Greta Christina's Blog

Born or Learned? Sexuality, Science, and Party Lines

When I first came out into the gay community, one of the most common party lines going around was, "Gay parents aren't any more likely to have gay kids than straight parents." Some of the big political battles being fought at the time had to do with gay parenting, and the community was trying to reassure/ convince the straight world that it was "safe" for gay people to have and raise kids, that our kids wouldn't be any more likely to be gay than anyone else's. (Of course, many of us personally thought, "So what if our kids turn out gay? There's nothing wrong with being gay, so why does it matter?" But we knew the straight world didn't feel that way. Hence, the line.)

Not too long after that, I started hearing the party line, "Being gay isn't a choice -- we're born that way." Again, this was used in political discussions and debates, as a way of putting anti-gay discrimination in the same civil rights camp as racist or sexist discrimination... and as a way of gaining sympathy. Now, this would seem to be in direct contradiction with the "Gay parents aren't any more likely to have gay kids" line. If people are born gay, doesn't that mean it's genetic, and doesn't that mean gay parents are more likely to have gay kids? But in fact, these two party lines overlapped. I heard them both at the same time for quite a while... and I never heard a good explanation for why they weren't contradictory. (Please see addendum at the end of this post for clarification of this point.)

Then I started hearing the strict constructionist line. "Sexual orientation is a social construct," it said. "Our sexuality is formed by our culture. All that 'we're born that way' stuff -- that's biological determinism, rigid, limiting, a denial of the fluid nature of sexuality and sexual identity." (I am embarrassed to admit that I bought and sold this line myself for quite some time, in a pretty hard-line way... solely because I liked the idea.)

And now... well, now it's kind of a mess. Some in the queer community say, "it's genetic," and argue that this is a core foundation of our fight for acceptance. Others fear that the "genetic" argument will lead to eugenics, parents aborting their gay fetuses, the genocide of our community. The constructionist line about rigidity and determinism still gets a fair amount of play. And more and more I'm starting to hear the combination theory: sexual orientation is shaped partly by genetics, partly by environment, and may be shaped differently for different people.

And in all of these debates and party lines, here's what I never heard very much of:

Evidence to support the theory.

Or, to be more precise: Solid evidence to support the theory. Carefully gathered evidence. Evidence that wasn't just anecdotal, that wasn't just personal experience.

The line of the day -- and the debates in our community surrounding it -- always seemed to be based primarily on personal feeling and political expedience. I'd occasionally hear mention of twin studies or gay sheep or something... but that was the exception, not the rule. And the line has shifted around over the years, based not on new evidence, but on shifting political needs, and shifting ways that our community has defined itself.

I am profoundly disturbed by the ease with which many in the queer community are willing to dismiss the emerging science behind this question. Yes, of course, scientists are biased, and the research they do often reflects their biases. But flawed as it is, science is still the best method we have for getting at the truth of this question (and any other question about physical reality). Double-blinding, control groups, randomization of samples, replication of experiments, peer review: all of this has one purpose. The scientific method is deliberately designed to filter out bias and preconception, as much as is humanly possible.

It's far from perfect. No reputable scientist would tell you otherwise. Among other things, it often takes time for this filtering process to happen. And it completely sucks when the filtering process is happening on your back: when you're the one being put in a mental institution, for instance, because scientists haven't yet figured out that homosexuality isn't a mental illness. But when you look at the history of science over time, you see a consistent pattern of culturally biased science eventually being dropped in the face of a preponderance of evidence.

And if you're concerned about bias affecting science, I think it's important to remember that many of the scientists researching this question are themselves gay or gay-positive. We can no longer assume that scientists are "them," malevolent or ignorant straight people examining us like freakish specimens. Many of them are us... and if they're not, they're our allies. Yes, science often reflects current cultural biases... but right now, the current cultural biases are a lot more gay-positive than they used to be. And that's even more true among highly educated groups such as the scientific community.

But more to the point: What other options are being offered? How else do we propose to answer this question? Or any other question about the possible causes of human behavior? If answering it based on science is subject to bias, then isn't answering it based on our own feelings and instincts even more subject to bias? How can we accuse scientists of bias in their attempts to answer this question -- and use that accusation as a reason to dismiss the science -- when our own responses to the question have been so thinly based on evidence, and so heavily based on personal preference and political expedience?

Unless you're going to go with the hard-core deconstructionist argument that there is no reality and all of our perceptions and experiences are 100% socially constructed, then you have to accept that the question, "Is sexual orientation genetically determined, learned, or a combination of both -- and if a combination, how much of each, and how do they work together?"... well, it's a question with an answer. It's not a matter of opinion. And it's exactly the kind of question that science is designed to answer: a question of cause and effect in the physical world.

I'm not a scientist myself. But I've been following this question in the science blogs for a little while now. And as best I can tell, here's the current scientific thinking on this question:

1) Sexual orientation is probably determined by some combination of genetics and environment (with in utero environment being another possible factor). (Here, btw, is a good summary of the current scientific research on this topic, and how it evolved.)

2) We really don't know yet. The research is in the early stages. It's probably a combination of genetics and environment... but we really don't know that for sure, and we don't know which factor is more influential, or how they work together, or whether different people are shaped more by one factor and others by the other. We just don't know.

