![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 10 to 34 of 34. Go back in thread:
Posted by noa on July 6, 2000, at 8:45:48
In reply to Why the drugs don't work, posted by Alex Birkett on July 5, 2000, at 8:39:41
> We have become obsessed with palliative care as if treating the causes of our real suffering was hopeless, so hopeless in fact that we too often happily deceive ourselves that no such causes exist at all.
I want to address myself to the term "palliative care".
I don't see antidepressants as "palliative". Sure, they are not curative, but they definitely halt the progress of the disease. Without treatment, the brain can undergo structural changes due to such things as high cortisol levels. People who have chronic untreated depression are more likely to have a progressively worsening course of the disease. Treating the illness stops this process and can therefore change the course of the disease and halt the damage to the brain.
Now, to address your more "macro" outlook on things: In a complex system, such as the system I will call "person-in-society", there are many points in the system that one can focus on if one wants to identify and define a problem or set of problems, and set about constructing possible solutions to such problems. Depending on where one focuses, the problems will obviously be defined differently and different courses of action to solve those problems will make sense. In the "person-in-society" system, one can focus on the smallest level, such as the atoms that comprise the chemicals that make up the cells of the person's body, or one can focus on a slightly larger scope, such as the person's relationships with family, or one can focus on a larger scope, such as the person's community, or even larger, the person's larger societal issues, etc. There are many examples both of the different size of the scope or the different types of things one can look at within each level.
Focusing on one part of the whole system, constructing a definition of a problem withing that part, and trying to solve that problem might or might not involve integrating solutions to problems in other parts of the system, or wider or narrower scopes. Optimally, one can address problems both as narrowly and as widely as possible at the same time, but this is rarely feasible. More feasible are the actions that find a manageable solution to a specific problem, but this does not preclude other solutions to other problems in the system, or wider scopes of action on larger parts of the system.
Taking antidepressants is not palliative care. It is not a cure, either, but it is a manageable solution, for now, to address a specific problem that left unaddressed, would likely shut down the person-in-society system altogether. That is the case for me, anyway. My taking antidepressants does not stop me from being aware of the society and world around me, or ignoring other aspects of my person-in-society system, or acting on more "macro" approaches to problems that occur on wider scopes within the system.
Drugs don't solve all the world's problems, and yes, there are some causes of suffering that won't be addressed by medicines, but that doesn't negate the fact that medications help a lot of people's problems in such a significant way.
To give a rather crude analogy, my toilet plunger doesn't make my house more energy efficient, but does that mean I must throw away the toilet plunger? Or if I use the plunger to unclog the toilet, does it necessarily follow that I am ignoring the need to make my house energy efficient? Or that the toilet plunger manufacturer is conspiring against the advocates of more energy efficient homes?
Posted by dj on July 6, 2000, at 11:19:10
In reply to Re: Why the drugs don't work, posted by noa on July 6, 2000, at 8:45:48
Though depression is not specifically noted in the following article from today's Globe and Mail (http://theglobeandmail.com)Dr.Maté's thoughtful commentary is relevant to the above discussion. He has written eloquently about the ADD syndrome (see the end of the article) which if I remember correctly (and I may not...) he may be challenged by himself. Read on:
Decoding the hype
Looking for genetic cures for disease lets us
sidestep the need to tackle the social
and environmental causes, says Dr. Gabor Maté
Dr. Gabor MatéThursday, July 6, 2000
Expressions of near-religious awe and prophesies of dramatic medical advances greeted last week's announcement that scientists are close to deciphering the human genome, the genetic blueprint for the human body. "Today, we are learning the language in which God created life," President Bill Clinton said at the White House ceremony marking the truce between two groups of scientists racing to complete the genome. "This is going to revolutionize medicine," enthused Stephen Warren, a U.S. medical geneticist. "We are going to understand not only what causes disease but what prevents disease."
The actual results are bound to be disappointing, except perhaps to the profit margins of pharmaceutical companies and to the grant coffers of researchers. A sober assessment suggests that little can be expected from the genome program that will lead to significant health benefits in the near future, if ever.
First, our current state of knowledge regarding human genetic makeup is like citing an incomplete copy of The Concise Oxford English Dictionary as "the model" from which Shakespeare created his plays. "All" that remains now is to find the prepositions, grammatical rules and phonetic indications, then figure out how Shakespeare arrived at story lines, dialogue and literary devices.
"The genome is biological programming," one thoughful science reporter has written, "but evolution has neglected to provide even the punctuation to show where genes stop and start, let alone any helpful notes as to what each gene is meant to do."
Second, contrary to the genetic fundamentalism that pervades medical thinking and public awareness these days, genes by themselves cannot possibly account for the complex psychological characteristics, behaviour or health or illness of human beings. Genes are codes for the synthesis of the proteins that give a particular cell its characteristic structure and functions. They are, as it were, alive and dynamic architectural and mechanical plans. Whether the plan becomes realized depends on far more than the gene itself.
The activities of cells are defined not simply by the genes in their nuclei, but by the needs of the entire organism -- and by the interaction of that organism with the environment in which it must survive. Genes are turned on or off by the environment.
Only a handful of illnesses is genetically determined. The most we can say is that some conditions are strongly genetic. Even in the case of well-known single-gene diseases such as Huntington's, a usually fatal degeneration of the nervous system, there may be protective environmental factors; of those who carry the gene, a few live to a ripe old age without developing signs of the disease.
In the case of schizophrenia, a mental illness it is currently fashionable to consider genetic, the most that can be shown is that if one member of a pair of identical twins is diagnosed with it, the other has a 50 per cent or 60 per cent chance of being similarly diagnosed. Lest people think this proves even a 50 per cent or 60 per cent genetic contribution, it must be remembered that identical twins spend nine months in the same formative uterine environment, and are acted on by identical biological and psychological influences. So the genetic effect in schizophrenia is less than half. The rest is environmental.
For the commonest North American afflictions -- heart disease, lung cancer, diabetes -- we don't need to seek genetic origins. The causes are apparent. The northwest Ontario Cree suffer diabetes at a rate five times the Canadian average, despite the traditionally low incidence of diabetes among First Nations populations. The genetic makeup of the Cree hasn't changed in a few generations. The destruction of their physically active way of life by what we call civilization, the introduction of high-calorie diets, and increased stress are responsible for the alarming rise in diabetes rates.
