Category: Health

Obamacare

By Sean Carroll | March 22, 2010 10:03 am

Good news and bad news last night, as the House passed health care reform.

The good news is: the House passed health care reform. The work isn’t completely done yet, of course. The House had already passed a heath care bill, months ago, but this isn’t it; last night they passed the Senate’s version of the Bill, which had some glaring flaws. Under ordinary circumstances the House and Senate would get together and hammer out a compromise between their two bills. But in the meantime Republicans picked up an extra Senate seat in Massachusetts after Teddy Kennedy died, and they had promised to filibuster the compromise package. (Because, after all, what courageous moral stand could be worth invoking arcane parliamentary procedures more than the fight to prevent millions of people from getting health insurance, especially if that was the life’s goal of the Senator whose death allowed you to improve from having twenty fewer votes than the opposition to only having eighteen fewer votes?)

So Obama will sign the Senate bill that the House just approved, and then the Senate will consider a reconciliation bill also passed by the House last night. Under even-more-arcane procedures, the reconciliation measure can be passed without threat of filibuster. It requires only “majority vote,” a quaint notion in this highly baroque age.

It’s not an especially huge bill, whatever you may have heard, but it will have an impact. Here is a list of the major impacts, and an interactive graphic to figure out how you will be affected. The most important features seem to be:

  • Establish health insurance exchanges, and provide subsidies for people below four times the poverty line.
  • Guarantee insurance for people with pre-existing conditions, and eliminate “rescissions” that take away insurance from people who get sick.
  • Push business to provide insurance for their employees, and self-employed individuals to buy insurance for themselves.
  • Close the “donut hole” in the existing Medicare payout structure.
  • Implement cost controls (mostly through slowing the growth of Medicare spending), thereby lowering the budget deficit by $130 billion over the first ten years, and by another $1 trillion over the next ten years.

Overall, it’s a relatively incremental bill, placing bandages over some of the more egregious wounds in the current system, while leaving in place the essential structure through which we funnel billions of dollars to middlemen while paying far more for medical care per person than any other country without getting better results. For 90% of Americans, coverage and insurance will continue as before. Basically, this brings us a little closer to where Western Europe was a century ago.

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CATEGORIZED UNDER: Health, Politics

Defending Science Isn't Always Pretty

By Sean Carroll | October 26, 2009 7:23 pm

This month’s issue of WIRED features a great story by Amy Wallace: “An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All.” It’s an overview of the anti-vaccination movement in the United States, a topic that should be very familiar to anyone who reads Discover‘s baddest astronomer. At ScienceBlogs, Orac and Abel Pharmboy gives big thumbs-up to the article.

The anti-vaccination movement is a little weird — they claim that vaccines, which are universally credited with wiping out smallpox and polio and other bad things, are responsible for causing autism and diabetes and other also-bad things, all just to make a buck for pharmaceutical companies. The underlying motivation seems to be a combination of the conviction that things must happen for a reason — if a child develops autism, there must be an enemy to blame — and a general distrust of science and technology. Certainly the pro-science point of view is fairly unequivocal; like any medicine, vaccines should be used properly, but they have done great good for the world and there are very real dangers of increased risk for epidemics if enough children stop receiving them. Good for WIRED for taking on the issue and publishing an uncompromisingly pro-science piece on it.

But the anti-vax movement is more than just committed; they’re pretty darn virulent. And since the article came out, author Amy Wallace has been subject to all sorts of attacks. She’s been documenting them on her Twitter feed, which I encourage you to check out. Some lowlights:

  • I’ve been called stupid, greedy, a whore, a prostitute, and a “fking lib.” I’ve been called the author of “heinous tripe.”
  • J.B. Handley, the founder of Generation Rescue, the anti-vaccine group that actress Jenny McCarthy helps promote, sent an essay titled “Paul Offit Rapes (intellectually) Amy Wallace and Wired Magazine.” In it, he implied that Offit had slipped me a date rape drug.
  • Just now, I got an email so sexually explicit that I can’t paraphrase it here. Except to say it contained the c-word. And a reference to dead fish.
  • In his book, Autism’s False Prophets, Dr. Offit writes about scientists who have been intimidated into staying silent about autism/vaccines. If scientists – who are armed with facts and trained to interpret them – are afraid, can it be any surprise that a lot of parents are, too?


