Lunches with Lucas – Session I

I gave Lucas a slight wave as he came in, as if to signal to him where I was sitting.  Not that it made any sense – we’d sat at this same table every week for as long as either of us could remember.  I noticed that Lucas sat down with a more intense look than usual.

“What’s up?” I asked.

Lucas responded with a smile, but clearly he had an agenda on his mind.  “Prove to me that God doesn’t exist!” he said.

“Whoa – usually you wait until we start eating to launch into your philosophical questions – why are you in such a hurry?”

“No hurry really.  I was just thinking that I’m usually the one on the defense – trying to ‘prove God’ and ‘explain the Bible’ and ‘justify why Christians do such awful things.’  Just seemed like it was time to turn the tables,” Lucas said with grin.  He obviously felt he had found some great line of thinking and was anxious to try it out.  “So – let’s have it – let’s hear your proof.”

I laughed at him in a way you can only do with an old friend.  “You know that’s not my problem.  You’re the one who has to prove things.  If you want people to believe in God, then the burden of proof is on you.”

“You’re just dodging the question.  Everyone has a ‘burden of proof’ if they want to make their point.  We each have our different viewpoint and if we want to argue our point, then we have an equal burden of proof.” 

“I don’t know about that, but the difference is that I don’t care if you agree with me – that’s why I don’t have the burden of proof,” I said.

“Hah!” he smiled.  “I’m pretty sure that you really do care.  Can’t we just agree that everyone has a burden of proof if they are trying to intelligently defend their point of view…and then we can move on to a real discussion?”

I had to admit that he had a reasonable point, but I didn’t feel like yielding the issue too easily.  “I’m not sure about that but, for the sake of a ‘real discussion’ as you call it, I’ll grant that we each have an equal burden of proof…although I think your burden of proof is more equal than mine!”

Lucas ignored my Orwellian reference.  He clearly wanted to get on with his agenda.  “Fine.  I’ll take that as the best I’m going to get.  So, now, will you consider my original question – how do you prove God does not exist?”

I was a bit surprised that Lucas was expressing such a simpleton question.  He usually started the conversation with something much more subtle and obtuse.  “You know that’s a trick question and not even worth addressing.  You can’t prove a universal negative like that.”  I figured Lucas would give me some slack regarding that last statement.

“So you admit that God could exist?” Lucas said, seeming pleased.

I rolled my eyes.  “Are you kidding me?  Is that your goal for the day – to get me to admit that there is some miniscule chance that God exists and then proclaim ‘then you must not be an atheist’?  That’s an old lame argument Lucas – I thought you were better than that.”  I could see, though, that he wasn’t serious – he was just trying to get me riled up.

“You know I have no interest in that.  I always use a more practical definition: an atheist is one who lives as if there were no God.  I’m not interested in technicalities of label definitions.  Actually, I know plenty of Christians who seem to qualify as atheists based on how they live!”

I was still confused as to where Lucas was going with this.  “So what’s your point?” 

Lucas thought for a moment.  “I think I’m not phrasing my question right.  …I mean, you are pretty certain there is no God, right?”

“Right.”

“You’re so certain that you’d bet your life on it, right?  I mean, really, you already have bet your life on it,” Lucas said.

“I suppose you could phrase it that way.  But, yes, as you know, I don’t think it is reasonable at all to believe that God exists,” I said.

“OK – good.  So, what is it that makes you so certain?  I know you understand that I’m not asking for proof – I know you can’t give 100% proof and neither can I – but you pretty much live your life based on the high probability that there is no God.  What gives you the confidence to live that way?”

I kind of felt like we had talked about this before, but it seemed like an open invitation to review the overwhelming evidence.  So, I let loose with my thoughts without bothering to be too organized.  “Well, first of all, all you have to do is look around.  Where is God in anything you see?  I don’t imagine there are leprechauns behind every tree and I don’t imagine there is God behind every bush.  When I look around, I don’t make things up.  Everything is natural and logical.  If there is an eclipse of the sun, I don’t freak out and think it is God at work – I know it is just the natural orbiting pattern of the planets.  I think it rains because of the weather patterns – ultimately based on laws of physics.  I don’t think it rains because some grandma somewhere prayed for it to rain.  I’m a scientist – so are you – and science has eliminated the need for explaining things through myths and fairy tales and by invoking supernatural beings.  I don’t need God to go through life.  Adding some idea of God just adds a lot of complication needlessly.  I’ve never found the need to bring God in.”

“Good,” Lucas said, “now we’re getting somewhere.  So you think science explains everything.”

“I’m not sure that I would phrase it as ‘science’ explains everything.  But we understand that everything around us is a natural process and so there is a no need to bring God into our explanations.”

“Great.  So how does science explain human consciousness?”

“I figured you’d go there.  Actually, I’m kind of surprised you didn’t ask me to explain human free will.”

“I wanted to,” he said with a smile, “but I know you don’t think there is such a thing as free will.  But everyone agrees there is such a thing as human consciousness.”

“I admit that human consciousness doesn’t have a really good explanation yet.  But there is plenty of work on that.  Just because we can’t explain it beginning to end doesn’t mean that we just throw up our hands and say ‘oh – it must be God at work.’”

“So, basically you believe that science will explain everything that hasn’t been explained?  Doesn’t that take a lot of faith?  Sounds like a religious belief to me.”

I knew Lucas was trying to get in one of his favorite digs.  “I know you like to call it ‘faith’ because it makes you feel better.  But we’re talking about a logical pattern of human thinking that has carried on for probably thousands of years but certainly for the past five hundred years.  As man has carefully explored the universe, he has discovered that there are logical and natural explanations for the things he sees.  The track record of science is overwhelming here.  It’s not just that science has done a good job of explaining a few things.  Almost everything has already been shown to fit into the logical framework of physics.  So, yes, I feel very confident that the few remaining ‘unknowns’ will eventually be explained based on those same laws of physics.  Or maybe it will require new laws of physics.  But the point is, the explanations will be based on nature, not God.  I’m standing on a very solid foundation here.  I know you don’t like it, but it’s not ‘faith’ – it’s based on the overwhelming evidence of the past.”

