Mark Pine

Gov. Rod Blagojevich may be scandalous, but Roland W. Burris is scandal-less. The appointment is legal, whether or not it was made by a governor under an ethical cloud. The appointed man, whom one Republican described as “a man who genuinely cares for the state of Illinois,” has a reputation for steady, deliberate governance.

Burris is an African-American who worked in the civil rights movement in Illinois. As the state’s comptroller and attorney general, and more recently as a political consultant, Burris supported liberal positions on abortion and gay/lesbian rights. He seems to be very much a man who would follow in the path of the man he would replace.

As a someone deeply concerned about the daunting domestic and international crises facing our new president, I do not want to see Obama and the Democrats distracted and debilitated by internecine warefare within the party. A fight over the appointment of Burris might drag on for weeks or months, impairing the political process.

I want the new president to have a full complement of Senate votes to move forward on his vitally needed plan for economic recovery. As a citizen, I’m also concerned that the people of Illinois have full representation at this very difficult time of urgency in our nation.

The seating of Burris as Illinois’ senator will not contravene justice in any way. If Blagojevich has committed a crime, he may still be indicted and tried. If he has violated the trust of his office, he may still be impeached.

But justice also requires that a decent, qualified man be granted the opportunity to serve in carrying out his legal appointment. And fairness demands that the people of America and Illinois have the representation they are entitled to in the U.S. Senate.

The discussion topic on C-SPAN this morning, as everywhere else, was the Israel-Hamas conflict and carnage. I didn’t keep a precise count, but the large majority of callers voiced anger at Israel, and many questioned the legitimacy of the IDF offensive. Very few openly supported the Jewish state. Do Americans support Israel as much as generally assumed? Perhaps not, when the other side suffers almost all the death, injury and destruction.

The most helpful comments came from Hisham Melham, a correspondent of Al Arabiya who was interviewed on the show, and from a number of callers, who insisted on the futility of blaming and taking sides. The cycle of violence in this bitter strife goes back so far and so long! There’s no point in trying to rationalize this fight. There’s no point in trying to make sense of it. Justice and transgression belong to both sides.

The only thing that matters is how to intervene and stop it. Melham said America remains the indispensable actor in the cause for peace, despite eight years of feckless and counterproductive one-sided support of Israel by the Bush administration. He spoke of getting past the arguments and accusations to recognize that both sides have long suffered and inflicted suffering.

The Israelis proclaim that this time they will neutralize Hamas and break its will. That is nonsense. Hamas will survive no matter how severely Israel dismembers them. They will return to fight again, and another episode of slaughter and destruction will follow.

I think it’s time for a truce put in place by a strong and effective U.N. force. Both sides would likely object, but tough American pressure could persuade Israel and Arab pressure the Gazans. Perhaps the international force should even be composed of American and Arab (Jordanian? Egyptian?) troops, and it should be empowered to conduct patrols and inspections on both sides of the border to make sure the adversaries comply.

Melham expressed hope that the Obama administration will take a more helpful approach than its predecessor. I hope so, too, and I think the whole world hopes that, as well. Obama has reiterated his fundamental support for Israel, and most Americans support Israel as our democratic ally in the Middle East. But America must come to play a more even-handed, constructive role. Perhaps this conflict (as the one in Lebanon two years ago) will demonstrate conclusive proof that neither side gains through endless fighting.

On Christmas Eve, Science Magazine emailed its yearly list of most popular stories. I find one of them, “Case Closed for Free Will?” problematic.

An April article reported that subjects in a functional MRI scanner were instructed to decide to press a button on the right or the left. They had to report the moment of the conscious choice based on a clocklike device in the scanner. The earliest brain pattern that coded for a left or right choice was in the frontopolar cortex, right behind the forehead. The pattern predicted a left or right decision with about 60% accuracy and occurred about 10 seconds before the conscious choice, according to the subjects’ reports. One of the authors commented “there’s not very much space for operation of free will.… The outcome of a decision is shaped very strongly by brain activity much earlier than the point in time when you feel to be making a decision.”

