A doctor’s touch September 30, 2011
Posted by Cameron Shelley in : STV202 , comments closedIn a recent TED video, Abraham Verghese discusses how computerization of medicine has distanced doctors from their patients. Whereas physical examination of patients was a standard part of medical practice, examinations now often focus on ordering tests, such as CAT scans, that can be examined on a computer. Conceding the informativeness of such tests, Verghese laments the damage they do to the doctor-patient relationship as he sees it. Doctors focus more on treating the “iPatient”, that is, the problem presented through a computerized representation of the patient, instead of the physical patient. The patient loses the sense of being cared for as a person and the doctor loses the opportunity to offer such care.
(Mcjudy/Wikimedia Commons)
Many people, I suspect, can sympathize with Dr. Verghese’s perspective. It is true that medical care, particularly for patients with complex or serious conditions, can seem like a serious of encounters with various, computerized diagnostic machines; not a particularly warm experience. It is true that we have traded off some of the personal qualities of patient care in exchange for increased effectiveness of treatment, and the opportunity to offer treatment on a large scale to more people. Indeed, this issue has been discussed before in this blog. As I noted earlier, it is not necessary for computerized medical technology to distance doctors from patients. For example, perhaps a computerized medical record system could require doctors to enter information obtained from a physical exam.
Part of the problem is that the design of medical equipment reflects the organization of industrial innovation, and the priorities of the public health system. On the first point, doctors like Verghese are often not involved in the development of diagnostic technology. Instead, engineers and programmers are given the job. A doctor might be engaged after a prototype has been created, after the design of the equipment has largely been set. It is not a mistake for engineers and programmers to do this sort of work. However, leaving until last consideration of how the equipment will affect doctor-patient interactions will likely lead to a less than wholly satisfactory result.
On the second point, medical technology is designed to provide health care at a low cost to as many people as possible. So, again, the effect that it might have on individual relations between doctor and patient do not naturally enter into the picture until it is too late. Also, the people who acquire such equipment for hospitals, for example, may be administrators without much experience in giving clinical care. As a result, they are not in a position to judge medical equipment based on how it mediates doctor-patient interactions.
In short, although Dr. Verghese makes a moving case for bringing back emphasis on physical examinations, I think that it does little good to plead the case to doctors. I would guess that many doctors would enjoy having the opportunity to interact appropriately with patients. However, that is not a priority for health administrators nor equipment designers. Those priorities need to change if the problem that Dr. Verghese highlights for us is to be addressed.
2011 Hagey Lecture: Ian Hacking September 26, 2011
Posted by Scott Campbell in : Events , comments closedThis year’s Hagey Lecture looks particularly interesting and relevant to CSTV. Ian Hacking is one of Canada’s foremost interdisciplinary philosophers and his talks deservedly fill rooms and lecture halls. I’d strongly recommend STV students and those with similar interests go see him at one of his talks next week!
How Did Mathematics Become Possible?
Presented by Dr. Ian Hacking, an Emeritus University Professor at the University of Toronto.
Monday, October 3, 2011 at 8:00pm
Humanities Theatre, Hagey HallAbout the Lecture
How come human beings can do mathematics? The question involves, among so many other things, capacities that have, presumably, arisen through natural selection, and discoveries of how to use those capacities, discoveries made at particular times and places in human history. We should see both as part of a broader series of questions about how this organism, on a planet like Earth, was able to become a mathematical animal, probably the only one in the universe.
At present we have only fragments of an understanding, drawn from recent cognitive science, the history of early mathematics, social studies of science, and what has been called the archaeology of mind—of how fashioning artifacts has changed the human mind itself. It is a matter of hands, minds, brain, communities, and much else about ourselves. The lecture aims less at “building bridges” between these different kinds of inquiry, than at highlighting how much we are learning right now, and how little we know.
