S'bu Zikode at Constitutional Court, May 14th 2009

Luckily work is so very busy, otherwise I’d get a free moment and be forced to dwell on the horrific fate of our friend S’bu and Raj’s Abahlali friends and colleagues.  Abahlali baseMjondolo is a shackdwellers movement in South Africa.  Our relationship with S’bu (who has lead the movement) has certainly broken any stereotypes I might have had about peoples movements, or people who live in shacks.  S’bu is a sophisticated thinker, a brilliant writer – and someone who’s been committed to the cause of the shackdwellers even after severe personal injury – he was picked up and beaten (quite randomly) by the Sydenham police last year.  Now, in this latest raid – apparently instigated by the ANC and supported by the police – they destroyed his house.  I’m hoping he, his wife and children are fine.  The settlement reports several deaths.  Although I speak of him, of course it’s the settlement that’s traumatized.  I think about a beautiful photograph in Raj’s upcoming book.  It’s a picture of Moses Mnewango pouring over council documents by candlelight in a shack, reading, studying, learning to support the fight to gain decent housing.  To move beyond the shack built on the slopes around a waste dump.  

I’ve been reading ‘The Lazarus Project’ by Alexsandaar Hemon.  Three stories intertwine – one from the turn of the 19th to 20th century, a jewish man, Lazarus, arrives at the door of a constable in Chicago and through a kind of misunderstanding is shot.  We learn about the context, the automatic slandering of the man as a ‘jewish anarchist’ and the targeting and harassment of his sister and broader community.  A second thread describes the horrors of the Bosnian/Serbian war, including the random killing of civilians and the more organized violence, as told by a photographer as he journeys back with the protagonist of the novel ‘to the homeland’, back to Sarajevo.  A sub-thread in the protagonists searching through records for the backstory to Lazarus reveals a pogrom in Moldovia.  The details of these take me back to 1984 in India.  And just when I finished the book I got a call from Raj about the Abahlali targeting and violence.  It’s very hard to wrap my head around how the proclivity to this kind of violence persists, how we can do such horrific things to each other. 

S’bu and Abahlali colleagues and friends are in the midst of a struggle.  There’s not much I can do.  Sign this petition if you know enough about the scenario that you feel comfortable in doing so.  The goal is to at least let the local ANC politicians and the police know that there’s a broad international community that knows what’s going down – they cannot keep perpetrating this violence and imagine they will go unnoticed.  It’s not much, but it’s a start.

Nothing - Nic; Photo by Jaroslaw Pocztarski

My Hero says:  My major hobby is teasing people who take themselves & the quality of their knowledge too seriously & those who don’t have the courage to sometimes say: I don’t know…”  I say, on this blog - “…goofiness is important, it reduces the probability of b.s.“   

Only difference is, I don’t think I’ve ever read anything by Nassim Nicholas Taleb, aka “Hero”, that suggests that moment of doubt, the moment of saying “I don’t know”.   And when I say I’m trying to reduce the chance of b.s., I’m first and foremost talking of reducing my own b.s.  I suspect that’s not Taleb’s starting point.  But I’m going to fantasize that on reading this he will crack a perfect joke, take himself down a notch, and remain My Hero.

In fact, my own viewpoint aligns with My Hero’s.  That is, an awareness of ‘not knowing’ is the right starting point for much analysis or action.  Unfortunately,  being told that one doesn’t know more than one knows can seriously disturb many a machismo and ego.

I’d like to interlace Disney & that 2002 web phenomenon “Hot-or-Not”, to illustrate.  With my own perverted sense of weekend relaxation, I spent one Saturday standing outside the downtown Disney store in the rain, holding posters of Winnie (leaking paint) and protesting the sacking of sweatshop employees in Disney’s factories in Bangladesh.  It was a a complicated case.  A contractor was found to have violated some labor laws in his subcontracted factory, so Disney peremptorily closed off the contract, resulting in all the employees losing their (already miserable) jobs.   

I had struggled with the case.  There were many complexities, not least of which was the contradiction between Disney following it’s ‘ethical’ guidelines to justify a move that resulted in real terms in even more damage to the workers than the initial violation.  Was it as simple as Disney giving itself a checkmark for following it’s ’socially responsible’ principles hoping that no one dug around to see that it’s scorecard in real terms had just gone even more negative?  Or should I be considering the corporate viewpoint, of the spirit “but what’s a good well-meaning company to do?”  Sarcasm aside, though, I do have some sense of how hard it is to toe the line of a principle you’ve set yourself especially as it’s ramifications play out in a complex society.  For example in this case, was it more important for the company to send a strong message to its’ other contractors, which in the longer run would be beneficial to workers everywhere? (Just for the sake of argument – I’m not assuming that this was truly Disney’s consideration – and there are in fact some much better alternatives).

