Perching atop hyacinth

I once watched an enjoyable documentary known as Darwin’s Nightmare. My memories of this film came back into focus today as I read last Saturday’s Globe and Mail (as a father and full-time pharmacist I read one issue of the G&M per week, always the Saturday edition, and I am usually finished it by the following Friday). According to the excellent article Disaster Lurking in the Weeds, by Sara Minogue, Lake Victoria in Africa is in the midst of another ecological crisis caused by the water hyacinth, considered by botanists everywhere to be one of the most invasive species known to man (apart from the purple loosestrife growing in my garden). This water hyacinth basically blankets the surface of the lake, choking off sun to underlying waters, hiding ferocious reptiles (which then feast on the unsuspecting locals) and generally disturbing the fragile ecosystem that is Africa’s largest lake. Where does Darwin’s Nightmare come into the picture? The movie portrays the fatal consequences of a scientific experiment gone horribly wrong. Nile Perch were introduced in 1954 to improve commercial fish production in the lake. What happened next could only have been predicted by those to whom governments do not listen. The Nile Perch completely took over the lake, scavenging everything in its path, and inexorably altering the life cycle of the lake and its surrounding human settlements. However, since the Nile Perch thrived so well in Lake Victoria, one would assume that the communities surrounding it should have thrived also. And they would have if another invasive species had not entered the picture: the wealthy Western world. You see, Nile Perch fetches a handsome sum in Europe. And by the twisted mechanisms of globalized economics, those selling these fish are not locals, but Europeans. The ones doing all the grunt work are underpaid locals, but the ones bringing in the dough are foreigners. Furthermore, the harvesting of Nile Perch is so aggressive and the processing of their meat so thorough, that only the slimmest pickings are left behind. That is what the locals eat. So you see, in order to satiate the obese Europeans and North Americans on the succulent meat of the Nile Perch, European corporations ship it from thousands of miles away, prying it out of the hands of the impoverished locals, who, if not for the completely psychotic arrangement, would be wealthy and plump. There is a scene in the movie where images of Europeans dining on the fish in fancy restaurants are juxtaposed with images of locals picking through the fish carcasses for something resembling food. The most disturbing statistic uttered in the narrative was that the shipments leaving Lake Victoria for Europe will feed upwards of 2 million people. That is precisely the number of people along the shores of Lake Victoria currently suffering from life-threatening famine. Oh, and the planes these companies use to ship out the fish? They are Eastern European operations that bring weapons to Lake Victoria to support the local militias fighting the civil and tribal wars causing so much bloodshed. The militias get the guns and the nice pilots get the fish. And all the while, the Europeans just get fat. Of course, no obliteration of a populations livelihood would be complete without a little bit of global warming induced mayhem. You see, the resurgence of the water hyacinth referred to above is thought to be a direct consequence of global warming. The pain in the ass about global warming is that the ones who caused the problem, namely North Americans and Western Europeans, are those most able to deal with the consequences, but who are doing absolutely nothing about it. The ones suffering most, and those who will continue to suffer most, are the poor and destitute in the world who are almost blameless in the whole mess. Its like giving Africans the climatic middle finger. Some fat North American sits down at a disgusting fast food chain in Anywhere, USA and devours a burger that only resembles beef in appearance and likely originated some 3000 miles away. The tractor trailer used to ship the beef across the continent spews fuel for the global furnace. The kindling is provided by Mr. America’s Hummer and pseudo-mansion that is three times larger than his family requires. And through a complex system of global thermodynamics, the collective contributions of all these grotesquely prosperous individuals ends up blanketing the surface of Lake Victoria with water hyacinth. So because some guy in North America just can’t pass on those few extra horses to impress the girls as he cruises down Main St, some poor sucker in Tanzania gets devoured by a crocodile he couldn’t see lurking beneath a fortress of water hyacinth. Hopefully through some twist of fate this problem will come back to haunt the rich Western world (of which I am a part). Maybe the water hyacinth will start to kill off the Nile Perch and Random European will have to forgo his favorite dish at the local restaurant. Of course, giving up your favorite food and dying from hunger are two very different things.

