Evaluating Evidence: Oncologists Do It Best

NormalThere is one crucial area of thought, one discipline where the vast majority of people could really use some education, and they are not getting it. You can see it everywhere. Some of the world’s most prominent and respected people are just really bad at it, have never been taught how to do it, and for the most part, do not need it.

Or they don’t think they need it, but a lack of understanding in this crucial area is leading to all manner of problems.

Evaluating evidence.

It sounds easy enough. We do it every day. We take in data, and try to predict what is going to happen, we get it wrong and reassess, and then stumble along doing it all over again.

Gradually, some enterprising individuals learn to put some order into it, learning that cloudy days may require an umbrella, or a flirtatious look and smile may be the beginning of a beautiful relationship. We come by that sort of thing naturally, without thought, but the lack of thought is what gives us away.

There are days when the cloudy skies mean snow, and days when that ‘look’ was for the guy behind you.

Politicians and Intellectual Ability

Political animals usually are smarter than average. The defined mean of Intelligence Quotient is 100, and most people who get into high school (though not necessarily out) have at least this much. There is a broad distribution, estimated by the typical ‘Bell Curve’ or normal or Gaussian distribution depicted above. Such probability distributions describe the variations of intelligence (and many other randomly organized characteristics), although the skewing of the underlying shape can look quite different. Generally, there is a lot of the population around the mean (average), tapering out to much smaller numbers at either end.

People reading about this often become defensive, thinking somehow that they are responsible for whatever level of failure or success they have in this area. While I know the brain is like a muscle in many respects, the more you think the smarter you get, most people are completely innocent of their particular level of intelligence. Knowledge is another thing, but even with knowledge, the level of acquisition of knowledge is related in many ways to what you were born with, and there is not a lot you can do about what you were born with.

People with IQs of 80 or less should not feel guilty about their abilities, any more than short people should blame themselves for not being able to dunk a basketball. But since only ten to fifteen percent of individuals have IQs in this range, for most it is not really an excuse to misunderstand the evaluation of evidence if they work at it a bit.

Politicians have the ability to understand evidence, as does the vast majority of the population.

But it is what you do with what you’ve got that is important, not what you were born with.

Evaluating Evidence Can be Tricky

There are, of course, wide variations in success of evaluating evidence, which do trend toward a correlation with intelligence, but if you never focus on the issue, lots of times you don’t know what you don’t know. Necessity, though, is the mother of invention.

Years ago, physicians caring for people with malignancy had a hard time figuring out what therapies helped, and what didn’t. In some disciplines, success of treatment can be recognized by simple observation. Common practice demonstrated pretty quickly that immobilizing a fracture was at least helpful for the pain, and putting bones back into alignment, and then keeping them there, was key to a functional recovery.

Obvious. Double blind clinical trials were really not terribly necessary for such a gross end result. To some extent, this type of observational study is anecdotal, but since it happens many times the world over, and the anecdotes add up, the evidence starts to approach a quality that is reliable. There are fundamental mathematical explanations of this, but it is also intuitively obvious that larger numbers of observations almost always lead to greater confidence in the conclusion. Almost.

And that’s one place where is gets tricky. But I’ll come back to that.

The Trouble With Oncology

Cancer is one of that last areas of medicine to bow to therapeutics. There is always a level of ‘noise’ when examining the results of any observation. Things happen to people in many random, or seemingly random, ways. It is not really random, but because the causes of variation are so numerous, it sure appears random.

People with cancer have life spans which vary considerably, even amongst those with the same disease, even amongst those diseases with the same stage. I routinely cared for patients with stage IV lung cancer, and when asked for timelines (which patients often request) average survival without treatment was four months, and with treatment they might get out to eight or ten months (it is finally getter better than that, by the way). We could tell them that on average, 90% would die within the year, 65% if they took treatments of some kind.

Notice that in medicine, physicians, especially specialists who can focus in smaller areas of interest and concern, give such answers in terms of probabilities. It has to be given with care and sensitivity, but, in my opinion at least, it ALWAYS has to be accurate. It is a rule of mine. You want your patients to believe you far more than you want them to like you. Never lie to the patient. Express doubt, even ignorance, but never lie.

I have had some patients (not generally lung cancer) live for ten years with metastatic disease, and others live only a matter of days or weeks. If you plot these kinds of events, such as survival over time, within this wide scatter is a trend. The more events you have, the clearer is that trend. At five years, virtually all lung cancer patients with stage IV disease on presentation have passed away. But around that trending curve of deterioration over that five years is incredible variation.

So how do you know, when a patient lives for two years on a specific treatment, that the treatment had any effect? If you compare two patients, one with the treatment and one without, it could end up either way. The problem was, with some treatments, the variation was so large (the noise), that even a hundred patients, or a thousand patients, was not enough to separate random fluctuation from actual treatment effect.

And that is about the same time that very clever people started to use sophisticated mathematics, probability analysis, and experimental designs, to establish a difference we could rely upon. Treatments in cancer were so poor, we could not see the differences within the noise, without very detailed and complicated analysis. To this day, at the extreme of complexity, understanding the science behind all of this is out of reach for any but the few who study such techniques all their lives.

The wide variations and poor efficacy of cancer therapies meant that oncologists had to learn a lot of these sophisticated techniques, and from my experience over the last forty years, we did so before lots of other specialties, because we had to. Otherwise we could not see the improvement over the background noise. Establishing clear proof was also necessitated by the fact that oncology treatments were so toxic. The physician’s maxim, “Primum non nocere,” or “First, do no harm,” was pretty difficult to follow in oncology.

As good as physicians doing this type of research get, it’s not good enough. Every major study using statistical techniques in medicine has a statistician or two in the background working with the authors to plan the experiment and evaluate the data. I entered medicine after an undergraduate degree in mathematics, with a lot of statistics in my repertoire, but I would never dare publish an article without formal professional statistical analysis by a statistician.

Pitfalls of Experimental Design

There are lots of ways, we discovered, of messing up an experiment or an observation. Just understanding the definition of randomness was a start. I remember well sitting in a seminar at the Princess Margaret Hospital in Toronto, forty years ago, where members of the team treating cancer patients were agonizing over the fact that survival curves of treated and untreated patients eventually fell back together…no matter how dramatic the initial improvement…until one observer pointed out that everybody dies eventually, so all survival curves come together. The survival curves were getting out to the normal lifespan, and nobody noticed that the results were competing with human age limits.

Studies,over twenty yeas ago, at my current centre showed that patients who underwent chemotherapy after surgery for esophageal cancer lived longer than those who didn’t. One might think this means chemotherapy helps. It actually does, but this study failed to show that because the two groups were selected retrospectively (not randomly or prospectively with a plan), and the groups were not identical apart from the treatments received. They were different in age by an average of ten years, for one thing, and the group that started ten years older did not live as long, of course. Additionally, it was recognized that patients who failed to adequately recover from the surgery they went through did not then always receive chemotherapy (they were too sick), thus biasing the results towards chemotherapy (basically proving only that sick people don’t do as well as healthy ones).

This last point is subtle. It basically noted that patients who got chemotherapy did better, but also noted that patients who got chemotherapy started off better. Such problems in experimental design have lead to concepts demanding similar populations and analysis based on the original ‘intent to treat’ (patients who are planned to get a treatment get counted in the treatment group even if life’s problems prevent them from starting or completing it).

The analysis of this study was clearly flawed by the selection bias and the age difference…something that the vast majority of people might easily overlook, but that Medical Oncologists are geared to, and trained to, understand. It was also NOT a randomized prospective study, it was an observational study looking back at a bunch of patients. When you look closely at the data, it basically proved that patients who do well with a complex treatment tend to do well. Not really very helpful.

Most experimental designs of clinical trials demand that the two populations being compared are ‘identical’ in every aspect EXCEPT the treatment they receive. If the control group is ten years older than the experimental group (as occurred in that study of patients with esophageal cancer above) one could expect they would die ten years sooner, thus confounding the treatment effect. This is a clear example of bias that can creep in when you are not looking, and extremely intelligent people fall victim to this obscuring effect if they are not extremely vigilant. It becomes pretty clear that people who do not do this stuff all the time may fall prey to confounders and experimental bias. It is subtle. It is powerful.

After all, we are all human, and we really want to see good results.

Because lives depend on understanding this stuff, Medical Oncologists are constantly immersed in this type of evaluation of evidence. But you can understand that not everybody else is. Most treatment effects are less subtle, and most other professions and disciplines have far less profound effects when they make a mistake.

Second Nature

So it all becomes second nature to us, those who practice medical oncology. When someone argues that a comparison of two groups, or a correlation of two populations with subsequent events, suggests a cause and a direct resulting effect, we stand back and look for all the confounding biases. And to us, because we live with this stuff every day, its all pretty easy to see coming. Correlation does NOT equal causation.

A few weeks ago, during a debate between Bernie Sanders and Ted Cruz on health care funding, Senator Cruz argued that patients who obtained private health insurance lived longer than patients who relied on Medicaid. Bernie had no answer to this, it seemed, though in this context he may never have got a chance to respond, or he may have felt the explanation would be lost on the audience. To those of us who understand the relationship between health outcomes and socioeconomic status (physicians, nurses, social workers, health care administrators) the answer was pretty obvious, and not at all clearly related to the quality of insurance or the delivery of health care. People in higher socioeconomic class ALWAYS live longer: more money means better education and better health life style including food, drugs, alcohol and smoking issues. There is simply no need to introduce the insurance aspects to explain the difference, but that is exactly what the politicians did, because they don’t understand evaluation of evidence and experimental analysis.

If a physician, particularly a research physician, made this claim on this evidence, we might suspect fraud, so egregious is this mistake. We recognize he might be right in his conclusion, though totally wrong in how he got to it, and we might still call it fraud, or at the very least, lazy ignorance.

Trump Does Not Understand Evidence

One thing we teach our medical students is to protect their brains. If they read something somewhere, a year later they cannot possibly remember where that informational tidbit came from. So don’t read that stuff, we tell them. Sources of information vary hugely in their quality (so do sources of news).

We teach our students to evaluate everything carefully, but we understand that they must delegate this work to others from time to time. So it is that we teach them to rely only upon peer-reviewed journals of high impact and integrity. Journals in medical information gain a level of respect which allows us to accept their findings based on historical activity. Something published in the New England Journal of Medicine, for example, is well known to be highly credible because editors scrutinize the studies, and peers review the results and report in letters, meetings and other journals. The Journal (NEJM) struggles to maintain that reputation, and if they ever fail, they are outed VERY quickly. In fact, reputable journals like NEJM and The Lancet usually out themselves. The Lancet retracted the Wakefield article connecting vaccines to autism when it realized the level of fraud involved in its production. It already knew the work was inaccurate, but it was the deception that prompted the first retraction for that journal in its history. [see Vaccines… this blog] Inaccurate reports are worthy of discussion. Fraudulent reports are worthy of ridicule (and discussion…this one, among some others, lead to major changes in rules governing authors’ activity in publishing medical journal articles, and medical journal editors in accepting them).

