The Ascent of Science

Our modern understanding of sea level rise can be traced back to Dipsomedes. Like his cousin Archimedes, Dipsomedes was fond of taking baths, in his case mostly because he was so filthy all the time. On one occasion he had stepped out of the bath and was whistling as he dried himself off. He didn't know how to whistle, but the passage of a draught through his wet rolls of fat produced a whistle Otis Redding would be proud of. He glanced back at the bath and noticed the high water mark, defined by a thick sheen of darkened grease and the rainbow coloured streaks of waterproof crayons he liked to draw in the bath with. Dipsomedes immediately shouted out a catchphrase that was later to be made famous by his cousin: Zeus on a gyro! This was subsequently recorded in history books in the original Greek, so few scientists that utter Eureka today are aware of its theological yet mouthwatering origins.

Although the exact details were not fully worked out for over 2,500 years, Dipsomedes' intuition was essentially correct - sea levels are not fixed, and may wax and wane over the course of a bath, or indeed millenia. Dipsomedes expounded his theory in the needlessly long On the Dermal Expansion of the Seas. Today the treatise is of purely gastronomic significance, containing as it does his mother's recipe for baklava on the back of each page, almost certainly due to a photocopying error.

This story illustrates nicely how many of science's greatest discoveries have been made - in the nude. Charles Darwin successfully cultivated the image of a gentleman scientist, yet those who journeyed with him confessed off the record that his expeditions were little more than trumped up P&O style party cruises. It is said that there wasn't a woman within three hundred nautical miles of the Galapagos that hadn't succumbed to Darwin's famed oratory prowess, and although scant evidence remains, few doubt that Darwin conferred a lot more than just his name upon many of the beautiful finches of the islands.

Then there was Niels Bohr, the great Danish physicist who helped usher in the stranger than fiction world of quantum theory. Bohr was also a vociferous campaigner for the rights of marmosets, and he famously spent the last ten minutes of his Nobel Prize acceptance speech decrying the plight of our evolutionary second cousins. "So they don't have prehensile tails," he would say, "does that give us the right to destroy their habitat? Even I, a genius, have no prehensile tail!" Bohr then dropped his trousers to prove his point, causing many in the Nobel Committee to question the existence of an objective reality. Bohr would go on to host a biennial man-marmoset three-legged race in the backstreets of his hometown Copenhagen, at which the shared history and future of these two species was underlined by the strict requirement of all participants to fully disrobe. The event was later wound up by angry administrators who claimed Bohr's grandson Tyler was diverting funds to Barbary apes, rhesus monkeys and other members of the macaque family.

Are isomorphisms crummy?

Raymond Smullyan, in his delightful book The Tao Is Silent, rejects the picture theory of ideas, which states that an idea resembles its object. What could be more ridiculous? The idea of Tao being vague because Tao is vague? The idea of red being red because red is red? The idea of stickiness being sticky because stickiness is sticky? Smullyan adds that some say there can be isomorphisms between thoughts and objects. But this strikes him as a crummy kind of resemblance!

I wasn't so quick to dismiss isomorphism between thoughts and objects. Why that is is worth a quick digression. Primarily it is the ways in which I see isomorphisms between thought and objects as nontrivial and meaningful. But I can also easily see that this is in large part due to my readings of mindologist extraordinaire Douglas Hofstadter, who has taught me the incredible value of isomorphism and analogy in human thought (and possibly porpoises too).

In a simple case, a thought may just be a label for an object, with no greater resemblance (or isomorphism) to it than the fact that we relate the two. This is a bit like language, in which some argue the labels we place on objects are completely arbitrary be could interchanged and, so long as we all agreed beforehand on what's attached to what.

But then I thought of Daniel Dennett's description of a computer simulation of a hurricane. How detailed does the simulation need to get - how many variables does it need to include - before we argue that we're actually getting kind of close to a real hurricane? It doesn't have to rain inside the hard drive for us to appreciate that the model may actually capture some aspects of this big, wet object.

So what happens when our thoughts are complicated, vague, multimeaninged and in other ways related to the objects they are about? I would argue that in precisely these cases, there are isomorphisms between the thoughts and the objects and this resemblance can be rather uncanny at times!

climate change science.