A tear of joy

My son will be 10 months old on Monday. I cannot believe how fast he is growing up. Pardon me if I find it confusing and almost offensive when men start a family and then spend the ensuing years neglecting their children so that they can work. Or take the example of a gentleman I know. He is so obsessed with exercising, maintaining his lawn, and washing and sweeping his driveway, that his wife had to buy him an ATV so he will go camping more often because that is the only way she can get him to spend time with the family. It is not torture people. Besides, if you don’t want to put time into raising your children, keep your jeans zipped up. As for myself, I recently experienced the most gratifying experience of parenthood yet. While my wife, henceforth known as Sexy Mama, was off buying groceries I was looking after my little guy. Since he is now so mobile (a fact that has drawn attention to how out of shape I am) there are numerous head-bonking incidents. While this is a small price to pay for the victories he achieves in his explorations of his ever-expanding universe, it still breaks my heart every time. But I have never felt more powerful, more loved, more needed, and more fulfilled than when I picked him up after a particularly traumatizing bonk and wiped away the tears under his eye. To think that in an instant I can evanesce all of his sadness and pain with the comfort of my firm cuddle, the anxiolysis of my soft words, and the reassurance of my gentle wiping touch, is the greatest feeling I have ever had. And it is so wonderful to know that through his numerous adventures and explorations as he grows, I will be able to do this time and again as he inevitably experiences pain along the way. While I do not wish pain upon him, it will occur, and knowing that my devotion to my family will have me by his side when it does, is something I look forward to more than any other aspiration I have thus far entertained.

Jumping to conclusions

It seems I may be guilty of the very thing I continuously rail against: jumping to conclusions. Although I do not do this often enough to warrant the use of a jumping to conclusions map (see Office Space), I am a frequent enough offender. The most recent offence relates to a previous post of mine in which I state that the name America originates from Amerigo Vespucci, a cartographer that tailed along with Columbus. Although the origin of a name such as America likely has a great deal of uncertainty attached to it, I stated it as though it were fact. Thanks to the wonderful book I received for Father’s Day, The Book of Origins by Trevor Homer, I realized that this “fact” was actually far from it. A quick note on this book. For any man who spends inordinate amounts of time on the toilet, even when you are not actually producing anything worthy of a toilet, this book is a must-buy. It is all about the origins of everything you can imagine from ancient empires to languages to communications to art forms etc.
In the chapter on origins of nations it talks about the genesis of America, including the controversy surrounding its name. Apparently there is a good deal of evidence supporting America being named after Richard Amerike, a frequent sponsor of exploratory voyages at the time. It is thought that he sponsored voyages on the condition that whatever was discovered was to be named after him (talk about a narcissist). His most famous sponsored voyage was that of Giovanni Caboto (AKA John Cabot). Upon discovering Newfoundland, he then hopped the short distance to America and claimed the land in the name of his sponsor.
The most interesting thing about this whole theory is the resemblance of Amerike’s family coat of arms to that of the current American flag. Apparently the coat of arms consists of a series of stars and stripes. Interesting.

Media frenzy

Before I ramble on about this, if you want the short version, check out this good summary by Dr. Michael Evans in the Globe and Mail.

I received a fax from my head office imploring me to call all of my patients on Avandia to discuss recent concerns raised in the lay press about this drug. I decided that before I called them all and freak the hell out of them I should look into the original article.

The article was published June 14 in the New England Journal of Medicine. The first thing that set me off was that the media coverage emerged May 22, meaning that information was released to the public before health professionals even had a chance to access the information to critically appraise it. Now that I have access to it, let us discuss the problems with this study and why you should not stop taking your Avandia.

First of all, a prelude to the study. Avandia is also known as rosiglitazone, a thiazolidinedione, a group of drugs that increase sensitivity of the body’s cells to insulin, thereby improving glucose uptake and reducing the signs and symptoms of diabetes and their ensuing consequences. When Avandia first came onto the market, it was recognized that it increased cardiovascular risk slightly, specifically in patients with congestive heart failure (CHF), a condition in which the heart can not efficiently pump blood often leading to fluid buildup and consequences of insufficient blood supply to the organs. Accordingly, Health Canada specifically states that Avandia should NOT be used in patients with severe CHF.

Furthermore, Avandia is not approved for use in combination with certain other diabetes medications, namely sulfonylureas (glyburide and gliclazide) and insulin.

So this is the first problem with the study. Since it is a meta-analysis it analyzes the results of studies already performed and so the populations used in these studies are known and tabulated in this study. In 17 of the 42 trials studied, the treatment group was receiving a rosiglitazone/other drug combination not approved for use in Canada.

Now this is where it may get boring for some of you, but as God as my witness, I love this stuff.

