Why as a researcher in medical science I oppose Hockey’s billions for medical research

We have all heard the mantra: prevention is the best cure.

When it comes to medicine and medical research this is very much true. And it is not perplexing why.

Regular exercise, while admittedly unpleasant for someone as physically indolent as myself, is cheaper and easier to do than develop a new and improved antihypertensive pharmaceutical, and have people take it, and deal with side effects, and so forth. Likewise, eating well is also much more straight forward than developing new treatments for insulin resistance. Any person living in a modern country who has a television can no doubt think of plenty of other examples. Moreover, when it comes to infectious diseases, we can all understand that not catching something in the first place is far superior a choice to catching it and then trying to treat it. Agreed? Okay. I’m not expecting much contest on this. I’m also not expecting much contest on the idea that GPs are an important source of information and advice on how to avoid preventable illnesses by adopting a healthy lifestyle.

So what of those illnesses that we have little if any control over? The cancers, the neurological disorders, and autoimmune disorders for example, that strike when we least expect it and might have relatively little to do with our lifestyle? The best and most cost effective treatment for these is early invervention. By a good old country mile.

The budget launched by smokin’ Joe Hockey tonight included a number of changes to just how much of one’s medical expenses Medicare will cover. Where in the past it was possible to see a bulk-billing doctor for free (admittedly they weren’t always easy to find), all visitors to the doctor will need to make a co-payment of $7. Furthermore, a co-payment of the same amount will also be required for blood tests and the like, which also used to be free. Add to this a hike in pharmaceutical payments, and it is beginning to look less and less likely that old Mrs. Jones, or down-on-his-luck Mr. Smith who was made redundant, will visit the doctor as soon as they feel that something might be amiss. After all, living on a limited income is tough – especially when one has to care for others – and when asked to choose between paying bills that might already be late, and seeing a doctor over what may or may not be a problem, one can understand why they might choose to deal with the more immediately pressing of the issues. Given the circumstances, it is an utterly forgivable choice.

Here’s where things get grim. What if that niggling pain in one’s gut is the beginning of a serious, though treatable if caught early, gastrointestinal condition? What if that dull lower back pain isn’t from lifting up the kids, but is the first sign of a malignancy? What if that odd bout of numbness was a transient ischaemic attack and a more severe stroke is just waiting to happen? What if old Mrs. Jones I mentioned before is taking warfarin and needs regular blood tests to regulate her dosage? Is she likely to keep all of these appointments if she has little spare money? These are all very worrying questions. These are also all situations where early intervention and consistent monitoring is the best option.

With the changes the government has proposed, it is very likely that people with low incomes will wait longer before seeing doctors and those who need regular care will be less likely to comply with treatment plans. People with limited incomes will also be far less likely than those of more ample means to see a doctor for advice on lifestyle changes, like weight loss or quitting smoking. This creates a situation that not only endangers their lives, but can generate more costs. Take the example of the transient ischaemic attack above – some routine tests and an affordable prescription for an anticoagulant may save this person from ever having the stroke. By far this is cheaper than treating a devastating large-scale stroke in hospital. It doesn’t take a team of medical scientists to make this plain.

In something of an attempt to make up for this, or to guilt the Australian public into accepting the changes being made, the government has also offered up billions in medical research funds. Hockey touted these funds as a potential source of cures for illnesses. Any person who has worked in health in Australia (I have worked in community pharmacy for years) knows that those who are most likely to suffer from treatable illnesses in Australia are those with the least monetary means – namely the elderly, the disabled and those trapped by poverty. I think you can see where I am going with this. Again, prevention and early intervention are always better than cures. They have made a crucial error in judgement on this and have given (comparatively little) with the one hand while taking (comparatively much) with the other.