About Professor Hacking
Ian Hacking is regarded as a leading scholar in the history and philosophy of science, although his work has touched fields as diverse as statistical inference and the emergence of multiple personality disorder. His contributions have earned many awards, including the Killam Prize for Humanities and an appointment to the Order of Canada.
Professor Hacking completed a B.A. in Mathematics and Physics from the University of British Columbia and a B.A. in Moral Sciences from Cambridge University, where he subsequently received both his M.A. and Ph.D. degrees. The scope of Professor Hacking’s academic interests is enormously broad, and his work has helped to provide a sense of the fundamental issues that unite discrete disciplines. Atrue bridge-builder, he is unequalled in his ability to connect with historians, philosophers, psychologists, logicians, scientists and sociologists across the globe. His work spans the philosophy of science, the philosophy of language, the theory of probability and statistical inference, and the socio-historical examination of the rise and fall of disciplines and theories.
Student Colloquia on Tuesday, October 4
Numbers and race: “Don’t ask for the reference (bedeutung), ask for the use.”
1-2:30 p.m. » HH 334
The 20th century Pythagoras: why did P.A.M. Dirac conjecture that the universe is a single very large integer?
3:30-5 p.m. » MC 5158
Nailed ‘em! September 21, 2011
Posted by Cameron Shelley in : STV203 , comments closedScienceDaily.com reports on some genetic research about obtaining human DNA sample from dead deer. The aim of the research has been to look for the DNA of hunters left on the dismembered body parts of their quarry after processing. If such DNA could be isolated, then it might be possible to identify poachers, that is, people who kill deer without a license or out of season.
(Martin H./Wikimedia commons)
I imagine that isolating human DNA reliably from a deer carcass is quite a feat. However, I foresee some further, non-technical obstacles to its application in the justice system.
First, in order to identify someone from a DNA sample, you need a database of people’s DNA to match the sample against. Like many countries, Britain has a national DNA database, with samples obtained from nearly anyone arrested (but not necessarily convicted) of a criminal offense. Using a large database of this sort will tend to increase the sensitivity of the test, that is, the likelihood of obtaining a match if the poacher’s DNA is in the database. However, it also increases the likelihood of a false positive, that is, obtaining a match with the DNA of someone who is not the poacher. Matching against a more specific database will reverse this tendency. The question becomes: What trade-off between missed matches and false accusations are you willing to live with? This issue is one for any forensic DNA database scheme.
Second, a DNA match would establish only that a given person’s DNA was present at the crime scene. The alleged offender could claim that he (or she) simply found the deer part already butchered by someone else. The fact that the person is a known poacher might only serve to make such a tale more plausible. Who else would be out in the woods handling bits of dead deer? Or, as Allan Jamieson points out, the accused could claim that his DNA was blown onto the crime scene from a distance. Perhaps a strand of his hair drifted on the wind during a walk in the woods and landed at the crime scene.
Far more convincing evidence of guilt would the old-fashioned kind where parts of an illicit deer are found in the possession of the accused. DNA evidence may suggest to police whose kitchen to search for such evidence. However, it would not serve to establish guilt on its own, as some readers of the article may infer.
Appropriate technology September 15, 2011
Posted by Cameron Shelley in : STV202 , comments closedAppropriate technology, roughly speaking, refers to the art and science of designing things that fit with the context in which they will be used. The problems of appropriate technology can be especially acute where transfer of technology between the developed and developing world is concerned. In this recent BBC article, for example, it is noted that, according to the World Health Organization, three quarters of medical devices sent by developed nations to developing ones remain unused. A common reason is that the design of the devices is not appropriate for their new home.
One example cited is the use of infrared sensors on hospital taps in sub-Saharan hospitals. Although there are obvious advantages to such taps, the fact that they are uncommon and unfamiliar means that they are unlikely to be repairable once they malfunction. Remarks Professor Chris Lavy:
“Within a year most of them had failed, some of them in the off position, and some of them in the on position.”