Among hard-core drug users in Vancouver's downtown east side, virtually anyone can give wrenching histories of childhood abuse or deprivation. Yet at a conference on addiction medicine I attended last year, not a single session was granted to social or psychological issues. Time was devoted, instead, to the genetic bases of substance addictions and alcoholism, as if the environment was not of fundamental importance in both causation and healing.
Given the paucity of evidence for the decisive role of genetic factors in most questions of illness, why all the hoopla about the genome project?
Science, as all disciplines, has its ideological and political dimensions. The assumption that illnesses, mental or physical, are primarily genetic allows us to avoid disturbing questions about the nature of the society in which we live. If genes -- rather than poverty or man-made toxins or a stressful culture -- are responsible for diseases, we can look to simple pharmacological and biological solutions. This approach helps to justify and preserve prevailing social values and structures. And it's profitable. The value of shares in Celera, the private company participating in the genome project, has risen 1,400 per cent in a year.
In Genesis,God fashions the universe first, then nature, and only afterward shapes humankind from the substance of Earth. God knew, if Mr. Clinton does not, that from their earliest beginnings humans could never be understood apart from their environment.
Gabor Maté, a Vancouver physician, is the author of Scattered Minds: A New Look at the Origins and Healing of Attention Deficit Disorder.
Posted by Rick E. on July 6, 2000, at 12:55:05
In reply to An eloquent M.D. writes about genetic(s) hype..., posted by dj on July 6, 2000, at 11:19:10
I have no argument with you over the genetics. I am a firm believer that my depression/anxiety state is caused by enviromental issues alone. What I do have a problem with, however, is this notion that drugs are not needed to curb the "side effects", if you will, of my conditions. I truly believe that if anybody has experienced the darkest side of depression, and then been treated and relieved by medications, they will read your posts with a great disbelief of the ignorance that surrounds this form of treatment. It DOES work.
After all, and you may consider this a selfish viewpoint, but we are only on this earth for a short time. In terms of measurement, my life is halfway over, and it has taken me this long to learn that there is hope for my anxious condition. I have had therapy for years, starting when I was 17 years old, and much of it, I still carry with me today, some of it I dismissed early on. Today, I deal with some side effects that are bothersome, but in comparison to the side effects of untreated depression, they are very, very mild. Maybe if I had treated my conditions with medication earlier, I never would have reached the depression state that I did 6 months ago. One truth that I have learned: MY ENVIRONMENT IS NOT GOING TO CHANGE, SO I WILL HAVE TO. All this talk of the 21st century being an enlightened society, pills for every ache and pain, blah, blah, blah...I don't buy it. I never have. If you want to talk about God, then I suggest that you read more of the bible and less worldly works. Revelation is the key here...the world is NOT SUPPOSED to become a better place, just a place where the human mind is much more easily led astray. I see that all around me. On the TV, this computer as I type!
Back to the land of solutions...I really don't think that you have ever experienced the deep rooted depression that many on this site have. If you had, you would not post such delusional things, and certainly show much more compassion. THAT I am sure of. Imagine that this were a board of cancer survivors offering advice and compassion to newly diagnosed patients. Would you then feel so comfortable posting messages that portrayed cancer as a purely environmental effect? Would anyone care what the cause was? I believe many people come here, already accepting the fact that there is SOMETHING WRONG, and their best efforts...were of no avail. So they, like me, seek out medical treatment. It's no easier to "think" cancer cells out of my body than it is to "think" my way out of depression. I know. I've lived through both. And both were miserable.
You have some interesting points, things I've started to ponder myself, and I thank you for that. However, when my time comes, and I must stand before God, I want to feel confident that I have done as much as I can to HELP others when they were in need...as others have helped me. Society as a whole is supposed to crumble. I believe it was planned. We as human beings were designed to suffer...and treatment of my condition, to me, is what God wants me to do. Were I laying around suffering from untreated depression, I would be thinking of ways to end my life right now, not out of pure selfishness, but out of wanting to stop suffering such excruciating mental AND physical pain. The drugs DO work, and I am convinced beyond the shadow of a doubt, that society and the spiritual world are better places for it.
Rick E.
Posted by stjames on July 6, 2000, at 13:15:35
In reply to Sometimes they DO work, on the surface..., posted by dj on July 6, 2000, at 8:27:37
My experience with ADs was that they helped me stabilize emotionally but cognitively and physcically they had negative impacts, which were intolerable to me once stabilized and who knows what the longterm impact would have been...nobody, especially not the pharm. cos.!!
James here....
Many of us don't have the negative impacts you mention. Longterm.....people have been on AD since the 1950's, how long term do you mean ?
james
Posted by dj on July 6, 2000, at 14:30:54
In reply to Re: Sometimes they DO work, on the surface..., posted by stjames on July 6, 2000, at 13:15:35
> James here....
>
> Many of us don't have the negative impacts you mention. Longterm.....people have been on AD since the 1950's, how long term do you mean ?
>
> jamesJames,
As the economist John M. Keynes once noted,in the long term we are all dead. The question with ADs is do they help make your life worth living, while you are still here on earth? With me the answer was no, except for a brief period (months) while I worked through the issues and stresses that led me there.
Obviously you and others have had more postive experiences and more power to you. However, that is not necessarily the norm. It may be but I've read and experienced enough to not trust the pharm. co's stats. and reporting of the immediate and longer term negative effects. Scientists and doctors not affiliated with pharm. co's. are the ones who should be judging this, as well as those who've experience with ADs, both good, bad and ugly.
Sante!
dj
Posted by dj on July 6, 2000, at 15:03:04
In reply to Re: An eloquent M.D. writes about genetic(s) hype..., posted by Rick E. on July 6, 2000, at 12:55:05
I don't have the time to deal with your whole post right now. It seems you did not carefully assess all of my comments or those whom I quoted. I suggest you re-read them and think about them very carefully. I will deal with a few of your comments below...
> MY ENVIRONMENT IS NOT GOING TO CHANGE, SO I >WILL HAVE TO.
Both can and do change, via various mechanisms including ADs, therapy, spirital and political action.
> If you want to talk about God, then I suggest that you read more of the bible and less worldly works. Revelation is the key here...the world is NOT SUPPOSED to become a better place, just a place where the human mind is much more easily led astray. I see that all around me. On the >TV, this computer as I type!
Perhaps that is your revelation and it is your view. I respectfully disagree and can and have cited sources whom I trust and consider authorative.
