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How do we know whether screening for something like cervical cancer is effective at saving women's lives? Two ongoing studies conducted in India (one funded by the National Cancer Institute and the other by The Gates Foundation) are aimed at answering that question — but their methods are under fire by critics.
It works like this. Say you want to test the effectiveness of a new screening method. You recruit a large group of women and you split them into two groups. One group gets the screening regularly. The other, the control group, doesn't get the screening. Then you follow them over time and track how many women in both groups died of cancer. That's a pretty basic scientific method. It's also something that prompts big questions about the treatment of women in the control group.
The people conducting the study say women in the control group were told they could seek out screening on their own. Critics argue that point (and the way the study worked) wasn't clearly explained, and that those alterante options weren't as available to the women as researchers imply. The majority of the women participating in the studies are poor and have very little formal education.
There are some important differences between this and the infamous Tuskegee syphilis experiment. In that case, researchers identified men with syphilis and neither told them about their disease nor offered them treatment — just monitored the deadly disease's progress. Here, there's clearly an attempt (however poorly executed) at being open with the women about what the study is and what is being done. And nobody is intentionally trying to prevent sick women from being treated. But the study definitely exists in an uncomfortable space and could reasonably be called unethical. Is it ever okay to not screen people for a disease that are pretty sure some of them have? If not, how do we figure out whether potentially life-saving screening methods are actually useful? How do you do statistics ethically when people are the numbers? I don't have good answers for these questions.
Here's what we do know. There are 76,000 women enrolled in the National Cancer Institute study, and another 31,000 in The Gates Foundation study. So far, they've been tracked for 12 years and at least 79 of the women in the control groups have died of cervical cancer.
Last year, I wrote a piece for BoingBoing about destructive storm systems and why it's so difficult to say, in concise sound-bite form, what relationship that destruction has to climate change. In that case, we were talking about tornadoes. But over the last couple of days, lots of people have been having roughly the same conversations about Hurricane Sandy. When the clouds have passed and everybody is done sleeping in airports, people are going to want answers. Was this an unavoidable act of nature? Or was this something caused directly by changes to Earth's climate that have happened because we burn fossil fuels which increase the concentration of carbon dioxide in the atmosphere?
Again, there's not an easy answer. And, again, part of the problem here is that we're expecting science to operate on the scale of American media news cycles, which doesn't really work. We want to talk about this while the storm is raging or, barring that, at least immediately afterwards. But scientists aren't really going to have anything particularly deep to say about this specific storm for months, if not years. During that time, data will be analyzed and compared, and other events will happen, and that's really the stuff that we need in order to say much of anything other than, "We don't know for certain." In some ways, expecting anything else means forcing scientists to speculate and extrapolate in ways they aren't usually comfortable with and that aren't a terribly great way to understand the big picture.
But there's also something new, that I kind of didn't really think about when I was writing that post on the tornadoes. The answer to these questions also really depends on the motivations behind why you asked, and what it is that you really want to know.
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Editorial note — Cow Week is a tongue-in-cheek look at risk analysis and why we fear the things we fear. It is inspired by the Discovery Channel's Shark Week, the popularity of which is largely driven by the public's fascination with and fear of sharks. Turns out, cows kill more people every year than sharks do. Each day, I will post about a cow-related death, and add to it some information about the bigger picture.
In 2009 and again in 2011, Welsh cattle joined forces to surround and kill women who were out walking their dogs on the outskirts of Cardiff. Apparently, cows really do not like it when you bring a dog around them. So, FYI on that. This story is from a survivor of the 2009 attack:
"I was slightly ahead when I saw the cows, they looked up and seemed curious and started to move towards us both," she said.
"They were coming in a semi-circular formation so I was heading towards the end so I could get away from them."
The next time she looked around Ms Hinchey appeared to be surrounded by the cows, she said.