So the reputable journals try very hard not to fail. They do that by having extensive peer review by experts in the field, by having internal evaluations, and perhaps most importantly by inviting and receiving ‘letters to the editor’ arguing for or against certain studies. And they publish opinion articles by experts which lay out arguments for and against articles that appear in their (and other) journals.

There are, unfortunately, many journals where that degree of professional integrity is not maintained. There are some, in fact, that have an preconceived agenda, either because they are actually produced by a pharmaceutical industry, or have a major connection to an organization with a vested interest in an ‘end result’. Some, for example, want to promote religious belief, and the power of prayer, or the power of Christian values. We know that, we know which journals carry this type of bias, and we take that into consideration whenever we evaluate evidence, starting with avoiding those sources completely. And we teach our students not to read those journals.

Because a year later they cannot possibly remember where that informational tidbit came from.

Many people do NOT understand this structure of evidence evaluation. Those of us who deal in evidence every day know that we have to start with an evaluation of the source of evidence, then of the logic of the evidence, then of the design of the experiment or observation. One thing upon which we all agree is that wonderful statement by Christopher Hitchens: “Anything which may be asserted without evidence, may be dismissed without evidence.” Dismissed as proof anyway. But idle chat and random thoughts, as well as disciplined thoughts, can and do lead to hypotheses to be investigated and tested.

It is somewhat similar to the another principle, this time in physics: “If the event cannot be observed in any way, it does not exist.” Physicists argue that if you cannot observe something, it is sort of pointless to talk about it.

Trump does not understand evidence. He is not alone, although many people seem to come by some form of evidence evaluation naturally, without formal education.

The source of information is clearly extremely important. Certain news agencies do not cut it because they have a history of not cutting it. “Future behavior is best predicted by past behavior.” If one of my very intelligent friends who never says anything without good supporting evidence, actually says something, I am more inclined to believe them than I am someone who never gets it right.

So when Trump uses politically motivated sources of information, it is suspect. When he uses sources that often get it wrong, it is even more suspect. When he uses Fox News, when they offer no evidence, and restates a meme without other independent evidence, his argument can easily be dismissed. Because in that context, if it is true it is completely coincidental.

The problem is that Trump never cites any evidence. He does not have the evidence to cite. Indeed, it seems he does not care about it. The people he speaks to are not waiting for evidence, they are waiting for him to make the same claim three times, usually in rapid succession.

“Fake news. Phony. Fake.” This was his claim at the CPAC speech. No evidence, just the claim. But he never points to an example. Indeed, often it is in response to corrections the media has made of his comments, pointing out his fake news, such as the claim of a landslide victory, which his election result clearly was not.

“Believe me.” He says this repeatedly, as an alternative to evidence. “Believe me.” Why? Nobody ever answers ‘why’.

“That Which May Be Asserted Without Evidence May Be Dismissed Without Evidence.”

So when Trump states that Hillary Clinton lied, if he cannot provide evidence, that statement should be dismissed. When he says some terrorist action occurred in Sweden last week, and provides no evidence (outside of saying “Someone said it,” or “I heard it from some people,” both very common Trump supporting statements), the thought he expresses should be dismissed. The big problem is that Trump NEVER accurately identifies his evidence, and you really have to assume he has none, if none is supplied. I have listened to him assiduously, to my extreme detriment, for the last year, and could count on my fingers the number of times he refers to some article, never to a source which is as reliable as a scientific or medical journal.

Trump makes such blanket statements all the time. “I inherited a mess,” he has said. No evidence. If you dig, the evidence is actually contrary. Trump says something is a disaster (well, he actually says this about everything) but never gives any evidence. Consider unemployment. Trump says unemployment is a disaster, though all apparent evidence suggests unemployment is at one of its lowest rates.

There are times he gets more sophisticated about his dishonest comments. The rate of change in murders jumped in 2015, in part because the rate was so low in 2014 (probably a reporting and clerical error, but murder rates are based on a huge number of variables). He jumped on that point to promote his fear riddled approach to his underlying desire to promote authoritarian rule through police and military. He overlooked the reality that murder rates (not rate of change) are massively lower now than they were thirty to forty years ago. In addition, the background ‘noise’, as in any ongoing observation of large numbers, does not allow us to figure out if this rate change is anything other than random variation.

But ‘cherry picking’ (taking results which are favorable to your agenda) is really the same as lying, if you know you’re doing it, or simply lazy, if you don’t.

Lies

If I tell you two plus two equals five, and I do not understand addition, that is not a lie. It is a mistake.

If I say two plus two equals five, and I know it equals four, that is a lie.

If I say two plus two equals four, and I really think, because I am not too bright, that it equals five, that too is a lie, even though the statement is correct.

If I say two plus two is five, and I know it is four but I say it is hyperbole or humor when someone catches me on it (but I say nothing if no one objects), that is a lie.

That’s what Trump does when he says Obamacare is a disaster. Or when he says Mexicans are rapists. Or all the other countless exaggerations for which he is forgiven in the right wing media that supports him. “Oh, that’s just Trump,” they say, dismissing complaints of lying because getting truth from your president isn’t as important as promoting the right wing agenda.

We humans project. We actually try not to lie, for the most part. We tell ourselves we never lie, though we know we do a little bit (“No dear, that hat looks lovely”). And we treat other people as if the potential for lying, real lying, is very rare. We are always surprised when it happens. The blatant lie right to your face, the ‘gaslighting,’…we simply do not expect or anticipate that, and much of our communication is colored by what we expect.

Evidence suggests that I have a pretty stable, confident brain that takes time to carefully decide things. And yet, thirty years ago I observed an event which I could not believe was possible, which I could not emotionally deal with. I pushed it out of my mind. I denied it. No one else was really hurt by this decision of my subconscious brain, and I hope that had there been any detrimental effects on others that my facing this event could avoid, I would not have denied what I saw. About a year later when the consequences of that event doubled down with other similar events, I remembered it, but it was the clearest, most powerful example of cognitive dissonance that I have ever seen, and it was all mine. To this day I find it hard to believe my brain is capable of that kind of self deception. It makes me shiver to think about it. The lesson is that we can deny what we do not wish to believe.

As a medical friend of mine suggests, “There are none so blind as those who refuse to see, none so deaf as those who refuse to hear.”

Accepting that someone can lie at every opportunity is too threatening to our world view to accept.

Professional Lying

Lying in medicine occurs very rarely. Even when is does, it may not be in the awareness of the authors. Generally, medical authors believe what they are concluding, even if they fudge the data a bit to support what they believe to be true. But when it does happen, as it did years ago in a specific breast cancer treatment, or in the retracted article about vaccines and a relationship to autism, it takes everybody by surprise, and it takes a long time to sort out. We project our honesty on to the person telling us stuff, and we simply do not expect anyone to lie all the time.

Lying in politics is probably far more common than in medicine (I’m not really denigrating politicians here; in medicine your thoughts are carefully written down and analyzed. In politics they can be ‘off the cuff, in the moment’ and getting it all as right as I describe here can be close to impossible), but mostly it amounts to making claims without supporting evidence, or ignoring data that doesn’t agree with your preconceived conclusions. Lying to shore up your own reputation, to support your exaggerated opinion of your own value, lying to make the claim you are better than everybody, at everything, is actually very rare. “I understand better than the generals do,” or “I understand…better than anybody.” When he says that, what are you thinking?

We humans are not used to dealing with someone who lies all the time. Even as I say this about Trump, who I know by now lies almost every day, I find it difficult to accept, to believe. We hear people right now simply saying that ‘that is Trump’ and setting the dishonesty aside. Rick Santorum, last night after Trump’s first speech to Congress, when cont=fronted with some of these lies replied that is was pretty minor stuff for a president.

When Trump stated there were crowds lining up to hear him at the CPAC (a ticketed event with no line-ups), he didn’t care that he didn’t know that. When he said he had the highest electoral college result in history, and was confronted with the truth, his response was simply to say he had heard this somewhere, the implication being that this was sufficient justification for this lie. “Some people say,” and “many people think,” are phrases he has used, phrases which are the closest thing to evidence he appears to cite.

I remember wondering what Trump would do when people started to see the patterns, started to recognize that nothing he says is reliable. I remember how long it took me to unblock that terrible event I observed.

But I should have known. Trump told us what he would do. He would counter-punch.

And so now Trump is attacking the news sources that are finally calling him out on all his lies. They are ‘fake news’ and he has banned the most reliable ones from a recent media event.

“Fake news. Phony. Fake.” He says it three times, often punctuated by, “Believe me.”

And that’s all the evidence he gives.

In truth, I do not know if Trump can evaluate evidence. The example of murder rates says he cannot. But the constant lying says evidence is not important to him. Maybe he can understand evidence. “I have a very good brain.” “Only I can fix it.”

Even a Medical Oncologist can see the problem with evidence here.

It’s not just that Trump doesn’t understand evidence. He just doesn’t use it.

 

 

Karate and Health

Fighting Brian

The author, a socially inept introvert, is on the right foreground, is about to be gently kicked by his friend, Tom. Many other friends in the background will also kick him during the course of this class. Don’t worry. It doesn’t really hurt.

Introduction

I came across this essay in my files, cleaning house getting ready to move. Sadly, I was forced to retire from martial arts training and teaching a few years ago. I was 65 years old at my last black belt grading in East Lansing, Michigan, retiring shortly thereafter at the rank of Sandan in Shidokan Karate, with a previous rank of Yondan in Chito-ryu Karate.

One of the greatest highlights of my life has been helping to start Grand River Karate with Sensei Fortunato Restagno (and a host of so many others), and now my grand children are about to start this journey, too. Because of their youth, and the subsequent natural ‘worry’ of their parents, I have taken the opportunity to dust off this essay. I have not changed it since the day I submitted it, and was ultimately awarded my first degree black belt by Sensei Jake Klaus and visiting dignitary Sensei Cezar Borkowski. Thus it lacks a certain maturity, and the medical references are not ‘up-to-date’; in particular, the fitness craze is no longer novel.

But there is much truth in these thoughts, and I think much solace to be gained in parents worried about engendering violent behavior in their children, or injury to their loved ones. Karate is a beautiful sport, under appreciated in our society still. I have never been in a fight since I was fifteen, long before I entered a dojo, but I am convinced karate saved my life. You may wish to read to see if you can figure out how and why.

