Mark Pine

One thousand species of bacteria live on your skin. But species diversity is greatest—probably not where you would guess—on your forearm. In contrast, diversity is the least behind your ear. In numbers of species, skin flora are comparable to flora in your gut, which also hosts 500-1000 species of these microscopic plants. Moreover, the bacterial cells your body hosts outnumber your own cells 10 to 1.

This information comes from researchers at NIH working on the Human Microbiome Project, an effort to discover the microbial communities living in different parts of the body in health and disease. Their article appeared this week in Science.

The investigators took skin scrapings from 10 volunteers, who had been instructed to wash with mild soap for a week and not at all for one day prior to the sampling. Scrapings were done at 20 skin sites, distributed among locations that were oily like the ear, moist like the armpit, and dry like the forearm. Bacterial species were identified by sequencing ribosomal RNA.

The largest number of species (44 on average) resides on the forearm, with only 19 species on average found behind the ear. The researchers also found that different individuals harbored the same species in the same sites on their bodies, and more variation occurred between different sites on the same individual than between same sites on different individuals.

Why does the forearm host the most? I suppose that we stick are arms into all sorts of places, but generally we only wash our hands up to the wrist. Think about that the next time you feel an urge to wipe your nose on your forearm. On the other hand the least diverse location is behind the ear, and when was the last time you poked your ear into some unusual place?

One bacterial species of great concern is methycillin-resistant Staphylococcus aureus. It turns out that this species is found most often inside the nose and in the crease of skin outside the nose. So wash your nose.

An aspect of the study worth noting is that the researchers sampled volunteers who had refrained from antibacterial washes for a week. I wonder what they would have found if they had sampled people who had washed with Dial or any of the antibacterial soaps that are commonly in use. It also makes me wonder how our modern cleanliness fetish (I plead guilty!) may be affecting our health. One of the theories regarding the increase of autoimmune diseases (asthma, arthritis, Crohn’s, and others) is that we may be living lives too clean.

We’re not surprised by a hard, nasty fight over a Supreme Court nomination. Still, I was shocked that conservatives could seize on Obama’s attribution of empathy to Judge Sotomayor and use it to criticize the nominee. As a phyisician, I was trained that empathy is the one of most valuable and essential emotional qualities I can possess in my professional life.

But as reported yesterday by Sheryl Stolberg in the NY Times, “conservatives have cast empathy as an epithet when it comes to the judiciary,” arguing that it warns of the potential for judicial activism. There are moments in the political discourse when the gap between left and right widens to a chasm. One side cannot hear or even see the other.

Before becoming a judge, Sotomayor was indeed an activist, when, for example, she worked as a lawyer in 1980 at an organization advocating for Puerto Ricans and other Latinos in New York City. But doesn’t justifies calling her a “racist” or a member of the “Latino KKK,” as some conservatives have done.

I’m stunned also that some Republican conservatives would fight the nomination in a manner that’s sure to offend many women and Latinos. The first group is the nation’s largest voting block and the second is the largest ethnic minority.

At a moment like this, though, it’s good to step back and realize that the left has also directed epithets and screeched insults at right-wing nominees: Think Thomas and Alito. In the present case, I’m provoked to mull over the differences of viewpoint and understanding between the political poles. How is it possible for some to see Sotomayor as courageous in the pursuit of justice (as I do), while others see her as radical and threatening?

I’ve long wondered about the spectrum of opinion that stretches from political left to right. On the left, for example, we emphasize social action in the pursuit of equality and equal opportunity. On the right, they stress individual freedom and accomplishment. But the right-wing’s puzzling use of “empathy” for the purpose of criticism prompts me to consider the political spectrum in the sense of that term. What could be the opposing, admirable quality that some on the right see as preferable?

I suspect the problem with empathy for conservatives is that is may lead to permissiveness and moral relativism. One the left we value the community of humanity, but on the right, I think people feel more esteem for individual excellence and rectitude. Moreover, liberals see excessive individualism as a failure of compassion, while conservatives see overemphasis on commonality as lack of will and moral discipline.

It might be noted, though, that the golden rule includes both poles of this spectrum: social compassion and individual righteousness.

In the following table, I’ve put down some thoughts on the qualities that “belong” to one side or the other. The left and right columns refer to position on the political spectrum. The positive and negative rows refer to qualities that are valued and owned by one side in contrast to others that are rejected and attributed to the other side. I don’t intend this to be seen as any kind of definitive psychopolitical system, just a tentative effort to make sense of the current debate.

