I like Bill Gates.  I really do.  They guy created a universal platform for microcomputing that pretty much birthed the computer business era.  Yeah, Zune sucks.  Vista sucks.  Lots of his ideas suck.  And his business model is passe and needs to give way to the innovation of open source and open access.  But I really like him for his charitable works.  The Gates Foundation has done more good for the world than anything you or I will ever do.

So I gve Bill Gates a lot of slack.  He’s also one of the top backers of research into “geo-engineering”, which is the science of technologically transforming the physical world.  One of the immediate applications of geo-engineering is to reduce the effects of global Climate Change. Check this out.

But this plan horrifies long time eco-warriors like George Monbiot, who makes strong arguments against geo-engineering here.

Here’s my take:  First, I believe Climate Change to be real and deadly deadly serious.  How serious?  Apocalytpically serious.  Given that seriousness, I think all options should be explored and developed… including extreme options like geo-engineering.

Second, it’s best to have that option well-researched and tested and ready to go, if indeed the Climate Change precipice is as sheer as the experts are suggesting.

But third, history has shown that such simplistic technological solutions never end well.  Why would this be any different?  We should be properly concerned and indeed horrified by the probable negative consequences of such extreme measures.  Let’s not pretend for a second that this is without substantial risk.

And fourth, who gets to make decisions about whether to engineer the Earth?  Bill Gates is but one man, as is George Monbiot.  The majority of humanity lives hand-to-mouth in powerless silence over these global events.  What arrogance it is to suggest that a wealthy few can decide to put the Earth at such pervasive risk.

So what is the solution?  Fund the research, prepare the options, and wait.  For what?  For things to become so dire that the world will want a solution –any solution, no matter the risk.

Okay, back to my drink.

This will likely surprise you, but did you know that infertility is considered to be at epidemic levels worldwide?  This is clearly at odds with our conception of the world as being overpopulated.  But, primarily in wealthier, developed nations, the provision of medical reproductive services to people deemed infertile is now a billion dollar global industry, spurred on both by advances in technology and the emergence of a globalized economy. Unsurprisingly, India is one of the world’s most popular providers of reproductive services, leveraging her medical depth, advantageous currency exchange, and her pervasive poverty.  But when human reproduction meets commerce, gender inequality and wealth disparity, the potential for ethical transgression becomes great indeed.

Someone is considered infertile if he or she has been having unprotected (heterosexual) sex for one year, with an intent to reproduce, without achieving pregnancy.  Conservative estimates hold that at least one billion women worldwide (and an unknown number of men) are presently experiencing a degree of infertility.  This estimate is stunted by the obvious fact that you don’t know if you’re infertile unless you’re actually trying to get pregnant.  The actual number is therefore likely to be substantially higher. The experiences of assisted reproduction clinics suggest that a fair proportion –if not a majority– of infertility issues are actually so-called “male factor” issues, meaning that the problem is often related to sperm quality.  Indeed, semen samples collected over the past seven decades suggest a global, dramatic reduction in semen quality, such that what is considered normal today might not even make the scale 70 years ago. This may be a universal, global human trend, or it may be relegated to the developed world.  We just don’t know yet.

Many theories have arisen for the increase in infertility in both sexes.  Undeniably, women in high income countries are waiting into their 30s and 40s to start their families, and this is dramatically reducing their ability to become pregnant.  The rise of obesity, and with it diabetes, has certainly contributed.  It is possible that soy products, mimicking human hormones, are affecting our reproductive cycles.  Some have theorized that overuse of the female contraceptive pill has made our drinking water more hormonal, or that some artificial compounds, such as plastics, may decay into substances that also mimic hormones.  At this point, all of this is mere speculation.  What is known is that the seeking of assisted reproductive techologies (ARTs) is at an all time high, and shows all the signs of accelerating.

The services sought include in vitro fertilization (IVF) –the classic “test tube baby”– a technology, that has been with us for over 30 years now; fertility drugs; sperm and egg donation; and maternal surrogacy.  The latter is characterized by a woman hiring out her womb to gestate an embryo on behalf of a client.

With the increase in demand, and with the maturation of reproductive technologies and services has come a global industry of cross-border reproductive service provision, rife with philosophical quandaries, legal pitfalls and ethical concerns.  Presently, in terms of financial transactions, the United States is the world’s greatest provider of reproductive services.  But hot on its tail is India, which is fast becoming the undisputed world champion of all manner of ARTs.  This phenomenon is most commonly called reproductive tourism, and is being monitored by ethicists and epidemiologists, myself among them, for its challenges to our ideas about the valuation of human biology.  This is particularly true for maternal surrogacy, since it necessarily involves the biological cooperation of another human being unconnected to the infertile couple.