I have recently started working in the NSW environment department's climate change science section. So expect some more and more serious science-related posts in the coming days and weeks and months and years. Of course, strict public service codes of conduct prohibit any kind of disclosure of any kind of information at all related to the work one does... so i'll have to watch my words. But there'll be words, mark mine.

Some of his work is behind him

Another relic from ye olde archives, I'm including this one because it gives a glimpse into how I spent a year of my life. 2006: The Year of the Honours!

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Cure cancer? Sure can, sir!

“…which may lead to a cure for cancer.” If I had a dollar for every time I’ve heard these words, I’d have enough money to fund research which may lead to a cure for cancer.

The hopeful tone of media reports is indicative of the enormous problem cancer poses to society. First and foremost it is a profoundly personal issue, but these days you’re also likely to see it framed in economic terms — lost hours (and years) of productivity, the burden on the healthcare system. Whichever way you slice it, one result has been considerable investment into cancer research.

Thousands of torches have been flung into cancer’s dark caves. As more space is lit up, more caves are revealed, typically connected to the cavernous depths of other areas of biology such as the cell cycle, genetics and the immune system. What will be the outcome of this oncological spelunking? Will we cure cancer and if so, what are the implications for society? We will come to these questions in due course, but it behoves me to first explain my role in all of this.

The link between the cytoskeletal protein tropomyosin and cancer is not obvious, but I hope to change this. The cytoskeleton is an extraordinary system of filaments and regulatory proteins tied up in a huge range of processes, including mitosis and muscle contraction. I study the cytoskeleton in neurons, which are great for this purpose because of their unique shape and easily identifiable compartments.

The cytoskeleton hasn’t always been appreciated. In my school days I was taught that the cell was a watery sac through which the molecules of life whizzed and spun. The cytoskeleton, if mentioned at all, was merely cellular scaffolding, a backdrop to more important events. This picture has changed dramatically. Today a more appropriate mental image is of responsive, rapidly remodelling networks and vast cellular superhighways, complete with exits and accidents.

We have known for some time that cancer cells possess an altered cytoskeleton. This may help them leave their site of origin and invade other tissues — a most malignant act. As a major component of the cytoskeleton, actin has been considered a logical target for chemotherapy. The problem is that all attempts to develop a viable anti-actin drug have been stifled by actin’s involvement in more biological processes than you can poke a filament at, including the life-sustaining contractile machinery of the heart and diaphragm.

This is where tropomyosin comes in. Most actin filaments in the body are not naked, but adorned with tropomyosin, itself a filament. Recent research suggests that tropomyosin is well placed to regulate the actin cytoskeleton throughout the whole body[1].

Thanks to the molecular card shuffling that is alternative splicing, there are over 40 different versions, or isoforms of tropomyosin! Different tropomyosin isoforms reside in different cellular locales, and appear able to regulate the access of a litany of other proteins to the all-important actin filament. A diminutive doorman, if you will. Perhaps most significantly, different actin filaments are decorated with different tropomyosin isoforms.

The upshot of this is that we could disrupt specific (non-essential) populations of actin by directing chemotherapeutics against the tropomyosin isoforms which clothe them, rather than actin itself. Right now, more needs to be learnt about the localisation and function of different tropomyosin isoforms, which is how I busy myself. The ultimate goal of my research is an effective cancer treatment and a greater understanding of the cytoskeleton.

But what about preventing cancer, rendering treatment unnecessary? Might we upregulate DNA-repair enzymes, reducing mutation and with it the grist for evolution’s mill? Perhaps then we could truly say goodbye to cancer as a life-threatening condition. Before popping our champagne corks, we would do well to remember that as (currently) mortal beings inextricably connected to our environment, the war against illness and disease is perpetually waged but never won.

Before wading into the opaque waters of philosophy, I will end in a fashion increasingly required of scientists; a practical one. It is simply our duty to do what we can to reduce extremes of pain and suffering in our fellow human beings. And that is what I’m trying to do.

[1] Gunning, P. W., et al. (2005). Tropomyosin isoforms: divining rods for actin cytoskeleton function. Trends Cell Biol 15(6): 333-41.