“So is science going to explain the resurrection of Jesus?” Lucas asked.

“Science doesn’t have to explain ancient myths.  But what science does show is that when we see or experience something unexpected – something you might call a ‘miracle’ – we find that it has a natural explanation.  Like an eclipse, as I mentioned before.”

“There’s a natural explanation for someone rising from the dead?”

“Well, there might be.  But in the case you’re talking about, it is clear that it didn’t happen the way you think it did.  I mean who knows if Jesus was even real.”

Lucas didn’t take my bait on my last statement.  “How do you know how it happened?  You weren’t there.”

“Right, and neither were you.  But, unlike you, I stand on the strong and firm foundation of science and history.  We know now that there is no such thing as miracles.  If someone is truly dead, they stay dead.  Again, the evidence there is overwhelming.  All of human history tells us that.  And science has helped explain why that is.  So when someone tells me that something happened that I know can’t happen, I don’t just so ‘oh, well, I guess five hundred years of science should be thrown out the window because you just saw a ghost.’  That’s foolishness.  When you try to tell me that someone 2000 years ago came to life after being dead for a few days, I don’t take it seriously at all.  I know you’d like to believe it happened, but it never happened and never will happen.”  I felt a little bad at pushing Lucas’s buttons, but then, he was the one who brought it up.  I was just here for a nice friendly lunch.

“Perfect then,” Lucas said with some finality, “there are no miracles.  There never have been any miracles in the past and there never will be any miracles in the future.”  He looked at me for some confirmation, but I said nothing.  “Right?” he challenged.

“Look, I can go through my day without needing to invoke any existence of a God or miracles or any other supernatural event.  I’m sorry that you don’t agree, but there is just no such thing as a miracle.  Everything has a natural explanation, not a supernatural one.”

“So, in the whole entire universe, there is nothing supernatural.”

“Everything is nature.”

“And you’re sure of that even though you haven’t been everywhere in the universe.”

I was a little frustrated with Lucas at this point.  “Now you’re back to looking for proof.  Of course I haven’t looked everywhere.  Neither have you.  But as far as everything that every human being has looked into for as long as history has been recorded, there is no finding of a ‘super-nature’.  Everything is just ‘nature.’  Have you looked and found some ‘super-nature’ under a rock somewhere?”

“Actually yes.”  Lucas brightened, “I found ‘super-nature’ behind a big rock in front of a tomb in Jerusalem.” 

Lucas was impressed with himself, I could see.  I was not.  I just rolled my eyes.  “Can we just eat?” I asked.

“Sure,” he said.  “Let me just summarize:  there is only nature and there is no such thing as anything ‘supernatural’, no such thing as a miracle, and no such thing as God.  There never has been and there never will be.  Is that about right?”

“Sounds good.  I hope you’re satisfied,” I said.  “I’ll be more satisfied when I can finish this sandwich!”

“OK.  We’ll talk more next time.”

“Oh, I really can’t wait!” I said…lying.

 <Next...Session II>

The Divide

          It seems that there is a greater divide in our society these days, particularly on moral issues.  I’m not totally sure that perception is reality – there was certainly a big divide during the 60’s – the 1960’s.  And, of course, the divide in the 1860’s has to be considered the worst.  That latter divide was only “resolved” by a civil war.  The current divide is not likely to be solved by a physical war, but I don’t see how the divide can stop progressing, becoming worse and worse.  I don’t know what the end result will be, but it does not seem good.

          I’d like to illustrate what I see as the fundamental problem and then offer a suggestion that could at least start the process for finding a solution.

          One big divide is on issues related to homosexuality.  People on both sides of the fence have views that are in direct opposition to one another.  Fundamentally, there are plenty of people on each side of that issue who cannot even imagine how someone could hold the opposite view to theirs.  That’s a big divide.  But focusing on that issue doesn’t get at the more foundational problem, and therefore arguing about such issues goes nowhere. 

          Instead, I think it is more instructive to look at issues that essentially everyone agrees on, and dig a bit deeper.  I’m going to pick one to serve as an example:  child molestation.  I think everyone would agree that child molestation is wrong.

          We have to then ask ourselves:  why do we consider child molestation to be wrong?  There are some, particularly Christians, who generally use the Bible as their basis for deciding truth.  They might choose a Bible verse to justify the view that such a thing is wrong.  If they do take this approach, their basis for considering child molestation to be wrong could also cause them to have the view that any sex outside of marriage is wrong.  They would have many “absolutes” like this that are based on Biblical teaching.  The same could be said for other religions that rely on a written set of absolutes.  Some people would not use a Bible verse to support their views but essentially hold the same view as those who do.  They may believe there are moral absolutes, but they couldn’t necessarily be able to articulate them succinctly.  For those individuals, a written moral code, such as the Bible, is an implied basis for making moral decisions, but they wouldn’t necessarily go back to the source. 

          However, the divide that we really have is that many people would generally reject the idea of a moral absolute.  They would say that everything is relative.  But, in general, they would still contend that child molestation is just plain wrong.  In that case, they need some other means of establishing that child molestation is wrong.  Here is where we can begin to explore the real foundations of our current divide.

          A first common means of establishing a moral “semi-absolute” would be that since “everyone” agrees that child molestation is wrong, then it is obviously wrong.  This implies a belief that moral issues can be decided by a kind of “majority rule.”  I think a lot of people probably implicitly have this view, although it is almost never stated explicitly.  That’s probably because it is a very slippery slope full of pitfalls.  For example, how big does the “everyone” in “everyone thinks it is wrong” have to be?  How big of a majority?  A 100% majority is impossible to achieve.  Is a mere 51% majority sufficient?  Who knows?  And who gets surveyed to make this decision?  There are plenty of practical issues like that, but a deeper problem with the “morals by majority” approach is that it often breaks down and becomes pretty immoral.  If a majority of people in the US South in the 1850’s thought that slavery was right, does that mean it was right?  Some might argue about the means of selecting and determining such a majority vote, but the basic problem is that there are moral issues that are clearly wrong (or right) regardless of what a majority of people might think at any given point in time or location.  I don’t think we can totally throw out the idea of a majority rule for moral issues, but it just doesn’t make a very good foundation.

