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The Myth Of Moral Ambiguity In Autonomous Cars

"2016-08-04-1470336740-4285115-DriverlessCars.jpg"

Image source: PhotoDune

When most vehicle manufacturers expect autonomous cars to be on the market by 2019 ― with more than 10 million on roads in 2020 ― one would expect people to start considering the various issues driverless cars create. For example, there are thousands of legal considerations to make, especially because different states or countries might enact different regulations on autonomous vehicles, preventing their owners from traveling from one place to another.

Yet, most people find these practical concerns incredibly dull. A much more exciting topic in regards to driverless cars is, surprisingly, ethics. Thanks to articles in the Atlantic (and elsewhere), giant swaths of the population have begun to question whether we can trust robot cars to make correct ethical decisions. What most people don't realize, however, is that these conversations are absolutely meaningless.

A Brief Discussion of Robots

Almost since their inception (in a 1920 Czech play) robots have incited discussions about ethics. Especially as science and tech inches ever closer to humanoid machines and artificial intelligence, people are becoming more concerned about the management of robots in all their forms. As we continue to establish egalitarian order in our society, discussions about robots are becoming more and more prevalent.

In simple terms, robots are not people, but by adding human-like traits to robots, such as voices, humanoid shape, or facial features, causes most humans to see the machines almost as equals. A handful of organizations have developed in support of robot rights; conversely, as robots continue to hijack vast numbers of jobs, other people are developing feelings of antipathy toward unconscious technology.

The Most Popular Ethical Issue with Driverless Cars

However, these ethical concerns are not the most popular discussions about autonomous cars. More commonly, non-academic writers and readers prefer to examine what is commonly called "The Trolley Problem." Undoubtedly, you've heard of it before:

A runaway trolley is careening down the street, heading toward a group of pedestrians who are milling about on the tracks. The trolley's conductor is limited in her ability to mitigate the damage; she can allow the trolley to continue on its course, hitting the crowd and causing injury to many people, or she can flip a switch, directing the trolley down an alternate route where the tracks are blocked by a lone child, who will certainly die from the collision.

There are dozens of variations of the trolley problem. In one, it is not the conductor's dilemma, but a bystander's, who has the opportunity to sacrifice one person for the sake of others. In another tale, the trolley conductor has the opportunity to derail the trolley, harming the people inside rather than anyone outside.

We only need to tweak the typical trolley problem to apply it to driverless cars:

"A driverless car is moving at speed on a crowded highway. An obstacle appears in the car's lane, forcing it to make a decision: It can swerve right to collide with an SUV, swerve left to hit a motorcyclist, or continue straight and certainly crash into the obstacle."

In each instance, the driverless car causes harm, but it is the robot car who decides the recipient of the harm. Again, there are several variations, some much more similar to the original trolley problem, but each raises a significant ethical question: Can we trust a car to make the right choice?

The Real Ethical Problems Driverless Cars Face

Most of us have driven cars for most of our lives, amassing thousands of miles on the road, and few (if any) have ever experienced such an unbearable ethical choice. Even putting aside the unlikelihood of such a scenario, we must remember that a human driver would never experience the opportunity to make a decision; rather, with only fractions of a second, human drivers would unconsciously react with little regard for costs or benefits or moral justice. If it isn't an ethical decision for a driver, it can hardly be an ethical decision for a robot car.

In actuality, no machines have the power to make decisions ever, regardless of time frame. Robots function because they have to, and the "decisions" they make are only protocols written by their programmers. Therefore, a more pressing ethical question when it comes to driverless cars is that of blame: If an autonomous vehicle malfunctions, who is responsible for the harm it causes? It could be the owner, manufacturer, or programmer.

In a traditional car collision, the drivers are under investigation, unless the collision is the result of machine malfunction, like Ford's potential brake failures, in which case the manufacturer is at fault. Yet in a driverless car, a collision should only occur when it cannot be avoided ― in which case, is it the liability of the programmer for not foreseeing such a situation?

Bottom Line:

These ethical problems are more pressing because they could stall the release of driverless cars onto the market. Before we can put autonomous vehicles on the road, manufacturers, insurers, and legislators must make a decision ― and not one that has anything to do with a trolley.

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Can Mutual Gaze Get You A Forever Passionate Love?
By Joy A. Dryer , Ph.D.

I. INTRO. Do you believe that intense romantic love can last a lifetime? OR, alternatively, do you believe that love naturally develops through phases? General phases such as the 3 that Margaret Mead is said to have defined: apparently she thought every woman needed three husbands: one for youthful sex, one for security while raising children, and one for joyful companionship in old age.

August is a good time to ask such long view questions. August is a kick-back month for many. Fewer folks in the office. Many on vacation. I hope you've taken a little time off from daily routines - maybe a few long weekends when you can kick up your feet and look at .... well ...along with a colorful garden...some beautiful view...... to look really look at your partner.

I'm here to tell you that mutual gaze with your partner is one way psychologists and neuroscientists have found you can know your partner more intimately, and help your passionate love last a lifetime.

Mutual eye gaze between you and your partner can help you learn to read, to understand, and to know one another better. Mutual gaze can help you feel more connected because it's emotionally arousing: your pupils dilate, the 'feel good' oxytocin neuropeptide releases. Try this exercise [3 minutes a night?] : you can use it to fight well. To soothe. To repair.

Here's the Gazing Exercise developed by Stan Tatkin, PsyD,[1] founder of PACT [Psychobiologic Approach to Couples Therapy][1]. Gaze quietly into your partner's eyes. [Not meant to be a sexual activity.] You can lie in bed or sit in facing chairs, knee to knee. No need to talk or to touch: ok to laugh, cry, giggle, or have whatever emotion arises. Try not to control your face. You can avoid feeling self-conscious by pouring your attention over your partner's face: notice every detail ...changes in his/ her eyes, face, skin color, skin tautness, breathing, muscle tension. I.e. your focus is on the Other, not on your own internal shifts or feelings. Look and be seen, just as you are. Know and be known, just as you are.