One problem with this study – and others like it in recent years – is the claim that they ascertain the moment of consciousness of a decision. If you think carefully about the methodologies, one thing they all have in common is that what is ascertained is not the moment of a conscious decision, but the moment a decision is made to go through with it. This study actually requires two sets of motor action: the hand action of pressing a button on the right or left and also the speech action of reporting the choice. Necessarily there were at least two decision processes to go through, and perhaps more. Subjects first had to decide which hand and button, and then they had to decide to go ahead with that choice and report it.

I think of the two decisions as a tentative or preparatory choice and then a confirmation of the choice, as if subjects were thinking: “I think I will choose this button,” and then a bit later, “Yes, that button, and I will report that choice.”

When the researchers noted that about 10 seconds passed between the frontopolar pattern and the reported time of the conscious decision, with the pattern predicting the choice about 60% of the time, that interval seems reasonable for the time it takes to formulate and then to confirm or reverse a decision. A similar previous study mentioned in the article found a shorter time lag that critics of the study thought might either have been an error or might have reflected preparation for a decision rather than the decision itself. The latter objection remains valid in this case, I think.

In reading several studies of this kind, I’ve found that the researchers do not fully consider the time that may pass between formulating a decision and somewhat later on actually making it. Particularly when the methodology involves making a report of a conscious experience like decision making, it may take time to decide what to report.

The experience of free choice and free will lies a the core of my moment-by-moment conscious experience. It is so fundamental that I am skeptical about research done in unusual and contrived conditions claiming to rule it out. While I am willing to be persuaded that free will is an illusion, in my view the threshold of proof is very high. The scientists making the claim must put forward an airtight case. And they did not do that in this article.

The catastrophe of 9/11 put the structure of the world in play. Americans and others around the world learned that new forces were at work on the earth, some of them dangerous. Once again, this time due to the financial crisis of 2008, the foundations have shaken. Again the world has seen the network of relationships on the planet stretched and distorted.

In both crises, people reacted with fear and hope. People waited and expectations rose. In such times, now like then, much can be accomplished in the service of change for the better. Political leaders can take us down a path to trouble and disorder or upward to a higher place. People are willing to move and follow.

In times like these now and those then, motivational power is the most potent force. We all want to do what’s necessary and help when we can, but to get started we must believe that our leaders are competent, intelligent, wise, honest, and good at heart.

Today the economist and columnist Paul Krugman wrote that Obama should work to make government not just “cool” (the president-elect’s word) but also good. Good government, totally free of influence and corruption, is what’s needed, he wrote. It’s true and it’s vital.

Obama must lead us, but he must do so openly, not with secret meetings and deals. He must lead truthfully, speaking clearly and frankly about the challenges and what must be done. And he must lead honestly, without favoring special interests.

The whole nation must believe that Obama is a good person. The liberal nation as well as the conservative nation must believe that. People who agree with him and those who disagree with him must believe that he listens and he is trustworthy.

Otherwise, it will not work. And now, with the world going the way it is, we may not get a second chance to try.

Christmas morning – perhaps a good day to post my first remark on the nature of consciousness.

I’ve planned to write a blog on this subject, since the years around 2000 when the NY Times hosted a web forum called “Explaining Consciousness.” Others and I posted there frequently. It was a great discussion, until the paper pulled that thread and many others.

As with health topics and current events, I think have some worthwhile thoughts to put out into our collective consciousness (nowadays reified in part as the blogosphere). Perhaps it comes from my past connection with the mental health field. My interest in consciousness goes back a long time.

One danger in thinking and speaking about consciousness: It’s easy to fall into mysticism. I intend my orientation to be scientific. I’m a physician. I value scientific knowledge of the body and the brain. But still, I don’t think consciousness can be explained in the same way as any usual biological question.

So let me begin with this thought: The mind is not like an object. This is something the Buddha said long ago. “Sentient beings have been led astray by mistaking the nature of their mind to be the same as the nature of any other object [Surangama Sutra].” Although I’m not a Buddhist, I think the Buddha thought more clearly about consciousness than any other pre-scientific thinker.

Modern scientists who have considered and investigated consciousness have sometimes made this mistake. Neuroscientists have tended to explain the mind as activity of the brain, on occasion describing it in a metaphor like a “movie-in-the-brain.”