A survey of the first two years of the universal health care program in Massachusetts shows significant gains in access and affordability for the 97.4% of residents who are currently insured through private or public programs. But most of the advances occurred in the first year and leveled off or retreated slightly during the second year.

Research by the Urban Institute reported today in the journal Health Affairs shows that the percent of state residents who had a usual source of care (not including ERs) rose from 86% in 2006 (before the new program took effect) to 91% in 2008. Among low-income people, the percentage rose from 79% to 86%.

There were significant declines in the percent of Residents who reported being unable to get care they thought they needed. Inability to get care for any reason fell 3-4%, while the financial burden of affording care, as measured by the percent of adults reporting medical bills exceeding 5% of family income, fell 4-6%. Affordability measured by the percent of adults who reported not getting needed care due to costs, dropped dramatically by 16% among all adults and 10-11% among low-income ones.

The most significant negative finding was the percent of families reporting difficulty getting care because providers weren’t accepting patients and/or refusing treatment for insurance-related reasons. In 2008, 15% of higher income adults reported such refusals, as did 29% of lower income people. Among adults with public-plan coverage 32% reported refusals.

The NY Times report of the research said that “many patients reported shortages of primary care physicians,” and it noted the lessons in that connection for Congressional committees preparing national health care legislation.

Despite the potential difficulty of increased demand for providers and refusals of care, which universal health care coverage might lead to, the research leaves little doubt that the Massachusetts program is working. For this, I am extremely grateful. A family member of mine faced loss of coverage because of a preexisting condition. Fortunately, because of residency in Massachusetts, the new program guaranteed continued coverage just in the nick of time.

A column yesterday in Scientific American online prompts this post. The article described two techniques of meditation—one of focused attention, such as the Transcendental Meditation practice of concentrating on mental repetition of a syllable or phrase, and a second method of undirected, detached awareness of mental phenomena, as they arise and subside within one’s mind.

As reported in the article, researchers at the University of Wisconsin have reported EEG findings in meditators during meditation of increased power of gamma waves (25-42 Hz) and phase synchrony at gamma frequencies among distant regions of the brain. Although it’s not clear what significance these findings may have, I think they do reflect the sensation of inner harmony that comes with meditation.

I meditated for many years, starting with TM in 1984, when in my late 30s. It was just after the birth of my twins. I wanted to develop greater equanimity and also to quit smoking. TM helped a good deal with both, I thought. But as I continued daily meditation for several years, I began to yearn for a deeper experience than the simple (but worthwhile) rest and relaxation provided by TM’s method of silent mantra repetition 20 minutes twice a day.

So, in 1989, I began a relationship with a small circle of meditators meeting weekly in McLean, VA at the house of one Lobsang, a man from Tibet with connections to the circle of the Dalai Lama. I learned that while in America, Lobsang sometimes provided local contact and support when His Holiness visited our capital city. He also translated a book of meditation from Tibetan into English (Mahamudra) and played a Tibetan monk in Martin Scorsese’s film Kundun.

Meditating with Lobsang and his small group for about four years, I used techniques of mental visualization, focusing on an internal image of a white circle, and also of detached awareness. We also used a technique Lobsang called Samadhi meditation, which was the emptying of the mind of all thought. Lobsang would also interject brief sermons, often on the subject of compassion.

During meditation with Lobsang and by myself, in the years I spent as a member of his group and afterward, I experienced a stronger connection with my consciousness. What I mean is: In ordinary daily life, one’s consciousness is filled with activity and one feels connected to the world at large. But in meditation the activity of consciousness subsides and one feels connected, instead, to inner awareness.

I believe that meditation provided me insight into the nature of conscious. I formed the opinon that our Western concept that consciousness is located within the human brain is implausible. In meditation, consciousness seems to have no boundary, and at its core, to arise from what Buddhists conceive of as essential “emptiness.”

I can’t think of anything I own that’s more personal to me than my genes. My genetic makeup is, after all, about 50% of who I am, since the scientific consensus seems to be that nature-nurture is something like a 50-50 balance.

But scientists and companies have obtained patents for genes for 30 years, usually by discovering the base sequence of the gene’s DNA. But like any form of intellectual property, patents can be bought and sold, and so sometimes companies obtain ownership of genes by buying them.

I’ve always thought this situation unjust. Even if I were to possess humanity’s only instance of a particular gene variant, it wouldn’t be mine to own, if someone else sequenced it. In the near future, whole-genome sequencing may become available as a laboratory test, which you might have done for a fee. There could be a number of reasons for you to do that: evaluate your medical risks, trace your ancestry, better understand your body and personality. But under the current system, it would not be you who had first rights to own your gene sequences, it would be the company that did the test and sequenced your genes.

