Book Review: The Borderlands of Science

The audiobook reviewed here is the ‘Borderlands of Science’ written by Michael Sherman and narrated by Grover Gardner. Gardner narrates at a moderate pace and with an expression that is able to keep the listener engaged over the 13 hours of the audiobook. Sherman’s book is about the areas at the ‘edge’ or borders of science and includes a discussion of the distinction between what he considers science, non-science and nonsense. I found myself sympathetic at times to Gardner’s arguments as he employs reasoning and evidence in his investigation of various fields. I found a central theme running through the book was that of evolutionary theory be this in the discussion of Edward Wallace’s codiscovery of natural selection and interest in spiritualism or a comparison of Darwin and Freud. Sherman is rather dismissive of Freud and psychoanalysis and relatively early in the book refers to psychoanalysis as a pseudoscience and later in his comparison of Freud and Darwin paints the picture of Freud as a celebrity in passing who’s writings have not stood the test of time in contrast with Darwin as a hero who’s greatness has increased through time as the validity of his theories have become increasingly evident. The manner in which Sherman paints the endeavours of a global body of psychoanalysts with a single label ‘pseudoscience’ is in my opinion unfortunate. This contrasts with Sherman’s discussion of the works of Frank Sulloway in establishing retrospectively a relationship between the works of great scientists and birth order supported in this same retrospective analysis with commentary on their personalities. While Sherman admonishes another author for the use of ‘confirmatory bias’ he himself applies this same bias to Freud by carefully selecting those statements made by Freud along with biographical details about him which when pastiched, caricature him as a self-styled conquistador who was preoccupied with his image and mythology. Freud has written on numerous occasions with humility imploring those who study his writings to employ them with due caution and to improve upon his theory. While there is much about Freud’s writings and approach that can be criticised he was a keen observer of human nature and had conducted basic science research and studied with one of the leading neurologists of his time Charcot before developing his methods of psychoanalysis. Freud’s writings are filled with references that will be familiar to clinicians such as the exclusion of organic states when examining the cases of ‘neurosis’ along with discussion with medical colleagues about appropriate management. This suggests that his practice was not an isolated ad hoc experimental journey led from his inner fantasy life but is instead an attempt to understand the mind through a systematic analytical process by a physician who was well versed in basic research methodology and who in his practice communicated, sought the opinions of and referred through patients to his colleagues in the medical profession. Indeed Sherman could on looking closely at some of Freud’s writings (see reviews here and here) see someone with similar values to himself as when Freud writes

‘There is no authority higher than reason’

Such parallels become obvious secondary to a thorough analysis of the relevant branch of the history of science – in this case psychoanalysis.

Similarly the field of psychoanalysis is far from an outdated model with no progress in research as suggested by Sherman but instead is supported by a variety of research studies broaching multiple disciplines (see as an example the debate (Wolpert and Fonagy, 2009)). Returning to the historical analysis by Sulloway as described by Sherman we hear of various speculations about the basis for these birth order findings. However it must be borne in mind that this is a retrospective analysis of a select group of figures. The speculation that follows can itself be considered prescience, in the sense that these speculations need to be backed up with evidence to stand on a firmer footing. These same speculations attempt to attribute a meaning that we can understand but ironically the meaning for an individual is much more likely to be afforded through the work done with an individual in therapy (depending on the objectives) than by the application of the results of group data analysis to an individual. Such group data works best at the group level but could properly be considered to offer a guide when applied to the individual because of the large number of confounders that may operate upon the relationship of interest. In addition the use of a five-factor model along with the birth-order is essentially a quantitative analysis. On the other hand an important feature of psychoanalysis which sets it up as a soft target is the use of a qualitative approach in which language and non-verbal communication aids the therapist in their role. Interestingly in communicating to the listener just what science is, Sherman is using the medium of language in a way which makes approximations and assumptions about the audience which may or may not be correct, references relationships and appeals to both reason and the emotion. In order to do so, it is reasonable to assume that Sherman values this medium sufficiently to use it as a vehicle for his message and in so doing he shares such an approach with therapists who communicate with each other through language and use language as a medium for therapy.

The end result is that Sherman espouses a view of science in which Darwin’s theory of natural selection is an example par excellence of the results of this approach. However if science is an attempt to gain a better understanding of the universe, neutral and undisturbed by our values and prejudices then our path to this understanding does not need to be constrained by a single approach – the quantitative approach generating large data sets and supported by unquestionable statistics with very small p-values. There should be a tacit acknowledgment that there are areas where the descriptive language differs – such as the languages that optimally describe the mind and the brain (see review here). Indeed it is the language of the mind that Sherman uses when he appeals to our reasoning and our emotions and which he does so adeptly. What I consider to be a hidden subtext of the validity of quantitative versus qualitative methodology is illustrated by Sherman’s quotation of an fMRI study in which the findings are used to ‘debunk’ a psychoanalytic explanation. This is done by referring to the ‘expertise’ of the neuroimaging researcher but the dangers of glossing over the many assumptions in such research have been well illustrated (see review here).