After thinking about it, I decided that even though I couldn’t balance all the possible pieces of this puzzle to land on a comprehensively supportable course of action, I should still join my couple of friends to protest Disney.   My philosophy, that we generally operate with an incomplete understanding of all the factors at play especially for distant scenarios, was a starting point.  Against this backdrop, I felt it eminently sensible to put in a pitch with what what was likely the statistically underrepresented side  – the side of the sacked workers. 

There are many such situations where I feel that supporting the underrepresented side is justified, even if the scenario seems complex, when the impact may be severe along the axes of health, food, shelter.  Disney didn’t need my help at all.  By being silent, I was in effect supporting Disney, not the workers.  Somewhere someone would adjust all the parameters and make decisions that would impact the scenario.  Me, I could do my bit to just ensure that those whose voices aren’t heard as often get a bit of support.  If you think of all the time that you’re spending not acting and contributing to the statistics (noise included) of the default, then a few times of standing in a crowd protesting the other side just can’t be wrong. 

That evening, through some random connections, I ended up hanging out with the guy who founded ‘Hot or Not’ and found myself explaining my day’s activities and my rationale.   But Hot (Not) was not only unconvinced by the rationale for my actions but also grew steadily angrier.  It became apparent to me that for someone who had just convinced himself that he was smart beyond the norm, having just recently been catapulted into sudden fame and perhaps even fortune, what I was justifying was in turn pulling the rug out from under his rationalized sense of his position in the world.  It was obviously upsetting to his sense of self that I was putting the weight of my personality behind a world view (similar to My Hero’s dare I say) where his newly proven smarts could never be sufficient or perhaps even useful.  I guess when your future wealth may depend on the profound and quantifiable metric, ‘degree of hotness’, you can’t bear to hear about how it may actually be less useful than something unassessed, something immeasurable at it’s core.

ASATA focuses on the challenges of racism, exploitation and communalism. Our actions emphasize our connection to the South Asian community, but our vision of change and solidarity is cross-group and communities. Photo by Eric Mar.

If you’re in the SF Bay Area, have any familial, coincidental or other relationship to South Asia, are politically inclined, understand and engage with the haves and have-nots of power, then join us in taking the Alliance of South Asians Taking Action (ASATA) to it’s next phase.  We’re meeting on Sat Mar 28th at 11am, and then again to continue transition conversations on Apr 7th at 7pm.  If you’re interested in joining, re-joining, re-engaging with a San Francisco Bay Area institution – especially if you’ve got some time to devote to a leadership position - drop me a line at miniATbrainbytesDOTcom  

ASATA, the Alliance of South Asians Taking Action, is a San Francisco Bay Area group working to educate, organize, and empower the Bay Area South Asian communities to end violence, oppression, racism and exploitation within and against our diverse communities.

A friend read the recent businessweek article on Dan Gillmor and Bayosphere in which I’m quoted (accurately) and said “guess who got the negative quote”. I hope he was kidding, but it forced me to think about the quote, and any future quotes. What’s the difference between a negative quote and a critical quote? There are rare cases where I feel the former is justified, whereas the latter is probably the norm for me. But to the readers eye, perhaps the line is blurred. If you have a tip to help differentiate one from the other, I’m all ears.

But the real shame for me was that I hadn’t read Dan’s thorough self-evaluation of the Bayosphere experiment before speaking with Heather Green of Business Week. I would have then built off his own points. The emphasis also could not then have been on anything but the net positives from the experiment.

Just wrote a followup on Bayosphere, with this conclusion: Another version of (Esther) Dyson’s “always make new mistakes” is the standard in science: You only progress by proving something wrong. Dan’s allowed us a calculus whereby he’s made mistakes and we’ve progressed. Very generous indeed. The rest of my Bayosphere post.