One of things that made me post this particular story was the disconnect between the idealized image of a field full of docile cattle, happily grazing on grass ... and the truly creepy and threatening image presented in the quote above. I mean, it's like something from a Stephen King novel. Of course, I also don't have a lot of experience with cows in my personal, daily life. So my idealized image isn't based so much on what I think cows are actually like, but what I want them to be like. That's what really makes this image creepy for me. The cows are behaving ways that I don't imagine cows should behave.
People who spend their careers thinking critically about risk say disconnects like this can play a role in determining what we fear. Craig Cormick is the manager of public awareness and community engagement for the Australian Department of Innovation, Industry, Science and Research. Part of his job is understanding what technologies the public finds really risky and why. Last year, he spoke at the University of Michigan's Risk Science Center. The discussion touched on the way people in Western countries often assign more risk to food issues—and obsess about the possible risks of food more—than they do with other areas of their lives.
... we’ve never lived at a time and society when people are so far divorced from agricultural production, most people never get to see a farm, they have no idea how livestock is produced, no idea how food is produced and have a perception that it should all be natural, and it should be great and that would – ideally that would be marvelous but reality is that’s not how our food is produced. large agricultural production is the only way to feed the numbers of people we have and so there’s a romantic idealized view of what is good natural food as opposed to food that’s not and so when people perceive that you are tinkering with the food yes they have outrage and they have rage about this and when you have rage and fear together it’s a very-very dominant cocktail of emotions it’s very hard to turn around, very hard to turn around.
READ ALL OF COW WEEK
• Cow Kills Irish Pensioner
• Bull Kills Man, Follows Him Until Certain He Is Dead
• Angry cows vs. angry mothers
Paul Douglas is a Minneapolis/St.Paul meteorologist. Meteorologists don't study the same things as climate scientists—remember, weather and climate are different things—but Douglas is a meteorologist who has taken the time to look at research published by climate scientists and listen to their expertise. Combined with the patterns he's seen in weather, that information has led Douglas to accept that climate change is real, and that it's something we need to be addressing.
Paul Douglas is also a conservative. In a recent guest blog post on Climate Progress, he explains why climate isn't (or, anyway, shouldn't be) a matter of political identity. We'll get back to that, but first I want to call attention to a really great analogy that Douglas uses to explain weather, climate, and the relationship between the two.
You can’t point to any one weather extreme and say “that’s climate change”. But a warmer atmosphere loads the dice, increasing the potential for historic spikes in temperature and more frequent and bizarre weather extremes. You can’t prove that any one of Barry Bond’s 762 home runs was sparked by (alleged) steroid use. But it did increase his “base state,” raising the overall odds of hitting a home run.
Mr. Douglas, I'm going to be stealing that analogy. (Don't worry, I credit!)
A few weeks ago, I linked you to the introduction from my new book, Before the Lights Go Out, where I argue that there are reasons for people to care about energy, even if they don't believe in climate change—and that we need to use those points of overlap to start making energy changes that everyone can agree on, even if we all don't agree on why we're changing.
But there's another, related, idea, which Paul Douglas' essay gets right to the heart of. Just like there's more than one reason to care about energy, there's also more than one way to care about climate. Concern for the environment—and for the impact changes to the environment could have on us—is not a concept that can only be expressed in the terms of lefty environmentalism.
You and I can think about the environment in very different ways. We can have very different identities, and disagree on lots of cultural and political issues. All of those things can be true—and, yet, we can still come to the same, basic conclusions about climate, risk, and what must be done. Here's Douglas' perspective:
I’m a Christian, and I can’t understand how people who profess to love and follow God roll their eyes when the subject of climate change comes up. Actions have consequences. Were we really put here to plunder the Earth, no questions asked? Isn’t that the definition of greed? In the Bible, Luke 16:2 says, “Man has been appointed as a steward for the management of God’s property, and ultimately he will give account for his stewardship.” Future generations will hold us responsible for today’s decisions.
This concept—Creation Care—is something that I've summed up as, "Your heavenly father wants you clean up after yourself." It's not a message that is going to make sense to everybody. But it's an important message, nonetheless, because it has the potential to reach people who might not otherwise see a place for themselves at this table.