Karate and Health

Brian Dingle, BSc, MSc, MD, FRCPC

1985

Submitted as part of Shodan Requirements, KW Karate (Sensei Jake Klaus)

“Health is a state of complete physical, mental and social well- being and not merely the absence of disease or infirmity”. This all-encompassing definition is included in the constitution of the World Health Organization (3), and provides a suitable standard against which the effects of any life-style may be evaluated. To establish the benefit of any life pattern to the health of an individual, be it the absence of smoking, the choice of diet, or the program of physical activity, one must look at the physical, mental and social implications of that pattern. On superficial examination, the study of a martial art would appear to benefit only the physical aspect of health; that the mental and social aspects of health are also developed is perhaps inherent in the meaning of the words Karate-do, for as the master, Gichin Funakoshi, writes
” True Karate-do is this: that in daily life one’s mind and body be trained and developed in the spirit of humility; and that in critical times one be utterly devoted to the cause of justice.” (5)
As a physician, I am dedicated to the “promotion of health” In the broadest sense of the phrase; to show the reader that the practice of Karate approaches this goal is the purpose of this essay.

Social Well-Being

“Karate-do begins and ends with courtesy. If superior to their teacher in skill, the disciples should never forget to respect their teachers.”

Zenryo Shi madukuro
1909-1969 (5)

As with any group endeavor, the practice of Karate requires talking and cooperating with other people. Being adept at these social skills is the essence of social well-being. Most adults and many teenagers have acquired these skills, though there is wide variation as to the degree. There is a moderately rigid social structure to Karate with both a hierarchy and a ritual, as in any religion or society. The structure provides comfort for those less socially secure, for the choice of behaviour in any social interaction is removed: the individual knows the ritual and so knows what is expected of him. He bows to Shomen (the front of the dojo) on entry and exit to show respect for the masters and the art; he bows to his partner or opponent before and after any practice session; and he bows to the instructor at the beginning and end of the class. He refers to his instructor with a special term of respect, ‘sensei’, and he soon views other higher belts (quickly identifiable by the colour) with a similar but “pro-rated” respect regardless of their age or social background outside the dojo. Importantly, he expects and receives similar treatment. There are no lingering doubts to this social interaction, and the individual can relax within this structure; even though he meets and talks to new people, even though he is called upon to touch or even “attack ” other individuals, the anxiety is limited because the structure of his behaviour is already set down. Even the most shy of us can do it, and its repetition buiIds confidence that inevitably extends to life outside the dojo.

The rituals of Karate at first may seem silly to the observer, but they have become second nature to those of us within the sport. Few of us think of these rituals but all of us practice them when we enter the dojo. The repetition and practice of the social rituals within Karate are of benefit to all: the child or the adult, the recluse or the socially adept. They are carried out even in the most adverse situations, as when experiencing exhaustion or defeat, or when facing someone (even someone unknown) who has just inflicted pain. Under such adversity, to smile, bow, and quietly walk away is a significant measure of social maturity.

Both the discipline of the class and the respectful behaviour displayed provide a useful model for children. Additionally, in contrast to North American “macho ” virtues popularized by television violence, the “no first strike” philosophy of Karate is emphasized; the training forms or kata always begin with a block of an imaginary attack. Participants are taught to run rather than to fight, to avoid confrontation in the first place for “…to win one hundred victories in one hundred battles is not the highest skill. To subdue the enemy without fighting is the highest skill.”(5) The self-confidence gained by the knowledge and practice of a martial art helps prevent playground fighting. It is the ego of the child in all of us that pushes us to submit to the urge of violence, and it is far easier to resist this urge when we know in our hearts that we could win.

Thus, in a general sense, the karate-ka practices the skills of social well-being with both friend and foe. More specifically, the camaraderie in the dojo may lead to lasting friendships, perhaps one of the most important aspects of social well-being.

Mental Well-being

“The ultimate aim of Karate lies not in victory nor defeat, but in the perfection of the character of its participants.”

Gichin Funikoshi
1869-1957 (1)

Mental well-being is, of course, closely allied to social well-being, but deals more with how the individual perceives himself. Mental health refers to “the ability to maintain an even temper, an alert intelligence, a socially considerate behaviour, and a happy disposition.”(8) There is little doubt that exercise in general can improve mental well-being, and exercise programs are prescribed by physicians to help patients both physically and emotionally.” (10) Paradoxically, chronic fatigue, often a sign of depression, responds well to an exercise program, in spite of the fact that most patients worry the added exertion will only wear them out further.

Most of us have experienced depression or stress at some time in our lives, and are well aware that hard physical exercise helps to suppress or even eradicate these feelings. While the mechanism of this improvement is still unknown, alterations in certain hormone levels and increased blood flow to the brain during peak physical activity probably play a large part.

While valuable for mental well-being, as is any exercise, Karate is not simply a form of physical exertion. “Traditional Karate training has always been concerned with deeper issues pertaining to self-discipline, self-awareness, control, mind body harmony, mental strength and relaxation, and personal development.” (8) The concentration required in a normal class drives other issues from conscious thought, providing a form of mental relief from the day’s stresses.

Drs. Konzak and Boudreau have attempted to measure the development of mental skills and personality changes in eighty-four Karate-ka (Karate participants) at two schools in Toronto. Their findings implied an improvement in a large number of personality factors including intelligence, self-sufficiency and tender-mindedness.(8) They conclude that studying Karate “…can enable (an) individual to experience a sense of personal physical and mental competence that is consistent with…mind/ body harmony and well-being.”

Karate has been of particular help to me in the management of stress. Caring for the terminally ill can be an emotionally draining experience, and forgetting this work at home can be difficult. I had tried other sports, but all left me thinking of my patients even as I participated. Karate was different. The effort in concentrating, the exhaustion, even the ritual meditation at the beginning of class made me forget the problems of my work. Soon this became a conditioned response, so that now I find my mind emptying even as I enter the dojo for a class. Colleagues and friends have asked how I can find the time for such a sport, but I have no doubt that Karate has helped increase my “productivity” above the time spent at it.

Physical Well-being

“It is my aim and ultimate goal to assist in the mental, physical, and spiritual development of our youth so that in the future they can better contribute to the demands of our society…”

Dr. Tsuyoshi Chitose
1898-1984 (5)

Few would deny that exercise is beneficial for physical well-being. Indeed, as the fitness craze takes North America by storm, doubters are considered heretics; all forms of miracles are attributed to running, squash, dancercise and some of them are even true.
In a very general sense, repetitive exercise allows an individual to complete the same amount of work more efficiently. Strength is increased, and the ability to transfer oxygen to the body’s tissues is enhanced. The same degree of work gradually requires less effort, and can be sustained for longer periods of time.

The amount of exercise necessary to improve fitness is substantial, generally estimated to be thirty minutes of moderately intense activity at least three times a week. The intensity of the exercise must be such that the body is achieving seventy per cent of its maximal oxygen consumption. As maximal oxygen consumption increases with improved fitness, the exertion required to continue progression also increases, so that all will eventually reach a plateau.

Signs of achieving seventy per cent oxygen consumption are mild to moderate perspiration, (warm, not the cold drenching sweat of illness or extreme exertion), mild breathlessness (still capable of speech and upright posture) and a pulse between 1 40 and 160 (for those aged 20, seven beats less per decade thereafter). As this degree of exertion must be maintained for thirty minutes, we’re not dealing with a walk in the country or a game of golf. A Karate class usually covers this requirement, with room to spare.

As an individual becomes more fit, the heart expands slightly, increasing the amount of blood pumped out each beat. The tissues extract a greater amount of oxygen, and consequently the resting heart rate drops. Blood pressure drops, the level of cholesterol available to harden arteries decreases, and the heart and lungs acquire greater reserves for times of illness or trauma. As muscles supporting the various joints and spine strengthen, common rheumatologic conditions such as chronic backache, fibrositis, and unstable joints improve.

The question is not so much whether exercise can produce these benefits, but rather which exercise can do so safely. Those watching an advanced Karate class might well be concerned over both the intensity of the exercise and the possibility of trauma.
Recent publicity of deaths of marathon runners, particularly the death of the fitness author James Fixx, gives cause for concern over vigorous physical exercise. However, medical researchers and epidemiologists have shown that although the risk of sudden death is greater during hard physical exercise, the overall decrease in risk at times other than exercise more than offsets this small hazard (9). Thus for the average healthy person, one need not be worried about participating in vigorous exercise; one rather should be worried about abstaining.

Trauma is a problem with any sport, each sport seeming to have its own peculiar “brand” of common injury: knee and shoulder injuries in hockey, football, and basketball; eye injuries in squash; head injuries in boxing; shin splints in running. Disregarding the pulled muscles, stiffness and minor scrapes that occur in all sports, the incidence of injury in Karate seems to contradict the apparent “violence.” In one large study it was found that serious injuries occur only rarely(1) and then mostly during sparring in competition. This is largely because of the control that is emphasized in all styles of the martial art. Certainly Karate compares favourably to football and hockey where deaths and paralysis are known to occur.

The usual injuries in Karate are pulled or torn muscles (generally the hamstrings in the thigh), digital injuries (toes and fingers), and hyperextension injuries of the elbows and knees. All are due to faulty practice or technique, and tend to decrease as the participant becomes more experienced. Proper warm-up and stretching routines are strongly emphasized (much more than in any organized sport or physical education class I’ve observed). The injuries I have seen in class or as the attending physician at competitions have always been minor, rarely resulting in time off from training. 

Conclusion

Karate is an individual sport which can be practiced as a group, or a group sport which can be practiced individually. Each participant progresses according to his own effort, age, and body type, and room for improvement is always present regardless of an individual’s proficiency. Special equipment is generally not required, and any medium sized room or lawn is sufficient space. Thus the sport can be continued throughout an entire lifetime, barring serious illness. The practice of Karate advances social,
mental and physical well-being.

In every sense of the phrase, Karate promotes health.

