The Medicated Child

I just watched a PBS Frontline investigation called The Medicated Child. Why do we use technology? In this case, for health.

Mental conditions once diagnosed only rarely in children are now identified in millions of US children. And we have technology--drugs--to treat them. Few systems are as complex as our bodies and few experiments are less controlled than medicating mental conditions.

One doctor was filmed prescribing drugs for children just a few years old. Interviewed afterward, he described the process as an experiment because there was insufficient data about what worked. After the newsmagazine 60 Minutes reported on a four-year-old dying from the drug their son was using, the family returned to the doctor to ask for alternatives to drugs. The doctor explained that 99% of addressing the boy's condition is with drugs and that alternatives, like therapy, can't work when the child can't control his impulses. I was impressed with his 99% confidence level, given that he's simply experimenting on this child, increasing dosage levels and introducing new drugs. The doctor was not asked, nor did he volunteer, how he predicts or accounts for synergistic effects of five or more simultaneous drugs.

Frontline noted that over time far more children have been diagnosed with mental conditions that require treatment (e.g. bipolar disorder increased 4000% in 10 years). On their website (not in the video), they suggest this is because diagnostics have simply improved. Supposedly, children have suffered from these conditions for centuries or millennia. On their website, they do add that

...some [experts] even speculate that environmental factors are playing a role in triggering childhood bipolar.

Since our fantastically intricate bodies are built from what we ingest and absorb from our environment, I would be surprised if our environment did not have a large influence. And yet, nobody commented on the food the children ate. One little girl bicycled to a convenience store and bought ice cream sandwiches. A four-year-old boy was fed corndogs, Goldfish crackers, a cookie, and Gatorade for lunch. Perhaps the antipsychotic drug (sounded like Rispordal) he was taking for bipolar disorder provided him all the nutrients he was missing from fresh fruit and vegetables, as well as whole grains. I find it hard not to be sarcastic, even though I know that seldom translates well in a blog.

The worried parents did not appear to consider diet, nor did the doctors ask. I'm sure there are plenty of other children eating junk food who do not present ADHD or bipolar. But if I were a parent, desperate to help my child, the first, safest, quickest, and cheapest step would be to provide a nutritious diet.

If I fueled and oiled my car with junk gasoline and junk oil, bearing little resemblance to good gasoline and good oil, I would not expect my car to run well, if at all. And I would not go to my mechanic seeking an expensive and experimental treatment so that I could continue to misfeed my car.

Let me pause to emphasize that this blog contains the technological literacy musings of KnowledgeContext's Executive Director Miguel F. Aznar, who is not a medical doctor. The blog does not necessarily represent the position of the nonprofit corporation KnowlegeContext or its supporters.

Disclaimer made, it appears to me that if we better understood our technology, and perhaps drew some parallels to our own bodies, we would take a very different approach to using pharmaceutical technology on our children. Or on ourselves. Click on the comments link just below to post yours.

Waste = Food

Waste equals food is one of the most striking (and memorable) principles that Bill McDonough presented at NASA Ames (Mountain View, California) February 5, 2008. His talk updated his book Cradle to Cradle and documentary The Next Industrial Revolution. (If NASA makes video of his inspiring and entertaining talk available online, I will link to it from here, so check back)

What does it mean? Life evolves to make use of waste. A cherry tree drops cherries, blossoms, and sometimes branches. These feed animals, fungi, and bacteria, which produce waste consumed by others. It fits in a cycle without vast stockpiles of material spreading unused and inedible.

Human systems produce many waste materials that do not serve as food for us or any life. Eventually, bacteria may evolve to eat plastics, but not until long after we bury ourselves in it. If such bacteria evolved soon, technological civilization would face disaster as our computers, vehicles, buildings, and much else were digested before our eyes. Resigned to throwing things away ("Where is away?" McDonough asked), environmental aims have been to waste less, to be less bad, rather than eliminate the concept of waste.

McDonough suggests that aspiring to be “less bad” is, well, bad on many levels. It doesn’t solve the critical problems we’re creating because it’s still going in the wrong direction, just slower. Also, it does not inspire. Wasting less is a negative approach that tries to restrict businesses from growing.

On the other hand, doing good solves the environmental problems we face and actually feeds of the growth of business. Doing good by eliminating the concept of waste could be done by designing our products so that at the end of their useful life, they could be separated into organic and technical nutrients. Organic nutrients, like paper, can be broken down by organic (often bacterial) systems. Think compost piles that enrich soil to grow more organic nutrients. Technical nutrients, like metals and plastics, can be recycled into new products.