I would argue that when a subject such as psychoanalysis is reduced to a simple notion then significant elements of truth and utility get lost in the process. By this stage it is all too easy to apply the rather dubious notion of ‘pseudoscience’. As Einstein once said,

‘Everything should be made as simple as possible but not simpler’

Of note, Einstein was working as a clerk at the patent office, isolated from the scientific community when he submitted his theory of relativity for publication, a theory which would be paradigm shifting and which he no doubt recognised as such. Interestingly Sherman discusses the above characteristics but in another context in which he predicts those who do not contribute meaningfully to science.

In other parts of the book, Shermer is convincing as in his discussion of the Piltdown Man hoax and his treatment of the life of Wallace and his heretical traits. Sherman is extremely comfortable and knowledgeable in writing about Wallace and there is much to learn from the story of the cocreator of the theory of natural selection. Sherman is also comfortable in tackling controversial areas and uses his knowledge of science to convincingly address problems that do not seem to have obvious answers. Shermer’s approach polarises the subjects he explores and this can be useful in helping to make decisions that apply to those areas. At the same time, as in the case of psychoanalysis which does not adhere to Shermer’s idealised scientific method outlined above, it impacts not just on the theory but also has the potential to impact on the wider culture related to that body of theory and sensitivity is merited in any such discussion.

References

Michael Shermer. The Borderlands of Science. Narrated by Grover Gardner. Books on Tape. 2001.

Wolpert L and Fonagy P. There is no place for the psychoanalytic case report in the British Journal of Psychiatry. In Debate. pp483-487. 2009.

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Review: Ubiquitous Healthcare Service Using Mobile Phone Technology

The article reviewed here is a South Korean paper on ‘Ubiquitous Healthcare Service Using Zigbee and Mobile Phone for Elderly Patients’ by Hak Jong Lee and colleagues. In the introduction the authors discuss the ever more pervasive nature of technology. While noting the focus on hospital information systems, they note the possibility of using technologies to allow communication between the hospital and patients outside of the hospital. They note that a new wireless internet protocol Zigbee has been developed which offers a number of advantages including low power consumption. Such technology is being increasingly used in consumer electronics and the researchers were interested to see how this might be applied in healthcare. They therefore looked at a specific population – older adults – and wanted to see if they could monitor glucose levels and ECG’s in the community.

The study was a small prospective study (n=29) carried out in 2005. I found it slightly amusing that the 6-page article had been initially received in June 2006 and that the revised version was received in July 2008 when it was accepted. However delays between submission and publication in journals can be due to the logistics involved. I wasn’t clear on how sample selection was achieved and this will have a bearing on the results as successful use of the technology requires that the subject is able to use several technologies effectively. 9 subjects in the study received an ECG vest which they wore and which took readings every hour. If they were symptomatic (e.g. with palpitations) they would press a button to initiate a data capture. 20 of the subjects used a glucometer – to measure blood glucose levels. The subjects were trained in the necessary skills to ensure that the data was transmitted from the equipment to the web using a web-based program. A nurse contacted patients once weekly to administer a questionnaire regarding ‘convenience and satisfaction’. The details of the questionnaire were not included in the paper, nor were details regarding the validity and reliability of this instrument. Technical data regarding the equipment such as error rates were also identified.

With regards to the glucometer readings, the researchers found that information loss between the glucometer and the web-based service occurred in 22% of recordings and that this occurred at several points along the pathway including the mobile phone and a defect of the glucometer. A problem noticed by the participants was a large difference between the new wireless enabled glucometer and readings on the previous glucometer causing several subjects to withdrawal. However overall satisfaction was rated as 8.5/10 by the subjects (which most probably represents the intuitive meaning of scoring out of 10 which is commonly used outside of the research field). In terms of the ECG monitoring, some of the subjects withdrew from this part of the study due to a

‘fear of transmission of electromagnetic waves, skin eruption at the place where the ECG line and electrode were attached to the body and troublesome problems of attaching ECG‘

Interestingly only 57.9% of the transmitted data from the ECG was considered useful. The mean satisfaction score for the ECG sensor was 5.79. Discomfort occurred as a result of the ECG being attached to the body for 24-hour periods. As there was frequent transmission of data, the battery life of the mobile phones was also an issue.

In conclusion, this was a proof of principle. The technology itself proved effective here but it must be remembered that the technology does not occur in isolation but instead must operate within the wider healthcare environment. This in turn is dependent upon cultural factors, budgets, infrastructure and an appropriate evidence-base for the relevant healthcare service. Many technologies that achieve the chosen objectives and fulfill a useful function do not pass on into the mainstream as these barriers must be overcome. The researchers note that the emphasis in this study was on the technical aspects of the technology rather than the clinical utility. The rate at which data loss occurred as well as the need for participants to use several pieces of technology and the relatively small sample size means that further studies should examine the clinical utility in more detail. Glucose and ECG monitoring are potentially useful in various services and if a successful technology is achievable then it offers an opportunity for leveraging healthcare resources. Other types of monitoring device have the potential to be utilised using the same wireless protocols although this is already occurring using a variety of other technologies also. This study illustrates some of the difficulties that a technological solution to a healthcare problem needs to overcome in order to be of clinical utility. If such barriers are consistently overcome then this would enable new services to be developed and may impact on outcome measures in services.

References

Lee H J, Lee S H, Ha K-S, Jang H C, Chung W-Y, Kim J Y, Change Y-S and Yoo D H. Ubiquitous healthcare service using Zigbee and mobile phone for elderly patients. International Journal of Medical Informatics. 78. 2009. 193-198.

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