It’s pretty horrifying stuff. But there is good news: Wallace also reports that the large majority of emails she has received were actually in favor of the piece, and expressed gratitude that she had written it. There are strong forces arrayed against science, but the truth is on our side, and a lot of people recognize it. It gives one a bit of hope.

Dwindling options

By Daniel Holz | September 9, 2009 5:09 pm

There’s one thing that all Americans, be they liberal or conservative, Democrat or Republican, rational or loony, seem to agree on. Our current medical system is broken, and needs to be fixed. You can listen to personal experience. You can look at pretty graphics. You can read expert discussion. Health care in the US is in need of Change.

Listening to the current health care debate is unbelievably depressing. It isn’t really a debate about healthcare at all. Instead, it has devolved into a debate about all the conservative boogeymen: big government, high taxes, Obama personally telling your doctor what to do. The “debate” is fundamentally unmoored from the actual proposals being set forth. This is one of the most important public discussions this nation has had in recent memory. The results will directly impact each and every American. And yet, the entire debate is completely incoherent and misleading.

The possibility of a “single-payer” healthcare program has fallen off the table. I’m not sure exactly how or when this option became untenable, but it shows how quickly the efforts of pharmaceutical and insurance companies can reframe a discussion. After all, there are billions upon billions of dollars at stake, which is precisely why it is such a profound issue for our long-term fiscal health. It is not at all surprising that these companies are spending millions to defeat meaningful reform. The essential goal of this reform, after all, is to reduce the amount of money our nation spends on health care (while improving overall care). Which is not at all in the interest of these companies. What is astounding is that they are actually succeeding in derailing the discussion into lunacy.

Now it looks as if a “public option” will fall victim as well, and be eliminated from consideration. An (incredibly vocal) minority has become convinced that the public option will destroy capitalism, and that Obama is the second coming of Hitler. Really. These people live in an alternate Universe. Here is a two-minute summary of the public option by Robert Reich:

As Paul Krugman says, “the argument against the public option boils down to the fact that it’s bad because it is, horrors, a government program.” In addition, “the argument against it is sheer nonsense. It is nothing but the insurance lobby.”

In a few minutes Obama will give a much-anticipated speech on healthcare. We can only hope he is able to change the nature of the discourse. We are at a critical juncture. The whole nation is focused on fixing healthcare. The diagnosis is clear. The patient is in crisis. Prospects for recovery are increasingly slim. Heroic action is needed.

Update: Text of the speech can be read here. Obama made a range of proposals, including a public option. He tells us: “Well the time for bickering is over. The time for games has passed. Now is the season for action. Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do. Now is the time to deliver on health care.” I hope he can.

As if on queue, a Republican from South Carolina interrupted Obama in the middle of his speech, yelling “You lie!”. The irony, of course, is that at that very moment Obama was busy decrying the absurd claims being widely promulgated by those who aren’t interested in civil dialogue, but aim to “kill reform at any cost”. It gives a good sense of the current state of affairs: that a Congressman would actually interrupt the President, and accuse him of lying, to his face, on national TV. And, needless to say, the Congressman was absolutely, unequivocally wrong. And, “surprise”, he receives lots of money from healthcare industry lobbyists, and is basically a nutcase.

CATEGORIZED UNDER: Health, Politics

Our Health Care Problems Are More Vivid When Presented in Colorful Graphical Video Form

By Sean Carroll | September 7, 2009 10:05 am

Talking about health care provides a great opportunity to link to this video by Peter Aldhous, Jim Giles and MacGregor Campbell — the last of whom was once Tom Levenson’s advisee. (Also via Bioephemera, who at least was kind enough to embed the video.)

The video, also at New Scientist, takes data from studies by Dartmouth and the OECD, and uses Gapminder to make the graphs come alive. It helps explain one of the paradoxes behind health care in the U.S.: we spend more than most other developed countries, and we get less for it. The explanation — you’ll be unsurprised to hear — lies in our screwy incentive system. By making health care a matter of profit for various sets of people — doctors, hospitals, insurance companies, pharmaceutical companies — we push into the background the incentive that we’d really like the system to have, namely keeping people healthy. Changing those incentives doesn’t mean that Barack Obama decides what treatment you get from your doctor; it just means that we can focus human ingenuity on the task of making people healthier, rather than just making other people wealthier.