An interesting example of an appropriate design described in the article is a stethoscope that can be plugged in to a cell phone. In that way, a doctor can monitor the health status of patients who are in remote or otherwise hard-to-reach locations. This design makes some sense as uptake of cell phones in sub-Saharan Africa has been intense, rendering communication by cell phone much easier, in some ways, than communication by road or rail.
(Lidor/Flickr.com)
The article correctly notes that this design is not an example of low-tech. That is, it represents a true innovation instead of a borrowing from earlier forms of western technology. Indeed, many patients in the developed world might benefit from the introduction of such a design there.
As a footnote, let me be clear that there is nothing wrong with borrowing from earlier forms of technological development. As this FastCompany article notes, the use of flywheels as a means of temporary energy storage is being re-introduced into US transit systems. Although, in the age of hi-tech batteries, a flywheel might appear to be like something from a Flintstones cartoon, the approach has the advantages of being relatively simple, effective, and well understood.
Perhaps the lesson here is that a mature design perspective is one that does not confuse appropriateness or innovation with cleverness or novelty.
Biotechnology, motherhood, and maternity leave September 7, 2011
Posted by Cameron Shelley in : STV203 , comments closedABCNews reports on the interesting case of a mother, Kara Krill, who has been denied maternity leave by her employer, Cubist Pharmaceuticals, on the grounds that her baby was delivered by a surrogate mother. That is, artificial techniques were used to fuse her husband’s sperm with ova (the article does not say whose) so that another women could carry the resulting embryos to term. The result was the birth of twins. Her employer granted her five days paid leave, the same that is granted as paternity leave for new fathers. She was denied maternity leave, which would be 13 weeks of paid leave, which she enjoyed after she gave birth to her first child in 2007.
To begin with, this case presents another illustration of how biotechnology challenges traditional, biological categories. Before fertility treatments came along, deciding on who was a mother was straightforward (with the significant exception of adopted parenthood, I grant you). Nowadays, a woman can be a biological mother without having been pregnant.
More interesting here is the issue of fairness. Kara claims that her treatment was unfair by way of, among other things, discrimination. Kara was unable to get pregnant again because she suffers from Asherman’s Syndrome, a condition that arose after she had her first child. Here is a quotation from her complaint to Cubist:
“As we have previously informed you, the children being born are mine and were conceived with my husband. They are only being carried by [a gestational carrier] as a result of my physical disability. … Cubist’s treatment of me differently than other employees having babies is not fair and is placing me in an untenable condition,” she wrote, according to court documents. “But for my physical disability, I would be receiving the paid maternity leave offered by Cubist. Accommodating my disability would not require [Cubist] to provide me with any more benefit than other mothers.”
In brief, as a mother, Kara is entitled to the same benefits as other mothers. For Cubist to deny her that entitlement is a violation of her contractual right and is therefore unfair.
In some ways, this way of the putting the claim is confusing. The article provides no support for her claim that Cubist targets people with Asherman’s Syndrome for exceptional treatment, nor does that sound likely. Neither do they deny that she is the mother of the twins carried by the surrogate. Kara’s lawyer claims that Cubist has something against people whose children are born via surrogates, although there is no evidence of this in the article either. Also, it is unclear that Cubist denied her claim in order to exploit her, that is, merely to save some money or get more work out of Kara than they would otherwise.
Instead, the claim of fairness revolves around what maternity leave is for. Two objectives are mentioned in the article:
- to recuperate from pregnancy and birth; and
- to bond with the new children.
It appears that the position of Cubist is that since Kara was not pregnant and did not give birth, then she does not need to recuperate. Thus, she needs only the lesser leave granted to new fathers for the purpose of allowing them to bond with their new children. As law professor June Carbone adds, Cubist could also turn the argument around: Providing full maternity leave solely for the purpose of bonding would discriminate against fathers, who have the same need but receive a much lesser benefit.