The power of the industry in India is based upon several factors.  They include: (1) the overabundance of English-speaking, highly trained doctors, as every Indian family strives to have at least one doctor in their midst.  (2) The existing, well developed and recognized medical tourism infrastructure, which includes integrated travel, hotel and insurance services.  (3) An advantageous currency exchange rate leading to a reduction in prices, often by a factor of 10 or more.  (4) A complicit Indian government; and (5) perceptions of Indian women.

The last two are particularly interesting.  The Indian government has actively been promoting its medical tourism services for some time now, for example by sponsoring junkets around the world.  The extent to which the state is complicit in encouraging the growth of reproductive services specifically is a bit more difficult to measure, but may include the nature of India’s adoption laws with respect to surrogates.  A surrogate mother in India loses all rights to a child that is not genetically hers at the point of delivery.  Whereas, in other countries, a surrogate tends to have some time after delivery to decide whether she wishes to state a claim on the child.  It is unclear to what extent the law in India is shaped by the needs of industry, and to what extent it truly reflects the values of Indians.

The perception of Indian women is a subtle and largely immeasurable point.  Poor, village-based Indian women are often perceived in some circles as being ideal surrogates due to their global image as demure and submissive.  Indian women are peceived to be less likely to drink alcohol, to smoke, and to engage in other practices seen to be detrimental to a successful pregnancy.  In other words, it is their powerlessness relative to men and to the structures of their society that make them attractive to this trade.  Hence, maternal surrogacy is where India’s dominance in the world ART market truly manifests, given her abundance of young, poor women.

And therein begins the discussion of the ethics of the international reproductive tourism industry.  When clients from a wealthy country, like the USA, Canada or the UK, seek biological services from vulnerable –and likely uneducated– individuals in a poor country, like India, the opportunity for exploitation, even unintentional, is great.  A maternal surrogate in India is handsomely paid, receiving anything from $2000 to $6000 per pregnancy, which is considerably more than she is typically likely to see in a year.  A strictly libertarian argument holds that “fair” monetary compensation, combined with freedom of choice, obviates any ethical concern.  A more nuanced perspective asks, if the alternative is poverty and death, is there really a choice at all?  This is the classic tension between autonomy and exploitation, in that a desperately poor person can be co-opted to express her autonomy in such a way that it leads to her exploitation.  There are identical scenarios involving international organ tourism, in which th extreme poor are convinced to sell their organs, and in many forms of prostitution.  The fundamental question becomes, is it ethical to seek a profoundly intimate (and sometimes self-damaging) service from a vulnerable stranger, knowing that she likely offers it from a position of desperation?

My work as an epidemiologist and ethicist has been to explore and describe the phenomenon of maternal surrogacy in India, without passing judgement on the service providers, clients or surrogates. I have managed to identify 21 distinct ethical pitfalls inherent in the extant industry.  But I wish to bring readers’ attention to just two of them: insufficient medical advocacy and limited informed consent.

The present commercial model for maternal surrogacy in almost every clinic in the developing world holds that a contractual relationship is forged between the client (usually a woman or couple from a wealthy country), the clinic and the surrogate.  But from a medical perspective, the clinician is directly responsible for the care of both the client and the surrogate, though is being paid by just the client.  This is clearly a conflict of interest.  Consider if a medical situation were to arise in which the clinician must act either to save the life of the fetus or the surrogate.  He has a strong financial incentive to choose on behalf of the the paying client, and thus the fetus. The absence of an independent medical advocate acting on behalf of the surrogate immediately nudges this relationship into the realm of exploitation.

Given that the surrogate is often quite poor, uneducated and semi-literate, it seems unlikely that she is even aware of the dangerous nature of her unequal status in this commercial relationship. This vulnerability further complicates the proper receipt of true informed consent.  In legal terms, informed consent is a process to avoid fraud and the imposition of one party’s will upon another.  In medical ethics, it is the process of a clinician receiving genuine permission from an autonomous person to perform a medical procedure on that person.

Contrary to its portrayal in popular media, informed consent is not simply the receipt of permission.  In TV shows like “House”, informed consent is co-opted from patients who are tricked into giving permission for a dangerous procedure. It is often rationalized away because “the doctor knows best”. True informed consent involves an ascertainment that the patient understands the nature of the procedure and the likelihood of all its known risks.  Illiteracy is but one barrier preventing the communication of such risk.  But when risk is presented in the same package as a significant financial incentive for accepting that risk, the negative consequences are necessarily muted in comparison.

