Whom to believe?
The relentless and often unpredictable coronavirus (SARS-CoV-2) has, among its many quirky terrors, dredged up once again the issue that will not die: science versus pseudoscience.
How does one learn to spot the con without getting a Ph.D. and spending years in a laboratory?
The scientists, experts who would be the first to admit they are not infallible, are now in danger of being drowned out by the growing chorus of pseudoscientists, conspiracy theorists, and just plain troublemakers that seem to be as symptomatic of the virus as fever and weakness.
How is the average citizen to filter this cacophony of information and misinformation posing as science alongside real science? While all that noise makes it difficult to separate the real stuff from the fakes, there is at least one positive aspect to it all.
A famous aphorism by one Charles Caleb Colton, a popular 19th-century English cleric and writer, says that "imitation is the sincerest form of flattery."
The frauds and the paranoid conspiracy mongers who would perpetrate false science on a susceptible public are at least recognizing the value of science—they imitate it. They imitate the ways in which science works and make claims as if they were scientists, because even they recognize the power of a scientific approach. They are inadvertently showing us how much we value science. Unfortunately they are just shabby counterfeits.
Separating real science from pseudoscience is not a new problem. Philosophers, politicians, scientists, and others have been worrying about this perhaps since science as we know it, a science based entirely on experiment and not opinion, arrived in the 1600s. The original charter of the British Royal Society, the first organized scientific society, stated that at their formal meetings there would be no discussion of politics, religion, or perpetual motion machines.
The first two of those for the obvious purpose of keeping the peace. But the third is interesting because at that time perpetual motion machines were one of the main offerings of the imitators, the bogus scientists who were sure that you could find ways around the universal laws of energy and make a buck on it. The motto adopted by the society was, and remains, Nullius in verba, Latin for "take nobody's word for it." Kind of an early version of Missouri's venerable state motto: "Show me."
You might think that telling phony science from the real thing wouldn't be so difficult, but events, historical and current, tell a very different story—often with tragic outcomes. Just one terrible example is the estimated 350,000 additional HIV deaths in South Africa directly caused by the now-infamous conspiracy theories of their own elected President no less (sound familiar?). It's surprisingly easy to dress up phony science as the real thing by simply adopting, or appearing to adopt, the trappings of science.
Thus, the anti-vaccine movement claims to be based on suspicion of authority, beginning with medical authority in this case, stemming from the fraudulent data published by the now-disgraced Andrew Wakefield, an English gastroenterologist. And it's true that much of science is based on suspicion of authority. Science got its start when the likes of Galileo and Copernicus claimed that the Church, the State, even Aristotle, could no longer be trusted as authoritative sources of knowledge.
But Galileo and those who followed him produced alternative explanations, and those alternatives were based on data that arose independently from many sources and generated a great deal of debate and, most importantly, could be tested by experiments that could prove them wrong. The anti-vaccine movement imitates science, still citing the discredited Wakefield report, but really offers nothing but suspicion—and that is paranoia, not science.
Similarly, there are those who try to cloak their nefarious motives in the trappings of science by claiming that they are taking the scientific posture of doubt. Science after all depends on doubt—every scientist doubts every finding they make. Every scientist knows that they can't possibly foresee all possible instances or situations in which they could be proven wrong, no matter how strong their data. Einstein was doubted for two decades, and cosmologists are still searching for experimental proofs of relativity. Science indeed progresses by doubt. In science revision is a victory.
But the imitators merely use doubt to suggest that science is not dependable and should not be used for informing policy or altering our behavior. They claim to be taking the legitimate scientific stance of doubt. Of course, they don't doubt everything, only what is problematic for their individual enterprises. They don't doubt the value of blood pressure medicine to control their hypertension. But they should, because every medicine has side effects and we don't completely understand how blood pressure is regulated and whether there may not be still better ways of controlling it.