One of the key features of a quality meta-analysis is a comprehensive literature search. If you do not include all the possible studies on the subject, you are running the risk of your study results reflecting publication bias. This is one place in which this paper failed. They did not do literature searches of the major electronic databases, nor the Cochrane collaboration, two very important sources of quality medical literature. Furthermore, they did not scour the reference lists of the studies used to find other relevant studies that may go unnoticed in a literature search. The real problem with this study is that it relies almost entirely on studies done by the manufacturer, GlaxoSmithKline, all garnered from their website. In total, 26 of the 42 studies used were unpublished in peer-reviewed medical literature. This is a huge problem as the quality of the studies, and therefore the validity of their results, is brought into question. Only 2 large well done studies were used in the entire meta-analysis.

One huge problem I have with their selection of studies is that they provided no measure of agreement among authors as to which papers should be included and which should not. This is mathematically expressed as a kappa statistic, something conspicuously absent from this paper. They also did no test for publication bias, that is, did the studies they include miss out on a big chunk of the available literature on the subject and therefore skew the eventual conclusion.

Next one must consider the test of heterogeneity. This is a test that determines the variation in results between the different studies. Variation will always exist, but the test of heterogeneity determines whether this variation is likely due to chance or if the studies are so varied in their results that we must question whether they can be combined into a pooled result. A HUGE problem here is that trials in which the subjects had no cardiovascular events were not included in the analyses. Consider that for a minute. You are trying to determine whether the medical literature out there supports the hypothesis that a certain drug causes cardiovascular events (heart attacks, strokes, etc.) You want to see if the studies you’ve included vary so much as to prevent them from being combined. Unfortunately, you do not include any study in which patients DID not have cardiovascular events. So of course your results will show a relative level of homogeneity, because you removed all the studies that stray from your hypothesis. Hmm.

When meta-analyses combine results of their individual studies, they use either a fixed-effects model (FEM) or a random effects model (REM). The FEM assumes that if all studies were infinitely large, the effect would be identical. For this to work, the test for heterogeneity needs to show very little variation. This study showed little variation, but not little enough. The REM, however, assumes that all study results will be randomly distributed around the true value. The researchers in this case used FEM which biases away from the null hypothesis: that is it will push toward the notion that there is an effect. The REM is more appropriate in most cases, because it is most conservative and biases toward the null: there is no effect.

Finally, let us look at the results. This is where the real problem arises. The article listed at the beginning touches on the distorted reporting of these results in the media. They reported all about relative risk and nothing on absolute risk. See, we shall now.

The odds ratio reported was 1.43, ranging anywhere from 1.03-1.98 with 95% confidence. So the truth lies somewhere between those receiving rosiglitazone being just as likely to 2 times as likely to have a heart attack than those not on rosiglitazone. However, if you look at the absolute risk increase, something entirely different emerges. It is incredibly small. First of all, the rate of heart attacks in both groups (treatment and control) rounds off to 0.6%. The most understandable value I can provide from this is the numbers needed to harm: 4854. This means that 4854 people would need to be treated with rosiglitazone versus controls in order for 1 heart attack to occur.

The biggest problem I have with the above is that the study authors did not even identify the total rate of heart attacks in both groups. Of course, having done so would have made their fancy odds ratio seem very silly.

So, if your neurons are still active after all of this, take the following home with you: be careful what you read in the papers. Most health journalists are not trained in the intricacies of epidemiology. Did you understand any of what I just said? Unless you are a pharmacist, physician, or other highly-trained healthcare professional, probably not. I took a whole semester in university just on learning how to analyze medical literature. Do you think the leading health journalists took that course?

Sure, information is a good thing to have, but careful what you do with false and misleading information, and almost more importantly, incomplete information. Please, for the sake of your health, do NOT stop taking this drug without having a serious discussion of the risks and benefits with your pharmacist and your physician. The last person you should be taking medical advice from is a journalist.

PS-On a side note, I have no connection to any pharmaceutical manufacturer that would bias my views in any way. I am heavily supported by Reason, Science, and Rational Thorough Analysis. Although these companies are publicly traded, not many people out there seem to be buying. Oh, and for the record, I will not be calling my patients to unnecessarily worry them. If they ask me about it, I will give them the short version of the above.