No need to set a timer. But try to do at least 3 minutes. Afterwards, notice how you both feel. Closer? Or more distant? Uncomfortable at any point? Triggered by what? If discomfort resolved, how?

This exercise can be a constructive and fun tool to use in your relationship. Below I describe why mutual eye gaze is so effective in oh so many let-me-count-the-ways.

II. MUTUAL EYE GAZE: Here's lookin' at you Kid. Baby researchers since the 1970's [2] showed us how babies' intense gaze at their mothers [or fathers] is a crucial psychological process of finding out who they are, and how to be in relationship with another. Present day psychologists are using the same gaze to help couples to know and to relate better to one another.

III. OUR PUPILS: Consciousness and Our unconscious. Scientists say they can study consciousness by observing pupil size changes. I'd add, that pupillary action and mutual gaze reflects our unconscious too! because our pupils involuntarily respond to our emotions.

When we look at someone we love, the visual cortex at the back of our brain [occipital lobe] captures the actual image. An older part of the brain, the autonomic nervous system [ANS] , actually registers and responds to these incoming signals. Our ANS regulates, without our awareness or permission, the continuous tuning of our pupil size [along with other involuntary functions including our internal organs such as our heart rate, heart rate variation, and blood pressure].

Our pupil size reflects both the Sympathetic [the accelerator, the exciting] branch - dilating our pupils -- and the Parasympathetic branch [the brakes, the relaxing] - constricting our pupils - branch. In a healthy secure relationship, when we feel safe, we can regulate our arousal state, balancing between excitement and tranquility. This occurs when both these branches of our ANS are in a synchronized balance of movement and stillness, self-activation and self-control. When you do the exercise I describe above, you both will likely be in a balanced state of what Tatkin [1] calls "quiet alertness."

IV. PUPIL SIZE and OXYTOCIN: Gazing is exciting. In our social interactions with another, we need to make quick assessments whether we are in a safe or dangerous situation, or with a safe or dangerous person. It turns out that when your pupils dilate with interest, arousal, or excitement, oxytocin is released. This is the "feel good" neuropeptide, or hormone, that plays a central role in enhancing emotions, communicating, and socially approaching others.

A slew of studies used double blind methods in which they randomly gave either the placebo or Oxytoxin [ administered through the nose] to participants. Results significantly showed that compared to the placebo groups, the Oxytocin groups a) gazed longer and more frequently toward angry vs. happy faces [3]; b) showed increased number of fixations and total gaze time toward the eyes [4] ; c) showed increased ability to read emotion more accurately in the eyes in the RMET - Reading the Mind in the Eyes Test [5].[Google the RMET.]

V. ATTACHMENT and OXYTOCIN: We're connected. Using oxytocin as the positive indicator of attachment, neuroscientists have used fMRI techniques to show what parts of the brain are activated when a pair is gazing at one another. They've discovered that similar areas of the brain light up when studying mutual gaze between parent-infant pairs who are attached to one another, and adult pairs who are attached. Some of these brain regions, like the substantia nigra, globus pallidus, and thalamus showed a high density of oxytocin and vasopressin receptors. [6]

Both oxytocin and vasopressin as "feel good" hormones flag these areas as dopamine-rich areas of the brain. In turn, dopamine is the primary neurotransmitter of the feel-good circuit in the brain, associated with reward, motivation, and wanting. You "feel good" while gazing at your partner. So you continue the same approach behavior. This feels good so it reinforces the continued positive loop.

VI. MUTUAL EYE GAZE: Start here. Go! So mutual gaze is the entry point into that feel-good circuit loop. We all can learn to read and to know our partners well. We can use this exercise to fight well. To soothe. To repair. Both Stan Tatkin in his PACT work with couples, and Helen Fisher and her research colleagues believe that romantic love c a n last a lifetime. And, mutual gaze is one way to keep curious and knowing, to keep your relationship feeling novel and exciting.

SUM. Thus we've come full circle to understand that gazing at one's partner is an exciting event. Our pupils dilate automatically, out of our awareness. Because the "feel good" neuropeptide oxytocin [a chemical communicator, or transmitter] is released when stimulated by mutual gaze, you "feel good" while gazing into the eyes of your partner. Thus, you can use mutual gaze in numerous positive ways. The kids can be clamoring at the breakfast table, and a minute gaze across the table at one another can be a quiet connecting moment. You might be in the middle of a fight, and if one of you can remember to slow down, touch the other's arm and say, Hey! Lookin at you, Babe ! Stay for a moment, you could change the emotional interaction.

So try this mutual gaze with your partner: kick back.... stop time... and be known by one another with a few minutes of gaze. Enjoy. Here's lookin' at you, kid.

REFERENCES. In the interest of space, and the general public audience nature of this blog, I have not included a Reference list of the studies I've read: [1] Tatkin, S. 2011; [2] Stern, D. 1985, Beebe, B 2016; 3] Guastella, JA., Carson, DS. et al, 2008; [4](Guastella, JA, Mitchell PB, Dadds, MR, 2008; [5] Domes, G. et al, 2007; [6] Fisher, H.,1992; Acevedo, BP, et al 2011. If interested in specific references, email me at jdryerphd@gmail.com. As always, I invite your comments to this blog. And follow me on Twitter @joydryerphd.

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The Current State of Manufacturing Human Organs
Thirteen. The number of people that die each day waiting for a life-saving kidney transplant.

$5 billion. The cost to create a new drug.

$3 billion plus. The amount invested in engineered tissue and organ research by the Federal government in a three year period.

Zero. The number of organs currently being manufactured by US industries for transplant.

