Science Talk August 23, 2006 -- Scientific American Magazine Single Topic Issue—"Energy's Future Beyond Carbon"; Well-Read Doctors.
Welcome to Science Talk, the podcast of Scientific american for the seven days starting August 23rd. I am Steve Mirsky. This week on the podcast, we're going to talk about a proposal for a sweeping new set of requirements for admission to medical school that I think you'll find interesting. The idea has come from Christopher Cowley who's on faculty at the School of Medicine at the University of East Anglia in England. We'll also quiz you about some recent science in the news. And first up, Editor in Chief John Rennie to talk about the annual special single-topic issue of Scientific American magazine.
Steve: Hey John. How are you doing?
Rennie: Hi Steve; just fine, Thanks.
Steve: So, we're going to get to the single topic issue in a moment, but first tell everybody about your weekend; you had an interesting weekend.
Rennie: Yes I did. I and my wife, Jennifer, went out to Los Angeles because she had been nominated for an Emmy award for her work as an editor on the History Channel program Rome: Engineering an Empire; and I am delighted to say that she won that Emmy.
Steve: She won the Emmy!
Rennie: That's right. She is my Emmy-award winning wife, Jennifer Honn.
Steve: That is really cool.
Rennie: Very exciting, definitely.
Steve: And you know, I think it's just viable to talk about it on the Scientific American podcast because this is a whole separate Emmy awards from the ones that people associate with the actors and the directors. These are really the technical Emmys.
Rennie: Yeah, that's a big part of that. I mean, some other sorts of awards were given as well, but that's right—a lot of it is the paying tribute to the technical side of what makes good television possible.
Steve: So Jennifer won. Now, how—this is what I've always wanted to know, because the Emmy is this heavy metal object with a lot of sharp edges.
Steve: So how do you get it through security to take it back to New York from Los Angeles?
Rennie: That's a very important point; and I think that's why a lot of people logically—just in the industry, and by the industry, I mean business...
Steve: ...of course...
Rennie: ...of course—they live around Los Angeles because, of course. they couldn't just possibly leave. Now this was [a] real question given the tightened airline security these days. We decided not to risk trying to bring the Emmy back for fear that we [would] have to [just]
this, you know, leave it in the garbage beside all the bottles of water and thrown away makeup bags.
Steve: The Emmy
M missed it then?
Rennie: (laughs) Yeah. No. So we decided to have it shipped back to us by some friends.
Steve: Well congratulations to Jennifer and let's talk about Scientific American single topic issue, the subject is ...
Rennie: This year, our theme is "Energy's Future Beyond Carbon".
Steve: Energy's future beyond carbon. Now...
Steve: ...am I going to really be interested to read eight articles about that?
Rennie: Oh! I think you are Steve, and first of all.
a[the] way I'm working.
Rennie: (laughs) Well that is true, and I command you to read it. But I think other people would also find this fascinating because the fact is that it brings together two important subjects of energy, which of course is very much in the news; and the problems with shortages of energy but also the issues related to global warming. I mean, I guess, here's the way I tend to look at the issue. The good news is that when we look right now at the problems with gasoline shortages and high prices and so forth, sometimes people worry, are we running out of energy? Well the good news is no, we're not running out of energy at all, we['ve] got tremendous options out there. We have mountains of coal we haven't tapped into, there is solar energy; there is wind; there are various things you can possibly try to do in nuclear energy; lots of different options. All of that amounts to the idea that there is no shortage of energy; that we can get to a lot of those energy technologies [that] aren't developed. But of course if you have confidence in how markets work, then over time, then a lot of those kinds of fairly new technologies will come along, and they'll all reach a point where they'll be able to provide energy at affordable prices. So that's the good news.
Steve: The bad news?