But I've said it before, and I will say it again: We should not be thinking about this question on the basis of which answer we would like to be true. We should not be thinking about this question on the basis of which answer we find most politically useful. We should be thinking about this question on the basis of which answer is true. We should be thinking about this question on the basis of which answer is best supported by the evidence.

If we don't, then we are no better than the creationists, refusing to accept evolution because it screws up their view of the world. We are no better than the 17th century Catholic Church, refusing to accept that the Earth revolves around the Sun because it contradicted their theology. We are no better than the Bush administration, refusing to recognize clear warnings about Iraq and Katrina and global warming because it got in the way of their ideological happy thoughts. We are no better than the "Biology for Christian Schools" textbook, which states on Page 1 that, ""If [scientific] conclusions contradict the Word of God, the conclusions are wrong, no matter how many scientific facts may appear to back them."

If we expect the straight world to accept the reality of our community, the reality that our lives and relationships and families are as healthy and stable as any other, then we ourselves need to be a committed part of the reality-based community. And we therefore need to accept the reality of the causes of our orientation... whatever that reality turns out to be.

So why don't we try a different angle for a while. Maybe something like this:

"We don't really know what causes sexual orientation. And we don't think it matters. It's probably a combination of genetics and environment, but until more research is done, we don't really know for sure. And we don't think it matters. It's an interesting question, one many people are curious about -- but it doesn't really matter. Homosexuality doesn't harm anybody, and it doesn't harm society, and our relationships are as healthy and stable and valid as anybody else's... and it isn't anybody's business but our own.

"We deserve rights and recognition because we are human beings and citizens: as much as racial minorities, whose skin color is inborn, and as much as religious minorities, whose religion or lack thereof is learned. The 'born versus learned' question is a fascinating one, with many possible implications about human consciousness generally. But it has absolutely no bearing on questions like job discrimination, or adoption of children by same-sex couples, or whether we should be able to marry. We don't yet know the answer to this question... but for any practical, political, social, or moral purposes, it absolutely does not matter."

*****

Addendum: As several commenters to this post have pointed out, it is actually possible for a trait (such as sexual orientation) to be genetically caused or influenced, and still not be any more likely for parents with that trait to have kids with it than parents without it. Fair point, and worth knowing. But I think my basic point about party lines, and the prioritization of political expedience over scientific evidence,still stands. After all, we didn't know that in the early '90s. Geneticists may have known it, I don't know -- but lay people in the queer community definitely didn't. And yet we were still willing to repeat both tropes: the "we're born that way" trope and the "gay parents aren't any more likely than straight parents to have gay kids" trope.

Fuck Anything That Flies: Bisexuality, Fruit Flies, And The Causes Of Sexual Orientation

This piece was originally published on the Blowfish Blog.

I love science.

From the vaunted Pharyngula science blog comes this hilarious and enlightening news of mutant bisexual fruit flies.

(As they say on Mythbusters: "Warning: Science Content." Lots of it, if you read the whole linked story.)

The gist, in case you don’t feel like reading all the darned neuroscience: In a particular species of fly, there is an occasional genetic variation -- I'm trying not to call it a mutation, that's such a judgmental word -- that causes them to behave bisexually. It causes some females to try to initiate sex with other females; it causes some males to wait for other males to initiate courtship; and it causes some males to attempt, equally, to initiate courtship with both females and males.

They will, to be blunt, fuck anything that flies.

And researchers haven't just identified the existence of the mutation -- excuse me, the variation. They haven't just identified the gene that causes it, even. They've identified the specific neurological mechanism.

(Hence the science content.)

Now, PZ Myers, Pharyngula blogger of song and story, warns that we shouldn't jump to conclusions about what this might mean for human sexuality. And I think he's right to do so. Human beings are rather more complex than fruit flies. And our sexuality is, to put it mildly, a lot more complex. Fruit flies don't, for instance, get hot for spanking, for latex, for women in seamed stockings, for men in seamed stockings, for bits and saddles, for stuffed animals, for cartoon characters, for curly-haired brunettes who look like Bette Davis.

So the fact that sexual orientation is genetically determined in fruit flies doesn't prove, even a little bit, that it's genetically determined in humans.

But it does tell us something about humans, and human sexuality.

It doesn't tell us that our sexual orientation is genetically determined, or even genetically influenced.

But it tells us that it might be.

It tells us that it's not ridiculous to consider the possibility.

It tells us that, at least in some animals, a tendency towards heterosexuality or bisexuality -- and arguably homosexuality, if you think about those male flies waiting coyly for the other male flies to make the first move -- is genetically determined. Entirely, as far as anyone can tell. And therefore, it tells us that it's not out of the question to think that it might be genetically determined -- at least partially -- in other animals as well.

Including humans.

And this is an important message: not just for the homophobic right wing, but for the queer-theory crowd as well.

There are queer theorists and activists who would be delighted to learn that sexual orientation is genetically determined at birth. For no other reason, they think it makes the civil rights battle easier to fight if they can play the "We were born this way" card. There are queer theorists and activists who think, not only that we might be born queer, but that we definitely are, and that the case is closed.

And there are queer theorists and activists who would be appalled to learn that orientation is determined by genetics. Even partially determined by genetics. Even a little bit determined by genetics. There are queer theorists and activists who actively resist this idea, who see it as dangerous and oppressive. There are queer theorists and activists who not only disagree with this theory, but who think that we should not even be considering it.