I expect that the first company to market such a test will insist on owning the results.

But now a group of patients, doctors, and research professionals in New York City, in cooperation with the ACLU and the Public Patent Foundation, a smaller advocacy group associated with the Benjamin N. Cardozo School of Law, has challenged the Patent and Trademark Office policy of granting patents for genes.

The case concerns Myriad Genetics of Salt Lake City, which owns patents on the BRCA genes that influence the risk of breast cancer. Myriad prevented some of the plaintiffs from screening patients for BRCA alleles without its permission. In doing so, the plaintiffs assert, Myriad violated their First Amendment free-speech rights by impeding research, restricting medical practice and denying access to medical information. The suit also asserts the established anti-patent precedent of “natural product” status in regard to genes.

I dearly hope the lawsuit succeeds. The practice of patenting genes and even forms of life has been an issue of concern in recent years, as biotechnology has advanced.

I have no problem with scientists and companies synthesizing new chemicals that don’t exist in nature and placing patents on them. Nor do I object to patenting a substance that has been extracted from a source in nature and then processed into a drug product by purification and packing in a dosage form. Where I draw the line is patenting something that exists in the patented form in nature, a product—not of human enterprise—but of the natural world.

David Sinclair, the Harvard biochemist who discovered that resveratrol activates the sirtuin gene, says of this drug: “We’re talking about is potentially making a 90-year-old as healthy as a 60-year-old.”

If you think that’s true, that minus three decades will come from a pill, you might as well believe in Tinkerbell and the tooth fairy.

Twelve of 60 Minutes last evening was an infomercial for this compound. But will it do what’s promised?

The fairy tale goes like this: The French people drink a lot of wine, but they consume a high-fat diet and still have a markedly lower mortality rate from coronary heart disease compared to other Western countries. So it must be the wine, and the resveratrol in the wine, right? (It couldn’t be the French health care system, rated best in the world by the WHO in 2000.)

Actually, if you think about it for a minute, it can’t possibly be the resveratrol in the wine. Sinclair says, “You’d need to drink about 1,000 bottles a day of red wine” to get the amount of resveratrol needed. Even the French don’t drink that much wine; ergo, it’s not the resveratrol. Although it may be true that “moderate alcohol use seems to offer some health benefits, particularly for the heart,” it can’t be because of resveratrol.

So what’s going on? 60 Minutes reported that several clinical trials of resveratrol are in process. But if you check the federal clinical trial registry, ten investigations are listed. Only one has been completed. It was a so-called Phase I study, lasting only 10 days in 40 people. And it was done only check blood levels of the drug and to make sure the drug didn’t harm anyone; it didn’t assess effectiveness for any purpose.

One trial discussed in the news report appears to be # NCT00654667 done at UCSF. The investigation looks at insulin sensitivity (an important factor in diabetes) in overweight/obese women. But though the study was scheduled for completion last August, it is listed as not even started.

The 60 Minutes segment showed a picture of jar of resveratrol with the chemical diagram on the label. It looked very scientific. But above the diagram, you could see the words “Dietary Supplement”. What that means is that the compound isn’t intended to be a drug but a food. It is, after all, found in the skins of red grapes, and that’s why it’s also found in red wine. But a dietary supplement can be marketed without proving that it works for anything at all. The FDA’s supplement regulations make sure that what’s put in the jar is pure, unadulterated and safe to consume. But they don’t require any kind of effectiveness.

You can guess what the plan might be: Hype this product in the press. Publicize it on reputable news programs like 60 Minutes. Stir up demand so that as Morley Safer said, “The question that most of us want answered is: when do we get this pill?”

Then make megabucks selling something that does who knows what?

Ten days ago, I posted about Paul Krugman’s column in the NY Times on the health care industry meeting at the White House. He was skeptical of the industry’s sincerity in pledging to voluntarily cut the cost of health care. Krugman wrote: “The point is that there’s every reason to be cynical about these players’ motives. Remember that what the rest of us call health care costs, they call income. … I would strongly urge the Obama administration to hang tough in the bargaining ahead.”

Like the illustrious columnist and Nobel Prize economist, I also distrusted industry’s promise and wrote, “I would push for single-payer health care insurance. At bottom, I doubt that reform can be enacted without a battle to the death with many of those industry folks.”