          I know there are a variety of strategies through which views on moral issues are decided without relying on absolutes, but I just want to focus on what, I think, would be the second most common response, at least with respect to child molestation.  That would be:  “anything that hurts another person is wrong.”  This statement itself is actually a moral absolute, but let’s ignore that for the moment.  Christianity is not the only place where such a sentiment is found.  One could say that “everyone” agrees with this idea (although I’m not totally sure that it is true).  It doesn’t really matter at this point.  The point is, basing moral decisions on the principle that if it hurts someone else, then it is wrong, is a pretty good principle that works a lot of the time.

          We have to go further to find the real divide.  I’m going to add a scenario that, although it is currently science fiction, is not really that far out from reality.  Specifically, consider the situation where we can immerse the child molester into a virtual reality situation that is so real that, as far as the child molester can know, the virtual reality world is the real world.  Now, let us allow the child molester to carry out his immoral acts in this virtual world.  He believes it is real.  But no actual, real child is hurt.

          Would that make child molestation in that case ok?  Or, at least, would it make the virtual act be ok (not calling it “child molestation”, since that has a moral meaning, but maybe calling it just a “virtual role-play”)? 

          I believe there are some at least, maybe more than a few, who would say that in the case of the virtual situation, that is ok.  No one is hurt.  Maybe we have to incarcerate child molesters so they don’t go out in the real world, but this type of virtual act is not morally wrong.  Actually, at the present time (2017) I would say that this view is more likely to come out in a different way:  people would defend the right of the virtual reality game-makers to include child molestation in the games they develop.  They would say that the developers have a right to create whatever game they want and there should be no moral absolutes applied to it.  But creating the game is not that far from playing it.  Thus, even if very few people would defend the “virtual” child molester today, I expect that, within the time frame it will take to create such a game, people’s views will have progressed to the point of saying that playing such a game is ok as well.

          And then, of course, there are those who would be sickened by the whole concept.  To them, whether someone is hurt or not, child molestation is wrong.  It is a moral absolute.  The idea isn’t up for discussion – it is just plain wrong.

          That is a really big divide.

          And we have to live together in the same country somehow.

          In the next entry I’m going to propose a solution.  Neither side will like it!

Conveying Information...

...or "Welcome to My Caveat Emptor World"!

          Imagine someone knocks on your door and when you open up, it is your neighbor and they start telling you all sorts of things in an intense tone:

“I noticed you have a big crack in your sidewalk – someone might trip on that.  Also I see that downspout is loose and it might fall and hit someone.  I saw a couple of termites coming out from that post there holding up the porch – probably should get that checked out.  I found this nail in your driveway.  I noticed that there are flames shooting out of your upstairs window.  There are some frayed cable wires by the side of your house – some animal is chewing on them.  Oh, and part of the fencing around the base of your deck is broken – animals love to get underneath and take up residence there…”

…and while he is still talking, another neighbor rushes up and says:

“There are flames shooting out of your upstairs window!”

          Now I ask you – which neighbor gave you the most information?

          Both neighbors told you that there were flames shooting out of your upstairs window.  But the first neighbor told you a lot more than that.  So isn’t it obvious that the first neighbor gave you the most information?

          Well, not to me.  To me it is obvious that the second neighbor gave the most information.  Even assuming that everything the first neighbor said was true, I say that the additional information clouds the important issue and therefore it borders on dis-information.  More information is not always more information.

          What’s the point?  The point is that our society is operating under the full assumption and belief that the first neighbor is clearly the better neighbor and is clearly providing more information.  And I don’t buy it one bit.

          I’ll just pick on one example, but there are many many other examples.  Specifically:  commercials for a new drug.  The FDA requires those commercials to list all of the possible side-effects of the drug.  Great idea.  Make sure the public knows about those.  For example, how about this one[1]:

“…Invokana can cause important side effects, including dehydration, which may cause you to feel dizzy, faint, lightheaded, or weak, especially when you stand up. Other side effects may include kidney problems, genital yeast infections, urinary tract infections, changes in urination, high potassium in the blood, or increases in cholesterol. Do not take Invokana if you have severe kidney problems, or are on dialysis. Stop taking and call your doctor right away, if you experience symptoms, such as rash, swelling, or difficulty breathing or swallowing, Tell your doctor about any medical conditions, medications you are taking, and if you have kidney or liver problems. Using Invokana with a sulfonylurea or insulin may increase risk of low blood sugar. ...”

          I know that many people consider drug companies evil and just out to get your money and that they would (and do) try to hide all of the side-effects of their drugs in order to make a profit.  Of course they do – they are a for-profit company.  Drugs have side-effects.  You should expect that.  As a result, you probably do have to require drug companies to present all of their side-effects or they will have a tendency not to do it.  I am not opposed to that.  What I am opposed to is being required to list every side-effect, essentially regardless of severity and frequency, in a big monologue laundry list. 