Rennie: Well the bad news is that unfortunately because of global warming considerations, we are on a timetable. Right now, we are pumping out about seven billion tons of carbon into the air every year. In about 50 years that'll probably rise—if we don’t do anything different—to about 14 billion tons. The problem is that by that time, we would then have started to double the amount of carbon dioxide in the atmosphere above what it was at pre-industrial levels. And the real concern that at that point you start to get not just severe global warming effects, but you start to see kind of an irreversible trend. So for example, the Greenland icecap starts to go away; that's what we have to try to avoid. So when, in fact, we have to try while still getting all of the energy that we need, we also need to start cutting back on our carbon emissions, and we have to start doing that right away because every year that we delay we are pumping that much more carbon dioxide into the atmosphere and getting closer and closer to those thresholds. So the longer we delay, the more drastic those carbon dioxide savings have to be down the line, and that's sort of the problem with the argument. Sometimes you hear people say, "Well, you just have great faith in other technologies that have going to come along." We have great confidence in those technologies too, but it's not realistic to think that they're going to be able to solve the problem if we have to wait too long.
Steve: One of the things I noticed, in looking at the table of contents, is that you have all the wind and solar kind of treatments that you would expect in the commie pinko magazine that we are according to some people. But you also have treatments of nuclear energy and coal energy; I mean, you really are looking at everything here.
Rennie: Right. The fact is
w[t]hat for reasons that are spelled out in the issue, it is again more good news. It's reasonable to think that we can actually do this; that if we use our technological resources wisely, we really can manage to head off the worst kinds of problems that could be associated with global warming; but it's not going to be a matter of just one magical technology. It's not like we can just build plenty of nuclear reactors and the problem goes away. It is not just a matter that if we started to use lots of coal gasification techniques [in] which your burning coal , which[and] you pull in the carbon dioxide out before it goes into the atmosphere—you can't just rely on those. What we have to do is stack up lots of different technologies and the contribution they make toward saving us carbon dioxide; and that's what will help us get there.
Steve: It's a war that has to be fought on many fronts ...
Rennie: Absolutely, yes.
Steve: ... simultaneously. One of the things I saw as I leafed through the magazine is just a little bit of a treatment about the fact that for anybody who complains about the cost of some of these things, you also have to always consider the cost of not doing these things.
Rennie: Well that's right. It's very easy to point at the cost that will be associated with shifting to a very different energy infrastructure. But, one, you've got the cost that would be associated with the global warming consequences of flooding and so forth and changes in growing seasons.
Steve: And disease.
Rennie: And disease. And all of these kinds of things are very, very disruptive. You know, another point is that even if you put aside those kinds of consequences, the fact is that you are always investing in your energy infrastructure anyway; so for example there are very expensive things you could do that would be involved in trying to change how electricity is distributed across the country to help along, you know, [a] hydrogen based economy. Those would be very expensive changes to make, but the fact is you are also still putting in about two-thirds that same amount just to keep up the infrastructure that we have now, so these costs really always have to be put in the right context.
Steve: Good stuff John. That's the September issue of Scientific American;
a[it']s the single topic issue.
Rennie: "Energy's Future Beyond Carbon".
Steve: Thanks John. Hey give yourself a bell there.
Rennie: That is nice.
Steve: You can check out the single topic issue of Scientific American at our Web site, www.sciam.com. Our 2002 single topic issue on time won the national magazine award that year. You can access that entire issue at our digital archive, www.sciamdigital.com.
Now its time to play TOTALL.......Y BOGUS. Here are four science stories, but only three are true. See if you know which Story number is TOTALL.......Y BOGUS. !
Story number 1: Periodic awakenings during hibernation allow animals to raise dangerously low body temperatures.
Story number 2: There are more species of venomous fish than venomous snakes.
Story number 3: The winner of a Fields Medal for mathematics inexplicably stayed home in Russia rather than accept the award.
And story number 4: Man
is st ruck in wad of chocolate [is] saved by cocoa butter.
We'll be back with the answer. But first, some well-known writers have been doctors—Somerset Maugham and Anton Chekhov come to mind.
by Christopher Cowley of the School of Medicine at the University of East Anglia thinks that all new medical students should at least have read some literature, if not actually written it. I called him at his home in England.
Steve: Dr. Cowley, great to talk to you today.
Cowley: Thank you.