CATEGORIZED UNDER: Health

What I Did on My Summer Vacation – Part 1

By John Conway | September 5, 2009 11:00 am

For most academics, summer is the time to devote full time to research and, perhaps, a vacation. Not for me, this year…I have been in the front lines of health care, and so the national focus on the health care insurance reform issue has been particularly poignant. Here is my report.

The health problem at the core is not my own, it’s my father’s. For some time, more than a year, he had had increasing trouble walking. I was convinced it was degeneration of his knees; at 77, after a physically demanding career as a locomotive mechanic in Chicago, that seemed to be the best explanation for his increasing difficulty.

In February we visited him in his house in Chicago and, unlike the previous visit in January, he came out to eat lunch. We had tremendous difficulty getting him down the stairs, to the car, into the restaurant, and back into his house. He took one stair at a time, very slowly, and we carried him up the last one. Clearly it would not be much more time until something had to happen. He had spent most of the winter inside; kind neighbors helped by buying him food at the store.

About a week later I got a call from him, on the cordless phone I had installed for him in the fall. He was on his way to the hospital, having fallen in the house. He had been unable to get up for hours, and finally the paramedics got the front door open and got him out of there. Being nearly 2000 miles away in California, with no family there in Chicago to help him, I was quite worried. He checked into the ER of a hospital near his house, and was admitted.

Over the next few weeks my dad received a full suite of tests to determine the underlying cause of his inability to walk, and got some physical therapy. The eventual diagnosis was scary: ALS, amyotrophic lateral sclerosis, or Lou Gehrig’s disease. ALS is the degeneartion of the voluntary motor neuron system. Any muscle that you can voluntarily control is affected. There is no known cause for ALS, and no known cure. The time from diagnosis to death, which is usually due to inability to breathe, is typically 3-5 years. There is no test for ALS; all you can do is rule out other conditions and it wasn’t joint degeneration, spinal cord damage, a toxin, brain tumor, or any of the numerous other things they checked. He was discharged to a skilled nursing facility for rehabilitation and physical therapy.

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CATEGORIZED UNDER: Health

Fiscal sickness

By Daniel Holz | August 4, 2009 2:07 pm

We have had a number of lively discussions on CV as of late (e.g., here and here) on the state of health care in the United States. Capitol Hill is at present completely consumed by healthcare reform. All of us interact with caregivers at some level, at some time in our lives, and thus we have a personal stake in the discussion. But why all the fuss about medical care at this particular moment? Are there not much more important issues to discuss? (Gravitational lensing? Dark Matter? Atheism?) Perhaps President Obama can help put it all in perspective:

…the greatest threat to America’s fiscal health is not Social Security, though that’s a significant challenge; it’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.

Without a doubt, medical care in the United States is in crisis. It is unsustainable as currently conceived, and it is failing its population in important ways. patient as ATM machine (from New Yorker)For “heroic” procedures our hospitals remain among the best in the world, but for day-to-day care our system is lackluster at best. Our life expectancy is considerably below most other industrialized nations: the average American lives five (5!) years less than their Japanese counterpart (Table 1 of the latest WHO report). This should shock and appall all Americans. Five extra years of life is a big deal. I’d be into that.

A couple of months ago the New Yorker had a nice article by Atul Gawande on the problems with medical care in the US. Gawande is a surgeon at Harvard, and I find him to be one of the more interesting and thoughtful commentators on medicine. In this article he explores the community in the US with the highest per capita medical costs. Care to guess which town? McAllen, Texas, in Hidalgo County. Gawande explores how this has come to pass, and highlights many of the fundamental problems facing our health care system along the way. For example, one of the defining characteristics of medical care in McAllen is that patients on average get more care than usual. They are not healthier than average. They just pay more, for more tests, more visits, more procedures:

Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse. For example, Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen. Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be. In fact, the four states with the highest levels of spending—Louisiana, Texas, California, and Florida—were near the bottom of the national rankings on the quality of patient care.