          What I would rather see is that the commercials must list the three (maximum!) most common or most severe side-effects.  Probably, in general, this would end up being an agreed-upon combination of frequency and severity.  As a default, I would say that in most cases we would want to know the most frequent side-effect (probably dizziness in the case of Invokana[2]) and the two most severe side-effects (I’m not sure what that would be in the case of Invokana – maybe the fact that you shouldn’t take it if you have kidney problems or are on dialysis).  In most cases, you would need to parse out the data a bit first to make a determination of what should be listed.  For example, if a study subject dies after taking a drug, that is obviously a severe side-effect.  But if a single death occurred in a study of 1000 subjects, and the death had an unknown relation to the drug, then that one might fall off the list in favor of something more common but somewhat less severe.  For example, if that same drug resulted in osteoporosis such that 5% of the study subjects had fractures within one year of being on the drug, that would certainly rise to the top of the list!  What I am suggesting is not simple to implement because it does take a judgement call.  I believe, however, that it would provide more information than an unranked laundry list.  Even on the package inserts, I would want to see those top three items in bold, larger font, and all the rest of the laundry list in smaller font (or just direct the super curious to a website where they can read the whole study results). 

          I think this approach would allow consumers to make a better comparison about the severity of side-effects of different drugs.  If drug A has a top three of:  1) light-headedness, 2) urinary tract infections, and 3) don’t take it if you have kidney problems; and drug B has a top three of:  1) tachycardia, 2) heart attack, 3) death…well, doesn’t that tell you something very important right away?

          I know that there are those who argue that such an approach is hiding a bunch of other side-effects and “what if I get one that isn’t listed?”  Well, that is certain to happen – rarely.  If you take a drug, any drug, you just have to know that you might be the one in one thousand who gets the odd, unusual, and possibly severe side-effect.  Or maybe you are the one in one thousand who gets a side-effect that no one encountered in the clinical trial and so it was unknown anyway.  In my opinion, you just have to know there is an underlying risk going into it, and accept that risk (or live in a bubble).

          Going back to my original illustration, let’s just say that one in ten-thousand side-walk cracks indicate an impending sinkhole, of which 1% of those sinkholes will be big enough to swallow your whole house.  Thus it may be – just possibly – that your sidewalk crack indicates a bigger impending doom than the fact that there are flames coming out of your upstairs window.  To me, the trade-off is worth the risk in this case.  If, by giving a laundry list of all the risks, you miss the one key risk that is most critical, most common, and most immediate, then that is a bad outcome.  For the one person who is about to be swallowed up in a sinkhole while his upstairs burns, well…he is having one really really bad day and there is nothing we can do about it.  Instead, I say, be like neighbor #2 and convey the critical information.  Better yet, bring your hose with you!

---

[1] I don’t know anything about Invokana – I just picked this one randomly because I could find the text of their commercial online easily.

[2] I didn’t go back and check the data here about Invokana – I’m just guessing for the sake of example here.

Drugs and Devices

          This entry is about my thoughts regarding medical treatment using drugs compared to medical treatment using devices (generally speaking, implanted devices).  First, some personal background so that you can see my biases.  I work in the implantable medical device field, so naturally I am biased towards them.  I have seen firsthand the impact that they can have – not only for the implant recipients I see at work, but also in my own family.  However, I personally do not have a device implanted inside me (yet!) – unless you count the pencil lead lodged in my thigh from an accident in second grade; or the small hunk of metal in my thumb from changing a tire in my rusted out Galaxy 500.  I have had electrodes implanted in my forearm and hand for various testing purposes, but they were just temporary.  I don’t like surgery – but who does?  Also, I’ve never been on any regular medication for anything other than the occasional antibiotic and various NSAIDS and cold medications.  So - that's my background.

          In general, devices are the option of last resort in medical treatment today.  By that I mean that the practice of medicine is designed to try to treat any disease with medications first, generally proceeding from the “least intense” to the “most intense” medication.  Along with treatment via medication, there will also be treatment via non-invasive therapies.  For example, if you have back pain, it will first be treated with some therapy (exercises and so on) and NSAIDS.  As it gets more intense, you will progress to more intense painkillers.  Eventually you may be prescribed an opiate.  If you fail all of those, then you might get back surgery.  And if you fail that, you might get an implanted device called a “spinal cord stimulator” (SCS) device for pain relief.  Of course the treatment path is not always linear, and it varies from specialty to specialty, but in essentially any case, the device is the last resort.

          Because of the field of research I am in, I frequently have the opportunity to talk to disabled individuals about their interest in having a device implanted in them to improve their function and independence.  Occasionally I come across someone who says that they never want to have a device implanted inside them.  At first I thought that it was because they didn’t want to go through surgery again, which is fully understandable.  But no, they are often willing to undergo surgery if it would help, just not have a device inside of them.  I found that to be rather interesting.  I hope they never need a pacemaker!

          To me, it comes down to this:  we are more afraid of what we can see than what we can’t see.  If you take an x-ray of someone who has a device implanted in their body, you’ll see the device plain as day.  It is obviously “unnatural” and that is rather unnerving to all of us.  If we see an x-ray somewhere that shows a lot of “hardware” inside of a person, we’re likely to be thankful that is not our x-ray.

          By contrast, if you take an x-ray of someone who is fully addicted to pain-killers, you won’t see anything different.  Even if you take an MRI, you won’t see anything different.  In fact, even if you take their brain, dissect it apart, and examine the individual neurons, you still might not see the addiction itself.  It is, for all intents and purposes, invisible to us.  For most of us, the effect of most drugs on our body is never immediately visible.  And so…it seems safe.  Even if we drink a bit of a poison like arsenic, there may be no immediate effect.  But it has effectively invaded every cell of our body.  We can’t get rid of it.

          The reality is that drugs are frequently more dangerous to us than any device.  Are there any drugs that do not have side-effects?  Often, a second drug is added to reverse the side-effects of the first drug, and so on.  We accept the side-effects because it seems like an acceptable trade-off if we get the relief we are seeking from our primary symptoms.  The problem is that some of the most serious side-effects are very slow developing.  Drugs that increase the likelihood of getting cancer, or damage our liver, are usually very slow acting and those more serious side-effects do not become apparent until years, even decades, later.  By then it is too late.  In those cases, you can’t reverse or even treat the effects.  If you stop taking the drug, you may still be left with its side-effects – sometimes for the rest of your life.