But what are these risks?  Childbirth is, after all, a natural process that pretty much all of these women have already gone through, since proven gestational ability is usually a prerequisite for serving as a surrogate.  However, there is a reason that maternal mortality rates are monitored in every country: pregnancy is an innately dangerous state for a woman, especially in a developing world context.  Surrogates risk metabolic and cirulatory complications, such as diabetes or extreme hypertension.  Death is a small but real risk, as is, through gestational injury, impairment of her ability to have future children.

Those are the known, medical risks that any obstetric specialist knows to communicate to a woman considering pregnancy.  In the case of maternal surrogacy in India, there are social risks that are just as dangerous as the biological ones.  Domestic violence and household strife have been known to arise when a surrogate’s husband dislikes the fact that she is carrying “the child of another man”.  There is one story of a surrogate being forced from her village after her neighbours learned she was carrying the baby of two gay Israeli men.  There is also uncertainty surrounding whether the surrogate will be able to control her diet, or enjoy continuing carnal relations with her husband, or whether her current childcare responsibilities will be interrupted.  These are all downstream negative consequences of the surrogacy procedure that need to be considered when formalizing the contractual relationship, though there is no evidence that these considerations are formally included in existing surrogacy negotiations.

Further complicating the quest for informed consent is the unavoidable power imbalance between doctor, client and surrogate. As the least powerful member of this triad, the surrogate is at risk for being cowed into compliance.  The fear is that unless conscious and overt steps are taken to ensure her full expression of choice and autonomy, a poor, semi-literate village woman will typically accept at face value the estimation of risk presented by a wealthy, educated and typically male doctor.  It takes unusual strrength to find the voice to question points in a formal contract if presented as a fait accompli by an officious clinician. It is in some ways the legacy of India’s colonial heritage, wherein informed consent can literally be coerced by identity; an English-speaking clinician in Western garb weilds extraordinary cultural authority.

A brochure of one Indian ART clinic featured the following quotation from a surrogate who had recently produced a child for an American client: “It’s a miracle.  I myself was wondering how I managed to deliver such a beautiful American, totally white baby.  I couldn’t believe it –I am very happy.”  The statement is presented as a marketing tool for potential foreign clients.  But what should be evident is that this woman failed to understand the genetic realities of the procedure in which she was a central part.  In other words, truly informed consent was not in play.

There is no doubt that maternal surrogacy presents a ripe opportunity for very poor women to make a dramatic improvements in their families’ lives.  So long as infertility remains prevalent globally, and so long as India experiences the tandem of advantageous global prices and widespread poverty, it is assured that India’s reproductive tourism industry will continue to grow.  Our goal, as responsible global consumers seeking to minimize suffering and exploitation, should be to make the process as fair and as safe as possible.  Ultimately, the creation of life is meaningless unless we also strive to respect the living.

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Dr Raywat Deonandan is an Assistant Professor in the Interdisciplinary School of Health Sciences at the University of Ottawa, the former Chief Science Advisor to Assisted Human Reproduction Canada, and an expert on the global industry of reproductive medical tourism. Links to this post are welcome, but please do not excerpt elements or text without informing the author.  Thank you.

Most people know who the first man in space was.  It was, of course, Yuri Gagarin, who was also the first man to orbit the Earth.  Gagarin’s flight took place in 1961, just a short period before Alan Shepard Jr. became the first American in space.  Shepard’s flight was suborbital, however.  It wasn’t until John Glenn in 1962 that an American orbited our planet.

But most people don’t know that prior to Project Mercury, the Americans had had another plan to put men into space. It was called the Man in Space Soonest (MISS) program, and existed solely to beat the Soviets into the void.  MISS’s plan involved rocket planes, most notably the X-15, which still holds the record as the fastest manned rocket plane ever flown.  Amongst space geeks like me, the X-15 has a special place in our hearts.  You can see a crash of an X-15-like vehicle in the opening credits of the Six Million Dollar Man.   Here’s another X-15 crash.

The amazing thing about the X-15 was that it actually succeeded in putting men into suborbital space… twice.  In July and August of 1963, American civilian pilot Joseph A. Walker flew the X-15 above 100km,  officially earning his astronaut wings.  This feat made Walker the first human being to go into outer space twice, and the first American civilian to do so a first time.  He was joined in the program by Neil Armstrong, who did not take the X-15 into the realm of space, but who, of course, ended up being the most celebrated astronaut in history.