An award-competing entry

This is another item from the vault, something I wrote in the attempt to win an essay contest that the Global Forum for Health Research was running around the middle of 2006. The theme was 'combating disease and promoting health'. Sadly, I didn't win. In retrospect it's a bit clunky, and could perhaps have been dressed up a bit better. Still, it's a decent read and I stand by the points I made. I like to think if I'd said I was from a developing country I'd have won pants down. Perhaps this all served me right for prostituting my goddess-given writing ability in the pursuit of glory and gold.

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Rethinking Health Promotion

In the debate on how to promote health, I can think of no better starting point than to define what it is we actually mean by health. According to the Collins Concise Dictionary, health is:

“The state of being bodily and mentally vigorous and free from disease”

I would like to use this definition as the basis for a discussion of what it would really mean to promote the health of all people around the world today.

The first part of this definition is noncontroversial, obvious even. Good health means good physical health — the absence of bumps and bruises, aches and pains, stresses and strains. The second component, mental vitality, is far too often neglected. Indeed it appears that little more than lip service is paid to the notion of promoting mental health. The final term in our dictionary definition of health, freedom from disease, is also not as clear-cut as it may seem, as will be discussed further below.

As a society we do far too little to promote mental health. How can I justify this serious claim? For starters, how can you promote mental health when there is no consensus on what it is! Is it happiness? Peace of mind? A state of grace? Or is it merely the absence of illness? We seem to be quite good at defining mental illness. Not only do we think we know what it is, we keep adding to the list. There are a myriad medical manuals devoted to documenting and reifying all sorts of mental maladies. Incidentally, there are clear conflicts of interests in the writing of these manuals. Sheldon Krimsky, of Tufts University, has found that contributors to the widely used Diagnostic & Statistical Manual IV often have financial ties with companies selling treatments for these disorders. Where are the manuals for mental health?

To be fair, mental health is not much different from physical health in this respect. The majority of medical science proceeds by focusing on illness, rather than health. Over the years this has been a remarkably fruitful strategy, and it still has its place. Yet any researcher will tell you we are still a long way from a complete understanding of even ‘simple’ organisms. As controversial scientist Craig Venter eloquently put it, “We don’t know shit”. In the mental sphere we are even more in the dark (despite regular sensational reports to the contrary in the science media). If we want to take health to another level, both physically and mentally, sooner or later we must shift our focus from illness to wellbeing.

Of course, it is a luxury to ponder questions that must seem terribly remote to those in the midst of acute physical and mental trauma. Shouldn’t we be tackling these problems first? Sadly, our record of public and private support for mental illness is woeful. It is in areas of treatment and community support, rather than research, that we really let ourselves – and I do mean ourselves - down. While the main sufferers of mental illness are the afflicted themselves, society also bears the burden of mental illness gone undetected, untreated and effectively punished. Amongst the homeless, the incarcerated and the lower rungs of society the mentally sick are overrepresented. This last point may be no coincidence. Michael Marmot, of University College London, has found evidence to suggest a relationship between inequality and poor physical and mental health.

Yet along with the luxury to think about these things comes the responsibility to think big. Returning to the question of mental health promotion, what we need are some indicators of mental health. What about happiness? For all the material advances of certain countries, there is no evidence that people living in these countries are any happier than they were in the past. Not only this, but are they any happier than people living in different countries? This is no excuse for maintaining the disgraceful discrepancies between the haves and have nots, both within and between countries. It simply demonstrates that, above a certain baseline, there is no clear link between income and happiness.

And happiness is but one measure of mental health. What about a sense of belonging, the opportunity to fulfil one’s potential (in other words self-actualisation), a connection with the natural environment, mental stimulation, a feeling of control over one’s life? I suspect that the reader could contribute many items to a checklist of mental health indicators. You get an idea of how neglected this area is by the amount of questions it raises. What sorts of employers create a workplace that promotes mental health? What sorts of communities contain mentally healthy people? What sorts of environments are good for your mental health?