> Back to the land of solutions...I really don't think that you have ever experienced the deep rooted depression that many on this site have. If you had, you would not post such delusional things, and certainly show much more compassion. >THAT I am sure of.
Don't be so sure of yourself because you are wrong. Compassion comes in many forms, not just in dogmatic agreement with what you choose to believe.
>Imagine that this were a board of cancer survivors offering advice and compassion to newly diagnosed patients. Would you then feel so comfortable posting messages that portrayed cancer as a purely environmental effect? Would >anyone care what the cause was?
If you carefully re-view my comments they are taking a systemic look at the issues, not a dogmatic one. My father died of cancer. Others in my family are dealing or have dealt with it and a systemic approach to healng was and is key.
Three people from my highschool graduating class (over 25 years ago) two of whom were dear friends died at thier own hands, one a month after my Dad died. And you wouldn't have wanted to experience the major depression I did at that and other times. All of these elements inform my sytemic analysis and interpretation.
> You have some interesting points, things I've started to ponder myself, and I thank you for >that.
You are welcome.
>However, when my time comes, and I must stand before God, I want to feel confident that I have done as much as I can to HELP others when they >were in need...as others have helped me.
I agree with you overall here but not on what form compassion and compassionate action might take and I don't speculate about what happens at the end. I generally focus on what I can do here and now, on an individual and systemic basis.
>Society as a whole is supposed to crumble. I believe it was planned. We as human beings were >designed to suffer
That is your belief, not mine.
I believe the degree of suffering we experience is influenced by the choices we make including what we choose to believe, as Buddhism and other approachs explain. First however we must become conscious of our choices and how they affect us and others.
For instance, scientific studies of whiplash pain sufferers have experienced have shown different experiences of pain in different cultures, dependant in some cases on the societal reward for suffering that being the way the insurance system evaluated and compensated for the impact. I recall discussing this with a health insurance rep. on an airline, around the time my Dad died, and have seen similar studies cited on occassion.
>...and treatment of my condition, to me, is what God wants me to do. Were I laying around suffering from untreated depression, I would be thinking of ways to end my life right now, not out of pure selfishness, but out of wanting to stop suffering such excruciating mental AND physical pain. The drugs DO work, and I am convinced beyond the shadow of a doubt, that society and the spiritual world are better places for it.
>
> Rick E.No place have I written that the drugs do not work. I've only questioned the degree of their effectiveness and their value in contrast with other approachs. And I noted that they deal with symptoms and not root causes. Only those affected can deal with root causes, if they so choose.
Something for you to ponder, if you choose to...
Peace be with you!
Namaste!
dj
Posted by SLS on July 6, 2000, at 16:07:00
In reply to An eloquent M.D. writes about genetic(s) hype..., posted by dj on July 6, 2000, at 11:19:10
Eloquence does not equate to accuracy. It may simply be that the writer displays an elegant style of being wrong.
> "Looking for genetic cures for disease lets us
sidestep the need to tackle the social
and environmental causes, says Dr. Gabor Maté"How is it that such eloquent people manage to create such unsophisticated constructs that rely upon unwarranted mutual exclusion? This is silly.
I can't even begin to deal with the rest. Maybe another time.
- Scott
Posted by dj on July 6, 2000, at 19:31:30
In reply to Re: An eloquent M.D. writes about genetic(s) hype..., posted by SLS on July 6, 2000, at 16:07:00
> Eloquence does not equate to accuracy. It may simply be that the writer displays an elegant
> style of being wrong.Or right!
>
> > "Looking for genetic cures for disease lets us
> sidestep the need to tackle the social
> and environmental causes, says Dr. Gabor Maté"
>
> How is it that such eloquent people manage to create such unsophisticated constructs that rely >upon unwarranted mutual exclusion? This is silly.The cited piece is from the editor's summary of what the article is about, so it is the editor's construct you are referencing. I doubt that Dr. Mate's view exludes the value of ADs, just their value by themselves alone.
> I can't even begin to deal with the rest. Maybe >another time.I'd love to see you or anyone attempt to refute the facts he cites, eloquently or not. The issue at essence is the historic argument of nature vs. nurture and he argues for the systemic interaction of both. Anyone who focuses on one only at the exclusion of the other is foolish, in my view.
Sante!
dj
Posted by shar on July 6, 2000, at 22:55:47
In reply to Re: An eloquent M.D. writes about genetic(s) hype..., posted by dj on July 6, 2000, at 19:31:30
With all due respect, and I mean that, and I am not trying to be antagonistic, I noticed that some of the people in the above posts and in other posts on this board, have indicated that they don't experience depression, anxiety, bipolar, etc. So, no need for therapy or meds, or both, they (I suppose) would be "normals".
So, I am sincerely curious why does someone post here that does not need the "support and education" offered by the Psych part of PsychoBabble? To make their opinions known to us, and perhaps change our lives/perspectives?
This especially would apply to the fellow with the initial post, that I didn't make it all the way through, who doesn't seem to "mesh" with this forum? I know it's a free country, and everyone has the right to post, but that seemed to be a more sociological/political/societal milieu oriented post.
I am curious, that's all. Obviously some of the PB's did read and respond to the post, so must have thought it was relevant.
BTW, I've been depressed without meds and then took meds. With meds is better, all things considered.
S
Posted by dj on July 6, 2000, at 23:44:38
In reply to With all due respect.....Y RU Here?, posted by shar on July 6, 2000, at 22:55:47
> With all due respect, and I mean that, and I am not trying to be antagonistic, I noticed that some of the people in the above posts and in other posts on this board, have indicated that they don't experience depression, anxiety, bipolar, etc. So, no need for therapy or meds, >or both, they (I suppose) would be "normals".
In my case, Shar, I have experienced severe major depressions as I've indicated above and elsewhere and still experience some depressive symptoms when feeling stressed though generally I am dealing much better with stress these days than I have in the past. And I have used ADs, had some one on one counselling intermittantly over the past 25 years as well as lots of different group dynamic experiences, done much reading and self exploration.
Around this time last year, I discovered the board when I was undergoing MAJOR depression. The folks and info. on the board helped me sort through some of the AD issues when I was considering going back on them, at my PDoc's advice. I received conflicting advise from some group counsellors whom knew me over a period of time. I did eventually do the ADs, after expermenting with several types and eventually ended up on a combo. of Wellbutrin and Prozax for several months.