This is why, even though I am a PhD scholar who does all of his research in a medical research facility and likely will build a career in such places, I cannot in good conscience approve of Medicare co-payments being funneled into a medical research fund. If I am serious about the health and well being of human beings, I cannot ignore the clear benefits of a responsible, affordable, accessible and effective preventative healthcare system. Despite the potential benefits to myself, I cannot muster the cognitive dissonance to do this. Now, I am not saying that medical research does not need money – not at all. Medical research and the finding of cures and new treatments is of course a very valuable and worthwhile activity in its correct context. It is also an activity that really does need government funding, as much important research in Australia focuses on illnesses that are unattractive to the bottom-line-oriented mentality of large pharmaceutical companies. Doing it at the cost of sound prevention, early intervention and ongoing treatment practices, however, is just not a sustainable or ethical strategy.


Hindering prevention and early detection with the one hand while helping ‘cure’ oriented research with the other seems a puzzling way to better the health of Australians.


Occupation: Mendicant Ponderer?

There are a good many high quality blogs that focus on life as a PhD student and what might come after it. Career options are a big focus, and while I understand why, I think it is also important not to forget that the value of a PhD goes beyond its economic worth. This is especially important in the current Australian political climate where the conservative government has a hard time understanding that anything can have a value beyond one measurable in dollars and cents.

I thought I might share a (lightly edited) comment I posted recently on thethesiswhisperer.com to a post that focused on career opportunities for PhD graduates:

I have to say that the subject matter of your piece often comes up in conversations I have with non-scholars and family. If I could choose any job on graduation, I would go with one in academia – I enjoy my research and I already teach and I love it. In fact I love it so much that I would do it (and have done it some of the time) for free. This being said, I entered into a PhD with virtually no expectations with regard to career prospects.

As a biological anthropologist, my field is about as unmarketable as you can get (obscure bit of knowledge about bonobo sexual practices anyone? Or perhaps a rant on cognitive sophistication of Neanderthals?). Okay, well perhaps I am going too far with that – I was a medical scientist first and foremost and have some marketable skills there.

So why did I pursue biological anthropology then?

The questions that the field deals with are, at least to me, among some of the most interesting to be asked. The field is also inherently multidisciplinary, which appeals to someone as eclectic-to-the-bone as I am. I have a desk in a human genome biology department, regularly attend discussion groups in the philosophy school, I spent most of today reading economic papers on game theory, and tomorrow will teach an Associate Degree sociology class. Boredom is unknown to me.

What I am getting at I suppose, is that I find it acceptable to view taking a PhD as a purely philosophical exercise in truth-seeking. Improved job prospects, should they exist, are a mere welcome bonus. Where things get irksome is when I give this answer to the inevitable barrage of ‘so what job does that get you?’ that a PhD student receives at dinners, and other social gatherings. It is usually met with either confusion, accusations of being an obtuse hipster, or chortled remarks of the ‘oh well you’ll change your mind about that one day’ sort.

I should mention here that I am 30 years old and have had a few ‘conventional careers’ already, ranging from low-paid bookstore manager to quite-well-paid-indeed teacher of English as a second language (something I still moonlight as). I have lived miserly and rather comfortably at different times – so I do know what I potentially am giving up in the long run by pursuing research for purely personal reasons. I should also add that when I speak of research for personal reasons one shouldn’t interpret it as me wishing to be a societal parasite – I still do conventional work (a heck of a lot more than most pursing a PhD) in other areas and contribute in that way.

Having dwelled upon this for a while now, an interesting question has just wiggled its way up into my consciousness:

What is it about the occupation of ‘mendicant ponderer’ (no religious overtones intended) that everyone seems to find so unnerving?

To borrow from Nietzsche, does choosing a PhD for non-career reasons constitute 'living voluntarily among ice and high mountains'?

To borrow from Nietzsche, does choosing a PhD for non-career reasons constitute ‘living voluntarily among ice and high mountains’?

A noble sentiment with a dash of wonky science – ‘I Am’ by Tom Shadyac

I recently acquired an app-based subscription television and film service – an overpriced Australian equivalent of Netflix essentially – with the principal goal of gaining legal access to timely viewing of Game of Thrones. You see I am one of those people who, perhaps sadly, enjoys the ‘water-cooler’ banter produced by the series. I am a long time fantasy fan, but in my line of work I have plenty of reading to do and as wonderful as the printed series surely is, ‘ain’t nobody got time for that’. I am also one of those people who feels as though I should pay for access to programming that I genuinely enjoy, and Game of Thrones certainly qualifies. The producers, actors, writers of score and so forth do a noteworthy job, so my sense of fairness and my conscience tells me that making sure that I contribute to their success in as direct a manner as possible is the right thing to do. This notion will be revisited.