322,762,018. The number of Americans in 2016 that could benefit from the Department of Defense's new Advanced Tissue Biofabrication Manufacturing Innovation Institute (ATB-MII).

The Department of Defense has been interested in engineering organs, tissues and limbs for decades as a means of treating its wounded soldiers. The number of veterans in need of tissue repair and limb replacement has skyrocketed in the 21st century, due primarily to the recent and pervasive use of improvised explosive devices, coupled with dramatic improvements in body armor that save lives but not without sacrifice. Meanwhile, the need is equally as strong in the civilian world, where hundreds of thousands of Americans wait on organ transplant lists living day-by-day in fear of what the future holds.

Many wonder: "Why can't we manufacture organs TODAY?" The charge is not new, nor will it fade in the coming years. It rises from the halls of Congress. It mingles with tears in homes across our nation. It echoes down hospital hallways and lingers in operating rooms. As a DoD scientist working in the field of biofabrication and tissue engineering for over 15 years, I wake up every morning trying to answer that same question; trying to explain to my children, my colleagues, my friend whose husband is on his second and final kidney transplant--why can't we make faster and more substantive progress?

The answer, as is often the case in the world of science, is not so simple. The world is full of promising technologies. Stem cells. Bioprinters. Gels that simulate the biological and structural properties of human tissue. Sophisticated imaging and computer-aided design technologies. Why, then, do we not have manufacturing plants that churn out organs? We should be able to use these starting materials just as Henry Ford used steel, rubber, and assembly lines to create the first automobiles, right? Answers like "Biology is really complicated" and "Soft, living materials are just more difficult to build than computer chips and iPhones", don't resonate too well, especially when the need is so high.

Despite these challenges, progress is being made on all fronts. After decades of research, these technologies are maturing to the point where manufactured tissue is almost within reach. All that is needed is one big push.

Enter the Government's most recent investment, bringing at least $160 million to the table to accelerate tissue and organ development: the Advanced Tissue Biofabrication Manufacturing Innovation Institute, or the ATB-MII for short, sponsored by the Manufacturing Technology Program within the Office of the Secretary of Defense for Acquisition, Technology and Logistics. The ATB-MII will pull emerging technologies into the industrial world--the world of manufacturing, automation and standardization. It will convene the best and brightest minds in the country across universities, small and large businesses, as well as local, state and federal governments, to identify, elevate, and synergize technologies. It will enable disruptive biofabrication tools, currently isolated in specialized laboratories across the country, to be inserted into manufacturing processes throughout diverse biotechnology sectors. It will enable biological starting materials and biofabrication tools to be standardized to the small- and mid-sized companies looking for a competitive edge. Ultimately, the ATB-MII will evolve into an enduring ecosystem that will accelerate the development to manufacture tissues, organs, and organ-based products.

Short-term products will emerge from the institute such as miniature tissues or organs, coined "organs-on-a-chip," that can be used to eliminate poorly performing drug candidates before they enter costly animal and human trials. These organs-on-a-chip will translate test results into the world of personalized medicine, helping speed up decision-making by clinicians looking to determine the most effective and least dangerous treatments for critically-ill patients.The industry is poised to revolutionize the way new drugs are discovered, as well as the way we engineer tissues and organs.

The ATB-MII is the path to create definable tools, products and standards that will have tangible

Dr. Ringeisen will serve as the DoD's Chief Technology Officer for the Advanced Tissue Biofabrication MII, which is currently under solicitation. He also serves as the Head of the Bioenergy and Biofabrication Section at the Naval Research Laboratory in Washington, DC.

This post is part of a series produced by The Huffington Post and ORGANIZE, a non-profit looking to end the organ donation crisis by identifying and building on opportunities for improvement through technology, advocacy, and policy. Learn more at ORGANIZE.org.

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A Closer Scientific Look at Antibacterial Soap Unearths Some Problems
Do antibacterial soaps do more harm than good? originally appeared on Quora - the knowledge sharing network where compelling questions are answered by people with unique insights.

Answer by Tirumalai Kamala, Immunologist, Ph.D., Mycobacteriology, on Quora:

Over the years, the consensus that the harm caused by antibacterial soaps outweighs the benefits has indeed coalesced. But to understand how antibacterial soaps could harm, we first need to understand how they differ from regular soaps. Also referred to as antimicrobial or antiseptic soaps, they contain chemicals that regular soaps don't.

Many liquid soaps labeled antibacterial contain triclosan, a synthetic compound, specifically a phenylether or chlorinated bisphenol. While the US FDA classifies it as a Class III drug, i.e., a compound with high solubility and low permeability, triclosan is also a pesticide. Triclocarban is another common chemical found in antibacterial soaps. Many of the concerns about triclosan also apply to triclocarban (1).

Since it appeared on the scene in 1972, triclosan has steadily permeated through the consumer landscape such that it's practically ubiquitous today (see lists below from 1 and 2).

"Screen

Triclosan is so ubiquitous it's even found embedded in medical devices such as catheters and sutures to prevent infections (3).

As for its beneficial effects, a 2015 study compared the bactericidal effects of plain versus triclosan-containing soaps in conditions that mimic hand washing, and found no difference in their ability to reduce bacterial numbers during a 20-second exposure (4). In other words, dubious benefit when used for routine hand washing under normal circumstances, i.e., only washing hands for a few seconds. After all, most of us don't scrub as though preparing to do surgery every time we wash our hands.

How Triclosan Inhibits/Kills Microbes

In vitro studies show triclosan can stop bacteria growing at low concentrations (bacteriostatic), and kill them at high concentrations (bactericidal). It also has some activity against some fungi (5) and even parasites such as those that cause malaria, Plasmodium falciparum, and toxoplasmosis, Toxoplasma gondii (6).