Bibliography

  1. Birrer, Richard B., and Birrer, Christina D.: Martial Arts Injuries. The Physician and Sports Medicine, 101(6): 103-108, June 1982
  2. Borkowski, Cezar: Modern Shodokan Karate; Masters Publications, Japanese Karate Academy Ltd., Hamilton, Canada, 1983
  3. Clark, Duncan W. and MacHon, Brian: Preventive Medicine J&E Churchill Ltd., London, 1967
  4. Feld, Michael S., McNair, Ronald E., and Wilk, Stephen R.The Physics of Karate.Scientific American 240: 150-158, April 79
  5. Funakoshi, Gichin: Karate-Do Kyohan; Kondasha International Ltd., Tokyo, New York and San Francisco, 1980
  6. Funakoshi * Gichin: Karate-Do, My way of Life; Kondasha International Ltd., Tokyo, New York and San Francisco, 1982
  7. Higashi, Shane Y.: Chito Ryu Karate; Chito Kai, Toronto,
  8. Konzak, Burt and Boudreau, Francoise: Martial Arts Training and Mental Health: An Exercise in Self-Help. Canada’ s Mental Health 32(4: 2-8, Dec 1984
  9. Siscovick, David S. et al: The Incidence of Primary Cardiac Arrest during Vigorous Exercise. The New England Journal of Medicine Oct 4, 1984
  10. Walker, Herbert E.: Occupational Therapy and Other Therapeutic Activities, Comprehensive Textbook of Psychiatry/ IV, Vol 2, Fourth Edition, Williams and Wilkins, Baltimore, 1985

Fast forward, December 20th, 2016: For those parents reading who are in London, Ontario, or Guelph Ontario, two other excellent affiliated dojos are London Shidokan Karate, Sensei Larry Bowlby, and ShidoKan Canada, Sensei Roy Paul. In Kitchener-Waterloo, of  course, is Grand River KarateThese are great schools with kind, welcoming instructors, and are part of the same much larger international organization Beikoku ShidoKan, lead by Sensei Seikichi Iha, Hanshi from Michigan, USA, which also includes Grand River Karate. Sensei Iha, in particular, sets the tone of these dojos emphasizing friendship as the most important value.

“You’re Grounded for Doing a Trumpy”

Donald_Trump_August_19,_2015_(cropped)

“Keep your head down, keep on working, and always keep the police on your side.”

It’s the only way to get through this. Learn from it, deal with it.

The day after someone like Trump wins the election, all the pundits in the world can examine the data, but those of us who are clever and are survivors will think of what to do.

What to do.

They are rioting in the streets today.

Usually such degree of unpopularity in a president is only achieved at the end of their terms, not at minus seventy-two days!

A Pettiness I Must Expiate

I do not like that the American people have elected such a man. I do not like his surrogates on CNN, who bristle with largely ignorant hubris to my eye, and for them to end up winning, and gloating, is very hard to bear. I am offended and insulted, and aggravated by their assumption of correctness that I cannot dent. It is a pettiness of mine.

The only way to bear it is to recognize that the majority of Trump’s supporters do not approve of his arrogance, his dishonesty, his misogyny and his braggadocio.

But What About the Children

I watched Van Jones, tearfully, asking, “How do I explain this to my children. I have friends who ask if they should leave the country…this was a whitelash!”

What to do. Van Jones will come to the answer, but I know what to do. And he will too.

“Keep your head down, keep on working, and always keep the police on your side.”

This has been my mantra for years, though I change it subtlely when I work in a hospital, as I normally do: “Keep your head down, keep on working, and always keep the nurses on your side.”

In politics, obviously, you have to take the good with the bad. You never get everything you want in a single candidate. That is the essence of democracy. You only get one president, and whoever they are, they cannot be all things to all people.

 What Were They Thinking?

The realization that came to me this morning, after many tears in the middle of the night, was that our friends to the south were not embracing the hubris in their president. Nor were they embracing the misogyny. They don’t really want their president to be a failure as a business-man, who declared bankruptcy four to six times to milk the system. Nor do they want their president to stiff his creditors, or cheat the tax man, or to brag so egregiously. They don’t want their president to rape women, or even to grope them, which is essentially the same thing. They don’t really want him to be a liar, or a cheat, or an ignoramus. In fact, they probably want him to be a hero, but nobody can be a hero in this day and age.

But you have to take the bad with the good. They wanted a change…a change from the politicians who they think are fixated on self-interest, and continued unrelenting control. They wanted a change from the stagnant economic doldrums, even though no leader can deliver them from those doldrums. They wanted someone to re-establish American hegemony, when such power has quite naturally passed them by. They wanted someone to make them lovable again, when years of self-centered American dirty trick foreign policy which created the hatred they feel so keenly in the backs of their necks, make them anything but lovable.

They wanted a miracle and they thought change in any form would give it to them. Or at least give that miracle a chance.

It was an unholy alliance of the con and those who wished to be conned.

 The American Dream

Americans want the American Dream again, but it is a mirage. They want to know that if they work hard, they too have the chance to become a Trump, or a Buffett, or a Gates, or another billionaire, when in fact, such occurrence is based often more on good luck than good management.

The American Dream has always been built on slavery. Of some kind, anyway. Four hundred years of slavery, which in latter years has been transformed into the more subtle ‘gap.’ Instead of ‘work for nothing,’ it is ‘work for pittance,’ when the 1% control the wealth of the 99%. And rich white old males reap the American Dream while asking others why they cannot succeed, others who can only pine for the excesses enjoyed by the few. But that distant allure only encourages them all to persist with a system that seems to make such dreams possible.

The Donald epitomizes the American Dream: inheriting wealth which self-perpetuates no matter how incompetent the beneficiary happens to be. Maybe they inherited money, or fame, or status, or class, or education, but whatever it was, that quality put that individual a step above others, and that advantage is what every American Dreamer pines for.

To get ahead.

Like the two hunters, one putting his shoes on while the other urges him to run, the first explaining that he doesn’t need to out run the bear that is coming, he just needs to outrun his friend who is urging him on.

In the end, as superficial as it was, old white males, and a whole bunch of their followers, decided to ignore Trump’s obvious faults, Trumpies, if you will, and instead decided to follow him over the cliff if only to get some kind of change.

Maybe that desire for change is healthy, after all. It’s what Bernie offered too, but in the end, the system decided Trump might succeed where Bernie would not. Or perhaps one part of the system knew that Bernie would succeed, and so he needed to be suppressed.

Basically, the American people decided that Trump’s obvious faults, the Trumpies, were ones they could live with and ignore, as long as he also provided the change they saw in his empty promises.

And it all makes a bizarre kind of sense. Americans, for the most part, do not need a role model to demonstrate how to behave. They know already that they should not be liars, or sexual predators, or braggarts, or cheaters, or conspiracy theorists. So they don’t really have to worry too much if their president is one of those, or even all of those. What they want is someone who will deliver them from the doldrums, who will return them to the prosperity they enjoyed in the past, even if all reality informs them they can never enjoy it again in the future.

So they voted for someone with empty promises balanced against faults they need no instruction to avoid.

“Grab their pussy if you must. We know that’s wrong, and we won’t do that. But while you are at it, could you show us how to make American great again without all the cheap labor from slavery? Could you show us how to do that? If you do, feel free to grope women, because we think it is probably worth it to old white male dominance, to know how to make America great.”

So, What to Do?

Americans, for the most part, do not need a role model to demonstrate how to behave. Not when they have something almost as good: a role model to demonstrate how NOT to behave.

Maybe the president should not primarily be a good positive role model. Maybe that’s too much trouble, and generally unachievable except rarely, as in Carter or Obama.

After all, there are excellent negative role models out there that even an outsider like me  can see: Nixon, JFK, Clinton (Bill, of course).

But What About the Children

What to do for our children?

This is an ideal win-win opportunity. Trump, as an example, can teach our children two major lessons.

The first, of course, is that the political democratic process can, and does, put despicable people into positions of power. Not everybody who becomes a major leader is worthy of respect. We all know that. Now we can point to a prominent example that can explain the issue to our children.

The second is to point to the individual obnoxious characteristics:

“Grab them by the pussy.” No son. Don’t do that. It is illegal and you could end up in jail for ten years. It is an assault and is disrespectful of women. Women are people (since 1920 anyway…). Yes, you can tell your children about the historical white male dominance that persists in many subtle and not so subtle ways. You can point out how a disparity in physical strength does not justify it’s use, any more than disparity in financial or political power, or even intellectual power, can justify any related abuse.

“I know more than the generals do.” Ideal examples for the six and seven year olds (Donald’s arrested development?). When they challenge their adult overseers that they know how to dodge traffic on a busy highway, you can call it a Trumpy. “He doesn’t know more than the generals do, and he doesn’t know how to dodge traffic. And neither do you.”

“Many people say…” Here we can teach the children the difference between logical fact based argument and sleazy innuendo weasel words. “Notice how the president uses language which cannot be disputed but is totally specious. Never say ‘Many people say…’. That’s a cop out. It’s a weasel argument; it’s a lie. It’s a Trumpy.”

It is an opportunity to show children how questioning the birthplace of someone clearly born in the United States is a not so subtle bigotry that is certainly designed to discriminate against their race. “You have no right to question something like that without at least a hint of evidence that raises the concern, and having a middle name that is from another religion is simply not enough. And it’s a silly antiquated law anyway, designed for a different time.”

“They’re bringing drugs, they’re bringing crime, they’re rapists and SOME I ASSUME ARE GOOD PEOPLE.” No, daughter dear, such smear statements of fear have no place in the polite conversation. Such generalizations are inaccurate and unfair, and dishonest in terms of numbers and predominance. And ethnic discrimination like this is never an acceptable method of argument.

“God has chosen President Trump.” No son. God did not choose president Trump. Why would he? If there were an omnipotent, omniscient, all powerful deity, would he pick a dishonest, adulterous, uncivil, ill-mannered man who brags about groping women, hell, who brags about everything? Of course not. No. If there were a god of the bible, he would not choose a Trump. He probably would not even choose a Clinton. If there were a god, and the deity made a choice, they would not even be as fallible as an Obama. No son, there is no evidence of a god. We have to make it on our own and make better choices next time.

World Leaders are Not Infallible

There is a tremendous lesson in finding such fault with a world leader. We hold these people in too great esteem. To be able to point at the president and explain the fault to a child is a powerful message. And with this man, there are so many opportunities, so many Trumpies.

If we accept that the election of a man like Donald Trump is not a celebration of his obnoxious characteristics, but instead a frustrated call for some kind of change, if we accept that the American people have decided that their president need not be a saint…if we accept that the vote was, rather, a repudiation of the status quo, then we have a wonderful opportunity to advance the education of appropriate civil behaviour for our children (while also feeling a little better about the American people themselves).

We can achieve this so easily now by pointing a finger at the new president and saying, “Don’t do that. For god’s sake, don’t do that. If you do, you’re grounded for doing a Trumpy.”

Returning to Physician Assisted Death

 CPSO

My college has taken a welcome proactive stance on Physician Assisted Death (PAD), with, I think, excellent results. It is necessarily a work in progress.

 Background

As I mention in an earlier blog post, the Supreme Court of Canada, in the case Carter vs. Canada, unanimously determined that an absolute prohibition on Physician Assisted Death violates the Charter of Rights and Freedoms. Currently this service is accessible only through exemption from a superior court judge, but it is anticipated that this legal requirement will also disappear by June 6, 2016. The College, not content to leave physicians of Ontario without guidance, has published its Interim Guidance on Physician-Assisted Death in the current issue of Dialogue, Volume 12, Issue 1, 2016.