Joseph Walker was killed in a crash in 1966, never seeing the culmination of the American space program on the surface of the Moon.  It’s a tragedy that his pioneering efforts are largely unknown to the world.  Yet he was undeniably one of the early greats, a man with truly the Right Stuff.

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Today’s Preamble

First off, please visit the Canadian Grand Challenges website and vote for the project proposed by my friend and colleague Dr Ophira Ginsburg.  Go.  Now!

Second, there’s a new article over at Skiffy.ca, this time a review of the TV show Sanctuary.

Third, I would like to express my gratitude to my former student Jill, who nominated Deonandia for a “media excellence” award from the University of Ottawa President’s office.  We didn’t win.  And though I’m not receiving formal recognition by the University at a reception tomorrow night, I will be attending, and have at least been acknowledged by the jury.  Details are here.  Here’s the text of the email from President Allan Rock:

Dear Professor Deonandan,

Please accept my congratulations on being recognized for a special mention by the jury in the recent 2011 Excellence in Media Relations Award. We received many nominations this year and although your accomplishments were very impressive, committee members ultimately selected professors Pascale Fournier and Norman O’Reilly.

Your research and writing in the areas of epidemiology and global health are helping to facilitate a better understanding of how these issues impact on the world’s population. Your unique talent in integrating literature, art, ethics, law and social policy into the study of global disease burden has had a powerful impact on the field. Thank you for sharing your insight with the media, which helped to inform and educate the broader community, and will no doubt continue to raise awareness and eloquently advocate for change in the realm of global health.

Congratulations once again on this well-deserved recognition. It is because of exceptional scholars and researchers such as you that the University of Ottawa is highly regarded among Canadian universities.

Sincerely,

Allan Rock

The concerning part is, of course, that now this blog is on the radar of people who employ me.  Given some questionable past content, this might not be such a great thing.  On the other hand, why stop now?  I do, however, feel the need to write more about epidemiology.  So now we move on to today’s real topic…

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Are Supplements Good For You?

If you’re on Facebook (and, really, who isn’t these days?) someone has probably sent you a link to this article: “No evidence for benefits of most vitamin supplements.”  The article summarizes a study by the University of Minnesota, where researchers surveyed 39000 women about their use of multivitamins, vitamins A, C, D and E as well as beta-carotene, B vitamins and minerals such as calcium, copper, magnesium, selenium and zinc.  It’s unclear how health outcomes were assessed, since the original study is not well described by the journalist.  But I assume health status was assessed via the questionnaire.

The article suggests that the findings of the study fail to show a link between supplement use and the avoidance of death from ailments that are meant to be treated by those very supplements.  Many in the media (and by media, I include Facebook) are citing this study –or more precisely, this article about the study– as evidence that the supplement industry is not only without benefit, but possibly deliberately duplicitous, as well.

Now, I don’t know what the intentions of supplement manufacturers is.  And I don’t really know if supplementation is good or bad for you.  All I really know is epidemiology: in other words, how to assess whether a study is really able to conclude the things that it concludes.

So let’s break it down.  First, I have not read the original study.  I, like everyone who is citing this report, have only read the news article.  So any misrepresentations I may make of the study are due to the linked media article having reported such misrepresentations.

As already noted, it is unclear how health outcomes were assessed in this study.  If indeed it was via questionnaires, then how could death rate have been ascertained?  Dead people don’t do surveys.   Additionally, if other health states were also assessed via survey, then something called “recall bias” is at play.  For example, if some asked you, “how many head colds have you had in the past 12 months?”, could you recall enough of your suffering to answer accurately?  And yet that is typically how a lot of this kind of research is done.

What’s more likely is that the Iowa Women’s Health Study, which is what this study was a part of, ascertained real health outcomes from direct observation of patients, and measured associations with those real outcomes with self-reported supplement usage that was ascertained via questionnaire.  In that case, death rates could have truly been measured, and the recall bias would have been in the ways subjects remembered their supplement usage.

The article presents no information about the selection criteria for subjects entering the study.  For all we know, only women with serious underlying health issues were enrolled.  In such a case, higher rates of mortality and morbidity, relative to the general population, would be expected.  Additionally, women who are ill may be more likely to seek supplementation.  Thus, their underlying health states constitute what we call a “confounder”, which is a factor that affects both the exposure (tendency to seek supplements) and the coutome (mortality and morbidity rates).  The existence of a confounder –unless it is controlled either methodologically or statistically– renders all conclusions of a study moot.

Again, I am not saying that confounding was in play, only that the study, as described by the news piece, does not discount its possibility.