However, once I stabilized thanks to the ADs and the counselling (from various sources) I eventually became wary of the negative side effects I was experiencing from the ADs and when I felt ready, phased them out, knowing I had successfully done so in the past and based on advice from a number of sources and what I was experiencing and had experienced in the past.
I am still dealing with many of the pressures that led to my major depressions but am dealing with them much better and generally with few indications of other than sometimes generally fleeting depression and anxiety more and more which I have come to recognize as my personal patterns or "algorithms" for going into and out of those cycles.
However, I am still sorting through and making sense of these patterns. And coming back to PB, for a while and some of the discussions here have helped me with this sifting and sorting of patterns. Some of the recent feedback I've recieved from Noa and Cass who experienced my sometimes less than gracious patterns previously, before taking a break from PB which I will probably do again soon, indicates to me that they've witnessed the progress which I've experienced.
My nature is to be very curious, scientific in my examination of issues and open to various possibilities. And when obssessive, as I have been and can be when experiencing my stress excessively, I can be dogmatic, perfectioistic and challenging but constantly work at not being so.
So to make a long story short I'm here attempting to clean up and connect some loose ends and doing some of this publically in this forum, as I ponder some issues and angle for some learning and integration of concepts I'vebeen pondering for years... which make more sense to me now, when considered from a systemic perspective.
I'm also here because, as part of this sifting and sorting process, I'm writing up a mediation over my educational experience last year, which was the source of much of my stress, anxiety and eventually my major depression because of a systemic quality mismatch between what I paid for and what I was delivered. And the ideas I've been exploring here, match up in some ways with the ideas I'm exploring in the mediation process I'm working on wrapping up, soon, very soon...
And as K. Vonnegut wrote, so it goes...
Namaste!
dj
Posted by Dr. Bob on July 7, 2000, at 0:38:36
In reply to Re: An eloquent M.D. writes about genetic(s) hype..., posted by Rick E. on July 6, 2000, at 12:55:05
> I really don't think that you have ever experienced the deep rooted depression that many on this site have. If you had, you would not post such delusional things, and certainly show much more compassion.
Please don't jump to conclusions about the experiences of others or imply that they're delusional or not compassionate.
Or, if you do, at least don't do it in a post!
Bob
PS: Thank you, dj, for not over-reacting to the that post.
Posted by Dr. Bob on July 7, 2000, at 0:39:45
In reply to With all due respect.....Y RU Here?, posted by shar on July 6, 2000, at 22:55:47
> I know it's a free country, and everyone has the right to post...
Yes, it's a free country, but no, not everyone has a right to post. Only those who abide by the rules may post. Thank you for your cooperation,
The Management
Posted by KarenB on July 7, 2000, at 2:59:32
In reply to Why the drugs don't work, posted by Alex Birkett on July 5, 2000, at 8:39:41
Just me, being civil...
Karen :#
Posted by harry b. on July 7, 2000, at 3:39:24
In reply to Re: I suggest www.drlaura.com/forum , posted by KarenB on July 7, 2000, at 2:59:32
> Just me, being civil...
>
> Karen :#OK, you did it.....my first laugh-out-loud of the
day, and it's only 4:30am
hb
Posted by kazoo on July 7, 2000, at 8:09:51
In reply to Re: I suggest www.drlaura.com/forum , posted by KarenB on July 7, 2000, at 2:59:32
> Just me, being civil...
>
> Karen :#^^^^^^^^^^^^^^^^
The "Wall Street Journal" recently reported that Dr. Laura had contributed 80 percent of her
brain to Harvard's Psychiatric Brain Acquisition Program back in 1990, which explains a lot of
things (but not to her).http://members.aol.com/drewfusmydrewfus/drlaura.html
KaZoO
Greetings to KarenB, and, of course, harry b.
Posted by SLS on July 7, 2000, at 8:26:21
In reply to Re: An eloquent M.D. writes about genetic(s) hype..., posted by SLS on July 6, 2000, at 16:07:00
> > Eloquence does not equate to accuracy. It may simply be that the writer displays an elegant
> > style of being wrong.
>
> Or right!Of course.
> > > "Looking for genetic cures for disease lets us
> > sidestep the need to tackle the social
> > and environmental causes, says Dr. Gabor Maté"
> >
> > How is it that such eloquent people manage to create such unsophisticated constructs that rely >upon unwarranted mutual exclusion? This is silly.
>
> The cited piece is from the editor's summary of what the article is about, so it is the editor's construct you are referencing. I doubt that Dr. Mate's view exludes the value of ADs, just their value by themselves alone.My apologies to the doctor, however, as it is written, it appears as though those were the doctor's words.
> > I can't even begin to deal with the rest. Maybe >another time.
>
> I'd love to see you or anyone attempt to refute the facts he cites, eloquently or not. The issue at essence is the historic argument of nature vs. nurture and he argues for the systemic interaction of both. Anyone who focuses on one only at the exclusion of the other is foolish, in my view.I am a bit confused. Who wrote the following?
"In the case of schizophrenia, a mental illness it is currently fashionable to consider genetic..."
Fashionable?
I think this one word drew my attention.
Also.
"For the commonest North American afflictions -- heart disease, lung cancer, diabetes -- we don't need to seek genetic origins"
This one I also found unpalatable. It seems far too polarized a statement and doesn't take into consideration the benefits that the knowledge of which genes are responsible for which processes in the body can bring - even in healthy people. Evaluation of a healthy person's genes may give rise to a screening process that would identify exactly which foods, drugs, and behaviors can be avoided for that individual to prevent these things from happening. Such would lead to much greater compliance to a change in lifestyle. That is just one example of what can be gleaned from figuring out just how our bodies operate. I don't understand how anyone can decide what is not worth discovering when only its discovery can determine its importance.
If the genetic constitution of the Cree lends itself to such intolerance of a particular foodstuff for which there is little opportunity to currently avoid, perhaps turning ON or turning OFF a combination of genes would remedy the situation. Of course dietary changes might help. How well? Which would be more practical (quicker - save more lives) given the current state of human affairs? In addition, there is no mention of what the rate of these diseases were in the Cree prior to European settlement. What does "alarming" mean. Was it high to begin with? If these diseases manifest at an age later than the child bearing years (allowing for successful reproduction), it could have been alarming all along. Perhaps knowledge of their genetics could lead to a better understanding of how to manage these diseases if dietary changes are not sufficient. These are just a few hypotheticals I came up with. That we *don't* need to seek genetic origins for the Cree has not yet been determined. I don't think it can be until we see how well the application of changing diet and exercise behaviors actually solves the problem in real life. Until then, perhaps the Cree would think differently about the need for genetic study. I don't know.