Interim Guidance

The document lays out professional and legal obligations, criteria for PAD, and guidance on the practice related issues. It reminds us first that ‘professionalism’ in the medical context includes compassion, service, altruism and trustworthiness, the key values which are the foundations of medical teaching to this day.

These values are reflected in the behaviors we all expect from of physicians: respecting patient autonomy, ensuring all patients receive equitable access to care, communication effectively and sensitively in a manner supporting the patients’ autonomy, and demonstrating competence (clinical, legal and professional).

From the Interim Guidance, it is possible and probably necessary to create a checklist:

  1. The patient must be a competent adult;
  2. The patient clearly consents to termination of life (this presumes they are informed);
  3. The patient has a grievous and irremediable condition (illness, disease, or disability); and
  4. The patient experiences enduring suffering that is intolerable to them.

The checklist can continue as a form of process map:

  1. First request is to the attending physician, whereupon the attending physician either refers to someone for this service or assesses the patient to ensure that criteria 1. through 4. have been satisfied;
  2. The physician reminds the patient they have the ability to rescind the request at any time;
  3. The attending physician finds that the patient meets these criteria, and documents the assessment with the date of the first request. If the physician finds that the patient does not meet criteria 1. through 4., the patient is entitled to make a request of another physician, who would then follow this procedure.
  4. A period of reflection follows, the length undefined;
  5. The patient makes a second request, which requires formal documentation;
  6. The patient’s written request, or transcribed oral request must be dated and signed by the patient, countersigned by an independent witness, and signed by the physician;
  7. A second consulting physician must again follow criteria 1. through 4., 6. and 7.;

Options of Service

  1. The patient may be given the prescription for a fatal dose of medication to take at home, or receive voluntary euthanasia administered by the physician;
  2. In the former case, patient and caregivers must be educated with respect to safeguarding the medication and ensuring that the process can actually be managed by the patient. Additionally, the physician must educate the patient and caregivers on what to expect;
  3. Physicians should consult Ontario government for guidance with respect to completion of the death certificates.

Frequently Asked Questions

The College document is supported by a section in the Journal issue referred to as ‘College’s bridging document on physician-assisted death’ starting on page 9. This has obviously been a contentious issue, and the article includes an FAQ.

There is important discussion of age (physicians are pretty used to this being fuzzy, recognizing the wide variation) which incorporates capacity and maturity, especially when the patient is less than 18 years of age.

Grievous and irremediable is more commonly a legal term, but the important issue for physicians is that imminent death is not a requirement, nor is the patient required to follow advice or treatment recommendations of physicians for their condition to be determined irremediable.

Intolerable suffering is determined by the patient, reminding me of Dr. Balfour Mount’s famous statement, “Pain is what the patient says it is, when the patient says it is.”

Capacity is required to the end; the patient must be in a state of being capable of declining the service and rescinding the order until the treatment is given successfully completed.

No patient is to be excluded from this service by virtue of mental illness; rather the important issue is their capacity to comprehend, and to receive and understand in order to provide informed consent.

The College does not address the concern of objecting family members in their document, but our Canadian Medical Protective Association is fully aware of the issues, and is willing to provide help to physicians facing such difficulties.

Conscientious Objection

This issue has perhaps raised some of the greatest concerns among a small section of physicians and general public. In the extreme, it has been argued that some physicians who object to providing this service also object to discussing it with patients or referring to others who would do so.

Notwithstanding those objections, the College does indicate what it considers to be the appropriate response of such a physician:

  1. The physician must respect the patient’s dignity.
  2. Physicians must not impede access to PAD even if it conflicts with their religious beliefs.
  3. Physicians must communicate their objection directly to the patient, and do so with sensitivity, pointing out that this decision is their personal decision, not a clinical decision for the patient.
  4. Physicians must not express personal moral judgments about the patient’s beliefs, lifestyle, identity or character.
  5. Physicians are required to provide information about all options for care that may be available; they must not withhold information about the existence of any service because it conflicts with the physicians’ conscience or religious beliefs.
  6. The physician is required to make an effective referral to a non-objecting, available and accessible physician or agency.
  7. Patients must not be exposed to adverse clinical outcomes due to delayed referral.

My Opinion

The message here is clear. Physicians may not rely on their conscience or their religious beliefs to avoid compliance with this guidance. The will of the people and importantly, the patient, take precedence over any conscientious or religious objection, frankly, very much as is required for abortion services.

My other blog has referred to the inflammatory and insensitive reference to PAD or euthanasia as ‘killing’, a word that seems to be used by the religious leaders as a means of imposing their authority over the issue. In addition, it is clear that the act of referring a patient to another physician does not ensure that PAD will actually take place. In fact, my impression is that the availability of PAD will actually go on to save lives, as one of my friends wrote to me the other day (thank you J. McG.) because the knowing of this option being readily available will help the patient endure trials of other treatments.

And for those physicians who cannot comply? In my opinion, your options are clear. Either you remove yourself from the conflict, or you lie and pray that nobody ever complains, because if you willfully fail your patient with regard to this guidance, you expose yourself to the allegation of professional misconduct.

Of course, there is a second problem for conscientious objectors who cannot compromise and do not withdraw themselves from the conflict (practice in areas of medicine where they can never be asked for this such as pathology, laboratory services, maybe radiology). If they think this through carefully, they can never refer to a physician who is a non-objector, lest that lead to offering the service of PAD against their conscience or religious beliefs. Is ignorance of the beliefs of the consulting physicians a reasonable defence? Not inside their conscience or religious beliefs, it isn’t.

I hope the conscientious objectors do compromise enough to refer these patients to others, realizing that the patient may not choose PAD. I know some of these doctors personally, who are fine physicians. We will have patients and families in our midst who object to this type of service because of religion and other beliefs, and it is important that the population of physicians reflects the population at large. The conscientious objectors provide services to these and many others, and while I may disagree with their premises and conclusions, I cannot dispute their discipline or integrity on the basis of their beliefs.

I hope that the understanding of PAD as a comforting option (that may actually help patients to take some ease in their end-of-life decisions) even if their patients never use PAD, will allow the conscientious objectors to accept what may be the greater good: that they compromise by making effective referrals and continue to provide the excellent care that all our patients deserve, thereby helping that many more.

Karate: Empty Hand, and a Mind Prepared to Learn

 

Karate Do, My Way of Life, by Guichin Funakoshi, was one of the first books I read about karate. Consequently, it probably had the greatest interest and influence.

 

Fighting BrianThe author, right foreground, about to be kicked by his friend Tom, Tom’s wife behind him to his right, and the club’s chief instructor, Larry, head down at the back of this line. At London ShidoKan

Karate as Discipline

Karate is really a product of Chinese boxing, like Kung Fu, which was taken by emissaries to Okinawa in the sixteen hundreds. The teaching of the discipline varied by practitioner and by city, almost like a game of telephone where the end message differs so much from the beginning. Each master, and subsequent style, added and changed a little bit.

The sport, or discipline, or ‘do’ as in ‘the way,’ was taught from master to student, and carried between cities with the inherent difficulties of transportation and isolation of distance at the times. It spread through Okinawa, and was then introduced to Japan in 1922 by Funakoshi.

The physical study of karate involves the practice of basic techniques of striking and kicking, along with balance and movement. Forms (which my wife would irreverently refer to as dances; ‘they are NOT dances’) referred to as kata, are consistent within the style, though subtle variations between styles are obvious and interesting. Each such form, which is performed by the practitioner, takes about a minute to perform, and requires the exertion one might experience from a 440 yard run.

Practicing Kata and Kumite

Forms consisting of moves, strikes, and kicks are practiced over and over. There are a variety of ways of practice, breaking each movement down. Fine tuning occurs of hand, foot, and body position, posture, intensity, and occasional kiai (a loud yell at the peak of intensity of a movement, usually a strike). Breathing is emphasized, in some styles more than others.

Often, once a kata is known, but not yet perfected (which never really happens, of course), the class may be taught the bunkai, or application of each move, and this may be practiced with partners. Many styles will even have pre-arranged movements based on the kata movements, which can be practiced with three or four partners taking various roles. Needless to say, the performer of the kata or bunkai always wins!

The application of bunkai might simulate the original kata, though sometimes the relation is a bit obscure, but smaller segments can be practiced with partners in the form of pre-arranged movements. Here, the advantage as well is that they can be performed both left side and right side, where the kata might only offer practice with one. This pre-arranged form with partners is called kumite.

Free style kumite is sparring; you don’t know what your opponent is going to do, but you have to be prepared to block and counter-strike.

Karate does not normally involve full power strikes. Blows from hands or feet generally are ‘pulled’, stopping just at touching if against a non-vital target, or stopping within a fraction of an inch if directed to face or head, or other vital or easily damaged structure. Joints, genitals and head are generally spared.

The North American tradition of establishing grades by belt color is important; one can gauge attacks and techniques depending on the proficiency of the adversary. In Japan, they used to be white or black, but here in North America the colors span the rainbow. And it helps. If I am attacking a yellow belt (usually about three to six months training) I will be slower, and less powerful, while anticipating that they might not exhibit the same level of control when attacking me. With other black belts, you can usually do pretty well whatever you want, especially once you know your opponent. Their skill level should provide adequate protection, and, of course, your skill level should also prevent damage.

Tournaments in Karate often involve free sparring, normally with protective head and hand/foot padding. Concussions are rare because striking full force to the head is not allowed.

Other competitive activities include kata, and it is often extremely difficult for non-practitioners to understand what we are looking at when we grade a kata performance. The movements are so fast, often to the uninitiated, it is all just a blur. Nevertheless, once a karate-ka achieves a black belt level, they can usually easily see the difference in a well performed kata, regardless of style.

Karate Tradition

‘Karate begins and ends with respect.’ This is an important part of training. There is a natural tendency to take offense at someone who hits you, even if by mistake. The respect exhibited by the traditions of bowing in, bowing to each other, silence during classes, and to some extent the minor military discipline, is all important at maintaining camaraderie and control. Some of my best friends have kicked me in the stomach, punched me in the face, or thrown me onto the mats. I have thrown one close friend through the ceiling, and kicked one casual female friend out the door. The overall intent, however, is to not harm your opponent.

In thirty years, I have never seen anger ensue to any of these rather violent activities. Even the guy whose hand I broke, who required three hours of surgery as a consequence, bowed to me after the incident (as he should, it was actually his fault).

The Meaning of Karate

The original words, ‘kara’ and ‘te’ meant ‘Chinese’ and ‘hand’ respectively, reflecting the origins of the art. Funakoshi, realizing that Japanese society might not accept that interpretation…they were quite opposed to anything Chinese at the time…changed the word ‘kara’ to the homonym in Japanese meaning ’empty,’ which was represented by a different Japanese character.