Triclosan is able to target many different types of bacteria by blocking the active site for an enzyme essential for bacterial fatty acid biosynthesis (7, 8). Blocking the enzyme enoyl-acyl carrier protein reductase, triclosan prevents bacteria from synthesizing fatty acids, which they need for their cell membranes and for reproduction.

Problems With Triclosan

I. Triclosan selects for antibiotic resistance

As widespread triclosan use increased, labs increasingly started finding cross-resistance to antibiotics. Under selection pressure from triclosan, bacteria mutate to develop resistance mechanisms to it, which end up bestowing antibiotic resistance as well. In other words, studies show triclosan selects for antibiotic resistance (see table below from 9).

"Screen

II. Discharged widely into the environment, triclosan can affect biomass such as algae and bacterial communities

Since it's widely used in such a diverse array of products, triclosan ends up in soil, ground water, and municipal wastewater treatment plants. Such plants require proper functioning of microbes to break down sewage. Triclosan can inhibit methane production in wastewater plant anaerobic digesters as well as select for multi-drug resistance in such bacterial communities (10). Triclosan's effects persist even beyond because it's discharged from wastewater treatment plants as effluent. Certain algae species in the vicinity of such plants have been found to be very sensitive to triclosan (11, 12). Triclosan also affects bacterial communities in rivers (13). Potential environmental risk of triclosan becomes even more relevant in areas of water scarcity where it doesn't get sufficiently diluted.

III. Triclosan can alter gut microbiota in fishes and rodents, potentially alter human microbiota, and even promote tumors in rodents

Triclosan could profoundly (14) and stably (12) alter fish gut microbiota as well as those of baby rats (15).
While so far triclosan doesn't appear to affect human gut microbiome, the data are far from conclusive, being based on just one study with 7 volunteers (16). On the other hand, a study on nasal secretions from 90 healthy adults found a positive correlation between presence of triclosan in nasal secretions and nasal colonization by Staphylococcus aureus (17). This suggests triclosan indeed has the potential to influence and even alter human microbiota.
One mouse model even found triclosan capable of promoting liver tumors (18).

IV. Triclosan can disrupt hormonal function

Triclosan was found to disrupt thyroid hormone-associated gene expression and altered the rate of frog metamorphosis (19). It could also disrupt thyroid (20, 21), estrogen (22), and testosterone (23) function in rats.

V. Triclosan bans

Given the increasing litany of concerns about triclosan's deleterious effects on the physiology of a wide variety of species, which may also increasingly include humans, several governments are either considering banning it or have already done so.

In March 2010, the European Union banned triclosan from any products that may come into contact with food (2).
On 16 May, 2014, the US state of Minnesota banned the sale of triclosan-containing cleaning products (soaps), giving manufacturers time until early 2017 to phase them out (24).
As of 2015, Health Canada was considering banning triclosan. It's estimated that ~1730 products, including cosmetics, health, and personal care products containing triclosan were available in Canada in 2011 (1).
The US FDA is mulling its regulation (25), with a report due in September 2016.

Bibliography

1. Dhillon, Gurpreet Singh, et al. "Triclosan: current status, occurrence, environmental risks and bioaccumulation potential." International journal of environmental research and public health 12.5 (2015): 5657-5684. Triclosan: Current Status, Occurrence, Environmental Risks and Bioaccumulation Potential

2. Alliance for the Prudent Use of Antibiotics. "Triclosan." White Paper prepared by the Alliance for the Prudent Use of Antibiotics (APUA) (2011). http://emerald.tufts.edu/med/apu...

3. Stickler, David James, G. Ll Jones, and Allan Denver Russell. "Control of encrustation and blockage of Foley catheters." The Lancet 361.9367 (2003): 1435-1437. http://carambola.usc.edu/Biofilm...

4. Kim, S. A., et al. "Bactericidal effects of triclosan in soap both in vitro and in vivo." Journal of Antimicrobial Chemotherapy (2015): dkv275.

5. Vischer, W. A., and J. Regös. "Antimicrobial spectrum of Triclosan, a broad-spectrum antimicrobial agent for topical application." Zentralblatt für Bakteriologie, Parasitenkunde, Infektionskrankheiten und Hygiene. Erste Abteilung Originale. Reihe A: Medizinische Mikrobiologie und Parasitologie 226.3 (1974): 376.

6. McLeod, Rima, et al. "Triclosan inhibits the growth of Plasmodium falciparum and Toxoplasma gondii by inhibition of Apicomplexan Fab I." International journal for parasitology 31.2 (2001): 109-113. https://www.researchgate.net/pro...

7. McMurry, Laura M., Margret Oethinger, and Stuart B. Levy. "Triclosan targets lipid synthesis." Nature 394.6693 (1998): 531-532.

8. Levy, Colin W., et al. "Molecular basis of triclosan activity." Nature 398.6726 (1999): 383-384.

9. Schweizer, Herbert P. "Triclosan: a widely used biocide and its link to antibiotics." FEMS microbiology letters 202.1 (2001): 1-7. http://femsle.oxfordjournals.org...

10. McNamara, Patrick J., Timothy M. LaPara, and Paige J. Novak. "The impacts of triclosan on anaerobic community structures, function, and antimicrobial resistance." Environmental science & technology 48.13 (2014): 7393-7400. https://www.researchgate.net/pro...

11. Reiss, Richard, et al. "An ecological risk assessment for triclosan in lotic systems following discharge from wastewater treatment plants in the United States." Environmental Toxicology and Chemistry 21.11 (2002): 2483-2492.

12. Lawrence, J. R., et al. "Resilience and recovery: The effect of triclosan exposure timing during development, on the structure and function of river biofilm communities." Aquatic Toxicology 161 (2015): 253-266. https://www.researchgate.net/pro...

13. Ricart, Marta, et al. "Triclosan persistence through wastewater treatment plants and its potential toxic effects on river biofilms." Aquatic Toxicology 100.4 (2010): http://www.clipmedia.net/galera/...