Steve: You have this piece in a recent issue of Journal of Medical Ethics and it is called "Five Proposals for a Medical School Admission Policy". Now I want to make
you clear, first of all, that this is really directed at [a] British audience in terms of the medical education there, but I think some of it is probably applicable to the situation in the U.S. and perhaps around the rest of the world as well. One quick thing; lets get this out of the way, right away, apparently—and I didn't know about this—the age of your medical students in England is different from that in the United States; is that right?
Cowley: Yes, that's true. That's not actually a British phenomenon, but most of Europe actually lets students begin at the age of 18.
Steve: Now let us talk about some of the proposals in your article. The first proposal is that all medical students should have a very high level of education in humanit
y[ies]. So, rather—we're very science heavy, you know, medical education and medical and premedical education here—but you want them to have a good background in the liberal arts of humanities.
Cowley: That's right. In the British system, we have these things called the A-levels, and at the age of 16 you specialize in three subjects. This is, again, not in like America. So most people who want to become doctors are told by the guidance counselors at the age 16 to choose three sciences, that this maximizes your chances and most medical schools in Britain will insist at least on biology and chemistry as two of those A-levels. And my suggestion is that the third A-level—i.e., a minimum of one A-level—should be humanit
y[ies] or social science; and I am interpreting that very broadly to include English literature, drama, history, religious studies, politics; anything that works with text and with people. And the point is that this will make them better rounded going into medical school.
Steve: And why—this may seem like a silly question—but why do we need better rounded doctors? Why shouldn’t they just be experts in the science?
Cowley: Well it depends. The big question here is what is [a] good doctor? And that is a larger debate; this is only a small part of it. My belief is that being a good doctor is certainly a science, and I am certainly not proposing that the science be reduced in content at all. My proposals are but a supplement and not a replacement. The science is very important, but it is also a human relationship. It's also a relationship with patients who are weak and vulnerable. and it is very important for the doctor to understand, to empathize, to imagine what its like to be in the patient's shoes.
Steve: Now your second proposal you want extra points, even more credit, if that excellent background is in English literature specifically.
Cowley: It is English literature that forces the student to take the individual characters seriously as individuals and this allows them to make sense of patients as individuals. Now of course none of this is a guarantee. I am suggesting that it'll improve the chances somewhat that a doctor will be able to empathize with the patient, will be able to imagine how the world looks in the patient's point of view. And this also has a repercussion in ethics. Now there has been lot of talk about ethics, and my own job is to be the lecturer in ethics in our medical school, and a lot of medical schools have come a long way in teaching ethics. Now I think that they don't—that the students with the scientific background are not sufficiently primed to
guess[get] as much out of the education in ethics and in the other social sciences without this social science background; and they are not as primed to get as much out of the ethics without on[a] disciplinary background. This ethics ultimately is about one individual and another individual trying to sort out difficult situation[s] and that means understanding different points of view ing.
Steve: Point number three in your list of proposals is a minimum age of 23; and you point out that in the U.S., that's sort of a de facto situation because the typical U.S. medical student has already completed an undergraduate degree.
Steve: But in England it would be different; and you would like just the kids to have been seasoned a little bit more, to have aged a little bit more prior to their entrance into medical school.
Cowley: I would make an age requirement such that it would force even the American graduates to work for one or two years after graduation, so that they see something of their real world. It's not only about being seasoned, it's also about being able to understand what ordinary jobs are like, what's its like to work in an office, in a boring job for a weekly or monthly pay packet, work with people you don't like, work for a boss you don't like; and therefore come
s back to understand the patients who are in these sorts of drudgery, these sorts of boring jobs.
Steve: And that gets us right to proposal number four which is you would like a full years' experience in a healthcare or charitable organization.
Cowley: Yes. I think, this is—actually along side the age criteria—maybe this one is the most important. It's the thought of giving medicine a go first; now you can't be a surgeon for a year obviously, but you can work with vulnerable people, and this means working for a full year full time, so 40 hours a week, probably for a mere pittance if not in an involuntary sector for nothing. And just realizing that it's not that glamorous as it might seem on TV.
Steve: Let's also talk about your last proposal, which is you'd like to change
this[the] structure of the medical school interview.
