Monthly Archives: April 2015

Research And Public Engagement – Generating New Knowledge, But Often Confusing the Public

A vigorous debate erupted this week in the Sports Medicine and Health worlds after my old colleague and laboratory head during my long past University of Cape Town days, Tim Noakes, published some ideas of his (and his collaborators) that exercise did not work to reduce weight if one did not improve one’s diet concurrently. This idea of Tim’s followed up other controversial ideas he has put forward during the last few years that carbohydrates are bad, and that one should eat a high fat diet and reduce carbohydrates to almost zero to optimize health. He has gone even further and suggested recently that one’s exercise capacity is optimized by a high fat diet as compared to a high carbohydrate diet, and furthermore that children should be ‘weaned’ onto a high fat diet from an early age, if I heard his message right. The problem for a lot of folk is that for more than 20 years before this, Tim strenuously advocated a high carbohydrate diet, and that carbohydrates were ‘king’, before having his epiphany and change of heart on diet, due apparently to himself being diagnosed as suffering from Type 2 diabetes a while ago and trying to alter his own diet as a result of this. Whether Tim is right or wrong with either his ‘old’ or ‘new’ messages, if all this is confusing for us scientists, I can imagine how difficult it must be for the general public to understand what is ‘right’ in the nutrition field, and why most folk often view the messages scientists propose with a high index of suspicion. So why does research and science often seem to confuse any issue rather than clarify it?

Research is defined as an endeavour to discover new, or collate old facts, by the scientific study of a subject or by a course of critical investigations. Research is not a new endeavour, and indeed most of any civilization’s progress must have been based on the testing of a hypothesis, or a change in lifestyle, and then accepting that change as custom / habit if it improved living conditions or quality of life. However, although research and science developed into a distinct entity with its own rules and way of doing things over hundreds of years, until the 20th century no detailed statistical testing was applied to any findings, and researchers and scientists merely reported individual case studies, or pooled data from a number of different case studies, with no attempt to control any variable, and made deductions from them. In the early part of the 20th century, with the advent of inferential statistics, researchers and clinical scientists began to believe that these case report studies were too simplistic, and possibly biased or prejudiced by external influences which were not reported or controlled for. From the 1930’s to the 1960’s, research methodology was technically improved, and studies were required to be well controlled before they were accepted for publication in scientific journals, which is and always has been the principle ‘vehicle’ of how research findings are made available to the scientific community and general public. Participants were required to be chosen randomly, variables well-controlled, and prospective replaced retrospective studies as the ‘gold standard’ for scientific / clinical research trials. Journals are now rated on the quality of research they publish, and studies that randomly select subjects, are ‘double-blind’ (meaning that neither the research subjects nor scientists know about the contents of a particular intervention or drug being tested during the trial), and examined participants in a controlled environment, have a greater chance of being published in a ‘quality’ journal than do studies that do not have these characteristics.

Unfortunately, this rigidity, while commendable, has led to problems of inference to the general public of the findings of such ‘gold-standard’, well controlled studies. In such trials, an individual is taken from their normal environment and turned into a laboratory ‘rat’ for the duration of the study / clinical experiment, and every possible variable is kept the same for each person in the trial, and any transgression of the ‘order’ of the trial leads to the expulsion of the participant from the trial. But human beings are not laboratory rats (and rats I am sure would say that not all laboratory rats are similar!). For example, during the ‘best’ drug or nutrition trials, participants are sometimes required to stay in a hospital or laboratory for the duration of the trial, and must all eat the same food and follow the same daily routine. The results assimilated from these artificially constructed environments are then published, and for example, a new drug or diet, based on the success of the trial, is approved and marketed to the general public. However, all individuals in their normal life will be following their own routines, probably with alcohol and perhaps tobacco consumption and unique diet, and to apply the average results derived from the original trial to this general public may be misrepresentative. All one can say with certainty after a well-controlled ‘gold standard’ trial is that in the specific group studied, in the specific environment where the test occurred, the drug or diet tested produced changes that were different from those produced by the placebo or other drug or diet it was tested against.