Also, here’s what I said as a comment to a followup post on Businessweek, re: Bayosphere

“…it’s important to note somethings that I think distinguished Bayosphere from start. Primarily, that Dan, better than anyone or any site I know, created a space for the expression of diverse opinions. Blogs and their related communities are generally quite partisan, especially when it comes to Politics. I thought (and think) that Dan, through his personality, focus on quality of discourse, and through the openness he engendered, created a unique space for differing viewpoints, across the spectrum of opinion and politics. This is hard to do, and rarely seen on the net, so for those looking for lessons on what to keep from Bayosphere, I’d recommend an analysis of Dan’s explicit and implicit sculpting of the space for community expressions. …”

There’s a bill currently in the house and senate addressing the issue of fetal pain, and what doctors should say to mothers that need abortions for fetuses beyond 22 weeks gestational age. Naturally, given the subject matter, it’s controversial. A week ago, a review was published in the prominent medical journal JAMA, which surveyed the medical and scientific field and found the bill wanting. It made the news. A day later, it was revealed that 1 of 5 authors had a prior connection to the pro-choice movement, one performed abortions. They were accused of bias; they disagreed. It also made the news. In all of this, the review it self was hard to obtain, so most of the disagreement and conflict occurred without direct reference to the meat of the paper. If there’s one call for action from this mess, it’s this: open the access to this and similar papers. It’s simply atrocious that as arguments progress in this area few will go through the trouble that I did to obtain the paper – signing up, providing personal information, and paying twelve dollars.
~> read more
But back to the bill, back to the science. The proposed legislation, the fetal pain bill, would require doctors to tell mothers needing abortions for fetuses of 22 weeks gestational age (20 weeks post-fertilization age) that fetuses feel pain. The bill includes a script that the doctor must use, which includes this: “The Congress of the United States has determined that at this stage of development, an unborn child has the physical structures necessary to experience pain.” The bill also requires doctors to suggest the use of fetal anesthetics.

Can we believe the accuracy of what “the Congress of the United States has determined”? The review article recently published in JAMA – “Fetal Pain: A systematic multidisciplinary review of the evidence” – does not. The authors, Lee et al from UCSF, state that what evidence there is on fetal pain suggests it occurs only after 29 weeks, gestational age – not the 22 weeks of the bill. The paper also summarizes the literature on fetal anesthetic procedures and tell us that fetal anesthetics and analgesics are currently used not to reduce pain, but to extend mortality of fetuses or neonates (for example, it helps immobilize them during surgical procedures, in this way making the surgeries more effective, and the chance of survival post-surgery, greater) Instead, there’s ample evidence that these fetal anesthetics reduce the chances of the mothers survival.

For a complex issue, and one characterized primarily by sparse information, the review assesses evidence on the multiple fronts necessary to understand what kind of legislation if any should be passed – pain for the fetus, survival for the mother, and the current state of fetal anesthetics.

The response to the papers content, both as expressed in the press and on right-to-life websites, has focused on the issue of pain – for the fetus. Dissenters point to evidence that pain is felt by the fetus at 22 weeks – fetuses at this age will show reactions to touch. At 23-24 weeks, according to the one scientist most prominently quoted, neonates will ‘cry’ when blood is drawn. These reactions are similar to our immediate physical reactions to touch, a cut or burn, etc. No one’s disagreed (yet) on the existence of these reactions and the fetal age at which they occur. The disagreement lies in interpretation. Some scientists (at least one) pro-life activists and the authors of the bill seem to think that this is an obvious marker of pain. Other scientists, and I will add pretty standard neuroscience, believe that nociception (stimulation of receptors of ‘pain’ on our skin), and reflexive reactions are distinct from perceived pain. Distinct to the extent that pain can occur without physical stimulus or reactions – for example pain can be felt in anticipation of a learned scenario, and also most strikingly from phantom limbs in adults, where there’s actually no physical stimulus at the time of the perception. It’s also generally agreed that to feel pain requires a functioning cortex.

So, do fetuses have cortexes at 22 weeks? Sort of, it’s developing. But what’s also only just developing at this time are the nerves that carry information from the periphery, feet, hands, legs and body – to the cortex. These nerves first grow to the thalamus, and then nerves from the thalamus grow towards and synapse onto the cortex. Here the evidence (not disputed as far as I can tell) is that thalamic neurons develop and reach the cortical plate at 23-24 weeks. Perhaps these are the ‘structures required to feel pain’ to which the bill refers – although this is still later than the 22 weeks mentioned. However, these ‘structures’ are just that – physical structures, the conduits for future communications. The nerves from the thalamus grow into the cortical plate by 23-24 weeks (undisputed) but once there, do they do anything? Again, standard development neuroscience fare is that there’s a lag between development of physical synapses and any functioning electrophysiology. Standard, only because all the evidence across species, development stage, and experiment-type reveal this two-staged activation of synapses. So as physical structures, the synapses between the rest of our body and our cortex, get cemented by 23-24 weeks, but do they fire up immediately? From Lee et al, the earliest signs of a ‘proper’ evoked electric potential (activate a neuron near the skin and see if the cortical neurons fires in response) or EEGs that look like sleep-wake cycles occur at 29-30 weeks. Therefore, say Lee et al, the earliest evidence for perceived pain in the fetus is at 29 weeks gestation age. Prior to this time, the nerves in the body that are receiving information about potential pain can’t even convey the information to the cortex. No cortical connection, no pain.