Walrus wins

Who would have ever thought such a lumbering beast as a Walrus could win a race? Oh wait, it wasn’t a real race, but the Walrus magazine, possibly the greatest magazine to ever emerge from Canada (Maclean’s used to be good but it now seems more like a soapbox placed firmly on the right side of the spectrum). Every year the National Magazine Awards Foundation holds the National Magazine Awards, a celebration of excellence in magazine journalism. And the Walrus kicked everyone else’s ass. It won 50 awards, including 6 golds, the most of any competitor. It beat the next best competitor, Toronto Life, by 27 awards. If you are a person interested in current events and political affairs, you have to subscribe to this magazine. It is not for the lighthearted, but man is it amazing. The writing is incredible, and they can make the most seemingly uninteresting subjects completely entrancing. Check it out.

Atheism: Is it the only truth?

So it seems society has settled on its new favorite reading material. For at least 6 weeks now, two books have shared top spots on the Globe and Mail’s bestsellers list. The books in question are God is Not Great by Christopher Hitchens and The God Delusion by Richard Dawkins. Both of these are essentially pugilistic diatribes against the whole concept of religion (in the case of the former) and the idea of the existence of God (in the latter case). The notion that those who believe in God or practice religion are somehow delusional is prevalent in our society. So allow me to be the first to admit that if this is so, I am one super delusional nutjob.

My problem is not with these gentlemen espousing their ideas nor with consumers buying their books. My problem is with the wholesale rejection of the opposing view by these authors and those who share their opinions. My biggest problem is with their assertion that atheism is somehow the default worldview, that it is the only one that makes sense, and that any other view should not be entertained for fear that we will only encourage the development of intellectual retards.

What these authors and many other thinkers do not accept is that their worldview is as much a leap of faith as mine. The belief that there is no God and that there is no place for religion in the world is no less based on objectivity than the alternative. One of the main arguments made by atheists such as Msrs. Hitchens and Dawkins is that believers in God and proponents of religious life are taking the easy way out and hiding behind a belief that cannot be empirically tested. Of course, this is an absurd argument because no cosmological belief as broad as this can be either proven or falsified but that does not make it any less of a valid view. Atheists cannot possibly test their view either, but somehow belief in nothing is more psychologically responsible than belief in something. So I will not sit here and commit the same faults as these thinkers by purporting that my worldview is correct, but I will say that ones mind must be open to exploring all views.

And that brings me to some alternatives. A new book was recently published by Pope Benedict XVI, AKA Joseph Ratzinger, called Jesus of Nazareth. In it he seeks to explain both the historical Jesus and the spiritual one. It is said to be surprisingly measured for a man commonly thought to be an ultraconservative polemicist. Now, while I have not read any of the above books yet, I am a believer in reading books that both challenge my worldview and confirm it, and I recommend the same for all of you out there.

I plan to read all three of these books in due time. Of course, I will most likely agree with the Holy Father, and most likely disagree with Msrs. Hitchens and Dawkins, but I find it incredibly refreshing to read the views of those who do not share mine.

For example, I once read Critiques of God, a collection of essays by many of today’s top thinkers on why the idea of a God creates dissonance with reason. While I really questioned some of the thoughts put forward, it was a very intriguing book and mind opening to read. In full fairness of disclosure, I will admit that more of the books I read on ontological philosophy are in support of my view, but I do try to intersperse them with those challenging my views, and I recommend the same for you. The next book on my list after the above two is Atheism: The Case Against God. If everyone in the world could embrace intellectual discovery, we wouldn’t have so many ridiculous squabbles over ideas.

Allow me for a moment to deal with one favorite of atheists: war and death in the world is all due to religion. While this may seem so on the surface, is it not equally likely that it is not religion itself causing the “Holy Wars” around the world, but instead the intellectual rigidity of those following these “religions”, which, equally likely the cause of these wars, are often not the true religions they have been named but distortions of the original concepts used by those leading the fight to bring followers to their side. Is it not also possible that if people were to just open up to other worldviews that the whole problem wouldn’t exist, that if the atheist mantra that there is only one true ontology and all others are to be spoken out against, that the problem would go away? Maybe it is in fact a poor grasp of the true meaning of spirituality and religious teaching that leads people to recklessly take the name of God in vain in pursuit of their twisted ideologies. Maybe Rosie O’Donnell was a bit emotional about it, but the Bush administration’s war against Islam is very much a part of the distortion of Christian belief held true by Bush and his followers, and although not overtly so, somewhat terroristic in nature. It is an extension of Manifest Destiny still held by many in the upper echelons of American political society.

Let us take a moment to reflect on a potent diatribe against the “Christian” theology of the Bush administration. This I take from John Tirman’s excellent 100 Ways America is Screwing Up the World.