A further problem with extrapolating research results to the general public is that researchers generally produces average values (means) to describe the outcomes for the group of individuals involved in a specific trial, and then suggests to the general public that their data averages / the results of their trials are applicable to the general public from which they were originally selected. But human beings are individuals and not averages, and it is therefore problematic to extrapolate averages from clinical or nutritional (or indeed any) trials to larger population groups. For example, to tell a patient or person who follows a particular diet that research has shown that they have a 30% chance of dying younger than those following another type of diet is fraught with potential error – each individual’s date with death could be anywhere along the bell-shaped mortality curve, independent of whatever diet they choose to eat in their daily life. Indeed, they may live to be 90 or 100 whatever they eat if that is what their genetic and physical program entails (and a good degree of ‘luck’ / chance is also perhaps involved given how many things can kill one en route to one’s programmed life end time), despite there being a difference in average age of death between those who eat the diet being tested and that eating another diet. The problem of inference / extrapolation is made even more complex because of the fact that most research relies on the current research techniques / tests available to test a diet or drug at the time the trial occurs, and these tests available may be too simplistic to pick up potentially significant signs of toxic changes occurring in the individuals being tested. For example, 70 year ago, anabolic steroids were routinely used in large doses to cure ‘melancholia’ and depression. A few decades later scientists and clinicians started realizing, as their assessment techniques improved with time, that anabolic steroid drugs in large does could cause liver, heart and lipid profile disorders, and might even lead to dependency and psychological dysfunction. Therefore, the clinicians and researchers who initially recommended the therapeutic use of anabolic steroids were unwittingly placing their patients at risk, because of a lack of adjunctive knowledge and simplistic research techniques available to inform their decision at the earlier historical time points.

Therefore, for all the reasons above, even the best researcher has to be cautious about extrapolating their findings to the general public, due to the inherent weaknesses of even the ‘best’ science, and a good scientist would always be cautious when announcing their findings, and when availing themselves to the press to discuss them. The problem of course is that a scientist’s ego often gets in the way, and they often rush to announce their findings, or perspectives on a finding of another scientist, to get their name in the press, and get themselves ‘in the spotlight’ as much as possible. A lot of science, as nicely put by Ad Lagendijk in an article in Nature a few years, involves aggressive men (this gender focus was specifically used in the article) ‘fighting for their scientific claims to, at best, miniscule advances’ in scientific knowledge, with ‘territorial behavior’ underpinning their claims, and with ‘successful scientists incessantly travelling round the world performing their routine (speeches about their findings and theories) like circus clowns – forcefully backing up their assertions over what their contributions are to the latest scientific priorities and findings’ (sic). While this is a somewhat gloomy / negative assessment of the behaviour of a lot of (male) scientific folk, there is potentially a grain of truth in this, and unfortunately some scientists are perhaps too quick to engage with the public about their own findings, in order to assuage a huge / weak ego, and this can only complicate a research ‘message’ even more than just the methodological issues described above. The chance for a scientist’s ego to be more involved than it should is made even easier in modern time with the advent of the internet and publication vehicles beyond that of the routine scientific peer-review process (though the peer-review process is not without its faults either) where any work published is peer-reviewed and too extreme conclusions are required to be ‘toned down’ before publication, such as Blogs, Twitter, Facebook, and other methods where scientists now can very easily speak directly to the public, and in some ways can cause more ‘harm’ than good potentially by doing so.