But here's the thing.

We shouldn't be thinking about this question on the basis of which answer we would like to be true.

We should be thinking about this question on the basis of which answer is true. We should be thinking about this question on the basis of which answer is supported by the evidence.

The question, "Is (X) behavior learned, genetically determined, or a combination of both -- and if a combination, how much of each, and how do they work together?"... this is, at least in theory, a question that can be answered. When it comes to human sexuality, it's probably beyond our current grasp... but that doesn't mean it always will be. It's probably going to wind up having an unbelievably complicated answer, but it's not the kind of question that inherently can't be answered with evidence and the scientific method. It's actually exactly the kind of question that the scientific method was designed to answer.

In fact, we're already beginning to gather some non-trivial data on this subject. And while the science is still in its infancy, or at least in its childhood, the current evidence seems to be leaning in the direction of "some combination of both." When it comes to human sexual orientation, genetics, at the very least, probably plays a significant role.


My inner twenty-something queer-theory constructionist is cringing at this. When I came out and started becoming active in the queer community, constructionism ("it's learned") was all the rage, and essentialism ("it's inborn") was seen as rigid and confining. It's been hard for me to accept the idea that sexual orientation may not, in fact, be entirely a product of a patriarchal society.

But my inner twenty-something queer-theory constructionist needs to get over it. The question of whether sexual orientation is born, learned, or both -- and if both, how and how much -- is not a question of opinion. It is not a question of politics or philosophy. And while there will almost certainly be ethical implications in the answer, it's not a question that should be answered based on which answer we think is morally right or wrong.

It's not a matter of opinion. It's a matter of reality. And I think that's how we should be looking at it.

Because no good -- politically, ethically, philosophically, or any other way -- has ever come from the denial of reality.

The Best Anti-Creationist Message Ever

All our atheist and anti- theocratic PR clearly needs to feature cute animals from now on.

From FreeThoughtPedia, via Cute Overload. A sentence I never expected to speak or write in my entire life...

The Blasphemy of Creationism

The story of the UC-Calvary lawsuit has been all over the atheosphere in the last few days. I'm not going to get into it in much detail (good pieces about it on Daylight Atheism and Dispatches from the Culture Wars), but to give you a quick summary so you know what I'm ranting about: A federal judge recently issued a preliminary ruling saying that UC Berkeley could, in fact, refuse to give college credit in biology for courses that taught young-earth creationism. (Calvary Chapel Christian School was trying to argue religious freedom; UC Berkeley was arguing that Calvary could have all the religious freedom they wanted, but they shouldn't expect UC to drop its academic standards and recognize non-science as science.)

So the Daylight Atheism piece on this had an excerpt from one of the textbooks in question. The textbook is Biology for Christian Schools, and the excerpt is as follows and begins now:

(1) "'Whatever the Bible says is so; whatever man says may or may not be so,' is the only [position] a Christian can take..."
(2) "If [scientific] conclusions contradict the Word of God, the conclusions are wrong, no matter how many scientific facts may appear to back them."
(3) "Christians must disregard [scientific hypotheses or theories] that contradict the Bible."

And this isn't buried somewhere in the back. This is on the very first page of the textbook. The science textbook.

After the top of my head had finished blowing off, I finally figured out why exactly this bothers me so much. Apart from all the obvious reasons, of course: the arrogance, the close-mindedness, the complete missing of the point of what science is about, etc.

What bothers me so much about it is how grotesquely disrespectful it is to their own God.

Let's say you're a theist. Let's say you believe in God, a creator god who made the world and the universe in all its beautiful and astonishing complexity.

Wouldn't you want to understand that universe, as well and as thoroughly as you could?

To me, the idea that scientific evidence is always trumped by the Bible is one of the most disrespectful attitudes you could possibly have about God. Even if you believe that the Bible was written by God (and you ignore all the evidence to the contrary), wouldn't you believe that the universe was also written by God? And in a much more direct way than the Bible was written, without having to be dictated through human secretaries? Wouldn't you put the universe, at the very least, on equal footing with the Bible? In fact, shouldn't you really be seeing the universe as much higher, much more important than the Bible, because the Bible is just one small part of God's creation and the universe is so much more vast?

It seems to me that setting your human religion above the enormous and awe-inspiring majesty of God's creation is blasphemy of the worst kind. To say that the Bible is always more real than the reality of the universe seems to me to be spitting on God and his creation. And it's not just spitting on the universe: it's spitting on that part of God's creation that is your brain and your mind, your capacity to perceive the universe and use reason and logic to understand it.

Of course, this sort of thinking is a perfect example of what Daniel Dennet was talking about in "Breaking the Spell": the ways that religion functions as a self-perpetuating meme, one that has built up an impressive array of armor and weaponry to defend itself against being seriously questioned. The idea that sacred texts can't be questioned; the idea that letting go of doubts and questions about your faith will make your life easier; the idea that holding onto faith in the face of evidence contradicting it makes you a good person... all of these function as an immune system that stops questions from breaking down the belief, or even from penetrating it in the first place.