Moving away from the mental realm, we are closer to knowing the kinds of things that promote physical health. Diet is obviously important. So is some sort of regular exercise, although I suspect it would be more beneficial if it were integrated into our lives rather than slotted in twice a week between morning and afternoon meetings. Don’t be surprised if you are soon told which genes you need to be healthy, thanks to the massive investments being made into identifying genetic markers of disease. One problem with focusing on the genetic basis of disease, as David Suzuki has pointed out, is that it can shift the burden of responsibility onto the individual, rather than the firms which create hazardous work environments or emit pollutants, and the governments which regulate them. We would benefit by diverting some of our resources towards understanding these controllable environmental factors.

The last part of the dictionary definition of health is freedom from disease. While we are diverting resources, we would do well to remember that millions of people suffer from entirely preventable illnesses. We could make a huge dent in these very quickly by dramatically increasing funding targeted to those most at risk. Rather than detailing grim statistics on life expectancy, infant mortality and malnourishment, I would make two points, both of which apply locally and globally. Firstly, we must judge ourselves by how we treat those who are least well off. Secondly, acting is not a matter of charity, but obligation.

Can we all eventually be free from disease? This sounds like a reasonable request at first blush. Indeed it is the implicit underpinning of medical science. But on closer inspection, disease is a blurry concept (as are most useful concepts, by the way). There is a continuum from the obvious (eg HIV) to the mostly obvious (cancer is a disease, but it shares its lifeblood – mutation – with evolution), to the conditional (sickle cell anaemia arises from the trade-off between healthy blood cells and malaria resistance), to the ambiguous (eg a slightly less effective version of some metabolic enzyme). As with mental illness, it is in the interests of some to have the broadest possible definition of disease. If we take this to its logical conclusion, we reach what I call Clarke’s Principle: there is a disease phenotype for every genotype. In other words, if you look hard enough, you’ll find in every single person some inherited deficiency with respect to the majority of the population.

In this technical sense, none of us are or ever will be free from disease. It is a statistical impossibility, unless we all become clones of one another. In the case of more clear-cut diseases, can we realistically evade them completely? In nature the battle against illness and disease is perpetually waged but never won. Gains in one generation are lost in the next. The vanquishing of one illness merely paves the way for another. We cannot use this as an excuse not to act in the face of people dying preventable deaths. But even this is not so straightforward. How far do we go to prevent a centenarian from dying? Researchers are now openly discussing the possibility that we may never die. Is this the sort of health we want to promote? How will this affect the environment? Our children? I suspect that before we reach immortality something will cut us down a notch, not because I am a doomsayer but because I see no reason to exempt us from the sort of cyclical fluctuations of boom and bust that beset other species.

In conclusion, if we are serious about health promotion there are several things we can do as individuals and as a society. We must address inequality in access to healthcare. We must take mental illness seriously. But it is not enough to fire disease; we must promote health. As a corollary, we must define health in terms of more than just the absence of illness. Lastly, we should not confuse standard of living with quality of life. One has been rising in some countries for decades, but it appears to have completely detached from the other. Few would argue that good health is a prerequisite to a reasonable quality of life. Let’s make our society reflect this.

Fire in the belly

As I was conducting one of my occasional vain trawls through my hard drive looking at things I've written over the years, I came across this piece from late 2006. It's part of I reckon around 50% of files that haven't made it onto Artful Science or Hammertime's Brog. If you just take science related writings into account, it's more like 90% that haven't made it onto this here blog.

It pleases me that not everything I've written is on one of my blogs. It seems kind of weird to pour everything into those (these) two vessels, kind of like putting all my eggs in one basket. Won't, one day when I get discovered, I want to have items that haven't made it into the public domain? (But hang on, haven't only two people ever read this blog? And didn't they each only read one post, leaving 89% of the blog unread? I really need to build up my readership. At the moment it's a reader flotsam or jetsam) Then I thought of a humourous part from Vicki Cristina Barcelona, where Javier Bardem's poet dad refuses to publish his writing because he hates the world and wants to deprive them of beauty. At the end of the day we can probably file this dilemma under the already overcrowded heading "Things I think too much about".