Krugman is back at it today, reporting that the insurers are planning ads like those of the successful Harry-and-Louise campaign against the Clinton health initiative in 1993. North Carolina Blue Cross and Blue Shield plans to single out the “public option”—the provision in the Obama plan to offer government run health insurance in competition with plans offered by private insurers, such as the Blues. Storyboards for the ads, obtained by the Washington Post, show unhappy people unable to choose their doctor or waiting long months for needed treament.

The health care industry is frightened to death of competing against a public plan. They have every reason to worry that the government will be able to offer health insurance at lower cost and with better benefits that they. The industry folks will cry that the competition is unfair. If they do that, though, they will be deluding themselves. I—and most Americans, I believe—am not concerned with how fair the competition is. We want good care at an affordable price, and fairness of competition is beside the point.

If I need major surgery, I’m not going to ask surgeons to send me proposals and bids for their services.

The Obama Administration’s health care system would offer public insurance as one of a suite of plans offered to Americans. All of them except the public plan would be run by private companies, much like the plans of the federal employees system (FEHBP), to which I am a subscriber. No one would be forced to choose the government option.

But the existence of a public plan in our future health care system will be crucial to bringing down health care costs. The government will best be able to negotiate with health care providers and suppliers over costs. The government will best be able to evaluate options for preventive and therapeutic care, choosing what works most effectively on the basis of medical evidence . The government will best be able to achieve economies of scale and implement cost-saving technologies.

The government plan would provide the standard for the private plans to match in benefits and costs. The existence of a government plan as one of the offerings in our future health care system will be vital factor in realizing the effectiveness and efficiencies that we must attain to make it work.

Michael Schermer has authored a column in the June issue of Scientific American explaining why people who believe in spiritual things are mistaken. Why am I not surprised? He argues in words that are new, but his contention is old and tired.

He says the reason for belief has two parts. He calls one “’patternicity,’ the human tendency to find meaningful patterns in meaningless noise.” The other is the human awareness of “mental states as desires and intentions in both ourselves and others—we infer agency behind the patterns we observe in a practice I call ‘agenticity’ the tendency to believe that the world is controlled by invisible agents.”

I don’t know enough of scientific psychology to decide whether his concepts add to that body of knowledge, but I doubt it. But all they amount to is the long-standing objection by scientific materialists (those who reject the idea of spiritual existence) that believers see what they want to see in natural phenomena.

As an example, Schermer cites a psychology experiment that he summarizes thus: “Subjects watching geometric shapes with eye spots interacting on a computer screen conclude that they represent agents with moral intentions.” What’s peculiar about his example is that the experiment was in fact an example of agenticity. It was designed by agents—the experimenters—so that the patterns on the computer screen appeared and acted in certain ways.

There is no way to prove or disprove the existence of spirit agents influencing natural phenomena, since the phenomena comprise all the evidence there is about them. Schermer’s argument boils down to the same one that skeptics have long used: There’s just no reason to add a layer of explanation of spiritual influence on top of the materialistic, mechanistic explanations of science.

In my view, Schermer’s and the skeptics arguments miss the point. The issue is not whether science and material explanations suffice. Within their realm, they do. But suppose some alien scientists from another world observed the goings on on earth, and one of them wanted to study the phenomenon of the Internet. That scientist would find that the workings of the network conformed entirely to the natural laws of physics, network theory, and statistics. He might conclude, therefore, that there was no need to infer agency behind its operation. But of course, we know he would be wrong: The existence of the network, as well as the content of the messages, are the results of the actions of agents.

The relevant question is not whether natural laws can explain a phenomenon, but whether there is a rational justification for believing in the existence and influence of entities other than the material and mechanistic ones. I point to one here: Quantum mechanical wave functions, also known as state vectors.

According to the Copenhagen interpretation of QM due to Niels Bohr, things that exist may be described as either particles or waves. Both descriptions are valid and real.

The particle description refers to entities that are composed of matter-energy (i.e., material things). But the wave description refers to entities that are mathematical and probabilistic (not material things). Particles can be measured directly by instruments to determine their mass, energy, momentum, etc., but wave functions (state vectors) cannot be observed or measured; their exisitence can only be inferred. Indeed, it is a fundamental concept of QM that if you observe a wave function, it instantly changes form and “collapses” from its mathematical, non-material form of existence into a particulate, material one.

Moreover, this non-material form of existence, the wave function or state vector, possesses a property that is somewhat like agenticity. It specifies the probabilities that influence (work invisibly behind) the visible form and arrangement of the particle(s) into which it collapses.