But I think that's awfully sad. To think that your faith -- not just a general faith in the existence of God, but your particular version of the specific details of how God does and does not work -- is more real than the reality of the universe.... that's just sad. It's isolating. It's cutting yourself off from reality, from the enormous, majestic, unutterably complex, constantly- surprising reality of the physical universe. And if you believe in God, a god who created all this majesty and whatnot, it's cutting yourself off from God.

It's saying that, given a choice between trying to understand the reality of God's creation, and convincing yourself that you and your sect are right, it's more important to be right. And that really is placing yourself above God... in a way that I think is more blasphemous than anything any atheist could ever come up with.

(Photo of Synchiropus splendidus by Luc Viatour.)

Sex, Lies, and Contraception: The Male Pill

This piece was originally published on the Blowfish Blog.

A question was raised recently on the Denialism science blog, and it has all sorts of interesting implications about sexual trust between men and women.

The question: Why don’t they make a birth control pill for men?

My knee-jerk response to this question has always pretty much been, "Because the pharmaceutical industry are a bunch of sexist pigs." But this post -- and the fascinating discussion that follows -- is making me realize that the question is actually a tad more complicated than that.

For starters, it turns out that there are genuine biological reasons why a pill for men is trickier than a pill for women. What with our reproductive systems being different and all.

But that doesn't seem to be the main obstacle. The main obstacle to a male pill seems to be that there simply might not be a big enough market for it.

Which, in all fairness, I can understand.

Because this isn't simply a question of sexist men dumping the responsibility for birth control onto women. It's a question of whether women would be willing to place the responsibility for birth control into the hands of men.

Or, as Mark Hoofnagle put it in his Denialism post: "Men are liars."

A bit harsh, but I can see his point.

(And yes, women are liars too. I'll get to that in a moment.)

If I were in a trusting, long-term relationship with a man, I might be willing to let him take care of the birth control. But if I were just dating and screwing around, the way I used to in my younger days, there'd be no way I'd trust some guy I'd just met at a party or a nightclub or an orgy, who told me, "Don't worry, baby, I'm on the pill." That's way too big a gamble to leave in the hands of someone I barely know.

Besides, I'd want to use condoms anyway -- since the pill doesn't protect against AIDS or other STIs.

But for exactly this same reason, I think Mark at Denialism may be mistaken. I think there might be a real market for a male contraceptive pill.

And it comes back to my earlier parenthetical remark:

Women are liars, too.

If I were a single guy, dating and screwing around, I wouldn't want to leave the contraception question in the hands of some woman I'd just met, either. I mean, think about it. If, as a woman, I wouldn't trust some strange guy who told me, "Don't worry, baby, I'm on the pill" -- then why on earth should men trust some strange woman to tell them the same thing? The consequences for men of an unwanted pregnancy aren't as intense as they are for women... but they're not negligible. (Can you say, "child support"?)

And I think that might point to the real market for the male pill. (Or patch, or injection, or however the drug winds up getting delivered.)

Mark thinks that, even if pharmaceutical researchers could make it effective, male hormonal contraception will always be a niche market, mainly limited to men in committed long-term relationships with women who trust them enough to leave the contraception in their hands. But while I can see his point, I think he may be overlooking another key market: the market of single men who want control of their own damn reproduction, just as much as women do. I think the biggest market for the male pill might well be single men who want the moral equivalent of a temporary vasectomy: a way to guarantee that they won't get stuck with offspring they didn't expect or want.

In other words -- single men who would want the pill for the exact same reasons single women want it.

The reality is that both women and men have sex with people they don't entirely trust. They have sex with people they trust enough: people they trust not to beat them up, not to steal their car, not to paint their living room hot pink while they sleep. But both women and men have sex with people who they don't trust enough to let them handle the responsibility, and make the decisions, about pregnancy and children. I think plenty of men would be happy to take a pill to ensure that their decisions about pregnancy and children weren’t being made by the hot number they met on Craig's List three weeks ago.

If I were a single man, I'd sure as hell want that.

Memories of a Good Science Education... and Worries About Bad Ones

I didn't see the point at the time.

When I was a kid, I always got annoyed by the lab portion of my science classes. I guess I've always been more of a theory person than a research person (hence my career as an essayist instead of a journalist). Rolling balls down inclines and measuring the speed; putting nails in different liquids and seeing how fast they rusted; cutting up fetal pigs... it always seemed like a waste of time.

I mean, I never had any problem understanding the theories being taught by the books and the teachers. And I was perfectly happy to believe the books and the teachers. After all, it's not like my measurements of gravity or magnetism or whatever were going to be written up in the science journals. Even at the time, I knew perfectly well that if my numbers didn't come out the way the theory said they should, the discrepancy would, without a doubt, turn out to be caused by my experimental methodology... not the theory.

And it's not like the theories we were learning in second -grade or sixth-grade or tenth-grade science class were on the cutting edge of new scientific thinking. Again, even at the time, I knew that the stuff we were learning was well-established, and had been experimentally verified thousands upon thousands of times... by researchers who were a whole lot more careful than my sixth-grade science class. I knew we weren't really verifying the theories. The theories had been verified, many times over. We were just seeing how they worked for ourselves.

Which I didn't think I needed. I got it. The books and teachers and theories made sense. I didn't need to roll the damn ball down the damn incline to see it for myself.

So it seemed like a waste of time.

