Doctor Who

(Source: Alice X. Zhang.)

Anesthesia

A colony of bacteria

Richard Dawkins once claimed in "The Richard Dimbleby Lecture: Science, Delusion and the Appetite for Wonder (1996):

For the first half of geological time our ancestors were bacteria. Most creatures still are bacteria, and each one of our trillions of cells is a colony of bacteria.

Hm, "each one of our trillions of cells is a colony of bacteria"? Sorry, I couldn't leave this glaringly inept bit unchallenged. I'll try to keep it short and only say a couple of things for now:

1. What does Dawkins mean by "each one"?

   a. For starters, "each one" of our cells is a single cell, not a "colony" of cells (let alone bacterial cells). But maybe Dawkins simply expressed himself poorly here.

   b. Or does Dawkins mean all the constituent parts of a cell within a single cell are themselves "a colony of bacteria"? If so, then that's just dumb. Are the constituent parts of a bacterial cell likewise "a colony of bacteria" within a single bacterial cell such that we have an infinite regress of "colonies of bacteria"? It's turtles (or bacteria) all the way down!

2. By the phrase "each one of our trillions of cells," I presume Dawkins is referring to a group of the same type of cells within the human body. Say brain cells like neurons. But how are neurons equivalent to "a colony of bacteria"?

   a. Does Dawkins mean neurons are literally "a colony of bacteria" residing in our brains? If so, there are several problems. For one, it fails to distinguish between self and non-self. If neurons are indeed "a colony of bacteria" in humans, then wouldn't we expect our immune system to recognize them as such and deal with them accordingly? (Or are they like gut flora, which if so would raise other issues which would appear to contradict established medical science?)

   b. Does Dawkins mean evolutionarily speaking neurons originated from "a colony of bacteria"? If so, that's a pretty big ask. And of course there are many arguments against neo-Darwinian theory as a whole (such as from the ID community).

As an aside, if we are "a colony of bacteria," does that make the Earth a Petri dish (or at least the appearance of a Petri dish)? :-)

Ectopic pregnancy

For what it's worth, if anything, here are some of my thoughts on the topic of ectopic pregnancy:

1. Keep in mind I'm a mere med student, not a physician, let alone an OB/GYN. I'm open to correction on the medical science and other related data.

2. The vast majority of ectopic pregnancies are tubal ectopic pregnancies. Specifically, 95-98% of all ectopic pregnancies are tubal ectopic pregnancies. This simply means they're in one of the Fallopian aka uterine tubes.

   Other types of ectopic pregnancies are far less common (e.g. ovarian, cervical, abdominal).

3. My understanding is if an ectopic pregnancy occurs (e.g. the embryo implants in one of the uterine tubes), then there are basically two possibilities:

   a. The pregnancy will end in miscarriage.

   b. The baby will grow too big and rupture the uterine tube. This may in turn damage adjacent organs. Worse, the rupture could likewise cause the mother to hemorrhage to death.

4. If ectopic pregnancy is discovered early on, and doctors think (a) is most likely, then doctors will attempt what's called "expectant management." This means the doctors will closely monitor the mother and hope the pregnancy will naturally resolve itself in a miscarriage. That way, nothing much needs to be done by the medical team, and the health outcomes for the mother are probably best (e.g. she'll still likely be fertile).

   But if (b) is more likely, then medical (in the form of an abortifacient drug i.e. methotrexate) and/or surgical intervention is needed. It could be a medical emergency depending on how close to rupturing it is.

5. A few possible if currently perhaps unrealistic pro-life options:

   All these assume the baby in the ectopic pregnancy is developing normally or at least not developing too abnormally. This may be a pretty big assumption though. It's quite possible the baby won't be developing normally. Not getting enough blood and nutrients from the mother and so on since it's not implanted in the mother's womb but outside it (by definition).

   a. A potential option is to surgically transplant the embryo from the uterine tube (or wherever else it is) to the uterus aka womb.

   However, at least to my knowledge, medical science isn't advanced enough to do this let alone do this safely.

   Maybe someday in the future.

   b. Another possible option is to allow the ectopic pregnancy to grow and develop as much as possible, and then to surgically remove the baby as a preemie.

   However, this is highly unrealistic in a tubal ectopic pregnancy. The diameter of the uterine tube is approximately half an inch or thereabouts (about 1.25 cm). While the uterine tube is extensible to some degree (depending on several factors), the bottom line is if the baby grows too much bigger than the diameter of the uterine tube, then it could rupture the tube, and put the mother's life at risk. The baby would already be about half an inch at around 6 weeks. By 8 weeks or so, the baby would have doubled this size. At this point, or not too much beyond this point, it's possible the uterine tube could be at grave danger of rupturing. But to remove the baby at even 10-12 weeks would mean it'd die.

   Currently the earliest we've been able to save babies is around 20 weeks, give or take. And that's extremely rare. Most don't make it.