The condensed version of what is wrong: The incentives in medical care are structured to maximize profit, and not to maximize health. Or even more condensed: Health care is a for-profit business. There are notable exceptions, with the Mayo Clinic, based in Rochester, MN, providing an extreme example. As Gawande touches upon, there is some hope that Mayo could be used as a model for a different sort of health care. But at present Mayo is certainly the exception which proves the rule:

But decades ago Mayo recognized that the first thing it needed to do was eliminate the financial barriers. It pooled all the money the doctors and the hospital system received and began paying everyone a salary, so that the doctors’ goal in patient care couldn’t be increasing their income. Mayo promoted leaders who focussed first on what was best for patients, and then on how to make this financially possible. No one there actually intends to do fewer expensive scans and procedures than is done elsewhere in the country. The aim is to raise quality and to help doctors and other staff members work as a team. But, almost by happenstance, the result has been lower costs. “When doctors put their heads together in a room, when they share expertise, you get more thinking and less testing”

There is no quick fix. And I’m not sure I find Gawande’s suggestions for progress all that compelling. But he does an admirable job of exploring some of the complexity of the problem. The vast majority of us living in this country will interact with the medical establishment at some point in our lives, for better or worse. And there are many reasons to be concerned. I want my five extra years of life.

CATEGORIZED UNDER: Health

Trying Not to Care

By John Conway | May 28, 2009 8:35 pm

Last night, watching a recorded episode of the Daily Show from last week, where Jon Stewart interviewed Elizabeth Edwards, Stewart took the conversation in the direction of health care. At one point, Edwards mentioned that “the President of UnitedHealth made so much money, that one of every $700 that was spent in this country on health care went to pay him.” I was totally floored by this statistic – could our for-profit health insurance industry be that twisted?

So here are some facts. In 2007, according to HHS, total health care expenditures in the US were $2.2 trillion, and expected to grow at a steady 6.1% to $2.33 trillion in 2008. Others, like the National Coalition for Health Care, estimate that in 2008 it was $2.4 trillion, fairly close. Now, 1/700 of that is $3.4 billion, which is actually a thousand times larger than Stephen Hemsley, the CEO of UnitedHealth Group, makes.

So was Elizabeth Edwards wrong? Turns out, she might have been referring to UnitedHealth’s former CEO, Willim McGuire, who was ousted in late 2006 after an options backdating scandal. McGuire made $125 million in 2005. That’s a mere 1 in every $20,000 spent on health care I guess. Taking into account the stock options he sat on, it might bring the ratio down…but I must conclude that there was some hyperbole on Edwards’ part.

I forgive her, mainly because this isn’t the point. What I find truly impossible to accept is that we have a for-profit healthcare insurance system at all. As I have pointed out in the past in CV, this seems to me to be one of the clearest conflicts of interest that you could devise: reward health insurance companies and their shareholders for giving as little actual health care as possible for every dollar received. What other way is there to maximize profits? Oh, right, I almost forgot: keep the costs of health care rising so that this industry grows out of control as a fraction of GDP.

The system where we rely on our employers to provide health care coverage is broken. The rising costs have driven some employers, like the big automakers (who spend more on healthcare than steel) to the brink of bankruptcy, and have driven others to continually pare back the level of coverage for their workers. Underinsurance is as serious a problem as the nearly 50 million not covered at all. Should the particular disease you get wipe you out financially just because it’s too rare a situation to be covered by your plan? Should companies and their shareholders be making profits while our loved ones are being denied treatment? Or even denied coverage at all due to a “pre-existing condition”?

The health care companies have realized that change is coming, quite possibly in the form of a government-run alternative plan with much smaller administrative costs and no profit motive. A report appeared recently in The Washington Post that Blue Cross Blue Shield is launching a large PR campaign against the possible government-sponsored public insurance option. In addition, the health cartel has put forth a plan a couple weeks ago promised to reduce the rate of growth of costs by 1.5%, to about 4.5% presumably. Whoopie.

The right wing is fearful of rationing, long waiting times, or being unable to choose a doctor. The problem is that they simply don’t seem to give a hoot about the 50 million un(der)insured, who wait until they are terribly ill and then show up in ER’s. Guess who pays for that.

Another huge factor in the exorbitant cost of health care in the US is a topic that seems to be very seldomly discussed in the media: the end of life. Something like 27% of Medicare costs go to the last year of a patient’s life. How much of this is simply due to the fact that the patient, and their family, wants to try anything possible to achieve a cure, when in fact the doctors and the nurses know full well that the patient is terminal? Greater emphasis on counseling patients and families, plus a change in our culture that would make us more accepting of death, and an increased focus on preventative and palliative care rather than heroic but clearly futile and expensive late-stage treatments could save our society hundreds of billions of dollars per year.