A wonderfully familiar illustration of how we currently fail to design for organic and technical recycling can be seen in The Story of Stuff: single-serving juice boxes. Layers of cardboard (organic), metal foil (technical), and plastic (technical) are not designed to be separated easily and cheaply. So where do you toss that empty box with the straw poking out the top? Paper recycling? Aluminum recycling? Plastic and glass recycling? No, no, and no. You send it to a landfill or incinerator (which spreads toxins into our air before sending toxic ash to landfills). In either case, we’ve harvested materials we need for our products and put them out of reach for reuse. Cradle to grave instead of cradle to cradle. And, so, we go off hunting for virgin materials. That can’t last.

A subtlety of reuse that McDonough pointed out is that product design must consider how it mixes similar materials. If several kinds of plastic are blended, that may make the plastic recyclable into only a cruder product, like a picnic table. He calls this downcycling because technical nutrients start in a refined state for one product and are then downcycled into a product with less demanding materials requirements. If that product's materials are also carelessly blended, it may downcycle into a product even more promiscuous, but then it's off to the landfill for sure. If product designers are concerned only with cheaply getting a product into consumer hands, then there's no motivation to make materials separable. However, if there is no "away" to throw the product and, instead, we want to reuse the technical nutrients, then design considers this. The book and documentary give examples of how this can work.

This connects to technological literacy and ICE-9 in any number of ways. How does technology work? It can be designed for separation of organic and technical nutrients for complete reuse. Where does technology come from? Biological inspiration, where waste equals food. What are technology’s costs and benefits? The pattern from Technology Challenged that the progress leads to obsolescence takes on a different light if obsolete technology could be completely recycled. What do you think?

Has Technology Made Us So Clean That We’re Sick?

In Technology Challenged I wrote about the impact of water supply, sanitation, and hygiene technology. The chapter on how technology has changed us described how this technology has improved human health and lifespan dramatically. The World Health Organization estimates its absence was responsible for 88% of the 1,800,000 deaths from diarrhoeal disease in 2004.

Sure, water supply, sanitation, and hygiene technology have benefits, but anyone who’s read Technology Challenged will note that technology almost invariably has both, too. So, what are the costs of these technologies?

A study comparing incidence of asthma and allergies in the former East and West Germanys, found children much less affected in East, where health care was poorer and pollution greater. Other studies have also suggested this correlation, now called the hygiene hypothesis, which suggests that a cleaner environment—treated water, hand-washing, vacuum cleaners, indoor floors not made of dirt—could lead to asthma, allergies, and autoimmune diseases. How might that work?

In Riddled with Life, Marlene Zuk describes our relationship with parasites, including those that rely on water to move from host to host. She offers a mechanism for causality behind the hygiene hypothesis:

Exactly what is it about early stimulation by bacteria, viruses, or other parasites that keeps the immune system calm in the face of harmless entities like pollen or ones own intestinal cells? Obviously the analogy of immune system cells being like bored unemployed workers that make mischief on the rest of the body is just that, an analogy, and even the most anthropomorphic among us stops short of assigning personality traits to bone-marrow products. The more accurate answer seems to lie in a characteristic of the immune system. Part of our response to foreign invaders of the body is mediated by a kind of white blood cell called a T cell. The T cells come in a variety of types, including killer T Cells and helper T cells. The helper T cells in turn are also divided into two types, called Th-1 and Th-2. The Th-1 and Th-2 responses are responsible for protection against different things, with the former concerned with bacterial and viral diseases and the latter with infections by worms and other large parasites. Each type of helper T cell produces a different set of chemical messengers used to regulate inflammatory response like tissue swelling and the production of mucus. These chemicals interact with each other and keep the entire system in balance.

In countries with scrupulous hygiene, where children are vaccinated and antibiotics are widely administered, the low level of Th-1 stimulation results in an increase in the Th-2 response. These Th-2 responses trigger an exaggerated mucus production and contraction of muscles in the airways, which can in turn cause allergic diseases and asthma. In countries where bacteria, worms, and other pathogens are abundant but vaccination and antibiotic levels are low, the Th-2 responses are activated, but they are regulated by repeated cycles of infection and inflammation, with the inflammation countered by natural antiallergic reactions. Thus they rarely escalate out of control as much as Th-2 responses in people from the industrialized areas. The immune systems of people from less developed countries still respond physiologically to allergens like pollen or house dust mites, but the people do not go on to develop a disease. It is as if the Th-2 arm learns to recognize an innocuous but foreign substance for what it is, and has a blasé “been there done that” reaction to it, rather than spiraling into a panicky cycle of swollen tissue and dripping glands. [pp. 46-47]

Where technology introduces a problem, there’s often a new technology invented to correct it (and then a newer technology to correct its problems). In this case, we have a story that will be hard to forget. A treatment for Crohn’s Disease, which may be an autoimmune reaction more common among those free of parasitic worms, is parasitic worms.