14. Narrowe, Adrienne B., et al. "Perturbation and restoration of the fathead minnow gut microbiome after low-level triclosan exposure." Microbiome 3.1 (2015): 1. Microbiome

15. Hu, Jianzhong, et al. "Effect of postnatal low-dose exposure to environmental chemicals on the gut microbiome in a rodent model." Microbiome 4.1 (2016): 1. Microbiome

16. Poole, Angela C., et al. "Crossover Control Study of the Effect of Personal Care Products Containing Triclosan on the Microbiome." mSphere 1.3 (2016): e00056-15. http://msphere.asm.org/content/m...

17. Syed, Adnan K., et al. "Triclosan promotes Staphylococcus aureus nasal colonization." MBio 5.2 (2014): e01015-13. Triclosan Promotes Staphylococcus aureus Nasal Colonization

18. Yueh, Mei-Fei, et al. "The commonly used antimicrobial additive triclosan is a liver tumor promoter." Proceedings of the National Academy of Sciences 111.48 (2014): 17200-17205. http://www.pnas.org/content/111/...

19. Veldhoen, Nik, et al. "The bactericidal agent triclosan modulates thyroid hormone-associated gene expression and disrupts postembryonic anuran development." Aquatic Toxicology 80.3 (2006): 217-227. https://www.researchgate.net/pro...

20. Crofton, Kevin M., et al. "Short-term in vivo exposure to the water contaminant triclosan: evidence for disruption of thyroxine." Environmental Toxicology and Pharmacology 24.2 (2007): 194-197. https://www.researchgate.net/pro...

21. Zorrilla, Leah M., et al. "The effects of triclosan on puberty and thyroid hormones in male Wistar rats." Toxicological Sciences 107.1 (2009): 56-64. The Effects of Triclosan on Puberty and Thyroid Hormones in Male Wistar Rats

22. Stoker, Tammy E., Emily K. Gibson, and Leah M. Zorrilla. "Triclosan exposure modulates estrogen-dependent responses in the female wistar rat." Toxicological Sciences (2010): kfq180. Triclosan exposure modulates estrogen-dependent responses in the female Wistar rat

23. Kumar, Vikas, et al. "Alteration of testicular steroidogenesis and histopathology of reproductive system in male rats treated with triclosan." Reproductive Toxicology 27.2 (2009): 177-185.

24. SF 2192 Status in the Senate for the 88th Legislature (2013

25. Kuehn, Bridget M. "FDA pushes makers of antimicrobial soap to prove safety and effectiveness." JAMA 311.3 (2014): 234-234.

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Politics, Propaganda, And Perspective: How Preventive Medicine Pertains

In any political campaign season, fidelity to facts is often sacrificed for the persuasiveness of propaganda. In this campaign season of roiling discontent, that is only all the more so. In particular, the identification of every act of terrorism or violence as a systemic failure of the current power structure is as specious as it is seductive. Preventive Medicine can lend some very relevant perspective.

As a board certified Preventive Medicine specialist, I know full well the major liability of my field. No one gets much credit for what doesn't happen.

There are no tears of gratitude from family members because father or mother, sister or brother did not have a heart attack. There are no cards on your office wall expressing abiding thanks for the stroke that never occurred. No crayon drawings of adulation from children who grow up without type 2 diabetes because of some policy or program. There are no philanthropists eager to support you in any way you ask because you saved their life, or the life of someone they love. Perhaps you did just that, but if you did, they certainly don't know it happened, and you may not even know it yourself.

Such is the thanklessness of prevention, but it's a price well worth paying. The field of Preventive Medicine has brought us cancer screening programs that save thousands upon thousands of lives, and immunizations that save millions. Luminaries in this field are why we need no longer fear such one-time ubiquitous perils as smallpox, and polio. And, of course, in the modern era the relevant efforts continue to address immunization and infectious disease, cancer screening and interdiction, while shifting ever more to an emphasis on lifestyle as medicine in the prevention of cardiometabolic and other chronic, degenerative diseases.

There is a direct analogy between such efforts and their often-unrecognized utility, and the work of homeland security, with all of its reverberations into the current, noisome political campaigns.

Let's revisit immunization. You have surely heard the false contention that vaccines cause autism, and have likely been tempted to believe it. You have doubtless heard the true indictments of the 1976 swine flu vaccine, one tainted batch of which caused cases of Guillain-Barre syndrome. But can you say how many lives have been saved with the MMR vaccine, or the flu vaccine? Can you even hazard at a guess at the ratio of infections prevented, or lives saved, over a given recent decade, to unintended adverse effects?

I am guessing you can't, because I can't, and it's my purview. I could look up the figures, but I don't know them off hand. What I do know is that those ratios are enormously favorable. They are likely in the general domain of millions to one, and reliably well into the many tens-of-thousands to one.

And yet, it's the “one” that makes headlines, and grabs our attention. The number of cases of measles prevented by that vaccine does not make news. The discredited claim that the MMR vaccine causes autism makes news again, and again, and again.

Similarly, we are unlikely to have any idea about most threats of terrorism that never come to fruition. Every now and then we hear about such a threat, interdicted when near to full maturity. But given the nature of prevention, most such crises are surely averted at earlier stages, entirely unconducive to drama. There is no drama, there are no headlines, and we are none the wiser.

We are, of course, unlikely to live in a world where no acts of terrorism take place, now that there are sizable entities with considerable resources dedicated to the perpetration of just such acts. It might be possible to achieve perfect interdiction in a fully militarized state, but the loss of liberty would be far too high a price to pay.

Similarly, we are unlikely to live in a world where civil liberties and privacy are fully unfettered. There are real dangers to contend with here. Were we to renounce all security for the sake of unmitigated liberty for all, we would be taking our lives in our hands at every gathering we attend.