          To be sure, there are some potential “side-effects” of devices.  The most common disadvantage with any implanted device is the risk of infection.  On rare occasions devices move inside the body, or some part breaks and it no longer works.  But, the point is, these are fixable problems because, in the worst case, the device can be removed to resolve the problem.  The thing that seems the scariest to us – the fact that we can see it on an x-ray – also makes it inherently safer.  If we can see it, we can remove it and get rid of it.  In most cases a device can be removed without any further consequences.

          Another apparent disadvantage of devices is their initial expense.  Because they involve surgery, and they are often very expensive themselves, the whole cost of getting a device can be quite high.  Insurance companies are reluctant to pay that up-front cost.  They would rather pay monthly for drugs you have to take daily than to pay for the one-time cost of implanting a device.  There is an aspect of human nature that would rather spend $5/day every day for the rest of their life than to pay $5,000 now and be done with it.  Often the math clearly comes out in the favor of the device, particularly if it is more effective than the drug, but that is usually ignored.  In that sense, we seem to prefer the “death by a thousand cuts”, though maybe that is a poor idiom to use in this case!

          The point is that since devices are nearly always relegated to the “last resort”, it means we all have to first live through the side effects of drugs before a device will be considered for treatment.  However, there are certain situations where that leads to two major disadvantages.  First, we are stuck with the side-effects of the drug, and some of those side-effects are difficult, if not impossible, to reverse.  Second, by the time a device is utilized for treatment, the disease has progressed to the point where it is much more difficult to treat by any means.  Thus a device, which might have provided relief at an earlier stage, can no longer provide any relief.  There is even some evidence that if devices were used at an earlier stage, they might halt or even reverse the progression of the disease.

          Medical devices do have to be made safer, smaller, less-invasive and more effective.  They are certainly not always the answer.  But there are cases where progression to treatment with a device is better for the patient and is more cost-effective, than continued treatment with drugs.  For example, our current health care system is set up to keep treating chronic pain with opiates until the person is potentially addicted, before considering treatment with a device like a spinal cord stimulator.  The device is not always the solution, but there is evidence that the device would be more effective if it were used earlier, and it does not have near the negative personal, social, and financial consequences that opiate addiction has. 

My point is that medical devices should be given a fair consideration in the treatment of various diseases and disabilities, and not always relegated to the “last resort.”  This is a significant change in thinking.  First, the practice of medicine will have to be convinced of the potential of devices to be more than a last resort in certain situations.  Second, the reimbursement structure will have to change to reflect this difference in thinking.  And, finally, the perception of devices by the general public as being more invasive than drugs will have to be adjusted.  Each one of these steps is a major undertaking.  It will certainly not happen overnight and probably not in my lifetime.  But I do think that eventually the general perception will change on this issue.

Writing Grants for Federal Research Funding – Some Tips!

          When I finally successfully defended my Ph.D. in Biomedical Engineering, one of the members of my committee wanted to meet with me separately after it was over.  When I met with him, he gave me some “advice” that has been seared into my brain ever since.  He said: “your writing is so bad that you’ll never get any papers published and you’ll never get any grants funded.”  A truly optimistic way to start a career in research!

          Well, he was right in one sense: my writing was terrible.  But that was over 25 years ago, and since then I have managed to get many papers published and get many grants funded.  I don’t have any teaching duties, so I and my staff are essentially fully supported by the grants I write.  My funding is mostly from National Institutes of Health (NIH) and the Department of Veterans Affairs (VA), but I’ve also had funding from the Department of Defense (DoD), the Food and Drug Administration (FDA), and a variety of different private foundations. These days it is very hard to maintain continuity in a research program.  The funding rates at NIH are typically around 10-15%, meaning that only one in ten grants is funded in any one cycle.  And you’re competing with a lot of really smart and creative people trying to solve equally valuable problems.  So I thought I would write some of my thoughts about the process of grant writing and give you my personal tips on how to write successful grants.  Hopefully it will be of some help to any of you who are trying to make a career in research.

Most of my thoughts are specifically related to medical research grants submitted to federal agencies where there is a scientific peer-review process, such NIH, VA, FDA, and DoD.  I personally haven't had funding from the National Science Foundation, but I presume the process would be fairly similar there as well.  Also, my area of research is implantable medical devices and rehabilitation, so that will totally color my comments.  For example, if you are doing basic cell research in a neuroscience field, my comments may not all be relevant or even correct.  In my experience, the different disciplines even within NIH have different “personalities” with respect to the types of projects they like to fund.  But, with that background in mind, here are some suggestions.

          Let’s start off by trying to put into perspective the difficulty that researchers face in getting funding.  I tell people that getting a grant funded is like bowling a perfect score. Bowling a perfect score is very hard to do – 13 strikes in a row – yet there are lots of bowlers who bowl a perfect score.  How do they do it?  Well, I would say there are two things that you need in order to bowl a perfect score: one is you have to be a very good bowler (obviously), and the second thing is that you have to bowl a lot.  Even the best professional bowlers don't bowl a perfect score every time - it's still a rare event. 

          The analogy with respect to grant writing is this:  you have to be a good researcher, and you have to submit a lot of high quality proposals.  By that I mean that you have to have good ideas, you have to do good research, you have to work as hard as you can to improve your skills and knowledge, and you have to be good at presenting your proposed work in written form.  But in this day and age you also have to write a lot of high quality grants.  This is, of course, hard to do because it takes time to write even one good, high quality grant.  Efficiency is therefore important – you have to keep evaluating what you are spending your time on.  I often ask myself as I’m working on a grant:  “will spending more time on this particular aspect of the proposal improve the grant’s chances of getting funded?”  If not, then don’t spend too much time on it!