   But maybe future medical technology will make this a viable option.

   c. In the vast majority of ectopic pregnancies (i.e. tubal ectopic pregnancies), unfortunately it seems the best option is either to allow the ectopic pregnancy to naturally end i.e. miscarriage, or to intervene and abort. This is where some philosophers and ethicists justify the abortion by the doctrine of double effect. But in a small percentage of ectopic pregnancies, it may be possible to save the baby and/or mother. Basically, my understanding is these are in general only realistic in abdominal ectopic pregnancies, although there may be some cases where it's happened in other types of ectopic pregnancies.

   If the ectopic pregnancy is in the abdomen, then there might be more room as well as sufficient blood supply (depending on where in the abdomen the baby is) for the baby to grow and develop and with some luck make it to 20+ weeks, and thus we could hope to remove the premature baby such that neonatologists have a fighting chance to work their magic and rescue the baby. Although even 20+ week old babies are still at huge risk of dying. (A full-term pregnancy is at least about 37 weeks.)

   But even still there's absolutely no guarantee both baby and mother won't die. I think it'd be best to look at abdominal ectopic pregnancies on a case by case basis and see what, if anything, can be done to save both, or one (if not both).

   Here is a list of some successful ectopic pregnancies. But note the vast majority of them (if not all of them) are abdominal ectopic pregnancies, not tubal ectopic pregnancies (which again constitute the vast majority of all ectopic pregnancies - i.e. 95-98%).

Acute porphyria

According to an atheist named porphyryredux:

The reason this philosophy [i.e. empiricism] is likely true or else the best one within the competing marketplace of ideas is that those who attack it, cannot do so unless data comes to them via one of their 5 physical senses, and they send out data intending to stimulate one of the 5 physical senses. If you are using empirical data to disprove empiricism, that is sort of like biting the hand that feeds you, isn’t it?

I should start by saying: although there are probably more sophisticated arguments for empiricism, at this point I'm just assuming porphyryredux means traditional empiricism. After all, it's not as if porphyryredux offers anything more.

1. Who uses "empirical data to disprove empiricism"? Who does he have in mind or what arguments does he have in mind?

2. As others like William Lane Craig have pointed out, empiricism is too narrow. It would exclude logical truths, mathematical truths, moral truths, aesthetic truths, etc.

3. Why should we think our sensory experience is a reliable source of knowledge anyway? Something like Plantinga's EAAN could be relevant for the atheist, for instance. What about arguments for solipsism, to take another example?

4. Why couldn't empiricism coupled with atheism logically lead to a denial of morality, value, meaning, purpose, etc.?

5. Also, what if the empirical data give us conflicting facts or truths?

6. Likewise, there's no empirical data for the existence of certain objects (e.g. the mutliverse, theoretical sub-subatomic particles). Presumably there never can be empirical data for the existence of say sub-subatomic particles either, at least short of building a particle accelerator the size of the solar system.

7. Finally, here is another way to look at empirical knowledge, and if true then it seems our knowledge is mainly a matter of probabilities rather than proofs. If so, then I presume probability type arguments for theism or against atheism would be relevant (e.g. Tim and Lydia McGrew, Richard Swinburne).

Two boundless oceans

Yesterday I saw a cardiac arrest. In fact, two cardiac arrests, in the same person.

The person was an obese woman around the age of 60.

I only came in at the very end of the surgery, but from what I could gather as I entered the OR the patient had had blocked arteries in her legs, and was having surgery to clear up the blockage (i.e. recanalization of femoral popliteal bypass).

The surgeon had just finished the surgery. It looked like a success. She was perfectly stable. The anesthesiologist was beginning to wake her up (e.g. putting in a reversal agent).

Suddenly, she went into cardiac arrest. Someone hit to call for help - code blue, resus team needed stat! The alarms in the OR went off and the lights at the entrance of the OR began flashing so people could see which OR needed assistance (since hospitals have hallways full of ORs).

At the time, near the end of surgery when I walked in, there were only a handful of people in the OR. Maybe 5 or 6 people. In a matter of seconds, there were about 20-25 people. (A senior anesthesiology resident later told me there didn't need to be so many people in the OR.)

A medical resident jumped on her chest and immediately began chest compressions (CPR), while the head anesthesiologist began barking out orders to get more IV access into the patient, fill up syringes with various drugs so he could push the meds, etc. It was all quite chaotic, but from what I could tell everyone was doing their jobs well enough.

They were able to get a heart rate, blood pressure, and so forth again. Everything looked fine. The patient was somewhat conscious again. She was waking up, breathing, but was doubtless exhausted, to say the least.

After several more minutes, when it looked like she was stable and medical staff were no longer needed, well over half the staff began going about their business again.

At this point, there were maybe 10 people in the room including me. While I was talking to a friend about all that just happened, we looked over at the anesthesia machine and noticed the patient's BP begin dropping precipitously. I think it started at 80/50, but then it dropped to 70 (systolic, i.e. the top number), then 50, then 20, then it actually read negative somehow on the machine, all within a matter of seconds.

Of course, the anesthesiologist and other staff noticed as well, and they began CPR again. Another mad rush to save the patient's life.