In my mind, there are wrinkles to the fetal pain story from Lee et al’s review. For something as complex as connecting our knowledge of the human fetus with our understanding of the neuroscience behind the cognitive percept of pain, it’s to be expected. Here are my questions: There’s a cortical subplate to which thalamic neurons make connections in gestation weeks 20-22. The subplate is a transient structure, but its thought to help the growth of thalamic neurons into the cortex. But are subplate neurons themselves making connections to the cortex earlier than 29 weeks, and as such proxying for thalamic-cortical connections? I couldn’t tell from the review. The EEG data in my mind is full of questions just because, as Lee et al themselves describe, neonatal baseline EEGs are different from adult baseline EEGs. This makes assessing the first ‘normal’ occurrence of an evoked potential in the fetus or neonate a little tenuous. Finally, I’d want to know more about the various hormonal responses that do occur in fetuses at 20 weeks or younger. Although here too, hormonal reactions are not in and of themselves predictors of pain – or a functioning cortex.

Others’ critiques of the JAMA review, and/or supporters of the bill focus only on the fetal pain issue rather than other aspects of the paper. The power of the review, though is not just its summary of the evidence on fetal pain, but in its review of the balance of evidence on pain, anesthetics, and mortality for both mother and fetus. That’s why it’s the sum total of the review that Lee et al present that’s key in informing the debate on the fetal pain bill. After all, the bill is not just about getting doctors to present seemingly factual information that may or may not be accurate about the percept of pain. Instead, it’s about providing information and suggestions that can negatively impact a mothers life.

But wait. Is the review it self believable? A day after the review was published came another sort of reaction. One of the authors worked with NARAL pro-choice America, the other performs abortions. The criticism: the authors should have revealed these potential sources of bias.

I absolutely agree. They should have, certainly for the NARAL connection. It’s a little less clear with the doctor performing abortions, but it wouldn’t have hurt. Given such an obviously charged arena, with an obvious political and legislative context that the authors themselves use to frame the paper, it’s disingenuous of those fingered for conflict of interest or potential bias to say that it’s not an issue.

That the authors didn’t bring up their personal politics shouldn’t be surprising to anyone. As a start, conflicts of interest are narrowly defined in scientific publishing as ‘financial connections’. The several paragraphs in JAMA’s disclosure rules focus on financial interests, of which the authors have none, nor are they accused of having any. Although there’s a phrase in the disclosure requirements on ‘personal relationships’ the meaning of which is left ambiguous – for example, personal relationships to what, and when? And beyond this, there is a deep cultural issue in science of assuming objectivity even in the face of obvious sources of conscious – or unconscious potential bias. The methodology of science is solid and powerful, but scientists are still human beings. Scientists choose questions, frame issues, and can miss things – because of default assumptions and inherent biases. If the potential for bias is acknowledged in a broad sense in the medical and scientific communities, then across the board we would have won one small battle in improving our quest for truth. But that’s another war. Here, the critiques brought up about the authors are not about the culture of science in general, or the nature of bias, but just about implications for this one paper.

So what can we pull out of the paper it self as being problematic? I haven’t heard about anything disagreed with in content – other than the one major interpretative difference on reflexes and pain. I read the review, and it seems transparent in methodology, as much as can be in a review. If there were only a couple of authors on the review, I might consider it more likely that in framing and emphasis we’d see more obvious impact of individual authors bias. But there were a total of five authors. Given this I rest mostly easy until I can find the evidence for bias having influenced method and results. In fact, one of the powers of the review is the diversity of (medical) background of the authors, bringing overlapping but distinct expertise to the review. And beyond the five authors, the article was peer-reviewed prior to publication by additional scientists. Not bullet-proof, but not too shabby.

So, back to the bill. As the prelude to the bill, some ‘findings’ are referenced. These, I presume, form the ‘factual’ basis for the rest of the bill. I’ve selected four from the seven findings:

(1) At least 20 weeks after fertilization, an unborn child has the physical structures necessary to experience pain.
(2) There is substantial evidence that by 20 weeks after fertilization, unborn children draw away from certain stimuli in a manner which in an infant or an adult would be interpreted as a response to pain.
(3) Anesthesia is routinely administered to unborn children who have developed 20 weeks or more past fertilization who undergo prenatal surgery.
(6) Medical science is capable of reducing such pain through the administration of anesthesia or other pain-reducing drugs directly to the unborn child.