I am not saying that no one should make a profit performing or delivering health care. Doctors, nurses, hospitals, medical suppliers do what they do to make a living. (Let’s leave Big Pharma out of it for a moment – that deserves a whole post by itself.) What I *am* saying is that no one should turn a profit by adding an unnecessary and bloated layer of bureaucracy. As Donald Cohen pointed out in March at the Huffington Post, the for-profit players are crying foul at Obama’s plan, essentially for a government-run Medicare-like option, because they don’t want the competition. As Cohen points out:

Private insurance overhead and profits eat up 20% and more of health care premiums while Medicare overhead (and no profit) is closer to 3%. There is big money to be made in health insurance. The top 7 “for profit” health insurers made a combined $12.6 billion in 2007– an increase of 170.2% from 2003. The same year, the average CEO compensation package for these health insurance companies was $14.3 million. Pay packages ranged from $3.7 million to $25.8 million.

Government-sponsored single-payer healthcare, which succeeds admirably in many other countries around the world, is probably not a realistic possibility in the US. I think that the next best thing in the long run is that an array of private, not-for-profit companies like Kaiser Permanente could run the for-profits into the ground. The government can encourage the non-profits in any number of ways, with little cost to taxpayers. One way or another I hope that Congress and the Obama administration can create a viable option for the 50 million uninsured, soon.

Access to quality health care should be a basic human right in a civilized, technologically advanced society like the US. It has become our greatest shame in the world that we cannot provide that for one in six of our people.

CATEGORIZED UNDER: Health, Human Rights

Fear the Reaper

By John Conway | December 3, 2008 6:45 pm

I am going to go out on a limb here and write about a subject that I know next to nothing about. But that’s part of the problem…

Imagine the sensation it would cause in the news media: a new disease appears in the US, killing hundreds, then thousands, then tens of thousands per year. The death rate closes in on 100,000 people per year. People are terrified, the medical community launches a massive campaign to control and eradicate the new pestilence, the federal government creates a new bureaucracy, a special arm of the CDC to deal with this growing death toll.

Here’s the weird thing. It’s here, and we may well top 100,000 dead per year soon in the US. There is no media outrage, no massive federal programs, and precious little available public information at all about it.

The disease? MRSA: methicillin-resistant staphlyococcus aureus. This “superbug”, a virulent strain of staph, has a chilling death rate: about 20-30% of the people who get it die from it. This is a highly variable statistic, because most of these infections are occurring in hospitals, and the people who are there are already very ill, and often immune-compromised. This so-called health-care-associated MRSA (HA-MRSA) is to be distinguished from the growing number of cases of community-associated MRSA (CA-MRSA) which account for around 15% of the incidence.

In fact, getting the total US death toll number is rather difficult to do, because hospitals don’t want to report these deaths and have actively lobbied against state laws requiring them to do so. In California, I am happy to say, The Governator signed into law in September a bill requiring such reporting (though he killed such a bill a year ago!) As of October, only half the states in the country had such laws. (Interesting aside: in 2003, then-Illinois state senator Barack Obama championed such legislation and got it passed.)

Maybe the media is finally getting the story. The Seattle Times recently had an editorial on the subject, lashing out at the hospital industry for bring this pestilence upon us, after an investigative report.

Okay, so what about that 100,000 number? Okay, I made that up. But in 2005, it is documented all over that there were about 19,000 deaths in the US, and infection rates were climbing very, very rapidly. In California the Department of Health Services estimated about 9,600 deaths from hospital related infections, which extrapolates to around 80,000 deaths nationwide. Not all of these are MRSA, clearly. But I am going to take a wild guess that the 9,600 number was low-balled. It is striking that we don’t know how many people are dying from MRSA, but it could become the fifth or sixth leading cause of death soon.

There are a lot of things that need to change, not least of which:

- There need to be more media stories; people need their awareness raised.

- The government, and the CDC in particular needs to get very serious about getting accurate statistics out and available openly.

- Hospitals need to put in place whatever measures they can, from copper door knobs to better MRSA screening on intake, to better staff education (no pun intended) on infection control.