But we use the pills we have because the science is sound even when it is not completely settled. Ask a hypertensive oil executive who would like you to believe that climate science should be ignored because there are too many uncertainties in the data, if he is willing to forgo his blood pressure medicine—because it, too, has its share of uncertainties and unwanted side effects.
The apparent success of pseudoscience is not due to gullibility on the part of the public. The problem is that science is recognized as valuable and that the imitators are unfortunately good at what they do. They take a scientific pose to gain your confidence and then distort the facts to their own purposes. How does one learn to spot the con without getting a Ph.D. and spending years in a laboratory?
"If someone claims to have the ultimate answer or that they know something for certain, the only thing for sure is that they are trying to fool you."
What can be done to make the distinction clearer? Several solutions have been tried—and seem to have failed. Radio and television shows about the latest scientific breakthroughs are a noble attempt to give the public a taste of good science, but they do nothing to help you distinguish between them and the pseudoscience being purveyed on the neighboring channel and its "scientific investigations" of haunted houses.
Similarly, attempts to inculcate what are called "scientific habits of mind" are of little practical help. These habits of mind are not so easy to adopt. They invariably require some amount of statistics and probability and much of that is counterintuitive—one of the great values of science is to help us to counter our normal biases and expectations by showing that the actual measurements may not bear them out.
Additionally, there is math—no matter how much you try to hide it, much of the language of science is math (Galileo said that). And half the audience is gone with each equation (Stephen Hawking said that). It's hard to imagine a successful program of making a non-scientifically trained public interested in adopting the rigors of scientific habits of mind. Indeed, I suspect there are some people, artists for example, who would be rightfully suspicious of changing their thinking to being habitually scientific. Many scientists are frustrated by the public's inability to think like a scientist, but in fact it is neither easy nor always desirable to do so. And it is certainly not practical.
There is a more intuitive and simpler way to tell the difference between the real thing and the cheap knock-off. In fact, it is not so much intuitive as it is counterintuitive, so it takes a little bit of mental work. But the good thing is it works almost all the time by following a simple, if as I say, counterintuitive, rule.
True science, you see, is mostly concerned with the unknown and the uncertain. If someone claims to have the ultimate answer or that they know something for certain, the only thing for sure is that they are trying to fool you. Mystery and uncertainty may not strike you right off as desirable or strong traits, but that is precisely where one finds the creative solutions that science has historically arrived at. Yes, science accumulates factual knowledge, but it is at its best when it generates new and better questions. Uncertainty is not a place of worry, but of opportunity. Progress lives at the border of the unknown.
How much would it take to alter the public perception of science to appreciate unknowns and uncertainties along with facts and conclusions? Less than you might think. In fact, we make decisions based on uncertainty every day—what to wear in case of 60 percent chance of rain—so it should not be so difficult to extend that to science, in spite of what you were taught in school about all the hard facts in those giant textbooks.
You can believe science that says there is clear evidence that takes us this far… and then we have to speculate a bit and it could go one of two or three ways—or maybe even some way we don't see yet. But like your blood pressure medicine, the stuff we know is reliable even if incomplete. It will lower your blood pressure, no matter that better treatments with fewer side effects may await us in the future.
Unsettled science is not unsound science. The honesty and humility of someone who is willing to tell you that they don't have all the answers, but they do have some thoughtful questions to pursue, are easy to distinguish from the charlatans who have ready answers or claim that nothing should be done until we are an impossible 100-percent sure.
Imitation may be the sincerest form of flattery.
The problem, as we all know, is that flattery will get you nowhere.
[Editor's Note: This article was originally published on June 8th, 2020 as part of a standalone magazine called GOOD10: The Pandemic Issue. Produced as a partnership among LeapsMag, The Aspen Institute, and GOOD, the magazine is available for free online.]
In December 1958, on a vacation with his wife in Kenya, a 28-year-old British tea broker named Robin Cavendish became suddenly ill. Neither he nor his wife Diana knew it at the time, but Robin's illness would change the course of medical history forever.