But this sort of thinking, it seems to me, identifies consciousness with something material, like light energy falling in patterns on a movie screen. I don’t think that consciousness or mind can be identified with organ activity, or even material mechanisms of any kind. Rather than consciousness being within the brain, I think it better to say that the brain is in consciousness. Not: a movie is in the brain, but the brain is in a movie.

How I can assert this, yet maintain, as I do, that my thinking is scientific is not easy to explain. But that is still to come, in future postings.

A recent provocative report in the JAMA, the AMA journal, looked at a thousand patients with heart disease for about five years. The two hundred who also suffered from depressive symptoms had nearly twice the rate of strokes and near strokes as those without symptoms. The depressed patients also suffered 1.5 to 2 times the rate of heart attacks and heart failure (reduced heart power). Overall they died about 50% more often.

Is it a case of mind-body connection – a sad brain leading to a weak heart? Not exactly. The article analyzed other factors besides depression. It turns out that the depressed folks exercised much less often – doing no exercise at all was twice as common. They also smoked at twice the rate as the non-depressed group. So, is it case of the depressed people being careless or lazy? Again, it’s not so simple.

Another fairly recent study, in the journal Preventive Medicine, surveyed dozens of research articles on the relationship between physical activity and depression. Most of the articles showed that physical activity reduced the likelihood of depression, and the more vigorous the activity, the more depression was reduced. But the authors said that even small amounts of activity might protect against depression.

So what happens might really be a vicious circle. Inactivity leading to depression leading to reduced heart health and less activity leading to more depression leading even more reduced heart power and less ability to exercise. If I were a patient caught in this kind of downward spiral, I’d start by taking pleasurable strolls. Even depressed people can find it pleasant to take a walk in the park. And the studies show that even small amounts of an easy activity could reverse the harmful cycle and start it spinning the other way: Activity leading to less depression and a healthier heart leading to more activity and even less depression and an even healthier heart.

This past weekend The New York Times ran a story on the mortgage meltdown pointing at the the president’s desire to expand home ownership and his administration’s lax regulation of lending. Then yesterday, according to CNN, the Bushies pushed back, calling the paper blind and naïve in its reporting.

So what’s the true cause? Bush does deserve some blame. The Ownership Society was his idea, and his method of achieving that goal was promoting lax financial regulation.

But in my view the root cause has been the return of laissez-faire. The term may date back to French merchants in the 17th century who wanted freedom from interference by the French monarchy. Laissez-faire was government policy in the U.S. from late 1800s until the election of Teddy Roosevelt. Following the Great Depression, it became a somewhat disreputable concept, since many blamed the philosophy for causing that economic catastrophy. FDR’s New Deal had rejected laissez-faire and put in place regulatory agencies to prevent another depression.

But with the election of Ronald Reagan, who declared in his first inaugural that “government is not the solution to our problem; government is the problem,” laissez-faire came back to power. Since then the attitude of government has been that “The Market” has the best financial knowledge and expertise; “The Market” can best ensure prosperity by deciding on products and prices and the allocation of resources. The idea became an article of economic faith among Democratic as well as Republican economic policy officials in the last three decades.

In the Bush years, the administration’s true believers put laissez-faire into practice as no administration in the previous century. Their most recent effort has been the disbursement of almost $350 billion to banks without any financial accountability for how they spend the taxpayers’ money. The lax oversight has been attributed to the hurried passage and implementation of the bailout bill in midst of the credit crisis that followed the abandonment of Lehman Brothers to the forces of The Market. But in truth, I suspect, the lack of oversight was just what Paulson & Co. wanted and got. Laissez-faire at their core, they believed that the banks knew best how to use the money and should be left-to-do.

So here we all are now. $350B spent and not much to show for it. This financial panic seems as fearsome as before. But finally the Bushies have decided that some more potent government intervention is in order. They have agreed to loan the auto companies $17 billion. But this time, they’re not going to be lax about it. The autos must drive down a very regulated road to get that money.

Medical researchers have long hoped that stems cells would provide new effective therapies for devastating wasting diseases. Among these conditions are heart failure, diabetes, Parkinson’s Disease, and other great modern afflictions. Rare, devastating diseases of this kind also exist, including those resulting from genetic defects, such as Huntington’s Disease in adults and spinal muscular atrophy in children. 