In health and security alike, we are seeking the sweet spot. We are aiming at a ratio of effective prevention to occasional lapse that rightly balances the advantages of interdiction with the costs, sacrifices, and inconveniences with which we are willing to purchase them.

But ratios and balance and realistic compromises are not the stuff of campaign bravado. Nor are they the stuff of headlines, and there are papers to sell and air time to fill every day. Failure of preventive efforts unfailingly gets the spotlight; success is consigned to the shadows.

Consequently, we will certainly know about every act of violence and terrorism that makes it through the existing filters, just as we will know about every screening test or vaccine gone awry. How easy, then, for anyone inclined to demagoguery to point an accusing finger at any evidence of current failure, blame it on those currently in charge, and promise us a world free of it- although invariably without any cogent explanation as to how.

In politics, this is how we tend to roll, and everyone seems to accept it. No doubt far too many are actually persuaded by the captivating combination of misdirected blame, and unsubstantiated promises.

But imagine for a moment if medicine worked this way. With every case of colon cancer, there would be an argument to abandon colon cancer screening altogether since, obviously, it had failed! The occurrence of breast cancer would propagate arguments to abandon mammography, rather than efforts to improve it. Opposing medical factions would blame bad outcomes on one another, and make vague promises about alternative approaches that would provide perfect results. We, the people, would favor first one group, then another, only to be disappointed by each in turn.

Whether in defense of the human body, or of our collective security, the best we can do is the best we can do. It involves tradeoffs between protection of life and limb, and protection of comfort, convenience, and civil liberties.

If inclined to think that someone else should be in charge because those who have been haven't prevented everything bad, ask yourself what you actually know about how much bad stuff has been prevented. The answer, inevitably for those of us without high-level security clearance, is: we don't know much. We might well be living in a world of six-sigma security, yet only know about the one failure in a million.

In my field, news not made by things that haven't happened tends to be what matters most of all. In a troubled, complicated world of terrorist organizations, much the same is apt to be true of our security.

Preventive Medicine invites us to consider the importance of what does not happen, along with that of what does. In so doing, it might help us see past the distortions of political propaganda and false promises of perfect success, to a balanced perspective about balancing priorities, and the best we can do with that reality.

-fin

David L. Katz

Director, Yale University Prevention Research Center; Griffin Hospital
President, American College of Lifestyle Medicine

Senior Medical Advisor, Verywell.com

Founder, The True Health Initiative

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The Midas Throne Row
There is some furor over an exhibit now at Philadelphia's Penn Museum: "The Golden Age of King Midas," showcasing the art of Turkey's ancient Phrygia, a kingdom ruled by Midas in the first millennium BC and known for its superb artistry. Particularly at issue is the curator of the show, C. Brian Rose, suggesting that one of the pieces on display, an ivory statuette known as the "lion tamer" could have been part of the "Midas throne" Herodotos mentions (but never describes) as Midas's gift to Delphi (the Greeks). To date, not even the remains of Midas have been found, although lots of exquisite Phrygian art has been recovered from the so-called "Midas Mound" at Gordion (present day Ankara) and from five tombs to the southwest near the village of Bayindir, with some of the most spectacular objects now on view in Philly through November.

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Lion Tamer

Actually, two pieces in the show that I know of -- there may be more revelations to come -- are now being disputed by archaeologists. And getting it right matters because such objects help us to understand human history. The other object, whose image opens and closes the Penn Museum show catalogue, is a silver statuette thought to be of a "eunuch priest." Phrygian priests traditionally emasculated themselves to honor the Phrygian goddess, Matar Kybele.

"2016-08-03-1470244732-717379-PhrygianSilverPriest.jpg"

Silver Priest

The eunuch priest had its public debut in America 27 years ago in a story I wrote with Turkish journalist Özgen Acar for the December 1989 issue of Connoisseur. The magazine (now defunct) at the time was run by Tom Hoving following his other famous run as director of the Metropolitan Museum of Art.

"2016-08-03-1470245693-9530099-ConnoisseurPhrygiap.1.jpg"

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A little background. . . The art we presented in our above Connoisseur story, experts dated between late 8th century BC and early 7th century BC -- and we interviewed a variety of experts. The pieces were found near present day Bayindir village (ancient Lycia), outside what once were the known borders of Phrygia. But there was a Phrygian presence in the region, including places for travelers and pilgrims to worship Matar Kebele, and Phrygian pottery and metal artifacts had been found in the area prior to the Bayindir discoveries. The Bayindir tombs were also adjacent to a stretch of meadow, considered a resting place for assorted ancient caravans en route to the Mediterranean Sea or making passage over the Taurus Mountains.

As we reported, the Bayindir art was largely considered by experts to be Phrygian in design -- and still is. And because the find was so far to the southwest, the story suggested that the map of ancient Asia Minor might have to be redrawn.

Özgen Acar and I both stand by what we reported then. Özgen has recently emailed me reaffirming:

"I think the Bayindir finds are Phrygian."

I did not have an opportunity to physically examine the Bayindir objects for Connoisseur in the hands-on way I had the Euphronios vases for an Economist magazine story the following year, prior to my coverage of Sotheby's sale of the Bunker and Herbert Hunt collection. Instead, I worked from slides of the artifacts found at Bayindir and from my taped conversations with scholars both here and in Turkey. Frankly, I was astonished by the brilliant artistry upon first seeing the silver pieces showcased in Philly.

Particularly dazzling in design is a belt made of one continuous sheet of metal incised with a four-square repeating pattern that was found in Tumulus D wrapped around the waist of the remains of a 20-25 year old woman (per pelvic bone analysis). The Phrygians loved geometrical design in art, some patterns meant to honor the Phrygian goddess and others intended as puzzles, mazes.