But now that I'm an adult, I see the value in it much more clearly. And especially now that I'm so engaged in the skeptical/ rational thinking/ science groupie blogosphere (what I've seen referred to as "the reality-based community"), I value it even more.

I see the value because I think there's an enormous difference between learning something purely by authority -- "it's true because I say it's true, and you can trust me" -- and learning something by seeing it for yourself. And the latter is the core of the skeptical, rational, reality-based approach to life that I think is so very valuable.

Let me give you an example. We'd learned very early on, of course, that the earth was round. But in a high school science class (freshman year, if I remember correctly), we learned how, exactly, the ancient Greeks determined that the earth was round. It had to do with comparing shadows: you measure the shadows of two poles of equal height set, say, a mile apart. You do it at noon, and again an hour later. And you do the math. The difference in the length of the two shadows will be different on a curved surface -- i.e., the earth -- than they would be on a flat surface. You can even figure out, within a crude approximation, how large the curved surface is.

So we learned how exactly this information was acquired. And then we went outside and acquired it ourselves. We did it with sticks set a few feet apart, so of course our measurements weren't super-accurate -- but we got measurable results that weren't that far off the mark.

And so now I know. I know that the earth is round, not because I read it in a book or was taught it by a teacher, but because I measured it myself. And now when I'm in a debate with some theist who says that science is just another religion and my belief that the earth is round is no different from their belief in God, I can say, "Yes, it is different. I know that the earth is round -- because I measured it myself."

Of course, in practical terms, most of what I know about science -- or what any other layperson knows about science -- is learned from authority. I haven't personally done experiments to see the effectiveness of antibiotics in treating pneumonia; I haven't personally dug up any of the millions upon millions of fossils supporting the theory of evolution. Had I but world enough and time... but I don't, so I'm not going to.

But the difference is that I could. Any smart, dedicated person with access to education can get into epidemiology or paleontology, and find out for themselves whether or not the stuff that the books say about antibiotics or fossils is true.

We can do this because scientific knowledge is transparent, and it's replicable. When researchers publish their findings, they publish not only what their results were, but how exactly they obtained them. They don't keep it an arcane secret, accessible only to those who have achieved the 34th Level of Poobahhood; they don't tell overly- inquisitive students to stop asking so many questions and just accept their teachings on faith. They say, "Here's what we think, and here's why, and here's what we did to find it out, and here's the kind of evidence that would prove us wrong, and here's exactly what you need to do to see it for yourself."

There were other good things about my grade- school and high- school science education. We learned a lot about the scientific method -- even as early as third grade, we were learning about the difference between observation and inference (illustrated with cartoons about wet tricycles on lawns -- the observation is that the tricycle is wet, the inference is that it rained... or that someone turned on the sprinkler). And we started learning very early on about the importance of careful measurements -- we were measuring liquids by reading the meniscus as early as third or fourth grade, and I remember a stern lecture from a science teacher about how screaming and cheering at the hamster running the maze would probably have a negative impact on his learning curve.

But of all the good things in my science education, I think the "see it for yourself" labs were probably the best. As annoying as I found them at the time, I now think that they were some of the most important and influential experiences in all of my early education. Because it taught me not to believe what the teacher told me, just because they were telling me. It taught me that I had the power to find things out for myself.

And it's one of the main reasons I get so upset when I read about the "No Child Left Behind," teaching- to- the- test style education that American public school kids are getting. Science education -- and indeed, all education -- needs to be about more than learning enough facts to let you pass standardized tests. Science education -- and indeed, all education -- needs to teach kids how to learn. It needs to teach kids how to think critically; how to ask questions; how to look things up. And it needs to teach kids that they don't have to believe everything they're told, just because they're told it. It needs to teach kids that they have the power to find things out for themselves.

Blood and Suffering: A Seriously Pissed-Off Rant About Alternative Medicine

Readers, be warned: This is not one of my more diplomatic pieces. I'm angry, and while I'm trying to be fair here, I'm not trying to be nice. If you don't want to read that, please don't. (It was also written under the influence of an entertaining assortment of prescription drugs; so if I'm more meandering than usual, please forgive me. Hey, what a pretty tree!)

As regular readers of this blog know, I've been home sick for several days with pneumonia. The experience hasn't been a picnic: as anyone who's had pneumonia knows, even a relatively moderate case that you don't have to be hospitalized for will totally kick your ass. I've been exhausted; I've been uncomfortable and at times in actual pain; and since all I could do for days was sit on the sofa breathing steam and watching TV, I've been bored out of my mind. (It's only been in the last couple of days that I've been alert enough, or able to stop hovering over the steamer for long enough, to do any writing.)

But the experience has given me a renewed respect for conventional medicine. And it's given me a renewed rage at the alternative medicine practitioners and proponents who are undermining it.

Here's the thing. As soon as I started suspecting that my bad cold was something more than a bad cold, I hightailed it over to Kaiser. And within two hours, I had a diagnosis, medicines in my hand, and a treatment plan. In case you're curious, here's what I'm on:

Antibiotics. Penicillin, quaintly enough. Obvious purpose -- to kill the infection in my lungs.

Cough medicine. Purpose: to quiet my cough, which had been doing this nasty self-perpetuating loop -- the cough was making my lungs irritated, which was making me cough even more. (This also reduces my pain and discomfort and lets me rest, since I got the good stuff with codeine.) Also -- not to be too gross about it -- it loosens the gunk in my lungs, so when I do cough it does some good.