Robin was rushed to a nearby hospital in Kenya where the medical staff delivered the crushing news: Robin had contracted polio, and the paralysis creeping up his body was almost certainly permanent. The doctors placed Robin on a ventilator through a tracheotomy in his neck, as the paralysis from his polio infection had rendered him unable to breathe on his own – and going off the average life expectancy at the time, they gave him only three months to live. Robin and Diana (who was pregnant at the time with their first child, Jonathan) flew back to England so he could be admitted to a hospital. They mentally prepared to wait out Robin's final days.
But Robin did something unexpected when he returned to the UK – just one of many things that would astonish doctors over the next several years: He survived. Diana gave birth to Jonathan in February 1959 and continued to visit Robin regularly in the hospital with the baby. Despite doctors warning that he would soon succumb to his illness, Robin kept living.
After a year in the hospital, Diana suggested something radical: She wanted Robin to leave the hospital and live at home in South Oxfordshire for as long as he possibly could, with her as his nurse. At the time, this suggestion was unheard of. People like Robin who depended on machinery to keep them breathing had only ever lived inside hospital walls, as the prevailing belief was that the machinery needed to keep them alive was too complicated for laypeople to operate. But Diana and Robin were up for the challenges – and the risks. Because his ventilator ran on electricity, if the house were to unexpectedly lose power, Diana would either need to restore power quickly or hand-pump air into his lungs to keep him alive.
Robin's wheelchair was not only the first of its kind; it became the model for the respiratory wheelchairs that people still use today.
In an interview as an adult, Jonathan Cavendish reflected on his parents' decision to live outside the hospital on a ventilator: "My father's mantra was quality of life," he explained. "He could have stayed in the hospital, but he didn't think that was as good of a life as he could manage. He would rather be two minutes away from death and living a full life."
After a few years of living at home, however, Robin became tired of being confined to his bed. He longed to sit outside, to visit friends, to travel – but had no way of doing so without his ventilator. So together with his friend Teddy Hall, a professor and engineer at Oxford University, the two collaborated in 1962 to create an entirely new invention: a battery-operated wheelchair prototype with a ventilator built in. With this, Robin could now venture outside the house – and soon the Cavendish family became famous for taking vacations. It was something that, by all accounts, had never been done before by someone who was ventilator-dependent. Robin and Hall also designed a van so that the wheelchair could be plugged in and powered during travel. Jonathan Cavendish later recalled a particular family vacation that nearly ended in disaster when the van broke down outside of Barcelona, Spain:
"My poor old uncle [plugged] my father's chair into the wrong socket," Cavendish later recalled, causing the electricity to short. "There was fire and smoke, and both the van and the chair ground to a halt." Johnathan, who was eight or nine at the time, his mother, and his uncle took turns hand-pumping Robin's ventilator by the roadside for the next thirty-six hours, waiting for Professor Hall to arrive in town and repair the van. Rather than being panicked, the Cavendishes managed to turn the vigil into a party. Townspeople came to greet them, bringing food and music, and a local priest even stopped by to give his blessing.
Robin had become a pioneer, showing the world that a person with severe disabilities could still have mobility, access, and a fuller quality of life than anyone had imagined. His mission, along with Hall's, then became gifting this independence to others like himself. Robin and Hall raised money – first from the Ernest Kleinwort Charitable Trust, and then from the British Department of Health – to fund more ventilator chairs, which were then manufactured by Hall's company, Littlemore Scientific Engineering, and given to fellow patients who wanted to live full lives at home. Robin and Hall used themselves as guinea pigs, testing out different models of the chairs and collaborating with scientists to create other devices for those with disabilities. One invention, called the Possum, allowed paraplegics to control things like the telephone and television set with just a nod of the head. Robin's wheelchair was not only the first of its kind; it became the model for the respiratory wheelchairs that people still use today.
Robin went on to enjoy a long and happy life with his family at their house in South Oxfordshire, surrounded by friends who would later attest to his "down-to-earth" personality, his sense of humor, and his "irresistible" charm. When he died peacefully at his home in 1994 at age 64, he was considered the world's oldest-living person who used a ventilator outside the hospital – breaking yet another barrier for what medical science thought was possible.