"Given the paucity of evidence for the decisive role of genetic factors in most questions of illness, why all the hoopla about the genome project?"
Again, I don't understand how anyone can decide what is not worth discovering when only its discovery can determine its importance. There is no paucity of evidence, in my opinion. Mendelian evidence has been recognized for a great many maladies for a great many years. Specific genes have already been identified that encode for specific proteins and enzymes that are responsible for a great many of these and other maladies. Inheritance and mutation need both be considered, among other things. Of course there are other factors involved in the expression of genes. But a great many illnesses cannot occur without the genes necessary to produce them, even if they are not produced in 100% of the individuals in which these genes exist.
Huntington's Chorea sucks.
Hurray for the Human Genome Project! By the way, the project has not been completed, but has only just begun. I don't think the media has done a very good job describing this. So far, we have identified all the words, but we haven't discovered all of their definitions yet. Sort of like deciphering the Rosetta Stone.
- Scott
Posted by dj on July 7, 2000, at 21:28:16
In reply to Re: please be civil, posted by Dr. Bob on July 7, 2000, at 0:38:36
>
> PS: Thank you, dj, for not over-reacting to the that post.Thank you for your thoughtfulness, Dr. Bob. My measured response is part of my self-mediation process. ; )
Posted by dj on July 7, 2000, at 21:48:57
In reply to Re: An eloquent M.D. writes about genetic(s) hype... » SLS, posted by SLS on July 7, 2000, at 8:26:21
>the project has not been completed, but has only just begun. I don't think the media has done a very good job describing this. So far, we have identified all the words, but we haven't discovered all of their definitions yet
>Scott,
Thanks for your thoughtful comments on that article. Lots of different angles to ponder as with all of these issues... I agree with the fact that the media has not done a very good job of covering the issues. The following article is an exception to that that raises some of the same concerns that Dr. Mate touched upon, though using different examples and context, and addresses some other concerns. It was published in the Globe and Mail's competior for the role of Canada's National Newspaper - The National Post and a related provincial newspaper: The Province.
Sante!
dj
June 27, 2000
The still unread book of life
There are many miles yet to go before scientists find the recipe for making a human being. Though the completed genome draft is indeed a milestone, there is much hype from various quarters
Margaret Munro
National PostGregor Mendel, a 19th-century monk, brilliantly inferred units of heredity -- or "genes" -- from his work in plant hybridization. One scientist says the gene concept is now so misleading it should be banned.
Stuart Davis,
The Province
Patricia Baird warns against inflated medical claims for genetics.
To listen to gene merchants tell it, we will soon have our chromosomes read as part of routine medical checkups.Our genetic foibles -- the mutations linked to dozens of disorders ranging from Alzheimer's to heart disease -- will be laid out for close inspection. And we will all be the better for it.
Craig Venter, who heads the leading U.S. genetics firm Celera, is so keen on the idea he talks of launching an Internet-based service to read millions of people's genes and then tailor drugs to their individual needs.
Francis Collins, head of the $5-billion international consortium that has just completed its draft of the human genome, also speaks of the benefits of routine gene checks. He says knowing our genetic weaknesses in advance should prompt us to cut out factors -- such as smoking and lousy diets -- that might trigger disease-causing genes. Either that, he says, or we will be able to take special drugs to stop the bad genes from kicking in.
Dream on, say the critics, who are more than a little wary of the hype surrounding the deciphering of the human genome.
It is a scientific milestone, they agree. But one that is so misconstrued there is a real danger billions of dollars are going to be misspent on needless genetic tests that exploit people's fears about having imperfect children and faulty genes.
"It is certainly not something that is going to change things in the next few years at all," says Patricia Baird, a medical geneticist and distinguished professor at the University of British Columbia. "It's just a stage along the way. A milestone in a long journey, and I'm afraid it may take us where we don't want to go."
She is so worried about the destination, she stood up at a recent meeting of the Genetics Society of America and listed a litany of concerns about the burgeoning genetics business. They range from fears of consumer exploitation by gene promoters to the need for university geneticists to declare their growing conflicts of interest.
The human genome is said to contain the recipe for life, the biochemical instructions that control everything from the colour of your eyes to production of the neurochemicals that make you think.
But scientists do not yet know how to interpret the genome, or its vast stretches of seemingly useless "junk" DNA. Nor are they sure how many genes there are in the genome. Estimates vary from 34,000 to 120,000. And they do not have a clue about what most of the human genes do, or what turns them on and off.
Bill Gelbart, a leading Harvard researcher, thinks the word "gene" is so misleading that he recently suggested it should be banned. It would be more accurate, he says, to speak of the compounds actually generated by different stretches or regions of DNA. This is because many "genes" produce different biochemical products depending on how they are tweaked by the various factors at work inside cells.
All of which makes the popular notion that genes cause disease more than a little simplistic. Or an "overly naive interpretation," as Baird puts it.
It is true that there are a handful of rare diseases, such as Huntington Disease, which are triggered by a single mutation on a known gene. People who inherit these disease-causing genes from their parents will eventually get the disease.
But most genetic factors involved in disease are much more subtle. More than a thousand different gene mutations have been linked with cystic fibrosis, Steve Jones, a British geneticist at University College in London, points out in a critique of the genome hype. And researchers, he notes, are years away from figuring out how to repair any of them.
He agrees completing the draft of the genome is a milestone. "An astonishing piece of research in micro-anatomy," he says. A breakthrough on a par with "Vesalius' dissection of the heart in 1543."
But do not hold your breath waiting for the medical revolution and payback promised by the genome "hyperbolists," says Jones. "Don't expect it for a while, not 400 years, maybe; but in my estimate nearer 40 than four."
He, like Baird, stresses that the big killers, such as cancer and heart disease, are triggered by a myriad of interacting factors including stress, pollution, diet, lifestyle and genes.
And there is plenty of evidence that the social and environmental components are more powerful -- and more treatable -- than the genetic factors, says Baird.
Genes no more cause heart disease, she says, than a high-stress job, a high-fat diet or a couch potato lifestyle, she says.
Baird chaired the Royal Commission on New Reproductive Technologies that assessed several emerging technologies, including genetics. In 1993, she and her fellow commissioners urged the federal health minister to introduce legislation to protect the public.