In Funakoshi’s mind, empty meant ‘no weapon’ but also reflected the meditation at the beginning of sessions in an attempt to empty the mind and make it more receptive to learning. ‘No weapon’ was traditionally important. When the Okinawan islands were invaded by Japan, weapons of the usual type were removed from the peasants, perhaps with a central chopping block and knife in the village square for cutting vegetables, so the samurai would have an easier time controlling the populace.

Because samurai ‘armor’ consisted of breast plates made of wood, the practice of karate was geared towards breaking such boards by preparing the hands with continued practice, forming thick callouses that can break through three inch boards without injury. The tradition of breaking boards in order to prove technique stems from this.

Even though karate means empty hand, weapons which are related to typical farming implements, sai, bo, nunchaku, and tonfa, are typically studied as an elective type of activity.

Karate and Physical Fitness

Karate provides a fine mixture of aerobic and anaerobic exercise involving the entire body. Endurance, supple joints, flexibility are emphasized, and amazing progress can often be identified. Even the most inflexible gradually develop this latter attribute in order to perform kicks and strikes required. I have the body of a football player, naturally inflexible. After years of karate, when being evaluated by spinal orthopedic surgeons for my spinal stenosis in my early sixties, they asked me to touch my toes, expecting my hands maybe to reach down to my knees. When I actually casually placed my palms on the floor beside my feet, legs straight at the knees, without apparent difficulty, they dismissed my complaints. Even at that time I was still able to kick an opponent in the head if need be, while remaining essentially vertical from the waste up.

The typical karate-ka goes to the dojo (‘jo’, the place, ‘do’, the way: the place of the way) for an hour and a half three times a week or more, for classes. A typical class is hard enough that the gi (uniform) weighs an extra kilo or two from acquired perspiration. Warm up calisthenics, then repeated basic techniques, followed by kata and bunkai constitute a typical class. Interspersed during the week will be five or six hours of other aerobics and weight training, as well as individual kata at home. I have never heard any instructor ask students to do this, and I have never known an advanced student not to do it. Thus most of us, even with busy schedules, would be doing 9 to 10 hours of fitness a week by the time we got to green belt anyway.

Karate and Mental Health

When I first started practicing medical oncology, many of my patients would have terminal illness. This was an emotional challenge, and achieving a balance in practice and life is always important for physicians in general, oncologists in particular. My first few years in practice were very difficult.

I tried a number of forms of exercise to help cope, but always I would find I was distracted by thoughts of some challenging patient. Running, squash, aerobics, tennis, it was no use. Until I got to karate. Basically the first three months were so hard, I was more concerned with not vomiting, and thoughts of my patients disappeared of necessity. Soon I found the meditation at the beginning of class, where I would actively empty my mind, was starting to work, and the paired association eventually lead to a calm befalling me whenever I enter a dojo.

I have had the opportunity of teaching many young people, and parents have always worried about karate being abused by their children when they get back to the schoolyard. Two things tend to inform me this is not a problem generally: respect of your partner is emphasized at all levels and times during the classes, and the confidence in one’s skills and techniques tend to prevent the need for the youngster to prove his or her expertise to others.

A good school teaches everyone that the best form of self defense is avoidance; indeed, one school I attended early on forced us to run for 30 minutes before the calisthenics, teaching us to run away from any fight. As the adage goes, the white belt gets in a fight and loses, the brown belt gets in a fight and wins, and the black belt isn’t there to get in the fight.

Karate in Fiction (Particularly, Mine)

In a scene from Hollow Moon, you are asked to visualize the extended karate sequence in slow motion. The hero, Garth, and an Ensign with him, are entering an airlock in the Carousel, a structure with artificially generated gravity in a weightless environment. They see two men in front of them, both armed, one small balding with a gun (Sig Sauer Mosquito) held by his elbow under his arm, the other one in sunglasses (who happens to be a Nefra). The two men are part of a drug gang in Trojan, and they are there to assassinate a potential snitch in the Ortho Burn Unit:

The Ensign did not register the danger, so continued to enter the air lock without hesitating. Mr. Sunglasses brought his gun up to eye level, arm straight, and aimed directly at the Ensign. Even as Garth started to lunge, he saw the smaller balding man look back, and with the surprise, released the clasping pressure on his silenced Mosquito. Garth heard the two consecutive spits from Mr. Sunglasses’ pistol, and saw the Ensign’s head jerk back. He felt hot viscous liquid spray across his own eyes. His right eye blurred as he hunched down slightly, continuing his forward momentum. Garth raised his left arm up under the outstretched arm with the SIG P226. 

Behind the shooter, the opposing air lock door opened to reveal a man and a woman, TPD officers, standing there in the hall. Garth vaguely recognized the male, as he made contact with the gun arm of the shooter in sunglasses. At the same time, Garth struck Mr. Sunglasses in the throat with a right handed uraken strike, his fist extended straight at the metacarpal phalangeal joint so that the first interphalangeal joints made contact, instead of the usual knuckles; his fist resembled a hockey puck in shape, flat, hard and narrow, and with years of practice, the powerful tightening of the fingers made the narrow contact rigid enough to break boards, narrow enough to sneak up between chin and sternum. 

The blow fractured the windpipe, immobilizing the assailant with pain, drop in blood pressure, and immediate airway blockage. While still levering the assailant’s right arm vertical, Garth followed that blow with a right jodan empi, an upper elbow strike to the jaw. Mr. Sunglasses’ arm was now pointed up and behind him. The gun spat once more, the bullet striking and piercing the green wall behind and above them at the juncture with the ceiling.

Garth continued his forward momentum, sliding his left arm up to the wrist of the assailant and inserting his right arm behind the right elbow of the now completely unconscious Mr. Sunglasses man, whose sunglasses were admittedly long gone, revealing large piercingly blue eyes. Garth pressed back on the assailant’s right wrist with his left arm to push the arm backwards over Mr. Sunglasses’ shoulder. Glancing over at the balding man, Garth brought his right leg forward in a mid-level roundhouse kick that caught the balding man in the left kidney with the extended toe of his shoe. The balding man had turned back to see the two TPD officers in front of him. One of them had just shouted. The SIG Mosquito hit the floor at about the same time, and the balding man collapsed into the next hall, at the feet of the two officers, as Garth brought his right leg, instep of his foot, really, in a smooth and continuous movement, down into the forward left ankle of the unconscious Mr. Sunglasses man, to foot sweep him to the floor. The foot sweep was really quite unnecessary at this point, but Garth did it anyway.

Sometime later, still shaken by the death of the Ensign and his brush with his own mortality, Garth sits down with Detective Inspector Simeran (a Nefra) and his partner Constable Rosie Williams. They have their own, professional reasons for wanting to hide the fact that Garth has just killed one hit man and disabled another: they need Garth to take medical care of the ‘snitch’ who is in the Ortho Burn Unit, and they want to protect Garth because he has just killed a member of the Nefra mafia. Simeran is discussing karate technique with Garth (who is an old friend and sparring partner with him, and with a mutual friend and fellow Nefra named Elper):

“That was impressive, by the way. You must show me that. A two on one defensive move, disarming perp one with the hand technique, elbow strike, then roundhouse to the secondary perp, followed by the foot-sweep on the main perp. Uraken, empi, mawashi-geri, ashi-barai in rapid succession. You practice that with Elper?” Before Garth could answer, Simeran added, with a smile, “Too bad I didn’t see it.”

Garth was nodding. “You should see Elper do it. God he’s smooth. He makes karate look easy; I always make it look hard.”

Excerpt From: Brian Henry Dingle. “Trojan: Hollow Moon of Jupiter.” iBooks.

The sequence of moves is accurate. It was actually the blow to the throat with the uraken strike that eventually killed the assassin, Mr. Sunglasses Man, with a crushed larynx. Half way through the maneuver, the power in the corridor goes out because of a stray shot from the perp’s gun, and weightlessness ensues, making Sunglasses’ resucitation difficult and unsuccessful.

When I talk of Elper, a Nefra who is the ‘brood house brother’ of Mer (the hero of Nefra Contact) I am thinking of Fortunato Restagno (Godan, 5th degree) who heads Grand River Karate, the dojo Fortch and I started in 1994. As I always said, “Fortch makes karate look easy, while I always made it look hard.”

Fortch has always been far better at karate than I.

While I have left Grand River Karate, Kitchener, when I moved to London, the club continues to this day, in the Shidokan Canada association under Roy Paul (6th degree) located in Guelph, Ontario.

Karate as Self-Defence

I have never been in a real fight, outside of sparring in the dojo and pre-arranged kumite, a fixed set of movements for training, which each participant knows are coming. I have spoken to several fellow karate-ka (karate practitioners) who have been in fights outside the dojo. While this is frowned upon, sometimes it is unavoidable. Their stories are surprisingly similar, and when you think of it, entirely understandable. There is nothing magical about all this. If you practice, you get better. If you practice a lot, you are very much better equipped than the person who does not practice at all.

What is a fight like for someone who is trained against someone who is not? I am told it is like slow motion. Boxers, mixed martial artists will tell you the same thing. If you are used to the trained person coming at you with some fast techniques, two things are apparent. First, especially with the novice, very very subtle movements by your opponent tell you exactly what they are going to do. Even before you consciously recognize it, you know they are coming at you, say, with a right roundhouse kick to the ribs, and their foot has not yet left the ground; or a feint kick, followed by a punch. Second, it all looks to be in slow motion: “Oh, look, here comes a right hand punch to my face…wait…wait…now, dodge and counter.”

It really is like that, and it is not magic. If you practice the piano, you can eventually learn to do some very fast passages you don’t even know you are doing at the time. If you are a goalie on a hockey team, your hand is going for the puck before you really see where it is going. This is quite routine. Often, you can tell where the puck is going before it leaves the ice.

I know a young woman in a related dojo, who has earned through years of repeated practice, a fourth degree black belt in Shidokan karate. She is a slight, feminine, attractive woman, who simply does not look like anyone’s bouncer, by any means.

While she was working as a waitress in a bar one night, some big, obese, 6 foot 2 inch biker was trying to physically hit on her, eventually grabbing her where she didn’t want to be grabbed. A ridge hand strike to the throat followed by a kick to the genitals and then a kick (same leg) immediately to the side of the right knee, and down he went. In the process, she had stepped to the side out of the way of the sweeping right arm that she knew was coming. He quickly hobbled out of the bar, to her chagrin because he was stiffing her with the bill. She had painfully disabled some Hell’s Angel type who was literally twice her size, and she worried about it for a while, thinking he might come back with friends. Even black belts don’t like guns. But how do you explain that to your friends?  Seems likely that biker guy kept his mouth shut. The sequence was over before she consciously knew what had happened, and it did look like slow motion to her.