Lastly, the article makes it a point to insist that supplementation does not decrease death rates for deaths caused by ailments that are supposed to be addressed by supplements.  But death is a fairly extreme outcome.  Most people don’t take vitamins to epxlicitly avoid death, but rather to avoid illness.  A study that fails to detect an association with supplementation and reduced death rate, is also likely to be insufficiently sensitive to detect an association between supplementation and reduced illness rate.

So what to conclude from all this?  Well, first that the National Post sucks at describing scientific studies.  Second, that the results of the cited study, as described by the National Post, do not necessarily suggest that supplementation is useless, but merely that in the case of women who may or may not have serious predisposing conditions, supplementation with these selected nutrients does not prevent death.

I’m an epidemiologist, which means that I’m supposed to be a champion of evidence.  (The definition of “evidence” is another long topic, that I hope to tackle in long form some other time.)  It also means that it has become my role to constantly debunk pseudo-science, and most commonly fake medicine.

One of my frivolous pasttimes is trying medical “therapies” that lie outside the realm of mainstream scientific belief.  I figure one shouldn’t criticize something unless one has tried that thing.  And believe you me, I’ve tried them all: Reiki, Bowen Therapy, Reflexology, Sound Therapy, Homeopathy, blah blah blah blah.

Some of them are quite pleasant.  I particularly enjoy all forms of Reflexology: it feels just great, even though there’s no evidence that it does anything it claims to do.  I will likely continue to seek Reflexology treatments, ’cause I’m a sucker for feeling good.

And I know this might offend some of my regular readers, but I have to tell you: the two most frustrating of the more popular evidence-free therapies are Homeopathy and Reiki, mostly because even their very premises are, well, completely insane.  (At least Bowen Therapy, to name one, purports to have a testable mechanism that is somewhat based on something resembling a scientific premise seated in known physiological facts.)  They are doubly frustrating because I know of so many demonstrably smart people who will swear by these forms of “therapy”, usually without the honest self-evaluation required to identify a placebo effect.

My criticisms aren’t based on any casual dismissal of premise, but on the published, rigorous evidence.  Show me new evidence and I will happily change my mind.  Seriously, I’m openminded like that.  I just wish defenders of these therapies were equally as openminded to the evidence discrediting their favourite techniques.  And, despite widespread belief to the contrary, there is heft of well designed clinical studies that have tested the more popular of the so-called alternative therapies.  Homeopathy in particular has been rigorously investigated.

Now, while I know that attempted suicide is no laughing matter, I had to laugh aloud when I read of Alexa Ray Joel’s suicide attempt…. she tried to overdose on a homeopathic drug!  That’s like trying to overdose on water!  I mean it’s possible… but just drink gallons of tap water, not a few pills from a quack’s bottle of nonsense!

As you can probably tell, I have special ire for Homeopathy, which persists in modern culture because it tries to hide amongst Naturopathy and other so-called “holistic” approaches, which frankly have stronger evidence legs to stand on.

And I have a lot of empathy for believers in Reiki because, well, there is something beautiful about envisioning a world in which one can cure with one’s “life energy” via “magic hands”.  It’s both generous and personal.  I wish it were real, I honestly do.  But sorry, the clinical trials say it ain’t so.

A lot of people reading this are going to confuse Homeopathy with Herbal Medicine.  They are NOT the same thing.  Herbal medicine employs actual pharmaco-active substances that usually do something or other in your body.  Homeopathy, if it worked, would actually violate pretty much every known law of Physics.  And again, I’m open to that possibility…. just show me some hard, reproducible and falsifiable evidence.

But, of course, no such evidence is forthcoming.  So I give you LiveScience.com’s list of the top “Alternative” medicine quackery thingies debunked in 2009. (Click the previous link for details):

1. Reiki
2. Reflexology
3. Homeopathy
4. Magnetic therapy
5. Kava

While we’re at it, here’s the same site’s list of medical myths that even some physicians keep pushing.  (I must say, even I have been guilty of the drowsy turkey one):

1. Myth: We use only 10 percent of our brains.
2. Myth: You should drink at least eight glasses of water a day.
3. Myth: Fingernails and hair grow after death.
4. Myth: Shaved hair grows back faster, coarser and darker.
5. Myth: Reading in dim light ruins your eyesight.
6. Myth: Eating turkey makes you drowsy.
7. Myth: Mobile phones are dangerous in hospitals.