Backtracking a little, after obtaining my weekly hit of backstabbing and skullduggery in the land of Westeros I came across a small selection of documentary films available on demand via the aforementioned app. Being somewhat bored and of the proclivity to procrastinate horizontally in bed with an iPad when faced with anything resembling work, I decided to take a chance on one of the films on offer. I went with I Am, a 2010 documentary by Tom Shadyac. Shadyac’s noteworthy prior productions were primarily of the comedic ilk. Among them were things I had enjoyed as a teen such as Ace Ventura: Pet Detective and Liar Liar.

In the film, Shadyac narrated his experience of receiving a concussion while cycling that left him with post-concussion syndrome – an unpleasant condition in which headaches, photosensitivity and mood instabilities including depression may be experienced for many months after the initial injury. This event triggered something of an existential crisis in Shadyac, who came to realise that something felt very wrong with the world. He looked at the materially obsessed consumption culture of the United States, a culture to which he felt he had contributed with his films, and felt that something had gone awry. With an anthropological tone it was pointed out that native American cultures often viewed the consumption of more than one needed as a kind of mental illness, and that people in modern, consumerist societies were perhaps attempting to fill a hole that had been left in them from a lack of fulfilling interactions with others. In other words, what comfort people could not find in each other, they attempted to find in accumulating various shiny knickknacks. A noble sentiment and at this early juncture in the film Shadyac had captured my interest.

Via interviews with a good many scholars of seemingly divergent repute – ranging from the venerable Noam Chomsky and genial David Suzuki to a host of variably wacky quantum-new-age semi(pseudo?)-scientists – the film then went on to examine how and why it is that we turned our backs on our natural, wholesome and cooperative ways. This is where the whole carriage seemed to have come off of the rails. To begin with, in describing the origins of our dog-eat-dog world of corporate domination, Darwin’s description of natural selection and the ‘survival of the fittest’ is blamed. This Social Darwinism was of course more so the work of interpreters of Darwin’s work, such as Francis Galton and Herbert Spencer (who actually first coined the term ‘survival of the fittest’), with Spencer’s involvement being so great that when teaching on this matter I tend to prefer that students refer to it as Social Spencerism. So while this movement and its attitudes may have encouraged certain types of predatory capitalism, attempting to blame the theory of Darwinian selection is to commit a serious fallacy – a fallacy so famous that it actually has a name: the naturalistic fallacy.

From this wobbly premise, Shadyac and his cohort of spacey companions (Chomsky and Suzuki aside) go on to explain that because natural selection, as it is taught, is inherently capable of only producing a world of selfish competition, that cooperation and kindness must be bewilderingly aberrant and utterly incompatible with bio-doctrine. They assert that the Darwinian model has led us astray – away from our warm and cuddly natures. With the sum total of Darwinian selection put to the side, smugly satisfied with their coup de gras, they amble on to deliver one of the weirdest explanations of altruism, kindness and cooperation I have ever encountered. They imbue in cooperation and kindness a kind of mystical healing quality that has something to do with the quantum entanglement of our minds and explain that it is entirely natural for us to express kindness to one another and live in harmony because of this interconnectedness. They even do an experiment ‘demonstrating’ that the living cells in yoghurt have the capacity to pick up your emotional state (or that their experimental device can pick up radio waves, or phone signals, or movements of people around a room and so on ad infinitum – what I am getting at is that it was an experimental design that would embarrass a high school biology student). In short, Shadyac concludes that our consumerist society and its inherent exploitation and dissatisfaction (again, a noble sentiment) is causing everyone to give off bad quantum-vibes and that is making everyone really bummed out man (wonky science).