Too often, both liberals and conservatives approach climate change as something that is tangled up in a lot of lifestyle, political, and cultural choices it has nothing to do with. Those assumptions lead the right to feel like they can't accept the reality of climate change without rejecting every other part of their identities and belief systems. Those same assumptions lead the left to spend way too much time preaching to choir—while being confused about why people outside the congregation aren't responding to their message.
That's why essays like Douglas' are so important. We look at the world in different ways. We come by our values for different reasons. But even though we might take different paths, we can come to some of the same places. Let's respect that. And let's have those conversations. Climate change is about facts, not ideologies. It's about risks that affect everyone. We need to do a better job of discussing climate change in a way that makes this clear. And that means reaching out to people with language and perspectives that they can identify with.
Read more about energy, climate, and what we can do to make the message of climate science more universal in my book, Before the Lights Go Out.
Here are two myths you need to let go of:
The solution to high gas prices is more oil.
Climate change is something that happens to polar bears and people from Kiribati.
The truth is that fossil fuels are extremely useful and valuable. And, by their very nature, the supplies are limited. Likewise, climate change isn't just something that's going happen—it's already taking place, and you can see the effects in your own backyard.
Too often, I think, we talk about the risks of fossil fuel dependence and climate change in ways that make them seem abstract to the very people who use the most fossil fuels and create the most greenhouse gases. That's a problem. There are lots of reasons to care about energy. But I think that fossil fuel limits and climate change are the most pressing reasons. And I think it's incredibly important to discuss those very real risks in a way that actually feels very real.
This isn't about morality, or lifestyle choices, or maintaining populations of cute, fuzzy animals. (Or, rather, it's not just about those things.) Instead, we have to consider what will happen to us and how much money we will have to spend if we choose to do nothing to change the way we make and use energy.
Over at Scientific American, you can read an excerpt from my upcoming book, Before the Lights Go Out. In it, you'll read about the energy risks hanging over the Kansas City metro area—a place that, in many ways, resembles the places and lifestyles shared by a majority of Americans. You've probably never been to Merriam, Kansas. But you can look at Merriam and see what could happen in your hometown.
Merriam isn't a small town. There's nothing really recognizable as a small town central business district. Instead, Merriam's stores and offices are mostly concentrated along two major thoroughfares—Shawnee Mission Parkway and Johnson Drive. These wide, multilane roads are dotted with clusters of shopping centers and big box stores, like necklaces strung with fat pearls. The municipal building and the police station are a couple of nondescript offices that sit off the frontage of Shawnee Mission Parkway, on a ridge overlooking the Interstate. Nothing about that says, "Classic Americana."
Yet Merriam isn't a suburb, either—or an urban city. It's too dense to be the first and not dense enough to be the latter. Merriam has a mixture of house styles. Drive down one street, and you'll see a 1930s bungalow standing shoulder to shoulder with a spare little 1950s Cape Cod. Next to that, there's a 1980s split-level with windows on the front and the back but none on the sides. More than three generations of the American Dream are living here.
It's ironic that Merriam doesn't really fit any of the classic American paradigms, because, quite frankly, most of us have already left those paradigms behind. We talk about this country as if it's full of neatly defined small towns, big cities, and tidy suburbs. In reality, the places where we live are lot mushier than that. Merriam isn't the exception. Merriam is the rule.
A diagnosis of brain cancer is basically a death sentence. It's a terrible thing for anyone to deal with, and it's only made worse by all the uncertainty. Doctors don't really understand how brain cancer works very well. Beyond death, there's often not a lot that they can tell patients about what to expect—how the cancer will affect the brain, how fast it will spread, where it will spread to.