Cowley: Well there were two aspects to my proposal. One is a consultation by literature, the other is a consultation about health politics. We publicize in advance a list of possible books to talk about and health political issues to talk about. Best example of a book is The Death of Ivan Ilych by Leo Tolstoy. This is the story of a very slow death of the narrator. The point is, in the interview, both the interviewer and the interviewee would have read the same book, the discussion would then go off in any number of direction[s]; and it's about whether the applicant can understand the issues, can understand the narrator. To health politics, this would be a number of issues in politics, because I don't think doctors are aware enough of politics. And in this country healthcare is becoming more and more political and decisions are being made by politicians and managers; and doctors themselves are complaining about these decisions, but are themselves sufficiently not interested or engaged, and I don't think they can afford to be disinterested, uninterested anymore.
Steve: You published this article at the end of July. What kind of response have you been getting?
Cowley: The response has been mixed, as I anticipated. There is a large group of doctors and medical students who just laugh it off. It's a non-medic who doesn't understand and yes, yes, yes, wouldn't it be great
with[if] all doctors could quote Shakespeare, but wouldn't it be a little better if they actually knew how to use a scalpel? Some doctors have been sympathetic to some of the ideas. One common response is to say that healthcare is a very broad church that has lots of room for lots of different types of people.
Steve: Isn't it in a way
of[a] false choice? Can't we have physicians who can use a scalpel and quote Shakespeare?
Cowley: Yes, I am optimistic to think that both are possible; but it also comes down to this basic question: What is a doctor? What is the job of a doctor? What is a good doctor? And I cannot help but see medicine as primarily [a] people-oriented profession rather than a science; though it has scientific tools of great sophistication, [it]
but is not primarily a science.
Steve: Dr. Cowley, very interesting. Thank you so much for talking to us.
Cowley: My pleasure.
Steve: You can read Christopher Cowley's entire Journal of Medical Ethics article about new admission standards for medical students at tinyurl.com/nlkns.
Now its time to see which Story number was TOTALL.......Y BOGUS.
Let's review the four stories
Story number 1: Hibernating animals periodically awaken to raise their body temperature.
Story number 2: Venomous fish species outnumber venomous snake species.
Story number 3: Fields Medal winner passes on the award.
And story number 4: Man stuck in chocolate saved by cocoa butter.
Story number 4 is true. In last week's most delicious near tragedy, a worker in [a] Kenosha, Wisconsin chocolate factory was stuck in a 110 degree vat of a dark chocolate so viscous that only mixing it with cocoa butter allowed the worker to finally be pulled free after more than two hours. No word on if you yell fire, because nobody would have come if he yelled, chocolate. It's an old joke.
Story number 2 is true. Researchers at the American Museum of Natural History estimate
s some 1,200 species of venomous fish based on DNA and anatomic studies. Their paper in the Journal of Heredity notes that the fish does make up the bulk of the 2,000 species of venomous vertebrates; about 500 snake species are poisonous.
And story number 3 is true. Grigory Perelman won a Fields Medal—often called the Nobel Prize of math—for his solution to the Poincaré conjecture, which deals with properties of spheres, but he never showed up at the ceremony in Spain. He may be ticked off at the rest of the math community for some reason; or as one colleague put it, his decision may not have any logic behind it at all, ironically. You can read more on our Web site, sciam.com, in the article called "Reclusive Genius Shuns World's Top Math Prize".
All of which means, that story number 1 about hibernating animals waking up to raise their body temperatures is TOTALL.......Y BOGUS. Because new research just reported at the Ecological Society of America meeting indicates that some hibernating animals wake up as a defense against bacterial infections. Antibody production is stopped during hibernation and the regular wake-up calls may be to kick start the immune system.
Well that's it for this edition of the Scientific American podcast. Our e-mail address is email@example.com; and also remember science news [is] updated daily on [the] Scientific American Web site, www.sciam.com; and don't forget the September special issue, the single-topic issue of the Scientific American mMagazine, "Energy's Future Beyond Carbon." For Science Talk, the podcast of Scientific American, I am Steve Mirsky. Thanks for clicking on us.