- There should be a major research effort launched to understand the new-gen superbugs like MRSA, C. difficile, and the lovely new one from the Iraq battlefield, A. baumanni.

I guess what I find most chilling here is the almost unbelievable cynicism of the hospital/health insurance companies who actively fight against having to report statistics on MRSA infection rates. To me, it just underscores a general conclusion that I have formed in the past several years: our health care system should not be managed by organizations that have a profit motive. Think about it: the free market has not produced an efficient, responsive health care system. The profit-based health insurance industry has only created an enormously expensive bureaucratic layer whose main effect has been to drive up health care costs at quadruple the inflation rate while continually restricting actual health care services, and has left 50 million Americans with no health care coverage at all.

I blame them.

Wallpapering a Curved Ceiling

By Julianne Dalcanton | September 15, 2008 3:18 pm

Well into my household’s Year of Sensory Input Issues, my husband is dealing with a detached retina. It’s been a sometimes frightening experience — for example, did you know that if you have to leave an international flight en route, that the customs agent will come out and clear your passport on the ambulance? And that in spite of their stinginess with blankets and pretzels, United Airlines really can come through in a crisis? Annoying as it’s been, the experience has been filled with Cool Applications of Physics, which helps me pass the time.

A retinal detachment involves the retina (which lines the back of your eye like wallpaper) sagging away from the back of the eye (as your wallpaper might do in a damp bathroom). Now, if you’ve ever tried to wallpaper a curved surface, you know it’s not easy to get some intrinsically flat thing to stick smoothly to the inside of the curve, especially when that bitch Gravity is pulling it down all the time. The clever way that retinal surgery deals with this (squeamish people stop reading now, please) is to suck some of the goo out of your eye and replace it with a gas bubble. You then tilt your head into the right position to have the gas bubble float up into the correct portion of the eye while the retina re-attaches. For a month. If you’re lucky, you get to sit up, but if you’re unlucky, you spend a month looking at the floor. In addition, you cannot go up or down in altitude by more than a thousand feet or so, because when you have an air bubble in your eye pressure changes are not a great idea.

My husband has been lucky enough to have a sitting-up kind of detachment so far (though I’m writing this while waiting for him to get out of surgery a second time, since it seems to have detached again, and based on where he lost vision and knowing the inversion of the image that takes place in the eye’s reimaging system, I’m worried he’s going to be a floor-looking guy when he comes out). The cool bit about getting to look at him face-on is that you can actually see the bubble! He looks like a human level, as the bubble readjusts as he tips his head.

The other physicsy bit is that when you have a gas bubble in your eye, your index of refraction is all wrong, and in spite of having a working retina attached in the right place, you still can’t see, because the air-lens interface steers the light to the wrong place. This gets better as the air is absorbed by the body and replaced with fluid. It’s also better when you tip your head down so the bubble floats away from the lens.

The upshot of all this is that I think that modern medicine is pretty darn clever, though I wish I didn’t have to know about it.

CATEGORIZED UNDER: Health, Personal, Technology

Guest Post: Tom Levenson on the Iraq War Suicides and the Material Basis of Consciousness

By Sean Carroll | June 4, 2008 6:50 pm

For his second guest post, Tom follows in our proud tradition of fearless eclecticism,
mixing neuroscience and current events with a bit of materialistic philosophizing. His first post was here, and his third is here.

——————————————————————

Burrowing into tragedy: a story behind the story of the Iraq War Suicides.

My thanks to all here who gave me such a warm welcome on Monday (and, again, to Sean for asking me here in the first place).

This post emerges out of this sad story of a week or so ago.

Over Memorial Day weekend this year there was a flurry of media coverage about the devastating psychological toll of the Iraq and Afghanistan wars. The single most awful paragraph in the round-up:

“According to the Army, more than 2,000 active-duty soldiers attempted suicide or suffered serious self-inflicted injuries in 2007, compared to fewer than 500 such cases in 2002, the year before the United States invaded Iraq. A recent study by the nonprofit Rand Corp. found that 300,000 of the nearly 1.7 million soldiers who’ve served in Iraq or Afghanistan suffer from PTSD or a major mental illness, conditions that are worsened by lengthy deployments and, if left untreated, can lead to suicide.”