Numbers 1 and 7 are particular pet peeves of mine.  Really, if we didn’t use 90% of our brains, we would have devolved brain matter generations ago.  And I am so sick of busy-body nurses telling me to turn off my mobile phone; they are never in the mood to listen to me explain the faulty physics of the premise.  Same goes for gas stations that are afraid of phones’ “static discharge” near the gas pumps: complete rubbish.

Want some comedy about this nonsense?  Check this out:

Today the Space Shuttle Atlantis completed its final mission.  There will be no more US shuttle missions.  It’s worth noting that most of my hardcore space friends did not bother to watch the landing live on TV, and neither did I.  That’s where we are.

See, I actually remember watching Apollo launches.  They were big deals.  They’re why I even once applied to be an astronaut! As a kid, I re-read that one issue of National Geographic about Skylab perhaps a hundred times.  I got up early to watch the very first shuttle launch –the Columbia– on April 12, 1981.  It was crewed by John Young, a veteran of the moonwalks, and Robert Crippen on his very first mission.  It makes me feel old that Crippen is now retired and Young is 80.

That first launch was such a media circus.  It was uncertain whether some of the re-entry tiles had been sloughed off during launch, so the military had to reveal that they had telescopes powerful enough to inspect the shuttle’s underside from Earth.  It was a bit of a minor sensation.

What burns hottest in my memory is a version of Willie Nelson’s “On The Road Again”, renamed “Columbia”.  They played it ad nauseam and it is now more familiar to me than the original.

I also remember, prior to the shuttle era, administrators harping on about how they hoped the shuttle would make space travel routine.  As a kid, I found this prospect quite exciting.  However, I hope you can see the problem.  NASA sort of succeeded.  And in that success, they lost the public imagination.  When something becomes routine, it becomes easier to cut its budget ’cause no one’s going to notice.

The end of US manned space travel is indicative of so many things.  I hardly know where to begin.  I’ve written about the affordability of manned space travel quite often in this space, most recently here, and with respect to unmanned missions here.    But on a geopolitical level, America’s decision to rely upon other countries to ferry her Astronauts to orbit and beyond reflects a nation resigned to its role as a declining empire.

It’s also indicative of a strange set of priorities.  Could the money be better spent on social programs?  Of course.  But the cost is equivalent to a few aircraft carriers.  Why not curtail military spending to sustain a world class space program that employs hundreds of thousands, assures American presence at the forefront of materials and space science, invests in a score of spin-off technologies and therefore industries, and whose product is peace, not death?

With the cancellation of the Crew Exploration Vehicle, also called the Orion, America (and thus its associated agencies, including the Canadian Space Agency) intends to rely on Russian and, eventually, private launches.

The other geopolitical element here is that both China and India are frantically developing space programs.  Both intend on being on the Moon by 2020, and China has already put men into space.

Are any of you still in doubt about the power shift to Asia?  One day, Neil Armstrong’s landing site might be a curious museum in the middle of a sprawling Chinese lunar colony.  Given China’s penchant for longterm policy planning, maybe that’s not such a bad thing.

I was just reading an article on Gawker about NASA’s new Mars rover.  The first reader comment, right on schedule, was an image of a starving African child and the statement, “shouldn’t we spend our millions worrying about life on earth, before worrying about life on Mars?”

Arrrgh!  How I hate that naive argument.  And how I hate the manipulative and simpleminded appropriation of the images of Black children to sell simplistic ideas of global health and development.

Now, I’ve tackled this before, as in this blog post about the idiot and hypocrite Ashton Kutcher.   Beyond their obvious exploratory value, I made the point then that each and every space mission is essentially a mini-industry that employs thousands and that re-injects millions of dollars into the local economy, serving as an investment in a nation’s high level human capital.  And this is done with a completely peaceful purpose and process, unlilke similar endeavours that are undertaken by the military.

Another reader of the Gawker article linked to the following clip from the TV show The West Wing, which sells the idea from a different perspective:

But what really annoys me is the unconcious hypocrisy of the people who insist that we should turf our scientific exploration budgets in favour of humanitarian aid.  Science expenditures are actually miniscule, but end up having enormous impacts down the road on everything from local and international economies to the development of new technologies that allow the actual humanitarian aid that we seek.  Few people realize that almost all of the techniques and materials utilized in the provision of primary health care by humanitarian aidworkers traveling to the most benighted parts of the world were developed in large part as a result of the space programme.

As Sam says in the clip above, “No one is hungrier, colder or dumber because we went to the Moon” (or something like that).  More to the point, I think it is demonstrable that many people are warmer, healthier and smarter exactly because we went to the Moon.