Given the difficulties in getting funding, you have to accept that sometimes you will have an excellent idea and write an excellent grant, and it just won’t get a good enough score to be funded.  The process takes a lot of perseverance.  There will be ups and downs.  Because of that, I highly recommend being part of a larger collaborative group of investigators.  Collaborative research itself is an important issue that may be a topic for future discussion, but from the standpoint of grant support, it almost seems necessary.  It's extremely difficult for a single isolated investigator to maintain continual grant funding.  By having a collaborative group, it is possible to “ride out” some lean times. 

I’m not going to talk here about the importance of your scientific ideas.  Obviously you have to have good ideas.  You have to conduct research on issues of importance.  You’ll have to listen to your colleagues and reviewers; and sometimes you’re going to have to face the hard truth:  you need to change your focus.  That can be very difficult.  About fifteen years ago I spent three or four years trying to get funding for an idea I had that involved restoring function in cases of peripheral nerve damage.  After a number of attempts I had to face the reality that it just wasn’t going to happen.  I still think it was a good idea, but I just was not going to get it funded, so I had to leave it behind.

You’re going to have to hone your writing skills.  Grants are written documents and, for the most part, science is conducted through the written word (grants, journal articles, books, etc.).  Grants themselves are never scored explicitly on grammar and clarity, but it absolutely plays a role in whether a grant gets funded or not.  For most of us in the hard sciences and engineering world, our college education didn’t include a lot of specific training in good writing skills.  Kind of odd, really.  However, there are certainly ways to improve your writing skills.  Early in my career, I read a couple of books on scientific writing that helped.  There are classes that you can take that help as well.  But I would say that the thing that helped me the most, by far, was reading and reviewing other people’s grants.  I found it especially instructive to read poorly written grants and papers and try to figure out what made them poor and how they could be improved.  It’s hard work.  You should also keep asking yourself “do I make the same mistakes in my own writing?”  If you are a young investigator, take advantage of opportunities to help review grants for others.  Do internal reviews of papers and grants.  Write out your comments and try to figure out what could be done to improve a grant to make it fundable.  This kind of review and introspection will help you immensely.

          The other major thing is that you absolutely have to understand the audience you are writing for.  If possible, find out the backgrounds of the type of people who are likely to be reviewing your grants.  If you are submitting to NIH, the general make-up of any review panel (Study Section) is publically available [here].  You should go through every name on the study section roster and see what department they are in and, if possible, find out what their area of study is.  Is the Study Section mostly composed of a group of basic neuroscientists?  M.D.s?  Engineers?  You need to know this because every sentence of your proposal needs to be written with that group of reviewers in mind.  I really mean every sentence – from the opening lines of the Specific Aims to the grant conclusion.  If I’m writing a grant that will be reviewed by a group of clinicians, then my whole grant is going to be couched around the disease state and clinical application that I am pursuing.  If I’m writing to engineers, then I need to catch their attention at the beginning with the innovation of my approach and I will certainly need to include more technical details. 

          As important as knowing the make-up of the Study Section, this next issue is even more important:  you have to understand and appreciate the general mental state of the individual who will be reviewing your grant.  By that I mean that you need to understand the personal conditions under which your grant is going to get reviewed.  Reviewers are generally successful researchers, which means they are busy people who have to write their own grants.  They participate in Study Sections because it is good scientific community citizenship.  They want to do a good job reading your grant, but when can they fit it in to their day?  Reading your grant will get pushed off until the late evening.  And it will get pushed off until close to the due date for the review.  It’s just human nature.  Ultimately they will not have quite as much time as they had hoped to read your grant in detail, but they will put time into it.  This puts a premium on the clarity of your writing.  Use of clear figures is mandatory.  Write your grant so that it can be read for someone who is tired and bleary-eyed and still has three more grants to read after they finish yours!

Also, in most cases, the topic of the grant will not be directly in the reviewer’s area of research.  In fact, your grant may cover some areas of scientific exploration that the reviewer is pretty fuzzy on.  Not that they don’t understand the basic science, but they surely have not been reading the same literature you have been reading.  For example, my research is in electrical stimulation for restoration of motor function, primarily in spinal cord injury.  It would be quite possible that, for example, I would be asked to review a grant on something like diagnostic ultrasonic imaging.  I know the basic principle of ultrasonic imaging, and I “know of” people who use it, but that’s about it.  I certainly haven’t read a paper about the advancements in that field in the past 25 years.  The odds are high that there are things in that grant that I really will not understand very well.  However, if the grant includes a brief “tutorial” on ultrasonic imaging and a clear introductory figure, that will help significantly in understanding the proposal.  In my opinion, it is worth the space, even though space is at a high premium in a grant.

          Along the same lines, I always encourage people to try to minimize the use of acronyms.  It is extremely difficult to read a grant if you have to keep going back to the front of the grant to find out what each acronym stands for.  I have a personal rule that I try to introduce no more than three new acronyms in any grant.  This means, again, that you have to know the background of your reviewers.  Will they all know what CNS stands for? (yes)  MRI? (yes)  EMG? (highly likely)  FES? (maybe)  NNP? (definitely not)  So, I try to use, at most, three acronyms that the reviewers are unlikely to know.  That means that I have to spell out a lot of other terms where an acronym would take up less space.  But it’s worth it.  Also, if it has been a few pages since I’ve used a particular acronym, I’ll spell it out again to remind them.  You wouldn’t be allowed to do that according to the rules of writing for a journal article, but a grant is not a journal article.  Your goal is to make it as easy to read as possible for the reviewers. 

          I’ll stop here for now.  There is no advice that can guarantee that you’ll get a grant funded – it just doesn’t work that way.  But if you keep working at the craft of grant-writing, you will greatly improve your chances of getting one funded.

Experimenting - #21 – Test Tube #2 – Entry #3

          This entry probably won’t make any sense unless you’ve read at least some of the previous entries.  The whole series starts <*here*>.

Our “experimental journey” has brought us to the edge of foolishness, and it can be a dangerous place to be.  Specifically, in the previous entry I asked the question “Is it remotely possible that God could put thoughts in our minds?”  I suggested that, in order to proceed with our experiment, we had to at least allow for the possibility that the answer to this question is “yes.”  I personally think the answer is yes, and I live my life as if it were so.  I know lots of other people who do the same.  But it presents a BIG problem.