The theory has been that stem cells could provide sources for new cells to replace aging, dying cells of declining organs. But problems have blocked the translation of these expectations into clinical practice. It has been difficult to implant stem cells into existing organs, to grow them into new organs, or to get them to function properly as specialized cells. 

But researchers at the University of Wisconsin have reported an extremely valuable new use for these cells. Starting with skin cells from a child with spinal muscular atrophy, a genetic disease causing devastating neurological degeneration, they used genetic techniques to reprogram the cells first into stem cells and then into new nerve cells.

 As they observed the cells develop into nerve cells in the laboratory, the researchers watched what happened when the genetic error leading to the disease took effect.

 Research of this kind should have the potential to discover the fundamental molecular mechanisms of many other genetic diseases. It might also be a new way for scientists to learn about aging-related effects of toxins and stress on healthy young cells, in order to study the causes chronic wasting diseases common in older populations.

Although the medical potential of stem cells has most often been seen as deriving from their potential ability to replace diseased cells in organs and tissues, stem cells possess the coexisting properties of being young and undamaged while at the same time holding the genetic predispositions for the development of disease. This unique combination may make it possible to develop new laboratory methods for discovering the causes of diseases, and it might become one of the most beneficial uses of stem cells.

The huge and rising cost of health care is one reason why now is the time to create a national health information system. Two meetings this week advanced this effort. The 5th Nationwide Health Information Network Forum, sponsored by the Department of Health and Human Services, and the Sentinel Initiative for monitoring medical product safety, sponsored by the Food and Drug Administration, were both held in Washington. I was able to attend the latter meeting.

An integrated national health information system will be vital to reducing healthcare costs. It will permit tracking the occurrence and course of diseases affecting the U.S. populace and evaluating the cost and effectiveness of therapies. Both proposed systems will link existing large databases and information systems. HHS’s proposal involves the Department of Veterans Affairs, the Department of Defense, the Social Security Administration (SSA), the Centers for Disease Control and Prevention, and the National Institutes of Health’s National Cancer Institute, as well as private sector organizations. FDA’s effort will also make use of some of these same agencies’ databases, its own medical product information system, the Medicare and Medicaid claims databases, and those of large regional healthcare organizations, such Kaiser Permanente and Harvard Pilgrim.

The greatest obstacles to implementation will likely involve the difficulty of linking the disparate systems. Each organization has developed its unique system for classifying and arranging health data. The hardest problem will probably be enabling the systems to “talk” to each other and developing queries to produce useful information.

Other concerns will include patient privacy and false results. Personal data must be anonymized so that it can be used without violating privacy. And once an integrated, anonymized national system is realized, it will be a huge challenge to make good use of all those terabytes of information. Many erroneous conclusions may follow from vast numbers of chance associations that appear in the data. Validating true conclusions will probably be as difficult as creating the system.

Justifiably, you’re disheartened by the victory in California, one of the nation’s most progressive states, of Proposition 8 to deny marriage to Gays and Lesbians. And you’re discouraged that President-Elect Obama, the progressives’ great hope, has chosen Rick Warren, who supported Prop 8 and offended homosexuals, to give the invocation at his inauguration.

But Lesbians and Gays need to imagine the view outward from that inauguration podium. The movement for full civil rights for homosexuals, equality, and complete acceptance by our American society is a Force of Nature, irresistible and unstoppable; it will come.

When Warren prays for the nation on January 20, he will be praying for all Americans, of course. But especially, he will be looking out upon his own flock, the fundamentalist and Evangelist Christians. It is THEY who have some reason for fear, not the Gay-Lesbian community. It will be their world that is most threatened by the facts that Obama will speak from that podium, blessed moments before by Rick Warren.

The Christians who follow Warren hold beliefs very dear to them. But they are beliefs that cannot endure in their present form. Their faith propounds the existence of a limited group of true believers in the midst of a planet moving rapidly toward integration of manifold variety and diversity. It is deeply worrying for them.

Obama’s giving Warren the podium speaks to these people. It doesn’t tell them that their fundamentalist causes, such as against homosexual marriage, will win in the end. Instead it says that the new administration does not want to exclude them from the new polity. It wants to hear what they have to say. And it hopes they do not choose isolation and bitterness. Because those Christians do say things we should hear and give consideration to, even if they will not, ultimately, prevail upon us as they have hoped.