The president’s first hundred days were focused on the economy—passing the stimulus plan, bailing out the banks, and reforming the auto industry. His actions were targeted to immediate and near-term problems, necessitated by a sudden economic crisis that Obama didn’t plan for during the campaign.

In this next hundred days, his gaze has shifted from the near to the longer term, indeed, to the end of his presidency and beyond. His efforts are now focusing on those issues that Obama sought the presidency to work on and bring change to—health care, Social Security, energy, global warming, education and the future of the workforce. None of this work will be completed by the time he leaves office, and much of it may just be getting off the ground.

Nothing demonstrates the profound differences between the political parties as the differences in the time span of outlook and concerns. For example, yesterday on C-span’s Washington Journal, Congressman Joe Barton of Texas spoke about the energy legislation—including cap-and-trade limits on CO2—that is now being marked up by the Energy and Commerce Committee, where he is the ranking member. Barton talked about increasing the fuel mileage requirements of autos and of the GM plant in his district that produces Tohoes, Yukons, and Esclalades. He said Texas families want to be free to choose, but he complained that new fuel standards and cap-and-trade limits would take away that freedom of choice and “force Americans” to chose cars they would not otherwise buy.

Absent from Barton’s defense of the freedom to buy big cars was any consideration of the long-term effects of such choices—effects on the climate, primarily, but also on the automotive industry itself and other aspects of American life. More big cars would mean more big emissions that will contribute to devastating effects on the environment. Continued big car production would mean continued delay in reforming and retooling the industry, which Barton said earlier in the interview he wanted to protect from loss of jobs.

But in defending the short-term advantage of buying of big cars and the present pattern of auto industry employment, Barton failed completely to consider that in the long term, the course he advocates will protect neither. It will soon become impossible for most families in Texas or anywhere else to buy big cars because they and the fuel they consume will be too expensive. And the jobs manufacturing those big cars will be lost anyway, because too few families will buy them.

In regard to health care, education and many of the bills to be initiated in this next 100 days, the confrontation between the parties will be much the same. Obama and the Democrats will look to the future and the long-term good of the nation. The Republicans and their leaders in Congress will decry the difficulties and costs that will trouble the nation in the short run, and they will use the prospect of those near-term problems to avert our attention from long-term disasters. The will argue against needed changes and stir up the public to resent and reject the reforms that must come.

Your credit card company is accumulating massive amounts of data about YOU. Are you sometimes bothered by the knowledge that Google is tracking your searches, that the web sites you visit monitor your clicks, that the NSA goes through your e-mails? Probably none of those guys know as much about you as your credit card company.

A remarkable article yesterday in the NY Times Sunday Magazine shows that our individual personalities, preferences, habits, and idiosyncrasies, are being laid bare for inspection and assessment by credit card companies that track and archive every purchase we make. Charles Duhigg, who wrote the Times’ piece, reports:

Small groups of executives at most of the large firms have spent the last decade studying cardholders from almost every angle…. They have sought to draw psychological and behavioral lessons from the enormous amounts of data the credit-card companies collect every day. They’ve run thousands of tests and crunched the numbers on millions of accounts.

For example, they’ve learned that “birdseed and snow-rake buyers pay off their debts,” but buyers of chrome skull ornaments often fail to pay up. And if you use credit cards to buy groceries (I do all the time), that might mean that you are financially strapped and trying to conserve cash.

Nothing in the credit card business seems beyond the pale anymore. The companies often charge interest rates that used to be considered a form of criminal enterprise called loan sharking. Yet brazenness has reached a new frontier with Capital One’s Card Lab. The company’s seductive invitation to put the photo of your choice on your card and choose the terms of your credit involves you in scientific research on human behavior, and YOU are the subject of the experiment.

Duhigg reports:

Capital One can watch as I navigate the site, learning more and more about me. The industry doesn’t have to drop rats in a maze anymore. We’ve started going there on our own. “Card Lab is at some level an enormous real-time, ongoing experiment,” says Jack Forestell, senior vice president of marketing and analytics at Capital One. By observing people’s choices and then tracking how they use their cards, the company has learned who is more willing to pay annual fees and who wants airline miles badly enough to pay higher interest rates. “We’ve learned interesting things, like people are more loyal to cards that have their kids’ photos on them,” Forestell says.

Does it concern you that your credit card company is tracking and saving data about every thing you do with it? Probably there’s not much we can do to stop it unless we pass laws prohibiting hording and mining of our data. In the meantime, if you spend on something you want to keep secret, pay cash.