Karate as a Social Structure

A lot of my life has been spent in a hospital or a dojo. Both provide exposure to an interesting slice of humanity. There are perhaps a lot of macho types in karate, but more and more in the last couple of decades, especially in parent-child programs where both are in the class (a common marketing technique where both child and parent start, at a cut rate, only to have the child give up after three months and the parent continue on to black belt!) the demographics have tended to represent all walks of life. Doctors (like me), teachers, professors, graphic designers, police, military of course, sales people, consultants and personal trainers, postal workers, health care personal, farmers, accountants, plumbers, electricians, construction workers, store managers, university students come to mind as I think of the people I know…and with all of these, often come their significant others, or their significant other wannabes. I have attended at least one wedding of two karate-ka who met at the dojo.

Parties, and social get-togethers are common, particularly after tournaments, collective movies when some martial arts B- or C-level film comes along (to laugh at) and with my last club, an annual three day camp at which the first half hour each day is spent going around a ‘circle of friendship’ where everybody shakes hands with everybody else.iha

To this day, even after several years of retirement from karate due to physical ailments, some of my best friends are karate-ka. While I had to stop early in life (at sixty-five), many go on until seventies or eighties, much as the Hanshi of our style of Beikoku Shidokan karate.

Seikichi Iha, Hanshi (10th dan) Beikoku Karate, Lansing Michigan. At 84, this chap could take on me, and three others like me! Even at my prime.

 

Karate is a wonderful sport. In unison with a class, or all alone. Once I got over the embarrassment of observers wondering what I was doing, with just a T-shirt and gi pants (kicking is easier in a karate-gi, and the uniform gives feedback when the strike is made with sufficient speed and power) I would do kata for an hour by myself, pretty well anywhere. On a beach, in a park. But unlike mainstream sports, most people do not understand karate unless they have done it for a while. Once you are bitten though, it becomes part of your life.

Vaccines, Shoddy Research and Jabberwocky

Alice_Liddell_2

 

Alice Liddell. Photograph by Charles Dodson (aka Lewis Carroll)

The Jabberwocky

‘Twas brillig, and the slithy toves
Did gyre and gimble in the wabe;
All mimsy were the borogoves,
And the mome raths outgrabe.

“Beware the Jabberwock, my son!
The jaws that bite, the claws that catch!
Beware the Jubjub bird, and shun
The frumious Bandersnatch!”

He took his vorpal sword in hand:
Long time the manxome foe he sought—
So rested he by the Tumtum tree,
And stood awhile in thought.

And as in uffish thought he stood,
The Jabberwock, with eyes of flame,
Came whiffling through the tulgey wood,
And burbled as it came!

One, two! One, two! and through and through
The vorpal blade went snicker-snack!
He left it dead, and with its head
He went galumphing back.

“And hast thou slain the Jabberwock?
Come to my arms, my beamish boy!
O frabjous day! Callooh! Callay!”
He chortled in his joy.

‘Twas brillig, and the slithy toves
Did gyre and gimble in the wabe;
All mimsy were the borogoves,
And the mome raths outgrabe.

‘Through the Looking Glass and What Alice Found There’ by Lewis Carroll.

This is one of the best known poems of doggerel in the English language, and there is a nice description with definitions of many of the words in the Wikipedia article. It was highlighted in a lecture I gave about six years ago on research fraud in medicine.

What on earth has the Jabberwocky to do with research fraud, or for that matter, Alice Liddell? It’s a bit of a story.

Shoddy Research

Years ago, in one of the most celebrated examples of misleading research, Andrew Wakefield published a paper in the Lancet entitled “Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children”, Volume 351, Number 9103, February 1998, which purported to draw a connection between vaccines and autism. If you look now, you will find that the Lancet has the word “Retracted” displayed prominently across the page after what was one of the longest hearings ever of the General Medical Council (doctor’s judicial organization) of the UK. The panel ultimately wrote the following paragraph in their report:

The Panel considers that Dr Wakefield’s conduct in relation to the facts found falls seriously short of the relevant standards and that suspension would not be sufficient or appropriate against a background of several aggravating factors and in the absence of any mitigating submissions made on his behalf. Dr Wakefield’s continued lack of insight as to his misconduct serve only to satisfy the Panel that suspension is not sufficient and that his actions are incompatible with his continued registration as a medical practitioner.

Accordingly the Panel has determined that Dr Wakefield’s name should be erased from the medical register (meaning he lost his license to practice medicine).

Reduced Compliance with Vaccination Program

Unfortunately, by this time, May 24, 2010, a lot of the damage had been done, and the number of children in the UK (vaccination compliance in two year olds dropped over 10% between 1996 and 2004 in England) and around the world receiving vaccines of any kind, dropped, exposing a lot of children to unnecessary illness and death. To this day you can still hear people citing this article. But the entire Lancet article is called into question by the behavior of it’s leading author, as indicated by the verdict of the GMC hearing:

The results of the research project were written up as an early report in the Lancet in February 1998. Dr Wakefield as a senior author undertook the drafting of the Lancet paper and wrote its final version. The reporting in that paper of a temporal link between gastrointestinal disease, developmental regression and the MMR vaccination had major public health implications and Dr Wakefield admitted that he knew it would attract intense public and media interest. The potential implications were therefore clear to him, as demonstrated in his correspondence with the Chief Medical Officer of Health and reports which had already appeared in the medical press. In the circumstances, Dr Wakefield had a clear and compelling duty to ensure that the factual information contained in the paper was true and accurate and he failed in this duty.

Wakefield’s co-workers disavowed the article, withdrawing their authorship, and saved their privilege of practicing medicine, although one other co-author was erased from the medical register (de-licenced) because of the part he played.

The damage to the world in terms of trust of the profession in general and vaccines in particular, was profound, and I have little doubt that many children lost their lives as a result of failing to obtain vaccinations for an extended period following the publication of this paper. To this day you can easily find people who think MMR vaccines cause autism.

Shoddy or Fraudulent Publications

Those not in the medical field will be shocked to hear that in the ‘good old days,’ becoming an author of a paper was overly easy, and the rules around what was required of authors extremely lax. I know on several examples I was listed as an author without ever knowing. Indeed, I just this week discovered I was a co-author on an abstract which to the best of my recollection I had never seen (fortunately a good summary, once a colleague of mine and I found it). This was common.

Not so any more, thank heaven.

Strict rules are outlined in ‘Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Writing and Editing for Biomedical Publication’ Updated April 2010. Publication Ethics: Sponsorship, Authorship, and Accountability International Committee of Medical Journal Editors. Responsibilities of all co-authors in any medical paper are laid out, and peer reviewed journals now generally abide strictly to these rules. Repercussions for fraudulent reporting can be severe, as they should be, for the results can be tragic.

OK, so vaccines took a bad rap from a badly conceived and implemented bit of research. What’s that got to do with the Jabberwocky?

The Slaying of Jabberwocky

Charles Dodson (aka Lewis Carroll) was a lecturer at Christ Church, Oxford. He befriended the family of the Dean, Henry Liddell. One of the children was Alice, in the picture above taken by Dodson (although sources are quick to point out that a parent was always in attendance). Concerns of over Dodson’s attentiveness and attraction to the children are in the literature surrounding Dodson, and it is hard to imagine there may not have been rumors of pedophilia. Nevertheless, all accounts I have seen suggest Dodson’s friendship with the family was innocent, but a ‘break’ in this family friendship may have been the result of gossip, it has been suggested.

Dodson has been questioned on the meaning of the word ‘Jabberwocky,’ and as referenced in the Wikipedia article above, Dodson himself described it as the ‘result of much excited and voluble discussion.’

Reminiscent of the ‘Music Man,’ of the women who gather to nit and to gossip:

Pick a little, talk a little, pick a little, talk a little/Pick, pick, pick, talk a lot, pick a little more.

Gossip. Or, the results of gossip, more specifically. Put another way, Jabberwocky is ‘the unexpected consequences of relying on unsupported assertions.’

Poorly conducted medical research, fraudulent research, misinterpreted research, can all lead to mistakes and faulty conclusions. So too can gossip. And I am reminded of Christopher Hitchens beautiful but always angry statement, in reference to other large areas of unsupported assertions, ‘that which can be asserted without evidence can also be dismissed without evidence.’

The results of gossip, the conclusions from unsupported assertions, those repercussions of faulty logic and research–this is all Jabberwock.

And when you think about it, charitably, poor old Dodson may have simply been very fond of children he would never have himself, perhaps especially Alice above (ultimately to become Alice in Wonderland), only to have that relationship cut off because of some possible malicious gossip…well…you can certainly see why he would have reveled in slaying the Jabberwocky, can’t you.

Slaying the Jabberwocky: Ridding the world of the consequences of accepting unsupported assertions.

Oh frabjous day!

 

Science, Religion and The Republicans

dynamic

Simple model of a dynamic process. 

 

 

 

The diagram here looks pretty simple, too simple to be bothered with. It is not the most simple dynamic model of changing processes, but it is pretty close.

Consider the red box (oddly, orange on some of my computers). Stuff comes in (a:top), stuff goes out (c:bottom), and stuff leaves by the side door (b:side). The amount of stuff in the red box is dependent upon all three, and most realistic dynamic processes are hugely more complicated than this one. In fact, some models have an infinite number of entrances and exits, but let’s stick with this one.

People who study any amount of Science at all are well versed with this model, as it applies to so many things. Unfortunately, people very well educated in the Arts (especially those who take pride in NOT studying science, or those who believe it is unimportant, or worse, impossible) sometimes find this perplexing and simplistic at the same time. But it is really pretty simple.

Take a look at it. Stuff inside the red box will remain exactly the same if the amount entering and the amount exiting remain the same, if a = b + c. If two people enter the front door every minute and one person exits at each other door every minute, then a = b + c. You see that, right?

But what if b=Asin(t)^2 (^2 means squared, sin is a sine wave and t is time) and c=Acos(t)^2, the stuff leaving varies with time at each door, then if a=A, the amount in the red box remains constant.

OK. I just lost all the Artsies, so I will stop doing that. Scientists and mathematicians can easily create formulas for the entrances and exits in such a way that the stuff in the box remains constant. Equilibrium.

Think of a lake with three rivers, (Lake of Bays in Ontario, one of my personal favorites) one entering, two going out. At some point a balance occurs with the rates of entrance, exit and the level of the lake. All of a sudden the model is beginning to look a whole lot more complicated, as people add logs to a dam, for example.

The model can be used in all kinds of places. Perhaps the exits could be the money the government takes and the money you spend, with the top arrow being your salary.

Or the number of people in a country can be the result of births, deaths and departures.

Think of a bath tub with a drain, and of course, the amount that flows out over the top. Only the tap is constant, all other exits vary in terms of rate, as you quickly discover when the water starts running out across the floor.