Baird is still waiting, saying the need is more urgent than ever given the way the biotech industry is gearing up to market and push its genetic wares.
The federal government and Allan Rock, the Health Minister, she says, have a responsibility to act to protect the well-being of the people of Canada.
"It would be the enlightened and principled and right thing to do," she says. "If we as a rich country don't start addressing this kind of thing it's simply going to be wide open internationally."
The threat, she says, is very real. And consumers are ripe for exploitation by the genetics industry that keeps growing, fuelled with big money and big expectations.
U.S. biotech companies raised US$8-billion a year through much of the 1990s and the investment is climbing. And enterprising companies like Celera, which has spent a fortune sequencing genes, are now looking for a return on their investments.
Biotech companies are expected to follow the promotional strategy that has worked so well for the pharmaceutical industry. It spends close to 24% of income on marketing, and has a sales force that visits doctors 30 million times a year to peddle its products, says Baird. The Internet is giving the companies an even broader reach, and Canadians are already availing themselves of the proliferating genetic tests that can be ordered over the Web.
As evidence of problems she points to the growing use of a $3,850 test to determine whether a woman has inherited genes linked to breast cancer.
Increasingly, she says, American doctors believe they should test all women, not just those with a family history of the disease.
Yet a negative test in no way guarantees a cancer-free life. Baird says fewer than 5% of all breast cancers are now thought to occur in women carrying the genes that can be picked up by the test.
She stresses that she is not against offering the test in families known to be at high risk of breast cancer. What concerns her is the commercial drive to use the test. "Inappropriate overuse is likely if low-risk women's anxiety is capitalized on by commercially oriented testing labs," says Baird, who wants the government to stipulate how and when such tests should be used and make sure they are accompanied by high-quality counselling and follow-up. MDS Laboratory Services started offering the $3,850 test in Canada in March, but there is no national consensus on who should have the test and who will pay for it. "It's a bit of a dog's breakfast," says Brian Harling, of MDS, referring to the way some provincial medical plans will pay for the test and others will not. He says he would welcome a standard Canadian approach.
Baird also worries about companies promoting genetic tests for human embryos.
In 1997, a Toronto fertility clinic, IVF Canada, started offering a service to screen human embryos for risk of 27 genetic diseases before they are implanted in mothers' wombs. In this $7,000 test, a sample is taken from a very early embryo that is probed to see whether it carries undesirable genes.
The test has been promoted as "the beginning of the end of genetic disease," says Baird. "Hyperbole," she says, that could lead to misuse. "Most people would like to have healthy children, and marketing of this technology could play into that goal in an exploitive and misleading way."
Academic geneticists are also increasingly entering into lucrative collaborations with big genetic companies or starting firms to promote their discoveries. "This means the opinions of academic researchers with investments in those firms, or with appointments on boards, or as consultants, can't necessarily be accepted as objective," says Baird, who wants scientists to be more up-front about their connections with industry.
"The blurring of academia with industry means a societal resource -- a body of independent scientists without commercial affiliation -- has been lost," she told the genetics meeting. "They may not provide objective input and opinion when society has to deal with choices posed by genetic technology."
Despite her long list of concerns, Baird says: "I'm not anti-genetic." Unravelling the genetic forces at work in disease will, she says, be very beneficial and, in some cases, lifesaving.
What she wants to see are safeguards to ensure that people are not misled and exploited and that genetics does not claim an inappropriately big slice of public research and health-care spending.
She also worries about framing, or defining ill health in way that pushes problems back on to the individual. "It allows awkward questions on social and health policies or inappropriate workplace organization to be avoided," says Baird, who points to studies showing that social and environmental factors, not genes, account for the recent and rapid changes in the incidence of breast cancer, heart disease and colon cancer.
"If ill health is defined as genetic, innate and simply unfolding, then social supports, good early nurturing, narrowing economic gaps and appropriate workplace organization are less likely to be underwritten by society," she says.
As for Craig Venter's musing that he will one day offer gene scans to the masses over the Internet, she doubts such a service will help "a bloody bit."
Only one-third of patients now follow their doctors' directions and at best 50% routinely take medications prescribed for their chronic medical problems. The idea that healthy people will take drugs for years on the basis of a genetic test and a future disease risk is likely to be low, she says. A persistent and irrational element in human nature appears to be stacked against such notions of mass genetic servicing.
Posted by Rick E. on July 7, 2000, at 22:19:00
In reply to Re: please be civil, posted by Dr. Bob on July 7, 2000, at 0:38:36
> > I really don't think that you have ever experienced the deep rooted depression that many on this site have. If you had, you would not post such delusional things, and certainly show much more compassion.
>
> Please don't jump to conclusions about the experiences of others or imply that they're delusional or not compassionate.
>
> Or, if you do, at least don't do it in a post!
>
> Bob
>
> PS: Thank you, dj, for not over-reacting to the that post.I agree, in part, that those were some harsh statements, and I would like to take this opportunity to apologize to anyone who may have been hurt by them.
Please allow me a second chance at possibly explaining myself in more "compassionate" terms, as I now feel that I have been marked as uncompassionate.
Compassion, to me, is void of political rhetoric. To me, it is something that comes purely from the heart, without question, to a person in need from a person who is able to give. I feel that I am able to give, and I strive now and always have strived to post only positive and constructive things, as I see them.
Dj, I would also like to apologize to you for mistakingly assuming that you were one in the same with the original thread, Alex Birkett, whom I have not seen post since. I think that many of my feelings about this subject stemmed primarily from his original post. To be more specific;
>We have become obsessed with palliative care as if treating the causes of our real suffering was hopeless, so hopeless in fact that we too often happily deceive ourselves that no such causes exist at all. To refute that our society is intrinsically ‘ok’ and that we are ‘ill’ when we feel unable to be happy in it has become a great taboo.In my mind, the way that I think, (and I may not write very eloquently at all), this is a direct insult not only to my intelligence, but to the choice that I have made to treat my depressive condition with medications. It is an "assumption" that I am weak, or too afraid to deal with what might be the causation of my condition. It further assumes that because I am so weak, that I make a conscious (or unconscious for that matter), even "happy" decision to elude any notion of a cause, ignoring it all together, and thinking that an antidepressant or antianxiety pill will cure me.
That would be a wrong assumption, for which Dr. Bob has chosen (at least at this point) not to defend ME for. I am not bitter to that fact, just making a point. I don't mind admitting when I have done something wrong, as I feel I have in this, I just don't think that the entire meaning of this original thread was taken into consideration.