Of course, it could be argued that the needs of bonding are different for mothers and fathers, which is the position of Gaia Bernstein, another law professor:
“The purpose of a maternity leave is not just to enable the mother to recuperate from giving birth but to enable her to bond with the baby,” Bernstein said. “This is even more important for a mother who did not bond through pregnancy.”
The article does not indicate why the need of the latter mothers is greater, although it could be true.
Another factor may be at play here. In addition to recuperation and bonding, another purpose of maternity leave might be to honour motherhood. Motherhood can be viewed as a kind of achievement that is recognized by society with a specific title, “Mother”, economic benefits like a “baby bonus”, special parking spaces, early entry onto commercial flights, and so on. By denying her full maternity leave, Cubist could be viewed as, in effect, trying to discount Kara’s status as a mom.
So, this case illustrates some interesting problems that arise from new biotechnologies. Most interesting to me is what it reveals about how technologies raise issues of fairness. In some cases, technology can facilitate discrimination against certain groups. In this case, however, fairness arises through challenging our received notions of what some social institutions, such as maternity leave, are actually for in the first place.
Reminder: STV404 New course for Fall 2011 September 6, 2011
Posted by Scott Campbell in : Announcements, STV404 , comments closedWhen you see the phrase “Made in Canada”, what does that tell you about a technology? Are there particular or peculiar characteristics that make a technology somehow “Canadian”? Does it matter who invented it or who uses it? Where it’s made, or where it is used? Does it look, feel, act, or smell “Canadian”? Do the technologies have to be objects or can they be processes or something else? How should we understand technologies that seem indelibly connected to the Canadian national dreams, mythology, identity, culture or sports? In a similar vein, what have Canadians thought about technology? These questions, and more, will be addressed in the new course for Fall 2011, STV 404: Technology in Canadian Society.
Enrolment is open right now for students in any faculty (engineering students should note that STV404 is a List A and List C course for the Complementary Studies Electives). Interested students who don’t meet the immediate prerequisites (any previous STV course), should still contact the instructor, Dr. Scott Campbell, to discuss the course.
The “aware” car September 6, 2011
Posted by Cameron Shelley in : STV202 , comments closedHere is an interesting segment from PBS about the development of the “aware” car at the MIT AgeLab. Researchers at the Lab are developing a system that monitors drivers for signs of distraction, impairment, etc. in case some intervention is needed for safety reasons. The emphasis is on problems that might arise with senior drivers, whose capacities may be reduced by age, impaired by medications, and so on.
Prof. Coughlin points out that this project is an urgent one, given the wave of baby boomers now entering retirement and old age. Both men and women in this cohort will probably expect to drive longer and maintain their independence, in an environment where alternatives such as public transportation are not always or widely available. So, to protect drivers and the public, and to delay institutionalization of seniors, rapid introduction of monitoring systems is appropriate. Plus, as Prof. Coughlin also points out, baby boomers are precisely the group that will be able to afford all this expensive new gear.
All of these points are correct but the conclusion that increased safety and longevity will ensue is not assured. Consider the now well-known story of ABS brakes. Decades were spent developing braking systems for cars that would help prevent skidding and loss of control for the purpose of increasing driver safety. However, the increase in safety did not materialize as expected. The reasons are controversial but may include the phenomenon of risk compensation (previously mentioned here), the tendency of people to respond to perceived increases in safety, perhaps induced by the presence of safety gear, by increasing the riskiness of their behavior.
So, we cannot know that new safety systems, however technically proficient, will increase actual safety without knowing how seniors will respond to their presence. Perhaps their driving habits will remain unchanged and the new systems will steer them clear of accidents or wake them up when they fall asleep at the wheel. Or, seniors may respond to these systems by driving more aggressively and even when they feel tired, thus negating the effects of the new gear. If the project proceeds apace, as Prof. Coughlin suggests it will, we may start to find out soon.
