Sunday, August 24, 2014

Dare to Disagree

"Understand, testifying to Congress is a bit like speaking to a senile aunt. They may hear you, but they just mutter something like "Whatever you say, dear," and go back to their soap opera"

Two years ago a TED Talk by Margaret Heffernan garnered 1,819,512 views, and well it should. Heffernan began her story by telling about a person whose acquaintance we shared, Dr. Alice Stewart (1906-2002)

Our first experience with Alice goes back to 1977, when she testified before a House Committee that was looking into the health effects of radiation from nuclear power plants. The Rogers Committee and had called Alice, her co-worker George Kneale and Dr. Thomas Mancuso to testify about their epidemiology study of the Hanford plutonium workers.

Also testifying that day were Drs. Rosalie Bertell and Irwin Bross, who conducted the Tri-state Leukemia Survey that linked in utero x-rays to childhood mortality and Dr. John W. Gofman, one of the co-discoverers of U-233, whose funding at Livermore National Laboratory was suspended when he revealed the world about the likely cancer and genetic consequences of the nation's rush to nuclear power.

All of these people would become friends of ours, some closer than others, but we took the opportunity while in Washington to bike down Constitution Avenue and attend the testimony Alice gave later that same day to the National Academy of Sciences.

Understand, testifying to Congress is a bit like speaking to a senile aunt. They may hear you, but they just mutter something like "Whatever you say, dear," and go back to their soap opera. Stewart, Kneale and Mancuso were received politely by the Congressmen, but apart from making a public record for the sake of history, nothing would come of it.

Down the road at the NAS it was a different story. The knives were out as soon as Alice had finished her opening statement. She was making waves not just in the world of electric power generation, but in the world of medicine and science. She was prepared to demonstrate, and to defend, strong findings that at even the most infinitesimally small doses, exposure to ionizing radiation carries an inexorable risk of mortality. There is no safe dose. She knew it. She could prove it.

The reason Alice Stewart was not afraid was because she had George Kneale.

George was completely ill-suited for the role he found himself thrust into that day; sitting beside Alice before both Congress and the NAS. A tall and heavy-set Brit resembling an unkempt Stephen Fry in a second hand suit, he gave us the impression, when we first spoke, of being marginally autistic, a savant perhaps, but a man who would not hold your eye and would much prefer he were somewhere far away.

Tom Mancuso, a full professor at the University of Pittsburgh at the time, was more like a pugnacious, union shop floor boss, someone who was not afraid to tussle for the rights of his workers if it came to it. Stewart, the medical doctor of the three, seemed weary, as if this experience had happened too many times before, and she knew it was all a colossal play for time — purchased at the cost of real children's lives, in very large numbers.

According to Stewart's telling at the Right Livelihood Awards ceremony in 1986, Kneale had two major contributions to biostatistics while he was still a young man advancing his degrees at Oxford. The first was to discover a way to isolate the confounding variable of death from pneumonia or other secondary infections by way of an impaired immune system (which is more than 300 times more likely to be fatal in children exposed to radiation) from death by leukemia within 5 years following radiation exposure.

Kneale's second achievement, some years later as he began studying radiation workers, was his proof that resistance to cancer from radiation is exceptionally high in men at 20 years of age, but by 50 years it may be no greater as it was shortly before birth.

Stewart first came to prominence as the first woman admitted to the UK Association of Physicians and the youngest ever admitted to the Royal Academy. During World War II she investigated the effects on workers of exposure to TNT in munitions factories, the effects of carbon tetrachloride, and the mysterious prevalence of tuberculosis among workers in the boot and shoe industry.

Heffernan tells Alice's story this way:
[Alice] was unusual because she was really interested in a new science, the emerging field of epidemiology, the study of patterns in disease. But like every scientist, she appreciated that to make her mark, what she needed to do was find a hard problem and solve it. The hard problem that Alice chose was the rising incidence of childhood cancers. Most disease is correlated with poverty, but in the case of childhood cancers, the children who were dying seemed mostly to come from affluent families. So, what, she wanted to know, could explain this anomaly?
Now, Alice had trouble getting funding for her research. In the end, she got just 1,000 pounds from the Lady Tata Memorial prize. And that meant she knew she only had one shot at collecting her data. Now, she had no idea what to look for. This really was a needle in a haystack sort of search, so she asked everything she could think of. Had the children eaten boiled sweets? Had they consumed colored drinks? Did they eat fish and chips? Did they have indoor or outdoor plumbing? What time of life had they started school?
And when her carbon copied questionnaire started to come back, one thing and one thing only jumped out with the statistical clarity of a kind that most scientists can only dream of. By a rate of two to one, the children who had died had had mothers who had been X-rayed when pregnant. Now that finding flew in the face of conventional wisdom. Conventional wisdom held that everything was safe up to a point, a threshold. It flew in the face of conventional wisdom, which was huge enthusiasm for the cool new technology of that age, which was the X-ray machine. And it flew in the face of doctors' idea of themselves, which was as people who helped patients, they didn't harm them.
Nevertheless, Alice Stewart rushed to publish her preliminary findings in The Lancet in 1956. People got very excited, there was talk of the Nobel Prize, and Alice really was in a big hurry to try to study all the cases of childhood cancer she could find before they disappeared. In fact, she need not have hurried. It was fully 25 years before the British and medical — British and American medical establishments abandoned the practice of X-raying pregnant women. The data was out there, it was open, it was freely available, but nobody wanted to know. A child a week was dying, but nothing changed. Openness alone can't drive change.
So for 25 years Alice Stewart had a very big fight on her hands. So, how did she know that she was right? Well, she had a fantastic model for thinking. She worked with a statistician named George Kneale, and George was pretty much everything that Alice wasn't. So, Alice was very outgoing and sociable, and George was a recluse. Alice was very warm, very empathetic with her patients. George frankly preferred numbers to people. But he said this fantastic thing about their working relationship. He said, "My job is to prove Dr. Stewart wrong." He actively sought disconfirmation. Different ways of looking at her models, at her statistics, different ways of crunching the data in order to disprove her. He saw his job as creating conflict around her theories. Because it was only by not being able to prove that she was wrong, that George could give Alice the confidence she needed to know that she was right.
It's a fantastic model of collaboration -- thinking partners who aren't echo chambers. I wonder how many of us have, or dare to have, such collaborators. Alice and George were very good at conflict. They saw it as thinking.
So what does that kind of constructive conflict require? Well, first of all, it requires that we find people who are very different from ourselves. That means we have to resist the neurobiological drive, which means that we really prefer people mostly like ourselves, and it means we have to seek out people with different backgrounds, different disciplines, different ways of thinking and different experience, and find ways to engage with them. That requires a lot of patience and a lot of energy.
And the more I've thought about this, the more I think, really, that that's a kind of love.
Because you simply won't commit that kind of energy and time if you don't really care. And it also means that we have to be prepared to change our minds. Alice's daughter told me that every time Alice went head-to-head with a fellow scientist, they made her think and think and think again. "My mother," she said, "My mother didn't enjoy a fight, but she was really good at them."
So it's one thing to do that in a one-to-one relationship. But it strikes me that the biggest problems we face, many of the biggest disasters that we've experienced, mostly haven't come from individuals, they've come from organizations, some of them bigger than countries, many of them capable of affecting hundreds, thousands, even millions of lives. So how do organizations think? Well, for the most part, they don't. And that isn't because they don't want to, it's really because they can't. And they can't because the people inside of them are too afraid of conflict.
Because we are the kind of species we are living in the world we inhabit, ethical choices are absolutely incumbent upon us, every day. Our larger task, as sentient life-forms, is to steward that which is placed in our care, nourish it if it is well, restore it to health if it is ill, and then safely pass it along to responsible successors in the next generation.