So let’s think of energy. But let’s turn all the arrows around. Now a is the energy leaving the box, and b and c represent energy entering the box.

dynamic2

Now, pretend that a = b + c. Clearly the total energy remains constant over time. Let’s be more specific. Let’s think of c as energy entering from the bottom as chemical energy, usually heat, to be simplistic, that is generated from chemical structures stored in the box. The arrow in (the bottom arrow, remember we reversed all directions) represents the conversion of chemical energy to heat, as when the chemical structures, bonds, are broken by some process (like oxidation). Don’t worry about the process, it could be any number of things. Burning, for example.

If the energy entering as radiant from hot objects at a distance, and the energy entering as c is from basic chemical changes, then the amount of energy in the red box goes up, unless the amount leaving, a, increases.

This can quickly become very complicated if the amount of energy in the red box alters the rates of any of the arrows, any of the a‘s, b‘s, or c‘s. In fact, such changes are very common. If the box fills up, arrows b and c may slow down because of some resistance.

Steady state is when the three arrows are perfectly balanced. You can probably imagine systems where, when one arrow changes, the others change, such as that lake. If the water level goes up, the river that exits starts roiling, and so on.

But let’s go back to the red box of energy, with radiant energy and chemical energy as its sources. Let’s pretend the exit of energy, (remember we reversed the arrows so this is a) usually radiant in the form of escaping heat, is perfectly balanced to the two sources. For years. For millennia. For eons. Maybe not forever, but of enough time we all get used to the red box. Comfy.

Now let’s suppose we started cooking inside the red box 250,000 years ago. And then started using fires to run equipment 200 years ago. And electricity becomes ubiquitous a hundred years ago. And then the motor vehicle in the early nineteen hundreds, and all the while, all of this increases as the world population goes from one billion in the year 1800 to 8 billion by the year 2025!

And just to make the process speed up, imagine we block the rate of a by increasing the carbon dioxide in the atmosphere. Don’t go away Artsies. Just know that carbon dioxide can prevent radiant energy from leaving (like another log in the dam). It can. It does. Sort of like cloud cover or something.

Clearly the balance has changed, if only by a fraction. Surely the radiant energy, a, like the roiling rivers, will increase. Yes it will, but never enough. It increases because the water level of the lake got higher, because the energy in the red box multiplied. And as with the roiling rivers, there is always a delay. Once the energy entering the red box has increased, the levels inside invariably go up, because the escape though a is always lagging slightly. The water pressure at the drain in the bottom of a bath tub will increase as the water level rises (weight of a column of water), so the flow out the drain increases, but not enough to stop the water overflowing.

Back to the energy diagram. If the energy going in, b and c, increases, only a  fool would deny the possibility of the red box increasing its total energy content. Why would we? We should not be denying increased energy in the red box; we should be expecting it.

The only reason for denying increased energy in the red box is if we do not wish to face the consequences of our own actions. If we wish to believe nothing bad can happen. If we prefer to let our children suffer the consequences rather than to deal with it now, because we don’t really care what happens to our kids, or we just put it out of our minds.

Well, there is one other reason. Maybe we believe it is God’s will. Maybe we believe God did a perfect job up front and so this problem cannot happen. God created heaven and earth.

Maybe we believe God will fix this problem, and we don’t have to worry about it. Or maybe we believe a holy text that tells us there will be an apocalypse which will start the beginning of the end-times which will make us all a lot happier.

For those of you who have trouble with models and analogies, the red box is the earth, the stuff, the energy, causes both climate change and increasing temperatures: the radiant energy b enters from the sun and is pretty much constant in our time lines, and the chemical energy c is everything combustable, everything that causes heat generation from the stored chemistry of the earth (fossil fuels, wood, nuclear energy etc.).

The advent of human-produced fires (cooking, warmth), machinery, electricity, nuclear energy, all multiplied by the huge population growth that magnifies all of these by a factor of eight in just the last two hundred years, is a magnified c. Really, it is now C.

And a is now quite a lot less than bc. The energy in the red box is increasing, relentlessly.

Deal with it now, deny it and leave it to your kids, or, equivalently, let God take care of it (like He has taken care of famine, and pestilence, and poverty, and disease, and catastrophe so well to the present time).

Frankly folks, if He is really out there, He is waiting for us to deal with this.

There is no point talking about the Democrats. They get this! They understand the science and they know there is a VERY high probability that humans are destroying the environment. Enough, really, to call it a day!

The Republicans (There’s the Rub)

John Kasich understands climate change. He appears to know that a, heat radiated out by the earthis reduced by carbon dioxide, that b, the energy from the sun, increases as reflective surfaces on the earth (glaciers, like mirrors to sunlight) disappear, and c, the chemical energy from burning stuff increases with technology and population.

Marco Rubio denies, for no apparent reason we can see, so we probably have to think it is some Pollyanna religious belief that either God won’t let it happen or the apocalypse will be that much closer. Listening to him, his arguments seem to be economic: if we do something about climate change it will destroy our economy. I don’t think he wants his kids to have to deal with it, nor do I think he really wants his kids to deal with the apocalypse.

I think he is being an ostrich.

Ted Cruz might be more apocalyptic about it, while remaining quiet in order not to loose votes from climate change deniers.

Trump just does’t appear to think about it, unless the red box represents his wallet, his ‘good looks’, or his personal power. Or maybe as a measure of fear he can produce in the voters’ minds.

Religion

 

NormalThe diagram to the right depicts an even more common scientific concept, (the normal, or Gaussian, or bell curve) that of random variation. Forget all the Greek letters (sciency folks like that kind of stuff), the curves suggest a general shape of normal random distribution around an average value. The blue one in particular shows a symmetrical random variation around an average of zero, while the green one shows the same thing with wider variation (standard deviation) around an average value of minus two.

All collections of things that vary randomly, or semi-randomly, fall into distributions similar to this, though the shapes might differ considerably.

Membership in a religion probably follows something like this. It could represent in a qualitative way, the intensity of belief from Radical Fundamentalist way off to the right, and Atheist (non-theist, really) way off to the left. Probably the average American might publicly proclaim themselves to be somewhere in between: the average family person with a couple of kids and a spouse, who goes to church on many, but not all Sundays. But if you could get inside their heads and read their minds, a lot of that might just be for public consumption. They might feel embarrassed about not really being sure, that their faith was not quite as strong as they would like. Or they may just like people and like making friends, and religion is an easy way of doing that.

They might just want to fit in. They might recognize the intense stigma that society tends to apply to non-believers, and wish to avoid it. It’s called ducking. Only fools and the arrogant don’t duck.

Since modern day North America does not take kindly to non-theists, there might actually be quite a lot of that.

The shape of those curves will look different for different populations. For example, a few years back it was reported that the National Academy of Science in the United States was 92% atheist. Since science is so antithetical to religion (climate change is a good example), in so many ways, and has been over so many centuries, some have even wondered why that number 92% is not higher.

In many ways, religious belief and gender preference have hidden in the closet for a long time, and still do. The Freedom From Religion Foundation, a group publicly supported and promoted by President Ronald Reagan’s son, is asking atheists and non-believers to reduce discrimination generally by coming out of the closet, so that atheists and agnostics can achieve some level of freedom that is increasingly accorded to the LGBT community. Now, it is almost unfair to LGBT to draw this comparison, because atheists can hide more easily, and do not seem to suffer the same degree of hostility in North America as LGBT do. But around the world, people are still killing them. (Who does he mean by ‘them’ you might ask. LGBT or atheists. Exactly.)

Clearly, there are groups who believe so rigidly in the bible and their particular dogma, that they cannot accept climate change as man-made. They refuse to believe that god would allow that to happen. Worse, some believe that the apocalypse is a good thing, and the destruction of the world heralds the next coming of Jesus, and therefore will not do anything about climate change, even to the point of refusing to accept the possibility.

Even when Florida is submerged. Funny it should be a Florida Senator, then.

Organized religion does not have a good reputation from an historical perspective, and part of that comes from the people who have used religion to gather people to follow them. Jared Diamond, in Guns, Germs and Steel, argues that one of the best ways of gathering people together in a common cause is to organize your family. But if you need more than just your family, more people than you are related to by blood, religion is the next best thing.

The Crusades, for example, were largely colonial economic conquests that went badly. At least one of them never even made it to the holy land.

The dispute with Galileo and the Catholic church (Galileo, fool that he was, suggested the Earth went around the Sun) was only resolved a few years back (not nearly soon enough to help Galileo), when after several centuries of difficult thought, the Catholic church recognized their fallibility, and apologized for imprisoning him.

Condoms have decreased spread of HIV (though by no means ideal, and not as much as abstention, although who believes promoting abstention really works?) but has been opposed by at least two mainstream religions. In a future blog, I’ll talk about the HPV vaccine and the dangerous position of certain religious groups.

Each advance in science and technology has chipped away at the veracity of religious claims.

Rule of the Poor, by the Clever, for the Rich (Lovell Carroll)

If climate change should fall victim to the religious right and the Republicans, who really want to make money and reduce government, and let the chaff (poor) blow away on the wind, as the meritorious (from their point of view) win the lottery, the American Dream…well, it will be their children (along with ours) who have to pay the price, not the Republican leadership. It is an abrogation of responsibility, from my point of view, and they justify it by saying there is no climate change because God is wonderful, and would not let wars and pestilence and disease and catastrophe and evil hurt earth’s chosen people (as He has not in the past).

We have heard Marco Rubio proclaim that laws directed at climate change would not work because there are so many other parties in this endeavor, with other countries abusing the environment to gain economic hegemony. What Marco Rubio is doing is following, not leading, and giving up, not persisting and prevailing.

If this report can be believed, Ted Cruz is possibly worse. He just doesn’t seem to bother knowing the science before he disputes it; he sure seems not to trust the concept of science, possibly because it contradicts God.

Apparently, Donald Trump has argued that ‘Climate change’ is a hoax by China to make them more financially competitive. Mind you, this was the Donald Trump of October 2015, so who knows now?

Folks, the energy contained within the earth and its atmosphere (the red box) is increasing, leading to storms and floods, shrinking glaciers and rising sea levels. It simply cannot be otherwise with billions of people burning billions of trees, billions of tons of coal, billions of gallons of oil.

How could we even think it might be otherwise?

The religious, some of them, try to explain away stuff they don’t understand by invoking God’s intervention, and rely upon that argument when they don’t want to take responsibility for stuff, or pay for stuff. Unfortunately, this anti-scientific, anti-environment, anti-contraception, anti-population control, anti-intellectual stance seems particularly popular among the Republicans and the Fundamentalist religious.

If only they would not impose their beliefs on the rest of us, the world would be a much better place.