the precedent? The vilification of choosing to conceive naturally? Will criminalization be far behind?


WIRED: The Truth About Cancer

WIRED magazine begins the year with an audacious premise in its cover story on cancer: Don't try to cure it. Just find it.

Naturally, you should try to find it then cure it. Finding it doesn't do much good otherwise. But I absolutely agree that the refinements of treatments directed at prolonging the lives of those with stage IV cancer of almost any type will yield diminishing returns. The real gains will be realized when we are able to shift the stage distribution of some of the deadliest cancers so they are detected at an earlier stage, when they are more readily curable.

This is no secret. While author Thomas Goetz complains that the National Cancer Insitute "spends just 8 percent of its research funds on early detection," I caution him not to trivialize this dollar amount. The NCI is an organization with a budget of $4.8b. That translates into about $350m spent each year on research into early detection.

Lung cancer is an area of particular importance. It is the deadliest cancer worldwide. It is the deadliest cancer among North American men and women, surpassing breast cancer for women about a decade ago. This year, 25,000 Canadians will be diagnosed with lung cancer and 20,000 will die of lung cancer.

About 80% of newly diagnosed lung cancers have already spread beyond the tumour nodule itself. For those with stage II or III disease, we try to cure them and succeed about a quarter of the time. The statistics are terrifying. In 40% of lung cancer patients, the tumour has already spread outside the chest at diagnosis, rendering them incurable. We treat such patients, but never expect to cure them. Half the patients diagnosed with stage IV lung cancer won't survive beyond nine months, and only 2% of stage IV patients survive five years.

I think that warrants repeating: Only 2% of stage IV patients survive five years, and about 40% of lung cancer is diagnosed as stage IV disease.

So why not find it earlier? You would think this would be relatively easy. A tumour is a solid nodule. In the lung, it would show up as a dense lesion on a low-density background of spongy, aerated lung. The lung airways are accessible to bronchoscopes, cameras which can be snaked down into the lung for a closer look and even tissue sampling.

To date, studies of chest x-rays and even CT scans have not yet demonstrated a survival advantage to screening. The outcome of the National Lung Screening Trial (NLST) of CT screening is due to be released in a few years. This study, sponsored by the NCI, enrolled 50,000 subjects and randomly assigned them to be screened either with CT scan or chest x-ray.

There are the tantalizing results of the Early Lung Cancer Action Program (ELCAP) which demonstrated a dramatic shift in stage distribution: 85% of lung cancers detected were found at stage I, confined only to the lung tumour with no lymph node or more distant involvement. The authour of the study report, Dr Claudia Henschke, has been criticized for her embracing of CT screening for lung cancer, and for her dubious though transparent funding source (the Vector group, parent company Liggett Tobacco).

Nevertheless, the results are encouraging indeed, and many observers are inclined to suggest CT screening, survival data be damned.

Other strategies have been pursued in lung cancer and I may discuss these at another time. No home runs yet. And lung cancer patients continue to die because we can't find their tumours soon enough.

Nanotechnology, microfluidics, genomics, functional imaging, all these technologies may have a role to play. But they will initially be expensive to deploy. Moreover, less than 1% of people out there are diagnosed with cancer each year. And for us to ask all of them to submit to a test looking for cancer because they might have it is a tough sell to most healthy, busy adults, and a tougher sell to private insurers or public payers, even if there is survival data.

The big three unscreened cancers are prostate, colorectal, and lung. We have great programs for cervical cancer and breast cancer screening, but even in British Columbia where mammograms are free, where vans are deployed with mobile mammography units throughout the province, with high literacy and a public medical system, where a helpful reminder is sent to you to undergo your mammogram when you need it, even here only 50% of eligible women participate in the mammographic screening program.

Care to guess the proportion of current and former smokers who will undergo regular CT scans, as often as four times a year to monitor some suspicious lesions? Smokers have lower educational attainment and incomes than non-smokers, and many of my lung cancer patients feel guilty about initiating their diagnosis. I'd be surprised if a quarter of those eligible underwent free screening CT scans.

Which all goes to show that the devil is in the details in terms of cost and participation rate, even if you can demonstrate that a test works. Colorectal cancer screening, sticking a metre-long camera up your tuckus every couple of years after a two-day colonic washout, and insufflating air into your colon like it was a Thanksgiving Day float, is a tough sell, unless you're scared because family members have been dying from it.

I remain optimistic that technology can offer better screening strategies: more sensitive, less invasive, less costly. We're still in the Dark Ages here. But I'm not holding my breath just yet. Too soon for that.


Invasion of Gaza: An Election Strategy?

On February 10, 2009, Israel will hold an election. The current PM, Ehud Olmert, who stepped in as Acting PM after Ariel Sharon suffered his fatal stroke in 2006, did not allow his name to stand for leadership of his party, Kadima. Tzipi Livni, the Foreign Minister, won the party's nomination in September. The other contenders on February 10 will be Benjamin Netanyahu (Likud) and Ehud Barak (Labor), the latter currently serving as the Defence Minister.

Livni has been taking a hard line in the conflict with Hamas in Gaza. "Hamas targets Israel whenever it likes and Israel shows restraint. This is no longer going to be the equation in this region."

Al Jazeera notes: "With an election due in Israel next month such a message from a woman who wants to be the next prime minister will do her prospects at the poll no harm."

Could Livni be so crass as that? Her competition is stiff. Benjamin Netanyahu's rhetoric is positively priapic: "The action that is required is something that removes this Hamas regime from the scene....With all the means necessary to achieve it." According to Barak, Israel "has a war to the bitter end against Hamas and its branches."

Kadima is closing in according to the latest polls. After riding high on the initial buzz when she contemplated the leadership of Kadima, Livni lost ground to Netanyahu's Likud. By mid-December, however, Livni rallied to pull even with Netanyahu. Could the invasion of Gaza and the elimination of Hamas--incurring along the way all the collateral damage that entails, mostly dead, non-combatant Palestinians--have simply been a strategy to put Livni over the top? To show Iron Lady resolve in advance of the election? Or maybe to allow Barak to win a few more seats for Labor.

Hamas is responding to the threat with characteristic bloodthirsty rhetoric, defiance, and reckless endangerment of the citizens it is charged to protect. The Times of London reports Hamas leader Mahmoud Zahar uttered the following disgusting threat: "They have legitimised the murder of their own children by killing the children of Palestine....They have legitimised the killing of their people all over the world by killing our people."

The Times continues: "Hamas, meanwhile, kept firing rockets into southern Israel, launching about 40 of its home-made Qassam rockets and more sophisticated Grad missiles. They again hit Beersheba, about 25 miles from Gaza. While Israeli forces have stormed into the northeastern area of the Strip, from where Hamas usually launches its projectiles, the Islamists have maintained their fire from within Gaza City.

"Many analysts believe that Hamas wants to goad Israel into its stronghold, a hellish landscape for urban combat, which the Islamists have had 18 months to prime with booby traps, ambushes and tunnels."

Monitor the fighting on this interactive map.

I Need a Subsidy

Calvin anticipates the Bailout Beggaring seen last fall.