Bronchiodilators. Purpose: to ease the constriction in my lungs. Thus helping me breathe, as well as helping me sleep.

Decongestants. Purpose: at the risk of thoroughly grossing you all out, to stop post-nasal drip from dripping into my lungs and gunking up the works even further. (The gross-out portion of this blog post is now complete. My apologies.)

All of which -- how exactly shall I put this? -- works. It does what it sets out to do. All of it was carefully, rigorously tested, with placebo controls and double-blinding and peer review and replicability and all that good stuff... and all of it has been shown to work. It's going to be a little while before I'm back to normal -- pneumonia is no joke -- but I started writing this three days after I started the treatment, and I'm already significantly and measurably better.

And contrary to one of the more popular misconceptions about conventional medicine, the doctor didn't just send me home with a bag of drugs. She also sent me home with instructions to breathe steam; drink enormous amounts of fluids (especially tea); stay warm; not talk too much; and rest as much as I possibly could. Plus she asked me about fifty times if I smoked. Contrary to the accusation leveled in a comment in this blog that "anything that isn't designed by a human in a lab isn't considered 'real medicine,'" a large part of my treatment plan had nothing to with anything designed in a lab or cooked up by a pharmaceutical company. And the non-drug part of the treatment didn't make anybody rich... except perhaps the Celestial Seasonings tea company. (Even the drugs in a bag weren't making anyone terribly rich; they're mostly old-school drugs that moved into generics long ago.)

Now, I haven't been tremendously happy these past few days. I've been exhausted, cranky, woozy, uncomfortable, and bored out of my mind. And let me tell you, the combination of codeine and Sudafed is one weird-ass speedball. I don't recommend it.

But here's what I haven't been:

Dead.

Or dying.

Or even suffering all that much.

The history of pneumonia before antibiotics is not pretty. Until the 20th century, treatment was pretty much non-existent. You either got better on your own, or you died. Mostly, you died. Pneumonia killed a ton of people, and it was known and feared for its special ability to kill young, healthy people in the prime of their life. And death from pneumonia is no fun at all. (I'll spare you the details, since I promised earlier to stop grossing you out.) There was some treatment beginning to be available in the early 20th century -- but antibiotics completely changed the picture.

Pneumonia still kills people today. Mostly the very young, the very old, the immune-suppressed, and people who don't get medical care in time. But thanks to conventional medicine and Big Pharma, I am rotting on the sofa for a week, feeling sorry for myself and watching all of "Firefly" on DVD... not rotting in a grave. And so are thousands of other people who got pneumonia this week. (Well, they're probably not all watching "Firefly"...)

Okay. All very good reasons for me to be happy about conventional medicine. So why is this experience making me angry about alternative medicine? Not just annoyed, not just amused, but deeply, seriously, lividly angry?

I'm angry because I think alternative medicine undermines conventional medicine.

I'm angry because so many alt medicine practitioners convince sick people to treat their illnesses, not with treatments that have been rigorously tested and shown to be effective, but with whatever powders and potions and procedures the practitioner's fancy happened to light upon, backed up at best with carelessly-done testing, and at worst with nothing but an interesting philosophy. With the best result being a placebo effect, and the worst being actual harm being done, either from neglect of the medical condition or from the sometimes harmful treatments themselves.

I'm angry because so many alt medicine practitioners promise "alternatives" that are easier, more pleasant, and more palatable than conventional treatments... along with promises of more complete and dramatic cures. I'm angry that they encourage people to pursue preventions and treatments based not on thorough testing of what does and does not work, but on what they find emotionally and psychologically and culturally appealing. I'm angry that they encourage people to abandon conventional medicine, which is often unpleasant and sometimes only partially effective, by offering appealing promises that they can't back up.

I'm angry because so many alt medicine practitioners and proponents convince people that conventional medicine only cares about symptoms and acute conditions and ignores prevention and overall health... when the reality is that doctors and nurses and public health officials around the world are desperately trying to get people to exercise, eat better, reduce their stress, and quit smoking.

Along that line, I'm angry because so many alt medicine proponents and practitioners convince people that "doctors don't know anything, and all they care about is making Big Pharma rich." (As if alt medicine practitioners were all-knowing, and nobody in the world were getting rich off of it.) I'm angry at the ways that alt medicine encourages the anti-intellectual strain so prevalent in American culture; the all- too- common attitude of, "What does that hi-falutin' doctor know anyway, with their book larnin' and their fancy degrees? Us simple folk know more about (X) than Dr. Fancy-Pants, with their years of specialized training and experience."

And I don't mean that altie practitioners and proponents encourage people to question doctors; to have a healthy skepticism about them; to treat them as fallible human beings who aren't God. I encourage people to do that. Hell, most doctors and nurses I know encourage people to do that. I mean that they encourage people, not to question doctors, but to disregard them at their whim.

Now, a lot of people will argue that many alt medicine practitioners don't do any such thing. They'll argue that many altie practitioners see alt medicine as a supplement to conventional medicine, not a replacement for it. That's why it's often called complementary and alternative medicine, or CAM -- because it complements conventional medicine, rather than supplanting it.