The current row over the two objects mentioned at the top of this story is largely a stylistic one, but, again, one that impacts history. And again, the pieces in question -- both in the Philly show -- are the two statuettes pictured above: (1) an ivory figure known as the "lion tamer" on loan to Penn Museum from the Archaeological Museum, Delphi, Greece, and (2) a silver eunuch priest on loan from the Antalya Museum.

The Penn Museum actually does indicate in its press that the silver priest is from Lycia (Bayindir) even though the object is the star image opening and closing the King Midas Phrygian show catalogue.

Lycia was a culture that was subject to both Near East and Greek influences, and was located in what is now southwest Turkey. It was the home of Sarpedon, the legendary prince depicted both in Homer's Iliad and on the Euphronios krater and wine cup auctioned at Sotheby's for the Hunt brothers (now returned to Italy).

The Penn exhibition also includes pieces found in other ancient cultures that had relationships with Phrygia: Lydia, Urartu, Assyria, Persia, Greece -- perhaps because art historians increasingly take the perspective that art of this period reflects diverse cultural influences as a result of trade, war, marriage and other associations.

But Dietrich von Bothmer, for one, chairman of the Met's department of Greek and Roman art, told me for the Connoisseur article that he clearly thought the silver eunuch priest and other objects found at Bayindir were "purely" Phrygian:

"This is a fabulous discovery. I have never seen anything like it. Each and every piece is of purely Phrygian type."

Oscar White Muscarella, who was early on part of the Gordion excavation team and for decades an Ancient Near East (ANE) expert at the Met, dated the Bayindir tombs at the time of our story late 8th to early 7th century BC -- in concurrence with a 2,000-page computer analysis of fibulae (ancient pins), some of which were found with the remains of the young woman in Tumulus D wearing the silver belt.

Muscarella has more recently told me: "Von Bothmer knew nothing about Phrygian art," saying further that he plans to review the objects presented in the Connoisseur story, claiming pieces may be East Greek. He has already expressed doubts in print about the silver eunuch priest being Phrygian.

We await Oscar Muscarella's further analysis. . .

However, it is the ivory "lion tamer" about which scholars are most divided and the reason is this. The claim has been made by Brian Rose, who also heads the Gordion excavation in Tukey for the University of Pennsylvania, that the piece is Phrygian, late 8th century BC. And in a 2012 article: "The Throne of Midas? Delphi and the Power Politics of Phrygia, Lydia, and Greece," which is based on an unfinished paper by University of Pennsylvania professor and museum curator Keith DeVries, Rose establishes his claim that the lion tamer may be a piece of the Midas throne Herodotos mentioned.

Brian Rose recently emailed me from Gordion, where he is digging for the summer, saying that he stands by the 2012 story:

"Thanks Suzan. I've written about this with Keith DeVries in 2012, and we still stand by that."

Other ANE experts say the link between the Midas throne and the ivory lion tamer seriously lacks evidence and is a distortion of history as well as commercial hype, partly to sell tickets to the Penn Museum show, which has been ongoing since early February.

There was, for example, a black tie "Golden Age of King Midas Gala" six months ago at Penn Museum where (tax deductible) tickets sold for $50,000 (premier sponsor), $25,000 (prime sponsor), $10,000 (sponsor), VIP ($1,500), $500 (individual).

However, the Rose/DeVries perspective is supported by Athanasia Psalti, director of the 10th Ephorate of Prehistoric and Classical Antiquities, Delphi, Greece -- even though a web site that seems to belong to the Archaeological Museum of Delphi indicates that the lion tamer it calls "Master of the Beasts," is from a "workshop in Asia Minor, but is the work of a Greek artisan as indicated by the meander on the base (7th century B.C.)."

A. Psalti recently emailed me saying that she stands by what she wrote when the lion tamer was part of the Met show "Assyria to Iberia," that is, she thinks DeVries/Rose "convincingly" make the case that the piece is from a workshop in Phrygia (also, in said Met show was an ivory statuette probably depicting Kybele, that made its American debut on page 2 of our above Connoisseur article, although neither the Met nor Penn Museum cites our story in its literature):

"Dear Suzan, you may consult the catalog entry of the exhibition Assyria to Iberia, at the Dawn of the Classical Age, edited by Joan Aruz, Sarah B. Graff and Yelena Rakic, New York, 2014, p. 308, nr. 180 with previous references as well as the attached article on the same subject. Should you need any further help, do not hesitate to contact me.

Athanasia"

The Metropolitan Museum of Art catalogue says the following:

"Initially attributed to a Greek artist under strong Near Eastern influence, more recently the figurine has been convincingly suggested to have originated from a Phrygian workshop. It has also been proposed that this unique object was made as a decorative attachment for the magnificent throne of Midas. . . ."

Those experts contesting the Rose/DeVries claim were all once part of the Gordion team: Oscar Muscarella; Ken Sams -- one of three archaeologists who Rose acknowledges as being "responsible in some way for the content" of the current King Midas exhibition and pictured in the Penn Museum show catalog; and Elizabeth Simpson -- a professor at Bard Graduate Center who is director of the Gordion Furniture Project as well as a consultant to Penn Museum.

Muscarella points out in a recent article, "An Ivory Statuette from Delphi---Not from King Midas's Throne," that DeVries's claim that the object was part of the Midas throne was made in January 2002 in articles in the New York Times, Philadelphia Inquirer and Christian Science Monitor (in that chronological order) and in Voice of America, February 2002. DeVries has since died.

Muscarella told me he questions why those news organization would publish the DeVries claim, didn't they do their own assessment of the piece? He's also told me that he contacted the Times about its coverage but got no response.

In his above-mentioned article, Muscarella notes further that the facial features, in particular, of the lion tamer are clearly not Phrygian:

"Although it could be argued that stylistic analysis is in the end largely subjective, even a cursory look at the items compared shows no components of the Delphi figure's face (mouth, eyes, etc.) or hair reflect Phrygian features."