The following are distortions of Christian belief taken up by Bush’s soldiers:

1. “How hard it will be for those who have riches to enter the kingdom of God!…It is easier for a camel to go through the eye of a needle than for a rich man to enter the kingdom of God.”

Mr. Tirman goes on to point out that Mr. Bush and his family are exorbitantly wealthy and most of the policies put forward by Bush Jr and Sr favored the rich and punished the poor, quite the opposite of Christian teaching.

2. “If anyone strikes you on the right cheek, turn to him the other also.”

There is no escape clause for 9/11. Retaliatory and preemptive strikes are not the purview of Christ.

3. “Blessed are the peacemakers, for they shall inherit the Earth”

Gandhi and his teaching of nonviolent resistance hit this one on the head, but Bush seems to have missed that sermon. “He who taketh up the sword shall perish by the sword. Think ye that evil can be overcome by evil or violence by violence? The way of peace requires courage and patience, but it will prevail.”

4. “Mortals go to war so that they can inherit dust. It is because their vision is distorted by the followers of the lie that they value that which is nothing. In destruction there is no victory but for darkness. The power of victory is not force but Love.” ‘Nuff said.

5. All the over-the-top public promotion of Christian beliefs, prayer breakfasts, etc.?

“And when thou prayest, thou shalt not be as the hypocrites are: for they love to pray standing in the synagogues and in the corners of the streets, that they may be seen of men. Verily I say unto you, they have their reward. But thou, when thou prayest, enter into they closet, and when thou hast shut thy door, pray to thy Father which is in secret.”

What a great piece.

Finally, to wrap it all up, I present to you a list of books I have read on the above topic for your perusal. Since the atheist books are quite high on the list right now, this may be welcome to believers in both views looking for some balance.

1. The Case For Faith, The Case for Christ, and The Case for a Creator, a series by Lee Strobel, a former atheist.

2. Seven Story Mountain, by Thomas Merton, a former atheist turned ascetic monk.

3. Science & Religion: From Conflict to Conversation, by John F. Haught

4. What Faith is Not, by Mitch Finley

5. Why God Won’t Go Away: Brain Science & the Biology of Belief, by Andrew Newberg, Eugene D’Aquili, and Vince Rause

This is a short list. I have numerous others on my Amazon wishlist that I have not read. If you would like more ideas, let me know.

I leave you with the following. While all worldviews differ in some way, I like to think that they are all intricately tied together by the big picture known as The Golden Rule: Do unto others what you would have them do unto you. See comparisons of this statement in numerous world religions at this site. And remember that everytime an atheist stands on his soapbox shouting that religion is the cause of all the world’s problems remember this: do not blame Christ or Allah or God, for their teachings are not the problem; blame their followers and then seek to teach them peace, love, and understanding.

Fill up my cup with Ducks

Fill it only 86.7%, in fact. So at the beginning of the NHL postseason I sat down and attempted to reason out the somewhat unpredictable outcome of the ensuing playoffs. I am an armchair statistics buff so I used what I had, combined with some good old rational thought, and attempted to devise a method to predict the outcome of the Stanley Cup Finals. Here is how my thought process worked.

In the playoffs, nothing matters but wins. Overtime losses don’t matter. Points don’t matter. So I wanted to find out what statistics correlate significantly with number of wins achieved during the regular season. I used the statistics from every NHL team to expand the sample size. From these calculations I found that 3 statistics significantly positively correlated with winning (goals per game, 5 on 5 goals for and against ratio, power play %) and 1 significantly negatively correlated with winning (goals against per game). However, all of them had at least some correlation, although not above 0.5. So I developed two separate scores based on a summation of the 4 stats, or a summation of all. What I did was take the correlation coefficients for each statistic and multiplied it by the actual statistic achieved by each team. I then added the products and arrived at a sum that I called the All Score, or the 4 Score. I then ranked the teams by descending all score or 4 score. I predicted the outcome of each series by comparing the scores of each competing team. By doing this, both of these scores correctly predicted the outcome of 13 of the 15 Stanley Cup playoff series, an 86.7% success rate. However, the truly amazing outcome was the prediction of the all-score. From the get go, before the playoffs even started, I used the all-score to predict the outcome of the entire tournament. It predicted an ANA v OTT final with ANA being victorious. Holy shit. The only series I predicted incorrectly were the first round DAL v VAN series, and the second round BUF v NYR series. So, we’ll will see if I am as successful next year!