I wrote this piece in response to an article by Martina Newell-McGloughlin spruiking the benefits of biotechnology and defending it against its critics. While it isn't exactly the kind of writing I envisioned ending up on the blog, I am strangely proud of it, belligerence, earnestness, profanity and all. And in the absence of any regular creative sciwriting spark, I might as well put the dang thing up. Stay tuned for a few more golden oldies from the C drive.

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Response to “Green genes” (Cosmos Issue 12, p112)

If you want to understand Martina Newell-McGloughlin’s argument, you could do worse than starting with the following comment. I want to be fair to Newell-McGloughlin, so I’ll let her speak for herself.

“Biotechnology has the potential to … improve the volume and quality of food, feed, fibre and biofuels; reduce agriculture’s dependency on chemicals and fossil fuels; diminish overcultivation and erosion; and lower the cost of raw materials – all in an environmentally sustainable manner.”

When put like this, it’s hard to argue. If we are to proceed rationally, we must embrace biotechnology. It almost seems unfair to the world’s suffering to deprive them of this hope. Just like it would be unfair to the world’s poor students to deprive them of untested immune drugs that lead to horrific side effects.

David Suzuki has often pointed out that biotechnology proponents promise the earth. Even the apparently impressive figures quoted by Newell-McGloughlin don’t bear a great deal of scrutiny. Take a step back. If someone tells you that they can solve the world’s problems, and has been telling you this for the last – oh, ten years, and the problems haven’t even come close to being solved… My friend, you see them for what they are. Cranks suffering from delusions of grandeur, with difficulty perceiving their environment accurately.

“Trust me, trust me. I’m a scientist.” This is one of the arguments they like to deliver. There is a distinct lack of humility in these men and women.

I’d like the reader to imagine a day when the great biotech companies are in full stride. When they get what they want. Making billion dollar quarterly profits, products with a worldwide reach. And the clout that comes with money. Power, in other words. We’ll start seeing mergers and acquisitions. Smaller players will get bought out. Do you really think the world’s problems will be solved? Will the poor be fed? Definitely – those that can afford it, anyway.

Are banks with $4b profits making the world a better place? Fuck no.

A considerable problem with Newell-McGloughlin’s opinion is that it is one-sided. Does the author not see any problems with biotechnology, or are they for us to gather elsewhere? From sources the biotech camp has discredited? Can we have a comment from someone without vested interests? Perhaps not, but we can at least pretend to be ‘fair and balanced’. At least pay lip service to counterarguments. Well, let’s see if I can.

Gene technology is amazing. We are learning so much about genes, cells, organisms, environments. It seems we will be able to do so much. Make the hungry full. Make the sad happy. Make the flaccid erect. Make the weak assertive. The feeder of people faces certain fundamental problems wherever they may be. Produce enough food, of enough nutritional value, with as little impact on the environment as possible so as to allow future repetition of the process. There are many ways of reaching this end, and gene technology is one. But it is not the only one, it is not the cheapest one, it is not the safest one, it is not the most effective one, it is not the most efficient one (funny how efficiency’s a virtue and effectiveness isn’t any more) and it is not the most rational one. But it is one.

This kind of reasoning presented in the opinion piece is eerily reminiscent of the way some drugs are presented. We find out a lot about the benefits (essentially it does something, although whether it’s good for you, better than competitors, alternatives, or doing nothing is murky), nothing about the problems. What we need is information about the whole situation, not just the efficacy of one option. We cannot judge the situation without knowing alternatives.

Could there be other ways of feeding people? What about us fatties in the west eat a little less? I forgot, these same companies will solve that problem by letting us eat what we want, and decreasing our set point weight at the drop of a tabsule.

Could there be other ways of reducing emissions? How much energy goes into running laboratories?

Is it really ‘status quo’ versus GM alone? Newell-McGoughlin seems to think so. What the hell’s the status quo anyway?

Are there other avenues of action available to us?

Of course there are. It is our job as a society to think of these alternatives, and to foster the conditions which will lead to creativity. Capitalism is supposed to be creative, but it either isn’t, or what we have isn’t capitalism. Too often the monopoly, the duopoly. The perversion of market forces. The stifling of creativity. It’s quite funny to see leaders, officials, sensible people happily declaring the inevitability of the way society is run. The inevitability of globalism. Of market forces.