So that the cure not be worse than the disease, patients were given tiny “pig whipworm” eggs, thousands of them mixed with Gatorade. Evolved to thrive in pigs’ colons, not the foreign and hostile human colon favored by a different species of whipworm, these reluctant pioneer worms could do little more than hatch, provoke a Th-2 response that regulated the patient’s Th-1 activity, and then die and pass out of the patient’s colon. In early tests (not double-blind with control groups), patients showed remission or improvement. More important, worms caused none of the hair loss / swelling / nausea side effects of the drugs used to treat Crohn’s Disease. Presumably the worms suffered no hair loss either.

Much more common than Crohn's Disease are stomach ulcers. The Nobel Prize in medicine went to the doctors that identified the bacterium Helicobacter pylori as responsible. Stress might exacerbate stomach ulcers, but the bacterium were the cause, allowing us to take antibiotics, kill the H pylori, and return to our stressful lifestyles. Not so fast! A 2007 study showed that H pylori helps to protect us against asthma and may play an important role in the development of the human immune system, preventing immune hyperreactivity. H pylori may be joining the legion of life that technology enables us to render extinct:

The key point, says Dr Blaser, is that H pylori colonization is the default human state of affairs, but it's a default position we're fast drifting away from. "About 10% of the US population now has detectable H pylori colonization. I was just in Sweden and Germany, where I'm told the figure is less than 5%. The proportion in the developing world is over 50%, and just a few generations ago the levels in our own societies were 70, 80, even 90%. So H pylori is disappearing really fast, and this disappearance is almost certainly mirrored in other microorganisms we can't detect as easily."

I am appreciating how multifaceted the costs and benefits of technology can be. Our bodies are complex systems that can react long after an exposure…or only to combinations of exposures. The same is true for the ecosystems in which we live, making it challenging to link cause and effect. Helping us evaluate our technologies is an important challenge to our investigative and modeling technologies.

I will blog more on this later, as I have been reading books on chemicals and disease. Perhaps not surprisingly, I am still seeking those who, like me, find this subject perfect for cocktail party conversation and pleasure reading.

Evaluating Toiletry Technology

I am shopping for an electric razor. Years ago—maybe 20—my father gave me one for Christmas and last month a small piece shielding the blades broke off. Looking for its replacement, I’ve discovered the popularity of rechargeable shavers…for manufacturers, who want customers returning more often than every few decades. Nearly everywhere I shave, I find a power outlet, so a rechargeable would bring me only the extra weight of batteries and their limited life. While batteries wear out with every recharge, my shaver’s power cord shows no signs of fatigue.

Evaluating shavers economically or ecologically turns me away from rechargeable. I suspect that shoppers are lured by marketing that promotes rechargeable as somehow better or they are simply frustrated that fewer corded shavers are available.

What could be worse economically or ecologically than rechargeable? Not empty-able. I found a low (initial) price on the Remington CleanXchange Razor (pictured), but when it fills with hair stubble, you can’t simply empty it into your sink. Advertising presents this as a feature, not a bug:

• Convenience: Messy cleanup is a thing of the past. When the cartridge gets full, simply eject the shaving head and replace with a brand new one.
• Performance: Each time you replace a shaving cartridge, it is like getting a brand new shaver. This means you never have to worry about worn-out blades again!

It is not like “getting a brand new shaver” because the rechargeable batteries are not replaced. What quality of steel dulls from cutting no more stubble than fills the shaving head? The blades in my old shaver are cutting fine after mowing decades of stubble...which decomposes unless encased in countless tiny metallic shaver heads. Remington facilitates your packing small and rather mundane time capsules for your great-great-grandchildren.

This pitch to save me “messy cleanup” and “worry about worn-out blades” in exchange for higher monetary and ecological cost reminded me of when saline manufacturers invented the “no rub” feature. Saving me the effort and calories of rubbing my contact lenses between thumb and forefinger, I could simply squirt saline at the lens for five seconds (about the time it takes to rub). I doubt that spraying works as well as rubbing, but I’m sure it uses far more saline, costing me more and sending more plastic bottles to the landfill. In the US, the last thing we need to save is calories.

These technologies would not exist if someone did not evaluate them as good. I am interested in your comments on this (post below). Do you use an electric shaver while backpacking or in developing countries without power outlets? Have you seen the documentary The Story of Stuff? It streams from their website, where one can also buy the DVD. Please share your stories of stuff and how you evaluate it.