So going back to the initial discussion of my old colleague Tim’s ‘flip flop’ on his diet message from high carbohydrates to high fat as being the best diet, and now that exercise may not be of benefit for weight loss (if I have read his latest message right, though it is very opaque what exactly is being said), folk should understand that scientists do have their own opinions and biases, do enjoy being in the limelight and press, and even if they have generated their conclusions on the basis of their own lab data, this data itself may be ‘flawed’ due to the reasons described above to no fault of the researcher themselves beyond not being cautious enough about their data. Therefore, all scientific information received by the public from scientists, particularly those scientists and clinicians that ‘shout the loudest’, should be taken with a strong ‘pinch of salt’ and heard with caution. For scientists themselves, we have to keep on remembering when venturing out of our labs to engage with the public that every word we say is ‘fraught with danger’ / has the potential to be incorrect or proved wrong in the future, and that the goal of every scientist and clinical researcher should perhaps not be to make a big new finding, but to be always dispassionate and cautious, no matter what one finds or concludes from ones time in the laboratory. As a friend and colleague of mine (and great scientist), Dr Angus Hunter once advised me, those that are the most passionate in science are the worst, and those that are most cautious in their message ‘the best’ (or words to that effect!). There is perhaps some truth in these words, at least when engaging with the public as a scientist, or conversely, when the public is trying to work out the validity of what a scientist / science is saying. Eat fat? Eat carbs? As the old wise words always suggest, moderation and balance is surely always best, and this goes not just for eating choices, but also for when scientists and clinicians engage with the public about their research work and findings!

Universities – Providing A Function To Society Similar To What Mitochondria Do For The Cell

I was reading up on basic cell physiological function, specifically that of cellular mitochondria, last week, around the time that at my University alma mater, the students there currently were protesting vigorously for the removal of statues of historical figures they did not appreciate which were on the campus. The student protests got me thinking of what the teleological function of Universities is, beyond just places of learning, and it struck me that they serve a function for states and societies similar to that which mitochondria serve for a cell. A University is broadly defined as an educational institution designed for instruction, examination (or both) of students in many branches of advanced learning, for conferring degrees in various faculties, and often embodying colleges and similar institutions. The original latin word for a University is ‘Universitas’, which describes a number of persons associated into one body, a society, or an institution, which is self-governing, independent and determines the qualifications of its members. To this day Universities have traditionally strongly protected their autonomy and independence from state institutions, even if paradoxically they are usually dependent on the state in which they exist for their existence in the form of funding and financial grants from the state for their running costs. Universities as we know them are thought to have developed from church teaching structures, starting in around the 6th Century AD in Europe and developing into the structures they still exist as in the 10th and 11th Century AD – for example the University of Bologna was established in 1088, the University of Paris in 1150 and the University of Oxford in 1167. Universities were set up initially as teaching institutions, but developed over the following centuries to incorporate research / knowledge generation as another important component of their business. In the early years, Universities generally taught general or ‘preparatory’ subjects such as arithmetic, geometry, music, politics, astronomy and languages, but with time developed increasing subject specialization in subjects like medicine, law, engineering and accounting amongst others. Modern Universities offer a huge, diverse array of courses, from sport science to clothing and building design, and even more specific postgraduate courses have been added to the University business offering / portfolio, along with Doctoral degrees which are traditionally research focussed, and associated with developing novel knowledge via the research endeavour in the field in which they are awarded. While these additions have strengthened and added to the rich tapestry of most University environments, and Universities are now ubiquitous through all countries in the world, what is interesting is that the basic concepts of the University which were present from their start all those years ago, of autonomy from the state and self-governorship, along with the same campus and faculty based working environment, and of course all the peculiar traditions such as gowns, caps, and professorial academic ranking, which are treasured by those working and attending Universities, still exist, even if they often appear asynchronous with modern garb and work environments.

Universities fulfil other functions in society beyond the formal teaching of specific subjects. Apart from being a place for developing an individual’s specific creative talents beyond that which could occur in the required uniformity of the school environment, Universities also are, or should be, an environment where the ‘human’ dynamic is nurtured and developed, as my current charismatic Rector, Professor Jonathan Jansen, well describes it. The ‘human’ virtues are those intangible ones, related to the quest for knowledge, the quest for truth, the quest for virtue, and the capacity in a protected environment, which Universities usually are, to challenge current thinking, challenge dogmas, and challenge any status quo. It is not for nothing that even today general degrees such as those of the humanities are still highly prized, given that they train future students to be leaders and managers, and not just skilled artisans in their particular area of training, who are able to see the ‘big picture’, are able to debate in a skilled way, and are able to understand that most of life is about influencing any activity one is involved in a nuanced and ‘politically’ astute and ‘humane’ way, rather than by brute force or ‘might is right’ way.