An idea doesn’t deserve to exist if it doesn’t make money. This is a wise and useful way to face the future. If we want to go extinct.

It’s a problem JR Saul has noted. When society is made up of interest groups – industry, government departments, non profit organisations, it doesn’t matter – they will fight for their interest, at the expense of other interests. It’s an exciting game, but I wouldn’t want my quality of life to be decided by the outcome of this game. The cards are stacked, even if it is the only game in town.

As mentioned above, Newell-McGoughlin invokes some impressive numbers in biotechnology’s defense. Quoting research just doesn’t carry the weight that it used to. People can quote statistics to justify many ends – in this case the positioning of biotechnology as saviour, without which society will founder. Do these people seriously believe this themselves? Are they surprised when their predictions do not come true? I suppose not, because they can point to statistics like a net farm income increase of $35.5 billion since GM crops were allowed.

Of course this (increase in net income) is the ultimate end which cannot be questioned. More money has been made by farm. Therefore biotechnology is goooood. QED. GDP increases when biotech PR people pollute the airwaves with their ‘information’. Seems like a sensible enough measure of the functioning of society.

It’s kind of like the way technocrats justify their existence and their miserable theories. IMF dude fishes around for some statistics that back her argument up. You’ll always find something. It’s basically how government advertising works.

We are told that “GM may actually be beneficial for animals as well”, owing to the fact that less space will be taken by ‘us’ away from ‘them’. People who think we’ll save species from extinction by using GM crops are kidding themselves. The idea that we’ll feed a forever-growing human population at no cost to the environment is ridiculous. And it’s not really the intention of businescientists. If you care to ask around, people will tell you there is already enough food to feed people. It’s an oh so simple question of political will, one which we are a long fucking way from at the moment. These people make me sick. Let’s try a little honesty. We are out to make a buck and would like you to get off our fucking back, or even better, defend us against our critics.

Biotechnology can be used to extend the climatic conditions at which we can grow food. That’s a great idea – let’s colonise whatever remaining space there is on earth. India and China will need more space in the future. What about the West – if the rest were like the West, we’d need five earths. How is biotech saving our souls here?

I should add a disclaimer that I am not in principle against technological advance aiding and abetting the human race. I just think that agendas exist, and we are kidding ourselves if we don’t question them. Simple question: who benefits? Who pays?

And what’s the real aim? Is it to feed everyone, or develop technology that allows us to survive in the desert for forty days and forty nights on a single pill? If we actually aim to improve the quality of life for the many who do not enjoy much of it, we might consider putting our resources to other more direct efforts.

The final joke of the opinion piece is to equate those in favour of biotechnology as being ‘enlightened’. It’s either that or the strange equating of ‘science’ with biotechnology. Nuclear weapons are based on science. Does that mean we should start developing them?

Enlightened, to me, would mean something like people having control over their own development. It would mean GM companies losing some control over their product. Funny, they’ll sue you if a GM seed accidentally takes in your soil, but they won’t cough up if there are any adverse effects from the business. Which is exactly what it is. A business. Can you predict who’ll bear the cost?

That’s right. You. Us. The government. We the fucking people.
And you better believe they want control. Why have so many millions of dollars been invested in drafting the bizarre TRIPS? In case you didn’t realise, that’s MINE and you cannot use it unless you PAY ME money. That bug. That’s mine. That plasmid. That’s mine. You can have it in fifty years.

Newell-McGloughlin thinks that if we steer clear of genetically modified agriculture, we run risks. No shit. In case you hadn’t noticed, we’re running quite a few risks at the moment. If we hand over control to those few companies touting GM (which is pretty much the way academia operates these days – oh, I’ve found something cool, let’s convert public knowledge into private profit otherwise the public money will be wasted!), we’ll no doubt run few risks too. But to pretend that it’s GM or starve is seriously deceptive and the kind of fear mongering a politician would be proud of.

Of course, on some level people these days know well enough not to trust big business, the government or increasingly ‘experts’ with an education. But it’s that little bit harder to see the full picture when there’s so much damn emotive propaganda out there.