Sarah Watts is a health and science writer based in Chicago. Follow her on Twitter at @swattswrites.
In June 2012, Kirstie Ennis was six months into her second deployment to Afghanistan and recently promoted to sergeant. The helicopter gunner and seven others were three hours into a routine mission of combat resupplies and troop transport when their CH-53D helicopter went down hard.
Miraculously, all eight people onboard survived, but Ennis' injuries were many and severe. She had a torn rotator cuff, torn labrum, crushed cervical discs, facial fractures, deep lacerations and traumatic brain injury. Despite a severely fractured ankle, doctors managed to save her foot, for a while at least.
In November 2015, after three years of constant pain and too many surgeries to count, Ennis relented. She elected to undergo a lower leg amputation but only after she completed the 1,000-mile, 72-day Walking with the Wounded journey across the UK.
On Veteran's Day of that year, on the other side of the country, orthopedic surgeon Cato Laurencin announced a moonshot challenge he was setting out to achieve on behalf of wounded warriors like Ennis: the Hartford Engineering A Limb (HEAL) Project.
Laurencin, who is a University of Connecticut professor of chemical, materials and biomedical engineering, teamed up with experts in tissue bioengineering and regenerative medicine from Harvard, Columbia, UC Irvine and SASTRA University in India. Laurencin and his colleagues at the Connecticut Convergence Institute for Translation in Regenerative Engineering made a bold commitment to regenerate an entire limb within 15 years – by the year 2030.
Dr. Cato Laurencin pictured in his office at UConn.
Photo Credit: UConn
Regenerative Engineering -- A Whole New Field
Limb regeneration in humans has been a medical and scientific fascination for decades, with little to show for the effort. However, Laurencin believes that if we are to reach the next level of 21st century medical advances, this puzzle must be solved.
An estimated 185,000 people undergo upper or lower limb amputation every year. Despite the significant advances in electromechanical prosthetics, these individuals still lack the ability to perform complex functions such as sensation for tactile input, normal gait and movement feedback. As far as Laurencin is concerned, the only clinical answer that makes sense is to regenerate a whole functional limb.
Laurencin feels other regeneration efforts were hampered by their siloed research methods with chemists, surgeons, engineers all working separately. Success, he argues, requires a paradigm shift to a trans-disciplinary approach that brings together cutting-edge technologies from disparate fields such as biology, material sciences, physical, chemical and engineering sciences.
As the only surgeon ever inducted into the academies of Science, Medicine and Innovation, Laurencin is uniquely suited for the challenge. He is regarded as the founder of Regenerative Engineering, defined as the convergence of advanced materials sciences, stem cell sciences, physics, developmental biology and clinical translation for the regeneration of complex tissues and organ systems.
But none of this is achievable without early clinician participation across scientific fields to develop new technologies and a deeper understanding of how to harness the body's innate regenerative capabilities. "When I perform a surgical procedure or something is torn or needs to be repaired, I count on the body being involved in regenerating tissue," he says. "So, understanding how the body works to regenerate itself and harnessing that ability is an important factor for the regeneration process."
The Birth of the Vision
Laurencin's passion for regeneration began when he was a sports medicine fellow at Cornell University Medical Center in the early 1990s. There he saw a significant number of injuries to the anterior cruciate ligament (ACL), the major ligament that stabilizes the knee. He believed he could develop a better way to address those injuries using biomaterials to regenerate the ligament. He sketched out a preliminary drawing on a napkin one night over dinner. He has spent the next 30 years regenerating tissues, including the patented L-C ligament.
As chair of Orthopaedic Surgery at the University of Virginia during the peak of the wars in Iraq and Afghanistan, Laurencin treated military personnel who survived because of improved helmets, body armor and battlefield medicine but were left with more devastating injuries, including traumatic brain injuries and limb loss.