Perhaps because of both this autonomy from surrounding state and other structures, and due to the inherent encouragement of Universities to challenge dogma, and to resist external change if it is deemed unethical or if it could potentially undermine the autonomy of the University itself, University folk, in particular the student body, are often ‘at odds’ with external individuals and organizations in society who have authority, and are often early agents for change in society. An example of this is evident in the 1950’s Hungarian student uprising against Russian control of Hungary, which lead to a nation-wide revolt, which while ultimately being unsuccessful and leading to a brutal suppression by Russia, weakened the ‘Iron Curtain’ which ‘hung’ over Eastern Europe for most of the second half of the 20th century. Another is that of the Kent State University demonstrations in the USA in the 1960’s against American involvement in the Vietnam war. The demonstrations turned violent after several protestors were shot by Ohio state guardsmen, and spread from Kent State University across University campuses throughout the USA, and eventually into the broader American society, and therefore surely played a part in the USA eventually withdrawing from the Vietnam conflict. So in effect, Universities can be major agent for social change, and its academics and students are often at the forefront of societal debates. Because of such protest action and civic demonstrations (and other forms of more benign methods of protest such as writing and debate), Universities often, as in the examples above, play the part of a societal moral conscience, or a ‘barometer’ of a societies needs or perceived shortcomings, to which the societies rulers potentially have a ‘blind spot’, or in societies whose leaders have brutal / repressive policies against their own citizens or a segment of them.

It must be noted though that Universities, because of the fact that they treasure their autonomy so highly, can also become ‘out of synch’ with their society in a conservative way too, and are not always progressive ‘vehicles’ for change. They may, in a changing social environment, retain practices which are deemed unacceptable, unethical or unhealthy by the society in which they exist. These include for example the practice of ‘hazing’ new students in University residences – initiation practices which are regarded as ‘right of practice’ and being part of University tradition by those who perform them, but in any contemporary environment would be regarded as overt bullying behaviour. In South Africa, a particularly challenging problem is transforming the ethnic demographics of University academics. As a relic of the Apartheid era, a number of Universities still have a predominantly white academic body, which is incongruous in relation to the ethnic demographics of South African society. Yet, when such Universities are challenged to transform, they often use University autonomy principles as a method of opposing any such changes, in either an overt or covert manner. It will long be a debate in such instances of how and when both the state and indeed society needs to intervene in such University environments – they have a powerful tool to do so in their capacity to ‘turn off’ the funding ‘tap’ – and whether the state, society, or indeed the Universities own student should physically intervene, as the students did at my alma mater a few weeks ago by demonstrating against their own University and its management in order to change the status quo which was perceived (rightfully in my opinion) to require change. So as much as Universities can be a vehicle for positive societal change, paradoxically due to their requirement for autonomy they can also be a vehicle for resisting positive change, and become out of kilter themselves morally and ethically with the society in which they exist. When this happens, strong moral leadership is required by both university and state leaders and managers to get things ‘right’ while equally maintaining the universities conventional level of autonomy.