Okay. Fair enough. So look at it this way. If I had gone to an alt medicine practitioner with my pneumonia symptoms, one of two things would have happened.

Option A: They would have tried to treat my pneumonia with their dilutions, their energy fields, their sacred herbs, whatever. Seriously. Here are some of the gems that my Google search on "pneumonia" + "alternative medicine" turned up. We have this site, recommending that pneumonia be treated with diet, bowel and dental cleansing, and -- believe it or not -- exercise. (Exercise being absolutely the last fucking thing in the world you ought to be doing if you have pneumonia -- except maybe for smoking.) No mention of antibiotics. We have this site, which mentions antibiotics but says they're problematic, and suggests as alternatives cayenne pepper, manuka honey, and hydrogen peroxide. And then we have Holisticonline.com, which recommends that pneumonia be treated with chiropractic care, pleurisy root, and the color red.

In which case they would, in my opinion, be guilty of reckless endangerment of human life. If anyone anywhere in the world has died, or even suffered needlessly, because they acted on the advice of an alt medicine practitioner and treated their pneumonia with exercise, cayenne pepper, or the color red, then that is blood and suffering on the hands of alternative medicine.

Don't believe me? Don't think that CAM practitioners prescribe CAM treatments for serious, life-threatening illnesses -- in the place of conventional medicine? Here's a nice little story from the BBC about homeopathists in Britain telling people that they didn't need to take anti-malarial drugs when visiting Africa or other high- malaria- risk parts of the world -- they just needed to take the homeopathic remedies. Read it and seethe. And there is no reason to think they did this for malaria only and not for any other life-threatening illnesses. Even a cursory Google search will turn up alt medicine treatments for cancer, heart disease, diabetes, AIDS, and more. And check out these "what's the harm?" sites for more stories of people suffering or dying because their serious illnesses got alt medicine instead of conventional medical treatment.

So that's one option. The reckless endangerment option. But the other option is B: They would have recognized that I had a serious medical condition that they couldn't treat, hustled me out the door, and sent me scurrying to a conventional doctor. (When I Googled "pneumonia" + "alternative medicine," this is what a number of the sites I found essentially did.)

In which case, what the hell is the point? If the only thing alt medicine is good for is mild health problems that quickly go away on their own, then why bother? What on earth is the point of a multi-billion dollar alternative medicine industry if it exists solely to make people feel slightly better when they have sniffles or sore muscles or tummy aches? (If it even does that, in any way other than as a placebo.)

Conventional medicine is far from perfect. Insert a standard "I know conventional medicine is flawed" disclaimer here; I've written them before, and I don't feel up to writing another one now. But it's the best game in town. It is, pretty much by definition, medicine that has been rigorously tested using the scientific method, with placebo controls and double-blinding and replicability and peer review and all that other difficult, expensive, time-consuming stuff that alt medicine doesn't bother with.

And the chances are excellent that you -- personally -- are alive today because of it. Whether it's the polio you didn't get because you got vaccinated, the smallpox you didn't get because it's been eradicated, the heart attack you didn't have because your high blood pressure is being treated, the pneumonia you didn't die of because it got cured... I could go on and on and on. And on. The benefits of conventional medicine are often invisible, an invisibility that's enhanced by short memories and insufficient history lessons. But the fact is that we easily prevent and treat diseases and conditions that used to routinely kill thousands and millions of people.

Medicine is about the prevention of death and the relief of suffering. And conventional medicine is, by definition, medicine that has been rigorously tested and shown to prevent death and relieve suffering. Alternative medicine, on the other hand, is, by definition, medicine that is outside that rigorous testing system. It is medicine that promises to prevent death and relieve suffering, but is unwilling to spend the time and work and money making damn well sure that it can back up that promise. It is medicine that shares every single one of the flaws of conventional medicine, from greed to arrogance to cultural blindness, without offering any real benefit that conventional medicine doesn't.

And it is medicine that undermines conventional medicine; medicine that draws people away from conventional medicine by making enticing promises that it can't deliver.

So it is therefore medicine with blood and suffering on its hands.

"Created By a Schoolteacher" Or, One More Thing About the Airborne Thing

Oh, one more thing about the Airborne thing:

The company who makes the fraudulent but widely popular cold preventative makes a big deal on their packaging and in their advertising about the fact that the overpriced vitamin pill was "created by a schoolteacher." It's part of their folksy, common-sense, "we ordinary folk may not be scientists, but we sure do have 'em beat when it comes to the common cold!" marketing plan. It was created by a schoolteacher, and schoolteachers are smart and nice -- so you know it's good!

So let's take that thinking and apply it to some other fields of endeavor.

This washing machine was created by a landscape designer -- so you know it's good!

This opera was created by a software engineer -- so you know it's good!

This apartment building was created by a microbiologist -- so you know it's good!

This MP3 player was created by a master chef -- so you know it's good!

This biography of James Madison was created by a veterinarian -- so you know it's good!

Does any of that make sense?

Then why does "This cold preventative was created by a schoolteacher -- so you know it's good!" make sense?

Schoolteachers are smart and talented people, for the most part. But that doesn't make them qualified to create preventatives and treatments for medical conditions. Creating preventatives and treatments for medical conditions is hard. It requires many years of specialized training in, you know, medicine. And the common cold is a particularly tough nut to crack. Second-grade teachers aren't qualified to do medical research... any more than medical researchers are qualified to teach second grade.