>We do suffer but not because we are morally or organically deranged. Our abilities to function in a healthy moral manner and keep our brain chemistry on course are utterly compromised by finding ourselves coerced into taking part in a social structure that alienates us from our real selves.Again, written as a stone cold fact, this is an assumption that once again we are as sheep being led astray by our incompetent doctors, acting at their whim, having no personal insight whatsoever as to our conditions or their solutions. Many depressives, I believe, are depressed BECAUSE they have such problems with our societal structure, which may be the point he further tried to make, but at this point is still very insulting and assumptive to me. I pray that I am not alienated from my real self, and as much introspection as I partake in, I find it hard to believe that I am, although certainly not an impossibilty.
>The coercion is not brought about by some sort of schitzo-paranoid or political conspiracy but by simple bounding conditions set up by our socio-economic belief system which, far from being ‘rational/utilitarian’ is an unquestioned and perversely superstitious religion in its own right."Bounding" & "unquestioned"...more assumptions and quite insulting to me.
I hope I have shed some light on my personal feelings here without injuring anybody. I certainly never meant to do that, and I have taken a look at what I had written, hopefully, at little more objectively. Again I apologize and truly am sorry if I hurt anybody.
Thank-you for your time. This board has helped me so much, I hope that I am still wanted here.
Rick E.
Posted by dj on July 7, 2000, at 22:22:48
In reply to Re: An eloquent M.D. writes about genetic(s) hype... » SLS, posted by SLS on July 7, 2000, at 8:26:21
> > I'd love to see you or anyone attempt to refute the facts he cites, eloquently or not. The issue at essence is the historic argument of nature vs. nurture and he argues for the systemic interaction of both. Anyone who focuses on one only at the exclusion of the other is foolish, in my view.
>
> I am a bit confused. Who wrote the following?
>
> "In the case of schizophrenia, a mental illness it is currently fashionable to consider genetic..."
>
> Fashionable?
>
> I think this one word drew my attention.
>I wrote the top para. and the fashionable comment was from Dr. Mate. Anyone who has seriously examined the history of medicine, both modern and ancient can tell you that doctors are just as susceptable to medical and academic fashions as anyone else. Any good book on depression discusses various competing theories of depression as does "Undoing Depression" which I cited above and elsewhere.
I've also previously cited: "Why Zebras Don't Get Ulcers : An Updated Guide to Stress, Stress-Related Diseases, and Coping" by Robert M. Sapolsky, which I was re-examining this afternoon and will quote some segments of below, from his chapter between links between stress and depression.
First though a note on the author from an Amazon.com overview on another of his books:
"As a professor of biology and neuroscience at Stanford and a recipient of a MacArthur Foundation "genius grant," Robert Sapolsky carries impressive credentials. Best of all, he's a gifted writer who possesses a delightfully devilish sense of humor. In these essays, which range widely but mostly focus on the relationships between biology and human behavior, hard and intricate science is handled with a deft touch that makes it accessible to the general reader."In Zebras S. writes:
"...depression can have a gentic component, as shown with a variety of pretty complicated studies. But, of vast importance, those studies have shown that just because someone may have one or more genes for depression, that doesn't guarantee they will develop the disease; a rough estimate, derived by cutting across a lot of different styles of genetic approachs, suggests that having a genetic propensity toward depression only gives you about a fifty percent chance of getting the disease. This is one of the critical lessons of behavioural genetics, and one that can't be emphasized often enough - genes in this realm are rarely about inevitability, but instead about vulnerability. And what that means is that an environmental trigger is needed to turn that vunerability into an overt disease...as the evidence in this chapter makes abundantly clear, depression is a gentic disorder of being vunerable to a stressful environment."At the end of the book he discusses some ways of dealing with stress. But as with ADs, your milage may vary...
Sante!
dj
Posted by dj on July 7, 2000, at 22:37:04
In reply to Re: please be civil, posted by Rick E. on July 7, 2000, at 22:19:00
> Dj, I would also like to apologize to you for mistakingly assuming that you were one in the same with the original thread, Alex Birkett, whom I have not seen post since. I think that many of my feelings about this subject stemmed primarily >from his original post.
No worries, Rick. I've been known to be re-active on occassion, so I understand and appreciate where you were coming from, even more so when I note that you mistakenly thought I was the original poster.
Like yourself and Scott I might query some of the rhetoric Alex used and some of the terminology, however I also believe there was some truth in some of his assertations as sweeping and potentially offensive as some of them may have been. The info. I've posted is an attempt to touch on some of his perspective, by citing folks whom I consider reasonable sources with reasonable and authorative explanations of their views.
And hopefully it is helpful to some here as it is helpful for me to re-view, re-consider it and read other people's perspectives.
Sante!
dj
Posted by SLS on July 8, 2000, at 10:05:26
In reply to An thoughtuful meds ethicist on genetic(s) hype..., posted by dj on July 7, 2000, at 21:48:57
> The following article is an exception to that that raises some of the same concerns that Dr. Mate touched upon, though using different examples and context, and addresses some other concerns. It was published in the Globe and Mail's competior for the role of Canada's National Newspaper - The National Post and a related provincial newspaper: The Province.
Dear dj,I would like to thank you for posting this article for me to look at. It will take me a while to get through, but I wanted to thank you in advance.
I would also like to apologize for the provocative tone I displayed in my first reply to your "eloquent" post (let's let that convey its flattering double meaning). I am also working on my self-discipline, but it's hard to tame a lion. I doubt that I will ever be able to cage it, but I really wouldn't want to. I know that I'll continue to roar from time to time, so just shove a chair (upholstered) in my face if I get out of line.
Sincerely,
Scott
> Sante!I am curious what this means.
Posted by dj on July 8, 2000, at 11:17:58
In reply to Re: A thoughtuful meds ethicist on genetic(s) hype..., posted by SLS on July 8, 2000, at 10:05:26
> I would like to thank you for posting this >article for me to look at.
You are welcome. I look forward to any comments you might have about it. I found your response to the initial poster, well considered and of a very even, though respectfully questioning tone.
> I would also like to apologize for the provocative tone I displayed in my first reply to your "eloquent" post (let's let that convey its >flattering double meaning).
; ) I love paradox, that's where the interesting and often most meaningul stuff happens, on the edges where things blur...