Am I questioning her credentials? Well, she is not industry, right? Well, websites proudly declare her expert ability to create links between academia and industry. And of course, there’s the little matter of her job and through it, her self-worth and security, depending in no small part on public acceptance of GM technology. None of this takes away from arguments that she makes, but I’ll be darned if finding out about someone’s background doesn’t help you discern their agendas.

Neonatal Vitamin K Injections

One thing I didn't think I'd be thinking about in the hours leading up to and immediately following the birth of my first child was whether or not to top up her fledgling baby body with Vitamin K (the biomolecule, not the recreational drug, as wikipedia so usefully disambiguates).

It is standard practice for Royal Prince Alfred Hospital in Sydney to provide this to newborn babies in their first hours outside the womb. The reasoning is as follows:
1) a tiny number* of babies have haemorrhagic disease of the newborn (HDN) a.k.a. vitamin k deficiency bleeding (VKDB). HDN can lead to brain haemorrhage or death in a small number of cases**
2) injecting babies with Vitamin K seems to prevent HDN
3) injecting babies with Vitamin K doesn't seem to do any harm to babies with or without HDN

On the surface of it then, there is no surprise that the Overlords of Australian Medicine decree that all babies should receive Vitamin K.

Yet when my wife and I decided that we'd like to dig a little deeper, we had no idea of the many and varied issues that lurk behind this seemingly simple and noncontroversial medical intervention.

These and other thoughts floated through mine and my wife's head
- what is the evidence, where do you get it and how do you weigh it up? are there any side effects to getting Vitamin K and what is the risk? How do they stack up with the same parameters for HDN?
- who do you trust - science? scientists? science as interpreted by public health authorities? dissenting opinions?
- public information on early childhood medical interventions is rather scanty
- somewhere (actually manywheres) out there lies the "hidden truth"
- the internet-facilitated self-education of the general public on health matters and others
- what the dickens is medical intervention all about? eradication of death? betterment of life? when is too much and when is not enough?
- what madness lies behind the word "management"? as in medical or business or natural resources management?
- why don't babies have Vitamin K if they need it so badly? Could there be (unknown) reasons babies have a low amount of Vitamin K? (nb I've seen 6 weeks and 6 months quoted as the time by which a baby builds up its own sufficient stores of Vitamin K). A study on rats by Israeli scientists tantalisingly suggests that low neonatal Vitamin K levels may be beneficial (especially if your mother's a smoker)
- the power of language e.g. VKDB assumes that no Vitamin K is the problem - as though that is the only way to cure HDN - presumably there are many other steps in the cascade of clotting events where intervention could be successful. By analogy, we could call headaches Panadol Deficiency Cranial Aches
- should we inject the Vitamin K (once, in the thigh muscle) or should we administer it orally (three doses, day 1, 6 and 28)? a study showed a link between intramuscular injections and childhood leukaemia - other studies have not. And how do we weigh up metadata (results from separate studies?)
- why the hell did we invest so much time investigating this 1 in 10,000 shot at badness, but not the myriad others that effect our lives and our baby's life? I now have in my possession a document outlining the causes of death in 0-17 year olds in NSW in 2006. Most are in the first 24 hours, and i didn't come across any due to HDN (or immunisation, or the diseases against which we immunise...). There are so many numbers out there, and who's going to analyse them?

The more you look into some things, the murkier they get.

I'd like to say we weighed up all the evidence carefully - the scientific papers, the medical brochures, the midwife run forums, the numbers... But a fair dose of emotion came into it - not that there's anything wrong with that! We came close to saying no - when the risk is so low, why intervene? We have no reason to suspect our bubba's at risk...

We chickened out in the end - what fools we'd look if little infant bled and bled and we'd done nothing! Funny how it comes down to fear - a friend once said fear is the underlying principle of society. It's just like insurance I guess. We plumped for the oral dose (why stick a needle into poor bubby's leg, plus a trace of cancer fear perhaps).

I wonder how many other parents have gone through something similar? At least a few, I'd suggest.

* the figure bandied about is 1 in 10,000, I have no idea on which population or at what time this number is based
** 1/2 and 1/5 of HDN cases respectively, again I haven't source the numbers