Coming back therefore to the example of the mitochondria in the cell and its relevance to the teleology of the University as an entity and its relationship to the State, the mitochondria occur in every cell in the body, and are essential for life, as they are responsible for breaking down most of the food and fuels we ingest into energy which is used by all the processes and activities in the cell. Yet, mitochondria are completely self-sufficient and autonomous and have even their own DNA and replicate independently of the cell’s DNA and routine cell replication. Some scientists believe mitochondria were incorporated into cells millions of years ago, before which they were unique and separate entities, and only when mitochondria did become part of the cell did ‘life’ as we know it begin (of course while being a great theory, the question one naturally asks is how the cell existed then before the mitochondria were incorporated!) in each cell, and then combinations of cells, and then the life forms which we currently know and exist as. In folk who have non-functioning or poorly functioning mitochondria, often due to genetic abnormalities or to toxins damaging them, individuals can live and function, but cannot ‘get out of first gear’ – exercise is difficult or impossible, and all affected cells and body systems function sub-optimally. Universities are therefore in some ways analogous to the mitochondria in the function they serve to the state and society. Without them, society and states would continue to exist, but would perhaps lose their capacity for invention, for new energy (in the form of the new leaders and thinkers they generate), and for new ways of doing things. Paradoxically, with all their centuries old habits and traditions, their funny gowns and academic hats, like mitochondria for cells, Universities are the ‘energy generators’ of states and societies and ensure that there is constant renewal, replacement, and regeneration of all of the state and societies functions, activities and ways of thinking. Long may Universities exist, and indeed be allowed to exist, by the society in which they continue to ply their trade in an autonomous yet surely essential way, in order for the societies and states to keep on developing, innovating, understanding and moderating their own behaviour and way of doing things!

Holism – The Sum of Any Systems Parts Creates Something More Than Its Component Parts

A recent and perhaps much needed debate in South Africa on the role of icons of the past in the makeup of its history and culture got me thinking of one of South Africa’s greatest statesmen, Jan Smuts, and some astonishing theoretical writing he did that had a major influence on my career and research thinking. While Smuts had blind spots as a leader, such as his lack of effort to solve the race issues which bedevilled South Africa in the 20th Century, he also had an amazing life and was perhaps the ultimate polymath, filling roles such as Prime Minister of his country, Boer War Field General, Oxford trained lawyer, Field Marshal in the British Army, and strategic confidante and ‘revered uncle’ to Winston Churchill, amongst his other life successes. But what is not well know about Smuts was his interest in nature and the control of life processes, and that he wrote a book called ‘Holism’ which was published in 1926, that I have read many times and which has pride of place on my bookshelf, and was simply ‘way ahead of its time’ in the concepts it outlined such as his philosophical response to Darwinism, whose tenets were very much in vogue (and obviously still are) when he wrote it.

Holism, as described by Smuts, and its partner philosophy, Emergence, proposes the idea that all natural systems should be viewed as ‘wholes’, which while made up of ‘parts’, have characteristics associated with their whole system that are more than can be explained by simply understanding and examining all their parts. While any system, be it physical, chemical, biological, psychological, or social, can surely have no separate existence without its underlying components, they can and do form more complex behaviour as a collective when the component parts operate as part of the complete system being observed. For example, at the level of physics, particles and how they interact create particular activity and behaviour which are associated with ‘laws’ developed by physicists to explain the observed behaviour at this physical level, such as the laws of thermodynamics, Einstein’s theory of relativity, and Heisenberg’s uncertainty principle. However, this subatomic activity ‘creates’ activity at a ‘higher’ level, namely chemistry, which is the study of the substances which are responsible for creating ‘matter’, which operate and ‘work’ under a different set of rules and properties, that cannot be explained by looking at behaviour at the subatomic level as physicists do. Similarly, chemical reactions and combinations of matter make up biological process such as occur in our body, which again while composed of chemical matter, operate very differently and appear to have a ‘life of its own – the life as we physically know it – as what occurs at the chemical level. Again psychology and our conscious interpretation of life ‘arises’ from physical processes, but are different to them, and social interactions occur as a result of our psychological drives and physical activity, but operate again in different ways, and with different properties, that would not be able to be predicted from observing activity at the underlying levels. So at each ‘higher’ level, in the best holistic principles, actions occur which cannot be understood by observing and understanding activity at a ‘lower’ level or hierarchy – though physicists of course believe their level of academic interest is the ‘highest’ form of understanding, and would not appreciate being described as occupying the ‘lowest’ level of system activity!