The problem is this:  how do you know when you’re hearing God’s “voice” rather than some other “voice”?  We hear all sorts of voices in our heads.  We have ideas.  Thoughts pop into our minds.  We daydream.  We have real dreams.  It is our constant experience that thoughts come and go from our minds.  By allowing for the possibility that some of these thoughts might actually come from God, we have opened ourselves up to utter foolishness.  I will give you a personal example of exactly this problem below, but I hope that you can immediately see the problem.  If you are like me, you have all sorts of thoughts and there are certainly some thoughts that are definitely not from God!  If you start believing that most of the thoughts in your mind are from God, then you’ve gone past the edge of foolishness – you are in total freefall toward a lot of really foolish ideas and foolish actions.  I don’t want you to go there.

The easiest solution is not to get anywhere close to the “edge of foolishness”.  Thus many people, even those who believe that there is a soul and a mind and a real, personal God, will simply reject any notion that God could put thoughts into your mind.  It’s not a bad approach.  I will probably need to come back to that whole line of thinking at some point in a future entry.  But, at the very least, we need to put a lot of boundaries around this whole concept.  I want to address some of those here.

First, “test tube #2” cannot be untethered from “test tube #1” <*see here*>.  Specifically, the Bible describes a lot about God and presents a lot of things that God “likes” and “doesn’t like”; things that God “hates” and “loves.”  Our experiment is related to God as described in the Bible, so we must start with the boundaries that are already written down.  Those are givens.  And, of course, we can’t know the givens unless we are reading the Bible, and thus test tube #1 has to come first.

I know that most people would like to be untethered from the Bible.  But then you are not doing the same experiment and not testing the same God.  In that situation, you have to be careful about what conclusions you draw.  Personally, I think there are many people who perform an “experiment” (usually not very seriously), completely untethered from the Bible, and then, when that experiment fails, conclude that the God described in the Bible must not exist.  For example, I talked about this previously <*here*> where someone stated:  “…Why can't he [God] just reveal his true self, clearly and unequivocally, and settle the question once and for all? If God existed, why wouldn't it just be obvious?”  God, as described in the Bible, is often subtle.  You might conclude that an “obvious God” doesn’t exist (because it’s not obvious!), but that does not mean you can also conclude that a “subtle God” does not exist <*here*>.

OK.  So, we’re going to subject the “voices in our mind” to the principles we find described in the Bible with respect to the kinds of things that God might say to us.  For example, if the voice in your mind is telling you that “God will protect you” if you attempt to harm yourself (e.g. “God wants me to jump off a cliff and He will protect me by catching me and setting me gently on the ground”), then you are definitely not hearing God!  In fact, that specific example is something Jesus experiences (see Matthew chapter 4 verse 6-7).  Jesus gives a principle here – you should not test God.  You can’t just “imagine” that God will do something and then expect him to do it.

We will have to discuss this whole issue much further, and there is a lot to cover, so let me end here by giving you a negative example from my own life.  This happened when I was an undergraduate.  I lived a pretty Spartan existence for much of my undergraduate life:  I went to class, I studied, I worked, I focused on my spiritual activities, and I slept and ate.  No TV, no internet[1], no games.  I was pretty boring.  But also very busy.  I was taking a full load of classes and working at least 20 hours a week.  If you’ve been there, you know what happens:  you don’t get much sleep!

At that time, I did a pretty good job of tracking my time in the various tasks that I did.  As a result, I could clearly see that there just weren’t enough hours in the day to do everything.  In fact, I calculated that I needed a 26.5 hour day.  I normally needed about 7.5 hours of sleep a day, so it was easy to see that if I could survive on 5 hours of sleep each day, I could get everything done.  I “believed” God wanted me to do all the things I was doing, so it seemed logical that God would do a miracle in my life:  specifically, He would allow me to live on 5 hours of sleep instead of 7.5.  All I needed was faith.  In this case “faith” would be exhibited by not allowing myself to sleep longer than 5 hours.  God was clearly going to do this and it was going to work out great.  So “I” thought.  I did allow for an out – I said that God would have to make it plain to me from the Bible that He did not want me to do this.

Well, I managed to keep this up for 10 days somehow, although I’m sure I didn’t learn anything in my classes during that time.  I still have my personal journal notes from that time, and it was clearly an awful time.  I had to set multiple alarms to get up.  I’m sure my roommates loved my “experiment in faith.”  I was totally exhausted.

On the tenth day I read the following verses from the Bible:  “Do you not know that your body is a temple of the Holy Spirit, who is in you, whom you have received from God? You are not your own; you were bought at a price. Therefore honor God with your body.” [I Corinthians 6:19-20].  Given what I was doing to my body by depriving it of sleep, I took that to mean that God did not want me to keep doing this.  In my journal I wrote that “I slept until noon the next day!”

That was over 35 years ago and I still remember it as an important lesson.  You can’t just dream up things that “God” is going to do and then expect Him to do it.  You can’t force God’s hand.  That was not God’s voice I heard in my mind, telling me I could get by on 5 hours of sleep. 

On the other hand, I personally did, and still do, feel that it was God who arranged for me to come across the verse in Corinthians that indicated I should stop being foolish.  I did not come across that verse randomly – I was systematically reading and studying through the Bible at that time – and came across it in the course of what I was reading.  It fit the situation perfectly.  I say that God “spoke” to me through that verse. 

If your natural response to my claim that God “spoke” to me is one of significant skepticism, then I’m with you.  It could have all been total coincidence.  Besides, after ten days of sleep deprivation, any verse could have been twisted to mean “stop being an idiot.”  The point is very valid.  However, the point of relaying this particular experience is not that you will believe that God spoke to me – that’s my problem – it is to understand how God might speak to you.  One way this could happen is that you come across a Bible passage that seems directly written to you for the very specific situation that you find yourself in at that particular time.  When these things all come together, it can be rather shocking.  But you have to experience it yourself.  If you allow for the possibility of God speaking to you in this way, then there is a chance, however remote, that it could happen.  If you exclude the possibility altogether, then there is zero chance it could happen.