I can see how the non-scientists out there eat this stuff up. The whole message has a kind of proletariat appeal that co-opts the folk-psychology that most people already possess. After all, who likes to be taken advantage of? Who willingly enters into a cycle of disappointing attempts to secure material happiness? What person doesn’t feel something when their loved ones are unhappy? Could it not be because of quantum brain juju? Like all successful deceptions (not that I think the creators of this film were being purposefully deceitful), the trick to this message having such wide appeal is that it is built on half-truths. The first half-truth is that capitalist consumerism is in some sense exploitative, as any sociologist with a grasp of Marxist theory will attest. The second half-truth is that material gain cannot serve as the sole provider of happiness in someone’s life – this realisation is at the core of many theologies and philosophies of ‘the good life’. The third half-truth, and the one that is of most interest to me, is that cooperation and kindness are indeed an important problem in evolutionary biology. Where this third half-truth has been unwittingly abused is that it is also a problem that has, to a large extent, been understood and resolved.

The question of whether cooperation and altruism fly in the face of natural selection is one that is best answered with a quote from Reverend Lovejoy, “Ooooh short answer yes with an if, long answer no with a but…”.

Let us take one of the basic premises of the modern evolutionary synthesis, that evolutionary success is defined in terms of fitness – traditionally the number of offspring left behind that go on themselves to be successful parents. Producing offspring requires resources, so it is in the interest of any given organism to secure as many resources as possible. This leads to the notion that organisms (or individual genes if one wants to take the ‘gene’s eye view’ of Dawkins) ought to be utterly selfish. Why share resources if it leads to less being available for one’s own offspring? Up to this point, we are in line with the kind of thinking that Shadyac and associates were engaging in. Now, let us add a twist. What if two organisms working together can obtain a greater bounty of resources than either could by working alone? If true, the organisms could simultaneously cooperate and be self-interested – or re-worded, they could cooperate out of self-interest. This of course leads to problems of the evolution of cheating, deception and so forth – organisms that can get away with such things will of course leave more children – but it will also often lead to the evolution of counter mechanisms that stop things from descending into chaos. In the end, the payoff of working together is often greater for all individuals involved than what would be achieved if they worked alone.

In nature, this is in fact what we see, from collaborations of cells (your body for instance) to social groups of animals (herds, schools, prides and so forth) and the complex social interactions of our own species, Homo sapiens. In fact, when it comes to us, one of the most remarkable things about our species is the comparatively extensive nature of our cooperative capacity and inclination toward altruism toward non-kin. We have every reason to expect that this is an evolved feature of our species, and as such it is perfectly natural for us to behave this way – we could not have built decent spears and huts without it more or less cities and computers. Put succinctly, the fitness payoffs of behaving this way outweigh the costs. Furthermore, if you feel bad when a fellow isn’t doing well it is probably because their perceived lack of success also has the potential to diminish your own – so reliant are we on cooperation to secure fitness. This isn’t to say that we have the whole process of human behavioral evolution figured out just yet – I would not have a doctoral project if we did – but what I am getting at is that we have no reason to believe it has anything to do with quantum brain vibes or anything else electrical devices can supposedly detect in yoghurt.

Coming back to Game of Thrones and my paying for a subscription, I find injustice and taking advantage of others distasteful and helping those that I appreciate rewarding. Moreover, I suspect that I feel this way for evolutionary reasons. This is why I pay when I could simply illegally download the episodes. As far as scientific research can gather it is a characteristic that is near typical of our species in many situations – with the notable exception of paying for content on the internet (it comes down to the likelihood of punishment on this one – remember what I said about mechanisms for cheating and detection? – in this case I suppose I am what is referred to in the literature as a strong reciprocator). It is near typical because evolution has shaped it to be so – it just so happens that cooperating and performing acts of altruism is a very good way of being selfish. In closing, while I sympathise with Shadyac’s concerns over our depressingly materialistic ways, his explanation of how they have come about is built upon the shakiest of foundations. So shaky that the word foundation is probably inappropriate. As to the question of how a species that is so heavily geared toward cooperation and kindness can produce a system that seems so devoid of it – well that is a topic for another post.