But the hypocrisy that eats at me is the inability for people to see the much larger expenditures wasted on frivolous items that have much fewer positive impacts on the world than does the space programme: fast food production and consumption, the glorification of professional sports, subsidized gas and agriculture, a bloated government bureaucracy, massive corporations that exist to do nothing more than move money from one pile to another, the bloated salary of any North American who makes over 100K/year, and, of course, pretty much anything military.

A given space mission costs tens of millions of dollars, is profoundly peaceful, publicly transparent, economically stimulating and results both in increased human knowledge and spin-off industries in textiles, manufacturing, information technology, medicine, and scores of other related disciplines.  Now think about the fees of top Hollywood actors, athletes and CEOs, each of whom could fund a space mission per year on his salary alone.  Now think about the cost of a single nuclear aircraft carrier, which exceeds the price of the entire Apollo space programme that employed tens of thousands and that sent 14 men toward the Moon.  And now ask yourself how much return on investment society gets for allowing so much of our resources to be controlled and pooled by such players.

We choose each day to spend the bulk of our treasure on frivolities that do nothing more than two things: line the pockets of a privileged few and spin the wheels of a few local economies in an unsustainable fashion.   And yet some insist that a fraction of that total invested in peaceful scientific exploration, despite the profound and wide-reaching intellectual and economic implications of such exploration, is a selfish waste because we could be saving starving kids in Africa.  Until you accept that sacrificing our other luxuries –professional sports, Hollywood movies, the empty middle-man roles of the corporate  West, the military, or indeed our daily latte and 20 minute hot showers– would do the job a million times better than denying us knowledge of the universe, then you are engaging in both hypocrisy and poor math.

You want to save starving African children?  So do I.  But I also want to explore the cosmos.  Here’s the thing: there’s plenty of money out there to do both.  It’s all about priorities and will.

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Want some more?  Here’s another great West Wing clip on the same topic.

Today marks the 50th anniversary of manned space flight, as noted in the current Google Doodle:

I’ve written enough about my hero, Yuri Gagarin (here, here, here and here), so I won’t bore you anymore.  I will say three things, though:

While Gagarin was undoubtedly the first human being to go into outer space and return safely to Earth, some conspiracy theorists insist that the Soviet Union had launched other cosmonauts into space and had failed to recover them.  This seems unlikely to me.

We celebrate Gagarin today.  But my thoughts are often of the dogs that the USSR had launched prior to any human being.  They died the most horrible deaths imaginable, alone and terrified in Earth orbit.

Today is also the 30th anniversary of the first Space Shuttle launch.  I remember that day quite clearly.  The pilots, as I recall, were John Young (a seasoned moonwalker) and Robert Crippen, the latter on his very first space mission.

But…

Today’s real topic, though, is the future of the world of computers.  Now, I’m not a computer expert.  However, computers –their history, construction and programming– is one of my serious hobbies.  Not surprisingly, my Gwitter project is a marriage of my career (global health) and my love (computing).  You can still vote for Gwitter until April 29, by clicking on the “thumbs up” icon in the lower right of the linked page; so go forth and do so!

Ever heard of Moore’s Law?  First articulated in 1965 by Gordon Moore, it essentially states that the density of transistors on an integrated circuit would double every 1.5 years.  Translated from Nerdese, it says that the raw power of computers would double in that time period, based almost entirely on technological advances in making smaller and smaller components.

Moore’s Law has actually held true for the past 45 years, and is expected to continue to be true for another 10-15 years.  A corollary states that the computing power available to us will always exceed the amount of computation needed to be performed.  At the turn of the century, there was some concern that this corollary would no longer hold, as the Human Genome Project was about to dump ungodly amounts of data onto our laps.

However, to my knowledge, this did not happen.  The rate of computing advancement continued to outstrip society’s demand for raw computational power.  This had the added economic advantage of allowing the computer industry to put out a new generation of machine every 1-2 years.  (Ever wonder why your laptop from 5 years ago doesn’t cut the mustard anymore?  It still works fine.  But since transistor density has outpaced it, software has also grown to match the new computers’ abilities, so your old laptop can’t keep up with the young’uns anymore.)

In my opinion, this has been the major force in maintaining the personal computer industry as a multibillion dollar affair.

Now experts are predicting that Moore’s Law will cease to apply in 1-2 decades, due to absolute physical and quantum limits in how small one can make transistors.  Some manufacturers are already feeling the crunch, hence the proliferation of multiple-core processors –it’s a way of increasing computing power without increasing transistor density.