Holism and its twin concept Emergence are in opposition to the concept of reductionism, which suggests that to best understand a system one observes, one should simplify the issue and examine one component of the system, and by understanding that one component, one has a better chance of understanding the system in its entirety. The reductionistic approach in science has ‘held sway’ for at least the last century, which has resulted in the ‘primacy of the gene’ and the success of molecular biology in understanding how very specific processes in biology occur, has focussed neuroscience on examining how single, or indeed multiple, cells in the brain fire and interact with each other, or how in physics particles interact with each other or other particles at the subatomic level, such as the Higgs Boson, which physicists believe has recently been ‘found’ to occur as a real entity. But while the reductionist approach is great for demonstrating ‘new’ activity or processes in the body, it does not help us explain how for example all genes in the body are coordinated in a three dimensional and both spatial and temporal manner to create the incredibly complex physical human which we are, it does not help explain how consciousness arises from the neurons whose firing rate is being examined, and it does not explain how the subatomic particles work as a ‘gestalt’ in both creating physical matter, or heck, whether subatomic particle activity is involved with, or whether it can ‘influence’, our conscious thoughts and social interactions.

The pendulum of how science is done is now to a degree ‘swinging back to a more ‘holistic’ / emergent / gestalt (another popular word associated with defining holistic processes) way of attempting to understand these more ‘big picture’ questions that reductionistic scientific methods will never likely be able to answer (though in science, one can never say never!), and fields such as complex system science, chaos and fractal theory, have attempted to explore and explain the emergent properties of systems, and the ‘big’ questions that still await explanation. Why the groundbreaking philosophical work of Jan Smuts is so difficult to accept and is largely ignored by most folk in science, is because it is so hard to test and explain, and also generates uncomfortable / very difficult questions for research folk, such as that it is difficult for theories like evolution to ‘explain’ concepts like emergence, and it brings into play philosophical concepts such as Universals (in the best Platonic tradition), which are of course intangible and create the ‘which comes first’ in the development of life conundrum – the ‘map of how it all works’, or its component parts. But that does not mean that surely a future generation will develop the laboratory techniques that will enable us to understand Holism related processes, and perhaps by doing so will help us explain the ‘big questions’ described above which to date defy explanation, and which are so important to our understanding of ‘life’ and how it works. A physicist working at the subatomic level will surely show us great things which we can (and do) all marvel at, but until the physicists understand that they are working within the constraints of a ‘closed system’ approach, and until they understand that biology, and indeed psychology and social behavior will affect activity at the sub-atomic level in our bodies (dare I say control it?), and work in big cross-discipline teams to develop holistic methods of understanding life’s properties, we will surely be ‘stuck in first gear’ and keep on working in closed silos, which will surely lead to great understanding of each silo, but perhaps not understand how ‘it all’ fits together to create the life as we know it, and that which we don’t.

So going back to Jan Smuts and his brilliant book describing holism, which he wrote amidst a period when he must have been working huge hours on a variety of ‘big issues’ that come with governing a country, leading nations in times of war, and influencing the thinking of great leaders, made me think how brilliant such folk are who are able to do so, and think about, so many things at once. Perhaps though, it is the very capacity of such folk such as Smuts to multi-task, and who ‘juggle many plates’ at any one time, who are the folk that are able to see the ‘big picture’ and that after a century or more of the specialist, perhaps it is time once more for the concept of the ‘renaissance person’ / polymath individual to take up a more pre-eminent place in the academic and world stage. Perhaps Smuts developed his innovative ideas from his own work managing large and complex organizational systems, which made him realize that changes in one area of the organization did not affect the ‘whole’. Perhaps like everything, life and scientific discovery occurs in cyclical phases, and we are at the cusp of moving from a reductionist to a ‘holistic’ way of understanding things, as we seek to make use of the astonishing scientific discoveries of the last few decades developed by reductionistic folk working in their labs and computer rooms, in a ‘bringing it all together’ manner which will help us understand how it ‘all’ works. But whatever happens going forward, hopefully the brilliant work and thinking of Jan Smuts and other which has in many ways been ‘lost in time’, will take its rightful place in the pantheon of great academic achievements, as it surely deserves. Whether he deserves to have a statue put up to acknowledge his excellent academic work, in the face of his leadership ‘blind spots’ and in the context of South Africa’s history and current issues, is for another discussion, of course!

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