Lee et al show through a consideration of others’ work, that the physical structures necessary to experience pain do not exist for a fetus 20 weeks after fertilization, unless one believes that reflexive actions imply the perception of pain. Drawing away from a stimulus is not interpreted as a response to pain in adults. It’s interpreted as existence of the appropriate nociceptive reflex. We learned this very early on in neuroscience graduate school, in fact it was drilled into us. Anesthesia is administered to neonates, but not for the purpose of reducing pain, instead, to make it more likely that a neonate can survive surgical procedures. And finally, there is no evidence that medical science is currently capable of reducing fetal ‘pain’, were it to exist. Instead there is ample evidence that administering these anesthetics to the fetus can harm the mother, to the extent of killing her.

Epilogue: Derivative Ping Pong

Now for the real pain. You may or may not agree with my review and analysis of the JAMA paper. But at least you should know that I *did* read the paper. I also read one other paper referenced on pro-life sites, and of course I read the articles in USA Today, LA times, NY Times, Forbes, the International Herald Tribune, CNN, SF Chronicle and more. But getting to the original JAMA article, on a subject clearly pertinent to me and my decisions (I want to have children) was certainly not easy. The article wasn’t available freely on-line, not as in beer, and not as in speech. I had to find the article on JAMA’s web-site, sign up for an account, and pay 12 dollars to actually read what others were derivatively going back and forth on.

If ever there were an argument for open access to medical publishing, it’s this article. How can we hope to get beyond superficial debate if we don’t even have access to the primary material? I’m putting a call out right now, that if JAMA has any moral sense of duty as per its medical mission, they should make the article freely available and easily accessible. This way people can actually read what they subsequently argue about.

You may disagree with me, but if you don’t have the article in front of you, it would be hard to have an even-handed discussion of points. We’d have lost before we’d begun. Even I wouldn’t enjoy that argument.

—-
My disclosures: I got my Ph.D. in neuroscience from UCSF. I believe it’s very important to keep pushing the boundaries of knowledge on the status of a fetus. I also believe that there’s a historical bias in our society towards undervaluing the life of a mother and the freedom of a woman.

A note on ages: Gestational age, used in the JAMA review, is age from fertilization + 2 weeks. The bill mentions fetal age 20 weeks from fertilization, which I’ve converted to 22 weeks gestational age. I’ve tried to be consistent and refer to all ages as gestational age.

“What I want to achieve – what I have been striving and pining to achieve these thirty years – is self realization … I live and move and have my being in pursuit of this goal. All that I do by way of speaking and writing, and all my ventures in the political field, are directed to this same end. But as I have all along believed that what is possible for one is possible for all, my experiments have not been conducted in the closet, but in the open; and I do not think that this fact detracts from their spiritual value. …

… Far be it from me to claim any degree of perfection for these experiments. I claim for them nothing more than does a scientist, who, though he conducts his experiments with the utmost accuracy, forethought and minuteness, never claims any finality about his conclusions, but keeps an open mind regarding them. I have gone through deep self-introspection, searched myself through and through, and examined and analysed every psychological situation. Yet I am far from claiming any finality or infallibility about my conclusions…”

- Mohandas Karamchand Gandhi in the introduction to “The Story of My Experiments with Truth”.

There is a lot that both amazes and disturbs in stories of the Mahatma (“often the title has deeply pained me”). But of every person, time and situation there is something to be taken and to be learned. Gandhi as scientist, and as artist – this is what I take from him.

“I am not a seer or a guru of non-violence. I am an artist of non-violence” *

Gandhi’s science in entirety is not mine. His vision is one of ‘the truth’, the one truth, in his words “the Absolute Truth, the Eternal Principle, that is God”.

I veer away from that philosophy of truth, and indeed of science where one is continually on the path to achieving this singular thing. I see that there is a beauty in this vision, indeed, an inspiration in it – as well as a potent balm for the realities of our conflicted and seemingly patternless lives. So I see and appreciate the role of this version of “Truth” in guiding us down the paths on which we choose to embark and even in the “doing” of science, full of uncertainty and noise as it is.

But moving away from that utilitarian perspective on truth, I think science is about a continual progression of guestimates. How unassuring that sounds! In this view, we do well at any one point – any spatio-temporal moment – to make educated guesses; the more ‘educated’ the more successfully they can contribute to predictions for the state of some future window or for a differently positioned window in time and space.

* (as published in Dodiya’s monograph for his Gandhi show)