(For details and a link to a PDF of the Army report – go here.)

This report, obviously, is the simply the quantitative background to a surfeit of individual tragedy – but my point here is not that war produces terrible consequences.

Rather, the accounts of the Iraq War suicides — 115 current or former servicemen and women in 2007 – struck me for what was implied, but as far as I could find, not discussed in the mass media: the subtle and almost surreptitious way in which the brain-mind dichotomy is breaking down, both as science and as popular culture.

How so? It is, thankfully, becoming much more broadly understood within the military and beyond that “shell shock” is not malingering, or evidence of an essential weakness of moral fiber. PTSD is now understood as a disease, and as one that involves physical changes in the brain.

The cause and effect chain between the sight of horror and feelings of despair cannot, given this knowledge, omit the crucial link of the material substrate in which the altered and destructive emotions can emerge. PTSD becomes thus a medical, and not a spiritual pathology.

(This idea still faces some resistance, certainly. I launched my blog with a discussion of the attempt to court martial a soldier for the circumstances surrounding her suicide attempt. But even so, the Army is vastly further along in this area that it was in the Vietnam era and before.)

Similarly, depression is clearly understood as a disease with a physical pathology that underlies the malign sadness of the condition. (H/t the biologist Louis Wolpert for the term and his somewhat oddly detached but fascinating memoir of depression.)

This notion of the material basis of things we experience as our mental selves is not just confined to pathology. So-called smart drugs let us know how chemically malleable our selves can be.

More broadly, the study of neuroplasticity provides a physiological basis for the common sense notion that experience changes who we perceive ourselves to be.

All this seems to me to be a good thing, in the sense that (a) the study of the brain is yielding significant results that now or will soon greatly advance human well being; and (b) that the public seems to be taking on board some of the essential messages. The abuses (overmedication, anyone?) are certainly there. But to me, it is an unalloyed good thing that we have left the age of shell shock mostly behind us.

At the same time, I’m a bit surprised that the implications of this increasingly public expression of an essentially materialist view of mind haven’t flared up as a major battle in the science culture wars.

Just to rehearse the obvious: the problem with cosmology for the other side in the culture war is that it conflicts with the idea of the omnipresent omnipotence of God. The embarrassment of evolutionary biology is that it denies humankind a special place in that God’s creation, destroying the unique status of the human species as distinct from all the rest of the living world.

Now along comes neuroscience to make the powerful case that our most intimate sense of participating in the numinous is an illusion.

Instead, the trend of current neuroscience seems to argue that the enormously powerful sense each of us has of a self as distinct from the matter of which we are made is false. Our minds, our selves may be real—but they are the outcome of a purely material process taking place in the liter or so of grey stuff between our ears.

(There are dissenters to be sure, those that argue against the imperial materialism they see in contemporary neuroscience. See this essay for a forceful expression of that view.)

I do know that this line of thought leads down a very convoluted rabbit hole, and that’s not where I am trying to go just now.

Instead, the reports of the Iraq suicides demonstrated for me that the way the news of the materiality of mind is is slipping into our public culture without actually daring (or needing) to speaking its name.

That the problem of consciousness is still truly unsolved matters less in this arena than the fact of fMRI experiments that demonstrate the alterations in brain structure and metabolism associated with the stresses of war or the easing of the blank, black hole of depression. The very piecemeal state of the field helps mask its potentially inflammatory cultural implications.

To me this suggests two possibilities. One is that it is conceivable that when the penny finally drops, we might see backlash against technological interventions into the self like that which has impeded stem cell research in the U.S.

On the other hand, I don’t think that the public can be motivated or even bamboozled into blocking the basic science in this field. Too much rests on the work; any family that has experienced Alzheimers knows just how urgent the field may be — not to mention anyone with a loved one in harms way.

This actually gives me hope for a shift in the culture war. For all the time and energy wasted over the last several years defending the idea of science against attacks on evolution, with the cosmologists taking their lumps too – the science of mind could force a shift in the terms of engagement decisively in the right direction.

Or I could be guilty of another bout of wishful thinking. Thoughts?

Image: Brain in a Vat, article illustration. Offered in homage to my friend and source of wisdom, Hilary Putnam, who introduced the brain-in-a-vat thought experiment in this book. Source: Wikimedia Commons.

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