I mean, would you send your kid to a school where the second grade was being taught by an epidemiologist, with no training in the education of young children?

Then why would you take a cold preventative invented by a second-grade teacher?

(Thoughts originally developed in a comment thread on Respectful Insolence. Thanks, dude.)

Airborne, and Medicine, and Why Skepticism of X Shouldn't Equal Faith in Y

In case you haven't heard about this yet: The company who makes Airborne, the overpriced vitamin pill that supposedly prevents you from catching colds but that actually does bupkis, has settled a large class action suit against them, and will be refunding $23.3 million to customers who bought the stuff. (Good piece about it on Respectful Insolence).

I don't so much want to talk about the story itself -- although I do find it interesting. Especially since the laws about making health claims for "dietary supplements" are so weak and half-assed. It's actually quite remarkable that this case succeeded. The Airborne people had an enormous amount of latitude in what kinds of claims they could make -- and they still screwed up and overstepped their extremely generous boundaries.

But that's not what I want to talk about.

There was a comment by Calli Arcale in the Respectful Insolence discussion about Airborne that really jumped out at me. I hadn't thought if it in these terms before, and it shifted some stuff around in my brain.

Here's the thought: Why should skepticism of conventional medicine translate into faith in alternative medicine?

There are good reasons to have a healthy skepticism of conventional medicine. It has horrors in its past; it's often too focused on pharmaceuticals and procedures instead of lifestyle changes (although that's changing a lot); and like all sciences, there's a huge amount it doesn't yet know. And in the United States, the conventional medical system is seriously broken. It's too corporate, too tied in with money and profit -- causing real harm to patients, and great frustration to the providers who genuinely want to give good health care. (In Europe it works a whole lot better... but that's not much help if you're living in the U.S.)

So yes. It's good to be skeptical of conventional medicine. Here, in my opinion, are some appropriate forms for that skepticism to take: Ask your doctor lots of questions. Do research on your health conditions and the treatments you're getting for them. Don't automatically take the first course of action your doctor recommends; find out what your options are. Periodically revisit your treatments and make sure they're still appropriate and up-to-date. Eat a healthy diet, get regular vigorous exercise, and for the love of Loki, quit smoking if you smoke. (Okay, those last ones aren't actually skeptical of conventional medicine -- conventional medicine is constantly begging people to eat better, exercise more, and quit smoking -- but it's a good way to improve your health and reduce the amount of time you spend in the doctor's office.)

But here, in my opinion, is a bad form for that skepticism to take: Reject conventional medicine entirely. And replace it with alternative medicine.... which has all of the flaws of conventional medicine, and just about none of its advantages.

Which brings me back to the question: Why should skepticism of conventional medicine translate into faith in alternative medicine?

Yes, conventional medicine is flawed. But a fair amount of the time, it works. Our life expectancy is almost twice that of our ancestors, and that's due in large part to conventional medicine. I could go on about it for days: from anti-depressants to heart surgery, from the elimination of huge numbers of deadly childhood diseases to the effective treatment of high blood pressure; from the eradication of smallpox to the fact that many people with AIDS can now have a pretty long and decent life.

And more to the point -- in fact, the very reason for all these successes -- conventional medicine has a system in place, the scientific method, for testing its treatments and making sure they actually, you know, work, and are reasonably safe. It's not a perfect system -- but it's far, far better than no system at all.

Which brings me back to the big question, the question I asked over and over again the last time I brought this up and to which I never got a satisfactory answer: What does alternative medicine have to offer that conventional medicine doesn't?

Alternative medicine has horrors and frauds in its past, every bit as much as conventional medicine. Read the history of the turn- of- the- century el-quacko health movement if you don't believe me. Alternative medicine is every bit as focused on powders and potions and weird procedures as conventional medicine -- they're just different powders and potions and procedures. Alternative medicine is flying in the dark every bit as much as conventional medicine -- in fact, far more so, since by definition conventional medicine is medicine that's been subjected to rigorous testing, and by definition alternative medicine is medicine that hasn't.

And alternative medicine is every bit as driven by money and profit as conventional medicine. The Airborne thing is a great example. Alternative medicine is a huge industry, and a hugely profitable one. In fact, the two are overlapping more and more: CAM companies (complimentary and alternative medicine) are being bought up in increasing numbers by the big bad Big Pharma... for the simple reason that CAM brings in pots of money, without all that pesky and expensive double-blind, placebo-controlled, peer-reviewed testing. (Funny how you hear so much about Big Pharma, but you almost never hear about Big CAM...)

So what does alternative medicine bring to the table that conventional medicine doesn't?

And once again, why should skepticism of conventional medicine translate into faith in alternative medicine?

I've seen this kind of thinking a lot. Western religion is bad... therefore Eastern religion is good. Modern strip-mall monoculture is bad... therefore our bucolic rural past was good. Capitalism is bad... therefore Communism is good. (You don't see this last one so much anymore, but it used to be very common indeed.) And in progressive lefty circles, there's almost a knee-jerk belief that anything conventional is bad, and anything alternative is good.

But it doesn't make sense. Being critical of something doesn't mean you should automatically embrace its opposite.