>I am also working on my self-discipline, but it's hard to tame a lion. I doubt that I will ever be able to cage it, but I really wouldn't want to. I know that I'll continue to roar from time to time, so just shove a chair (upholstered) in my face if I get out of line.
>No worries, mate! Our nature is our nature, and our nurture is our nurture and the two do meet and interwine...in interesting ways at times...
> > Sante!
>
> I am curious what this means.French for to health!!
Namaste! (eastern asian means something like I bow to the light inside you and I)
Cheerio,
dj
Posted by SLS on July 8, 2000, at 18:23:47
In reply to An thoughtuful meds ethicist on genetic(s) hype..., posted by dj on July 7, 2000, at 21:48:57
Hi dj,
I figured I should exercise my wilting brain a little more today.
I agree with the concerns of Prof. Baird. This may be an exaggeration, but splitting the chromosome might be both as dangerous and as productive as splitting the atom. It will probably require as much responsible regulation and overseeing as does nuclear energy. It will probably even need international agreements and proliferation treaties. Big business the smallest of my concerns.
> To listen to gene merchants tell it, we will soon have our chromosomes read as part of routine medical checkups.
I think that this becomes common practice is quite likely and, in my opinion, very desirable. I'm just not sure how soon "soon" is.
> But scientists do not yet know how to interpret the genome, or its vast stretches of seemingly useless "junk" DNA. Nor are they sure how many genes there are in the genome. Estimates vary from 34,000 to 120,000. And they do not have a clue about what most of the human genes do, or what turns them on and off.
This is what the public has not been properly informed of.
Bye the way, there is more "junk" than there are genes.
> "The blurring of academia with industry means a societal resource -- a body of independent scientists without commercial affiliation -- has been lost,"
This has been one of my greatest fears over the last few years, as I have seen one researcher after another leave critical institutions of learning to enter lucrative careers in the pharmaceutical industry. I want the smart people to keep trying to figure out how to get me well.
> All of which makes the popular notion that genes cause disease more than a little simplistic. Or an "overly naive interpretation," as Baird puts it.
> "If ill health is defined as genetic, innate and simply unfolding, then social supports, good early nurturing, narrowing economic gaps and appropriate workplace organization are less likely to be underwritten by society," she says.
> Only one-third of patients now follow their doctors' directions and at best 50% routinely take medications prescribed for their chronic medical problems. The idea that healthy people will take drugs for years on the basis of a genetic test and a future disease risk is likely to be low, she says. A persistent and irrational element in human nature appears to be stacked against such notions of mass genetic servicing.
I think a great many of the concerns and arguments of Prof. Baird and the author rest upon the presumed persisting ignorance of the public, the government, and even health-care professionals. All are educable - at least to the point of not needing to slow the pace of discovery to accommodate them. One not need know the physics and logistics of building and operating nuclear reactors and distributing their energy to be able to turn on a light and not get electrocuted.
- Scott
Posted by dj on July 9, 2000, at 23:12:26
In reply to Re: A thoughtuful meds ethicist on genetic(s) hype... » dj, posted by SLS on July 8, 2000, at 18:23:47
> I agree with the concerns of Prof. Baird. This may be an exaggeration, but splitting the chromosome might be both as dangerous and as productive as splitting the atom. It will probably require as much responsible regulation and overseeing as does nuclear energy. It will probably even need international agreements and proliferation treaties. Big business the smallest of my concerns.
>Scott,
My impression is that you've read and thought a fair bit about all of this. Much more so than me, certainly. I just pay attention to a few stories that catch my eyes and ears, here and there... I'm particularly interested in ethical issues so those ones are more likely to catch my attention.
When I can I listen to CBC-Radio as the quality of their in-depth reviews on different issues is usually very thoughtful, balanced and well explained. Recently, and previously (on their CBC-Morning and/or evening Ideas program) I've heard discussions of unethical practices that some university researchers from a univ. in Texas had used when obtaining genetic samples from some folks in a small town in rural Newfoundland, an island off Canada's east coast where the genetic stock has been pretty stable for a few centuries because there is more out than in-migration, etc.
Issues like that are the ones that concern me - the actual and potential mis-use of personal genetic information by unscrupulous individuals and organizations for purposes that serve them and not the folks affected by their actions. How predominant or widespread such practices are I have no idea.
However that sort of thing is what I think we need to be vigilant about and though I agree that people and people within organizations are educatable I also am aware that a lot of folks opt for entertainment over education, more often than not. As American social critic, writer and gadfly H.L. Mencken wrote back in the 20's or 30's: "No one ever lost money by underestimating the intelligence of the American public."
Unfortunately there's a strong grain of truth in that statement. The fact that the National Enquirer is the top selling newspaper in North America (or so it once was, according to a brilliant former Mass Communicatins professor of mine) is a cause for concern, I believe, as it shows just how gulliable so many people are as does so much of the pap, sap and crap that dominates all of our media.
As someone who was trained and worked in public relations and politics I can tell you how pervasive the influence of corporate PR (disguised marketing and advocacy) on the press is, by just looking at the so-called news any day.
Estimates over 15 years ago were that 70-80% of so-called news orginated with PR sources. And if anything those numbers have gone up as news staff have become leaner and more corporate in their ownership.And then there are the fraud artists, many who are disguised as supposedly legitimate folks on the stock market but todays news and history tells us that there are many crooks there and much gulliability amongst the general public when it comes to stocks. Just looke at the internet hype and effects... Take that same model and apply it to hyped genetics stocks and also apply quarterly corporate performance demands to scientists who are supposed to be focused on the long term...
I see systemically many causes for concern and pressures and systems in our society leading toward more, rather than less fraud, stress, distortions and pressures for bottom-line performances, which are more focused on quantity (of sales, money, etc) than quality (of life -except for a select few, who are often sociopaths).
I hope that my concerns are ill-based and that people and organizations 'better angels' will win the day. However as J.F.K. once noted when referring to dealing with the Russians in the sixties: "Civility is not a sign of weakness and sincerity is subject to the burden of proof." So here's to both!!
Sante!
dj
> I think a great many of the concerns and arguments of Prof. Baird and the author rest upon the presumed persisting ignorance of the public, the government, and even health-care professionals. All are educable - at least to the point of not needing to slow the pace of discovery to accommodate them. One not need know the physics and logistics of building and operating nuclear reactors and distributing their energy to be able to turn on a light and not get electrocuted.
>
>
> - Scott
This is the end of the thread.
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