"I was so honored to care for them and I so admired their steadfast courage that I became determined to do something big for them," says Laurencin.
When he tells people about his plans to regrow a limb, he gets a lot of eye rolls, which he finds amusing but not discouraging. Growing bone cells was relatively new when he was first focused on regenerating bone in 1987 at MIT; in 2007 he was well on his way to regenerating ligaments at UVA when many still doubted that ligaments could even be reconstructed. He and his team have already regenerated torn rotator cuff tendons and ACL ligaments using a nano-textured fabric seeded with stem cells.
Even as a finalist for the $4 million NIH Pioneer Award for high-risk/high-reward research, he faced a skeptical scientific audience in 2014. "They said, 'Well what do you plan to do?' I said 'I plan to regenerate a whole limb in people.' There was a lot of incredulousness. They stared at me and asked a lot of questions. About three days later, I received probably the best score I've ever gotten on an NIH grant."
In the Thick of the Science
Humans are born with regenerative abilities--two-year-olds have regrown fingertips--but lose that ability with age. Salamanders are the only vertebrates that can regenerate lost body parts as adults; axolotl, the rare Mexican salamander, can grow extra limbs.
The axolotl is important as a model organism because it is a four-footed vertebrate with a similar body plan to humans. Mapping the axolotl genome in 2018 enhanced scientists' genetic understanding of their evolution, development, and regeneration. Being easy to breed in captivity allowed the HEAL team to closely study these amphibians and discover a new cell type they believe may shed light on how to mimic the process in humans.
"Whenever limb regeneration takes place in the salamander, there is a huge amount of something called heparan sulfate around that area," explains Laurencin. "We thought, 'What if this heparan sulfate is the key ingredient to allowing regeneration to take place?' We found these groups of cells that were interspersed in tissues during the time of regeneration that seemed to have connections to each other that expressed this heparan sulfate."
Called GRID (Groups that are Regenerative, Interspersed and Dendritic), these cells were also recently discovered in mice. While GRID cells don't regenerate as well in mice as in salamanders, finding them in mammals was significant.
"If they're found in mice. we might be able to find these in humans in some form," Laurencin says. "We think maybe it will help us figure out regeneration or we can create cells that mimic what grid cells do and create an artificial grid cell."
What Comes Next?
Laurencin and his team have individually engineered and made every single tissue in the lower limb, including bone, cartilage, ligament, skin, nerve, blood vessels. Regenerating joints and joint tissue is the next big mile marker, which Laurencin sees as essential to regenerating a limb that functions and performs in the way he envisions.
"Using stem cells and amnion tissue, we can regenerate joints that are damaged, and have severe arthritis," he says. "We're making progress on all fronts, and making discoveries we believe are going to be helping people along the way."
That focus and advancement is vital to Ennis. After laboring over the decision to have her leg amputated below the knee, she contracted MRSA two weeks post-surgery. In less than a month, she went from a below-the-knee-amputee to a through-the-knee amputee to an above-the-knee amputee.
"A below-the-knee amputation is night-and-day from above-the-knee," she said. "You have to relearn everything. You're basically a toddler."
Kirstie Ennis pictured in July 2020.
Photo Credit: Ennis' Instagram
The clock is ticking on the timeline Laurencin set for himself. Nine years might seem like forever if you're doing time but it might appear fleeting when you're trying to create something that's never been done before. But Laurencin isn't worried. He's convinced time is on his side.
"Every week, I receive an email or a call from someone, maybe a mother whose child has lost a finger or I'm in communication with a disabled American veteran who wants to know how the progress is going. That energizes me to continue to work hard to try to create these sorts of solutions because we're talking about people and their lives."
He devotes about 60 hours a week to the project and the roughly 100 students, faculty and staff who make up the HEAL team at the Convergence Institute seem acutely aware of what's at stake and appear equally dedicated.
"We're in the thick of the science in terms of making this happen," says Laurencin. "We've moved from making the impossible possible to making the possible a reality. That's what science is all about."