We are, by virtue of our genetic heritage as herd animals, required to look out for our kin. As we allow our consciousness to expand, as it must, we extend the definition of kin out to all our relations; those with two legs, four legs, eight legs, wings, fins, shells, roots in the ground and taxa beyond number. All our relations. We need them, they need us. It is because they have worth that we have worth.

This is something Alice and George understood very well. They knew they would not be welcome in the lions' den. They knew their seminal works would be challenged on the size of their statistical sample, on the unorthadoxy of a superlinear dose response curve (lower doses are more deadly than higher because they mutate rather than kill cells) and, far worse, go unheeded while thousands perished from lax regulations of these insidious new poisons.

Alice knew John Gofman was right that nuclear power would kill millions of people from legally permitted emissions, even with no accidents (although accidents happen every day). She knew Rosalie Bertell was right about the cause of a childhood epidemic in x-ray-caused leukemias in New York, Pennsylvania and New Jersey. She knew all of that could have been prevented if people like those who sat across the table from her at the National Academy — those whose decisions set the standards — would have the courage to choose to act.

It is not as thought they just sat, though. Those who listened to her two public talks that day in 1977 and had authority to take action did. They cut her research funding. When she received the Right Livelihood Award in 1986 she used the small amount of money that came with that to restore funding to yet another of her studies that was being defunded, an investigation into the potential health damage caused to fetuses by ultrasound.

Before she died in 2002, Stewart told The Guardian:
"'Good people are seldom fully recognized during their lifetimes, and here, there are serious problems of corruption. One day it will be realized that my findings should have been acknowledged.'"

"'Plants get all their energy from the sun and so should we,' she would say. Then she would smile wistfully, for she knew how very long that learning curve might be."

Given this pattern of lopping the heads off anyone who tries to warn of danger, it is a wonder why anyone bothers to speak up the way Alice and George did. We know the territory all too well from working on chronically underfunded but incredibly significant projects, and having done so for most of our lives. Occasionally some allies take notice and help us down the path a bit further. Other times we just have to tough it out or hole up until we find the support to make it to next stages of our research.

This week we published a collection of our essays that appeared on this site from 2008 to 2014 and were selected by our readers as most popular. These are our biggest hits. They are now a free download for members of Kindle Unlimited, and $1.99 to everyone else. It is our hope that the collection will generate enough sales to get us to our next stop, which is the North American Permaculture Convergence in Minnesota over Labor Day weekend. We have been invited there to speak on the subject of the state of permaculture in 2014, but they don't provide expenses or honoraria.

Our feelings about permaculture is that it is a useful framework, a multiplier for energy efficiency, but all by itself does not pay the rent. It may be ethical but it is not always economic, and therein lies its greatest challenge — macroeconomic reform to account for neglected externalities like coral reefs, social justice and children with leukemia.

It's worth having that conversation. We are hoping enough others agree to make it possible. So far, enough people have bought our new book, Pour Evian on Your Radishes,
in the first 24 hours to push it to the ninth best seller of Kindle's collected essays category.  

The last image in the book is a photograph of a handmade protest sign. In a dusty rural village in Mexico we happened upon this, stapled to a picket fence. The wind was blowing, so we had to reach out and hold it to the fence while we took the photo. 

The sign says, "If you want justice, don't have fear. If you want peace, don't be of faint heart."


Unknown said...

Excellent article, Al,thank you. 4323

k-dog said...

A great article. Raised as most of us are to believe that conflict is to be avoided we wind up destroying the world by a thousand small cuts. Pointing out the fatal externalities of avoiding disagreement and conflict this article does great a service.

Thank You !




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