So, given that transistor technology development will slow in coming years, here are my non-expert predictions (informed in part by a recent article in University of Toronto Magazine) for what this will mean for the computing universe:

1. The new trend will continue: how many cores can one shove into a single computer?

2. The industry focus will shift away from developing more powerful computers to the development of personalized devices (smart phones, book readers, wearable computers, etc) in an attempt to increase market share without dramatically pushing technological advancement.

3. Since the raw guts of the machine will plateau in power, a greater reliance will be placed on software development for the purposes of improving speed and efficiency.  Perhaps this will mean a reduction in software bloat.

4. Cloud computing will continue to expand and evolve.  Since the rate limiting step in this process is network speed, more focus will be placed on vectorizing devices’ access to networks.  (Yes, “vectorize” is a real word; I borrowed it from my old FORTRAN programming days.)

4(a). New modalities for cloud computing will evolve.  A variety of smaller computing “farms” will arise to compete with Google for supremacy in the Cloud market.

5. A crisis in the IT industry will be experienced in 1.5-2 decades, as workers and companies must re-task themselves away from chip development toward application development.

6. A push will be on to develop the first consumer-ready quantum computers.  Such devices would be paradigm-shifting industry arrivals which may do away with the need for transistor density altogether.

And there you have it.  I’d welcome any comments from people who are actually experts in this field.

The Grand Challenges grant seeks to identify emerging leaders in global health research and reward their innovative ideas with a hefty start-up grant.  My idea is something called “Gwitter”, which is essentially a social networking platform akin to Twitter, but which links clinicians in low income countries with specialists in high income countries, for the purposes of allowing for timely access to high quality specialist consultation.  Why?  Because lack of such access is one of the great causes of preventable deaths in the developing world.

Gwitter is a little more complicated than just a new kind of Twitter.  We aim to create an efficient online linguistic translator and a rapid speech-text-speech converter so that language and technical savvy will not be barriers to its global use.  But most importantly, we will create an algorithm for ranking responses from multiple specialists so that the most appropriate answer to any query is the first that reaches the person who asked the question.  In this way we hope to leverage the vast untapped wisdom, skills and energy of professionals in the developed workd.  Instead of asking for weeks of donated time, we instead ask for mere seconds.

(And yes, I’m aware that one of the great barriers to this project is the potential liability on the part of the consulting specialists… that’s one of the things we will work on, if we get the money.)

So why am I telling you?  Because there’s a public voting process involved in the grant competition.  I’m asking you, dear reader, to vote for my project by visiting this link and following the instructions:

GWITTER

Now, be aware that my video SUCKS.  This is because it was put together on a moving train 10 minutes before the deadline.  Do not interpret this as me not caring about the project.  It’s just that I was negotiating for a more professional video production service up until the last minute, and when that fell through my only option was to film something quickly on my webcam.

So please judge it on the merits of the project.  I hope you will vote for Gwitter!

This Sunday will mark the 43rd anniversary of the death of one of my heroes –one of the bravest men of the 20th century– Yuri Gagarin, the first man in space.

Here’s a rare pic of Gagarin with Fidel Castro:

In 1968, he was killed at the age of 34 in a mysterious airplane crash, but not before performing a feat so terrifying it would stultify most other people.  Atop a ballistic missile 7 years earlier, he had been hurtled into Earth orbit, an environment whose hostility and survivability had been a total unknown at the time.  He never lived to see men walk on the moon, a mere 8 years after he pioneered our entry into outer space.

What few realize is that the USA was only months away from putting their own man in space (he ended up being Alan Shepard Jr) and were shocked to have been scooped by the USSR.  But it’s important to note that the Americans were, at that point, unable to put a man into orbit; Shepard’s flight had been suborbital, straight up and down.  Gagarin, on the other hand, soared around the world in awe and astonishment.

To their credit, and near the height of the Cold War space race, NASA presented the Soviets with a plaque commemorating Gagarin’s feat:

Mind you, there was never a video taken of Gagarin’s historic flight.  We don’t know what he saw.  Until know.  The crew of the International Space Station will recreate Gagarin’s trajectory to create a Youtube clip for all the world to experience.  Linger on this magnificent photo of an astronaut observing the Earth through the ISS’s window:

Much of the world, dominated as it is by American media, has forgotten Yuri Gagarin.  Every year I ask my students who the fellow on my T-shirt is, and few (if any) ever know, even though his name is emblazoned in large type below his head (not visible in the following photo):

I think it’s about time someone made a feature film about the first flight of Yuri Gagarin, one of the bravest men of the 20th century.