I did spend some time examining the hair on the ivory lion tamer while in Philly because the room was dimly lit. Muscarella is right about the lion tamer's hair not have the interesting texture depicted on other Phrygian art from Gordion and Bayindir.

Ken Sams, who is now a professor of classical archaeology at the University of North Carolina, Chapel Hill, recently emailed me commenting:

"The ivory piece from Delphi, currently on display at the University Museum in Philadelphia, is assuredly not Phrygian [emphasis added], in my opinion, but the product of a west Anatolian or East Greek workshop. The meander is found in Phrygian furniture, but it came to be such a widely used motif that one cannot use it to determine origin. It is a strange piece that I have wondered about for years. The lion, for whatever reason has an erection, for which I know of no parallels."

Muscarella further advised by phone regarding the lion:

"That is not an erection!"

Elizabeth Simpson emailed these salient points to me regarding the lion tamer:

"Have you read Brian Rose's 2012 article in The Archaeology of Phrygian Gordion? His comparanda is not convincing[emphasis added], and it is generally acknowledged by colleagues that there is no evidence [emphasis added] that the ivory Lion Tamer statuette is Phrygian in style per se.

The Delphi Museum's posted description [you emailed me] is much more accurate than Rose's contention. Do you know if the Delphi Museum post is official? Is this what the museum label for the Lion Tamer says? Can you please let me know? I am curious.

In terms of the meander design on the base (which is published upside down in Rose's article), this exact pattern is not found on any Phrygian furniture that I know of, and the cross-within-a-square is particularly unusual in that regard.

In terms of form and joinery, the piece was recovered in fragments and has been restored; not all of it is preserved, and I have not seen the bottom of the base. There is a mortise (square cutting) in the back of the figure, but it is shallow, suggesting that the Lion Tamer was not a structural element but decorative. I am not sure how or where the Lion Tamer would have been attached to whatever it once belonged to.

Apart from the style of the ivory figure, the pattern on the base, and its form and joinery, however, one must consider whether the Lion Tamer is from a piece of Phrygian furniture at all -- and whether there is any evidence that it "is" or "may be" from Midas's famous throne.

1. First, a large collection of Phrygian royal furniture survives from the tombs at Gordion, and none of it has carved figures as elements, let alone ivory figures of this sort. You can see what the Gordion furniture looks like from my publications, particularly my 2010 Brill book on the furniture from Tumulus MM (in the MMA library, the Bard Graduate Center library, and elsewhere). A brief summary and bibliography can be found in the Wikipedia article:
https://en.wikipedia.org/wiki/Gordion_Furniture_and_Wooden_Artifacts

Although there are no "thrones" from the Gordion tombs, there was a small chair in Tumulus MM, but it has no carved human figures -- only a crest with small animals in panels carved in relief.

There were ancient Near Eastern thrones that had carved human figures (or deities) as elements, but there is no evidence of this from Phrygia. Such figural elements occur initially in the third millennium B.C., and they are found later in Assyria, Urartu, and elsewhere in the first millennium B.C.

Ivory attachments of various types are well known from the second and first millennia in the ANE [Ancient Near East], but ivory attachments are not found on the royal furniture from the Gordion tombs. Several small, square ivory plaques were excavated in association with wood fragments from Megaron 3 on the City Mound at Gordion, but the figures carved in relief on these plaques are Phrygian in style, like those on the crest rail of the chair from Tumulus MM -- and bear no stylistic resemblance to the Lion Tamer from Delphi. You can read about ANE furniture in my article, "Furniture in Ancient Western Asia," here attached.

Rather, the design and decoration of Phrygian royal furniture involved the abstraction of three-dimensional forms, and elaborate inlaid geometric patterns with complex symmetry, including mazes, apotropaic and religious symbols, and "genealogical patterns." Phrygian furniture seems to be completely different from its eastern counterparts. The examples we have are made of wood, typically boxwood inlaid with juniper and walnut, which survived in relatively good condition in several tombs at Gordion.

So, the ivory Lion Tamer is in no way characteristic of Phrygian furniture, in terms of extant evidence. In fact, it looks completely unrelated in this regard.

2. Second, might the Lion Tamer have come from the throne that Midas dedicated in the sanctuary of Apollo at Delphi? Although I suppose it is remotely possible, there is absolutely no evidence for this contention. As already discussed, there is no evidence that the statuette is actually Phrygian, although it may have been made somewhere in Anatolia. And carved figures of this type are not found on Phrygian royal furniture as we know it.

But let's just imagine that Midas did have a throne with carved figures on it. Maybe he imported it from Urartu or Assyria. Even if that were the case, there is no evidence that this particular carved figure came from it [emphasis in original]. Indeed, the Lion Tamer does not look either Assyrian or Urartian, and it is hard to tell exactly where it was made or what it was once attached to.

I do not doubt that Herodotus saw a throne at Delphi that he believed was dedicated by King Midas [Herodotus 1.14). Unfortunately, he does not describe it.

I gave a lecture on April 2, 2016, at the Penn Museum at the conference, "The World of Phrygian Gordion," in which I said all these things. Brian Rose was in attendance, as the convener of the conference. He heard what I said and appeared to acknowledge the cogency of my argument. Nonetheless he continues to stand by his 2012 article.

Oscar[Muscarella]'s source article on the Lion Tamer is very good on the various issues. I also plan to write an article on "Midas's Throne," as it is important that Rose's article not stand unchallenged."

Following is one bronze object found at Bayindir in Tumulus C and now at Antalya Museum that has been suppressed, except for mention on page 2 of our above Connoisseur story, where we describe it as "a ring of phallus-shaped knobs probably made as a fertility symbol":

"2016-08-04-1470269758-3429103-PhrygianfertilityringAntalyaMuseum.jpg"

Phrygian or East Greek?

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