Eric Kostelich is one of the researchers who is trying to change that, by approaching the problem of brain cancer from a new angle. Kostelich is a mathematician. In particular, he's interested in how we can use math to better predict the behavior of complex and chaotic systems. Right now, this mostly means that he studies the weather. In fact, he's part of a team that developed a new algorithm for weather prediction, called the Local Ensemble Transform Kalman Filter. But Kostelich thinks that the LETKF could have applications outside the nightly news.
In a recent study, published December 21 in Biology Direct, he joined forces with cancer researchers, to see whether the statistical methods that make chaotic weather patterns more predictable could do the same thing for chaotic behavior in cancer cells. The results are promising. A couple of weeks ago, I spoke to Kostelich to find out more about the history of forecasting uncertainty, how algorithms like LETKF work, and what we might learn if we apply these systems to cancer.
Maggie Koerth-Baker: When you set out to apply the methods used to forecast the weather to cancer, why did you choose brain cancer?
Eric Kostelich: Partly it's because I had a family member with a brain tumor. The scientist in me got interested because these really are terrible tumors. Getting to know a number of clinicians, it seemed to me that new ideas, anything that could help people live a little better would be welcome.
Right now, I'm reading a book about why catastrophic technological failures happen and what, if anything, we can actually do about them. It's called Normal Accidents by Charles Perrow, a Yale sociologist.
I've not finished this book yet, but I've gotten far enough into it that I think I get Perrow's basic thesis. (People with more Perrow-reading experience, feel free to correct me, here.) Essentially, it's this: When there is inherent risk in using a technology, we try to build systems that take into account obvious, single-point failures and prevent them. The more single-point failures we try to prevent through system design, however, the more complex the systems become. Eventually, you have a system where the interactions between different fail-safes can, ironically, cause bigger failures that are harder to predict, and harder to spot as they're happening. Because of this, we have to make our decisions about technology from the position that we can never, truly, make technology risk-free.
I couldn't help think of Charles Perrow this morning, while reading Popular Mechanics' gripping account of what really happened on Air France 447, the jetliner that plunged into the Atlantic Ocean in the summer of 2009.
As writer Jeff Wise works his way through the transcript of the doomed plane's cockpit voice recorder, what we see, on the surface, looks like human error. Dumb pilots. But there's more going on than that. That's one of the other things I'm picking up from Perrow. What we call human error is often a mixture of simple mistakes, and the confusion inherent in working with complex systems.
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I've talked here before about how difficult it is to attribute any individual climactic catastrophe to climate change, particularly in the short term. Patterns and trends can be said to link to a rise in global temperature, which is linked to a rise in greenhouse gas concentrations in the atmosphere. But a heatwave, or a tornado, or a flood? How can you say which would have happened without a rising global temperature, and which wouldn't?
Some German researchers are trying to make that process a little easier, using a computer model and a whole lot of probability power. They published a paper about this method recently, using their system to estimate an 80% likelihood that the 2010 Russian heatwave was the result of climate change. Wired's Brandon Keim explains how the system works:
The new method, described by Rahmstorf and Potsdam geophysicist Dim Coumou in an Oct. 25 Proceedings of the National Academy of Sciences study, relies on a computational approach called Monte Carlo modeling. Named for that city’s famous casinos, it’s a tool for investigating tricky, probabilistic processes involving both defined and random influences: Make a model, run it enough times, and trends emerge.
“If you roll dice only once, it doesn’t tell you anything about probabilities,” said Rahmstorf. “Roll them 100,000 times, and afterwards I can say, on average, how many times I’ll roll a six.”
Rahmstorf and Comou’s “dice” were a simulation made from a century of average July temperatures in Moscow. These provided a baseline temperature trend. Parameters for random variability came from the extent to which each individual July was warmer or cooler than usual.
After running the simulation 100,000 times, “we could see how many times we got an extreme temperature like the one in 2010,” said Rahmstorf. After that, the researchers ran a simulation that didn’t include the warming trend, then compared the results.
“For every five new records observed in the last few years, one would happen without climate change. An additional four happen with climate change,” said Rahmstorf. “There’s an 80 percent probability” that climate change produced the Russian heat wave.