There is much more to go on this topic, as it is fairly complex.  Next we will have to discuss the various things that can influence our mind.

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[1] Punch cards: yes – internet: no.

Experimenting - #20 – Test Tube #2 – Entry #2

         There’s no way to get around it – for many of you this is going to be a very strange series of entries – one that will seem completely crazy.  But I hope you will humor me for a bit and consider this topic at face value.

          We have been talking about communicating with God; aka “prayer”.  In the previous entry <*here*> I talked about two important elements: 1) go to a quiet place, and 2) talk to God.  This time we are going to talk about the third element I mentioned: “listen to God”.

          I have to say that the topic of “listening to God” is an odd topic even for those who say that God “speaks” to them all the time.  I have talked to lots and lots of people who mention casually that God spoke to them, but I can’t ever remember hearing anyone give an in-depth lesson on what it really means to say “God spoke to me”.  What I find even more interesting – even somewhat troubling – is that the Bible does the same thing.  God speaks to lots of people in the Bible, from Adam in the Garden to the Apostle John on the Island of Patmos, yet I don’t know of any passage in the Bible that talks about the principle of God speaking to human beings.  How does hearing God really happen???

          All I can do is relate my own experiences and my own thoughts about the whole concept of listening to God.  I already gave one example from my own life <*here*>. 

          Actually, I don’t think the concept of hearing from God, or at least some outside influence, is that foreign to anyone.  We are all familiar with the cartoon character who is trying to decide what to do and has an angel on one shoulder and a devil on the other, both of them arguing with the character, trying to get him to make either a good or bad choice.  We don’t have to be told what that means because we’ve experience it ourselves.  We’ve had our own internal debates about what to do.  We have a sense that we are being pulled to the good or pulled to the bad.  We describe an “inner voice.”  What is that?  People who hear audible voices are often considered mentally unstable.  So why is hearing voices in our minds so normal?  We feel urges of all sorts that seem to come from outside our brains.  From where??

          Another thing we see in cartoons that immediately makes sense to us is the lightbulb above the character’s head.  We know what that means.  We’ve all experienced the “aha” moment.  An idea pops into our head.  From where?  Or we suddenly understand something that we’ve never understood before.  How?

          Well, if you are a good materialist and don’t believe the mind is anything more than neurons firing, then you won’t ascribe any of these concepts to anything other than…neurons firing.  What else could you ascribe it to?  You might say that some of these thoughts, ideas, daydreams, etc. are actually due to random neural activity.  If there is something fundamentally random in the universe, then it might affect neurons and occasionally they might just fire off a random thought.  Such an event must not be entirely common or otherwise our thoughts couldn’t be rational.  It could be that neurons fire randomly all the time but they are normally suppressed by all the rational thinking going on in our brains.  Who knows?  But, anyway, the point is, if there is no “mind” beyond neurons, then of course the whole idea that there could be a supernatural being – or even a “force” – influencing your thoughts is out of the question.

          But, as I’ve said before, that’s alocked door.  If you are a convinced materialist, then there is no reason to be trying these experiments as I’m describing them.  If no amount of evidence will change your mind, then why waste time looking for evidence to the contrary?

          So, if you want to continue, you’re going to have to open the door to what I’m about to tell you, and I think this may be the hardest door to open. 

Is it remotely possible that God could put thoughts in our minds?

The next entry will delve into that in more detail…but you’ll have to decide first whether the answer to that last question is at least a tentative yes.  If not, I don’t really see a way to continue on with the experimental approach.

I thought I would end this entry with an example from my own life – a case where I am convinced that God controlled my brain for a brief instant.  This occurred during my first month of undergraduate study at the University of Iowa.  This would have been the fall of 1979.  I had been invited to attend a meeting of Christian students that met every Tuesday evening in the student lounge area (I remember calling the building the “Student Union”, but I see it is officially called the “Iowa Memorial Union” building).  On the evening of the first meeting, I really wasn’t intending to go.  I hated meeting new people and I wasn’t sure how much I wanted to hang out with a bunch of Christians.  My nature would have been to put it off forever.  What I generally did in the evenings was to take my trombone and go practice in the music building.  That was much more fun. 

          The first Tuesday evening after I had been invited to this meeting, I had grabbed my trombone and I was headed off toward the music school.  It was a bit of a walk and it was also in the same direction as the Iowa Memorial Union where the Christian meeting was.  I don’t remember if maybe I had forgotten about the meeting and then remembered or if it was weighing on my mind as something I should do.  As I was walking along the path, there was a point at which the path literally made a Y-branch (for those of you who have been at U of Iowa, I was coming from Hillcrest Hall).  One branch headed off in the direction of the music school and the other branch headed off to the Union building.  A true “fork in the road.”  I remember that my feet just went toward the Union building.  I wasn’t making a decision to go.  It wasn’t really what I was intending to do – I mean, I had my trombone with me!  But my feet just took me there.  I felt powerless to stop it.  Ultimately, it was a critical life-changing event for me that evening.  I consider it a supernatural intervention in my brain.

          Of course it is possible that a random neuron fired, causing a chain of events that resulted in my going right instead of left on the path.  And it is possible that that random neuron just happened to fire at the right time as I approached that fork in the path.  I can’t argue that there could not be a possible natural explanation for what happened.  As I’ve mentioned before, I only present these personal experiences as examples of what happened to me in hopes that it will help you understand what I’m talking about.  But you have to have your own personal experience.  If your answer to the question above (in red) is a confident “no”, then you cannot have your own personal experience.  Hopefully you are fine with that.  All I can say is that you are missing out on an exciting adventure.