While the doctors and nurses were rescuing her, my friend and I noticed her left ear had gone dark blue and purple. It was cyanosed. Not enough blood perfusion, not enough oxygen circulating. Bad news.

Eventually the medical staff were able to resuscitate her once again. They got her ready to be transported to the cath lab, where they'd have a better chance to figure out what happened to her as well as to fix it (e.g. the leading theory seemed to be a rogue blood clot). They attached equipment to monitor her vital signs, made sure she had a defibrillator on her bed in case she went into cardiac arrest en route from the OR to the cath lab, bag valve mask ventilated her so she would be oxygenated, etc.

I still don't know what happened to her. Hopefully I'll find out next week when I return.

As for what directly necessitated the code, I thought she had gone into VF (ventricular fibrillation, which is a type of erratic beating of her heart). However, another staff member told me he thought she had in fact gone into asystole (which means flatlined and no heart activity).

Either way, one thing was for sure: she was teetering on the brink between life and death.

As a med student, I don't know much in any case, and thus I wouldn't have been allowed to do anything, but I wish I could have done something to help. Still, it was medically instructive for me to watch.

As I watched, though, I wasn't actually thinking about medicine. Instead, the overriding thought I had in my mind was how close she was to crossing over from life into death, and hence into either heaven or hell. One second she was perfectly stable and ready to emerge from her sleep, and then in a flash everything changed and she could have died on the operating table. She may have in fact died in the cath lab for all I know. How near to eternity we are, and usually without even realizing it.

As John Wesley once said to his brother Charles Wesley: "I desire to have both heaven and hell ever in my eye, while I stand on this isthmus of life, between two boundless oceans."

I, robot

Richard Dawkins once said:

Biology is the study of complicated things that give the appearance of having been designed for a purpose.

Imagine a genius inventor is able to manufacture a human android. Say an android like David 8 in Ridley Scott's Prometheus. But far better (e.g. sans white colored blood, etc.). Indistinguishable from an actual human being.

Of course, one could ask, is David a "living" organism? But given the beliefs and worldview of someone like Richard Dawkins or Jerry Coyne (e.g. atheism, materialism, reductionism, neo-Darwinism), would there be a substantial difference between David and a living, breathing human being like Dawkins?

If so, what would it be?

If not, then how would an evolutionist like Dawkins differentiate between a "living" human being which evolved and David who is an artificial creation? Say the inventor is the only other who knows and he's not telling! Neither is David.

After all, both appear designed. But real humans (e.g. Dawkins) have come to appear designed due to unguided and purposeless natural processes, whereas artificial humans like David have come to appear designed due to the guided and purposeful intelligence of a genius inventor. That is, real humans have the appearance of design, while artificial humans have in fact been designed.

This scenario may sound far-fetched to many people; it's in the realm of science fiction, naught else. Maybe so. But given Dawkins' worldview, why not...someday? Indeed, Craig Venter "created" artificial life not too long ago. Apparently Venter had even placed a genetic signature or watermark in his synthetic life in order to make it known it was his creation. Not unlike, perhaps, Mr. Weyland placing "W" on the fingertip of his creation David in Prometheus:

So, short of some sort of a watermark or signature in the cell, if it's not possible to distinguish between a real human being and an artificially designed human being, then how could we tell one did indeed evolve according to unguided and purposeless natural processes, whereas the other was intelligently designed?

If we can't, then an outsider might as well conclude David evolved according to evolutionary theory, whereas Dawkins was designed by a genius inventor. But we don't really know because we can't distinguish between the two.

As such, on what grounds could Dawkins aka the Dawkbot say humans merely have the "appearance" of design rather than actual design? Couldn't it go either way? If so, then Dawkins shouldn't be so quick to pronounce the appearance of design over actual intelligent design.

A quick and dirty intro to ID

This is just a quick and dirty intro to Intelligent Design (ID).

Obviously, I think it'd be best for people to go straight to the source and read about ID directly from websites like Uncommon Descent and Evolution News & Views. To say nothing of the plethora of published works by ID theorists William Dembski, Stephen Meyer, Michael Behe, et al.

However, since I've had friends and others ask me to explain ID, I thought it'd be worth summarizing what I think is the main point of ID to them.

---

Francis Crick, who co-discovered the structure of DNA along with James Watson, once said:

Biologists must constantly keep in mind that what they see was not designed, but rather evolved.

By the same token, the militant atheist and evolutionist Richard Dawkins has said:

Biology is the study of complicated things that give the appearance of having been designed for a purpose.

As ID theorists have pointed out, the key word is "appearance." Individuals like Dawkins believe living organisms merely "appear" to have been designed when in fact they are anything but. They believe living organisms have instead come into being via unguided and purposeless natural processes. And that these natural processes are best explicated in neo-Darwinism.

By contrast, a reason ID theorists use the term "intelligent" in ID is because they wish to distinguish between an unguided and purposeless natural process vs a guided and purposeful process best explained by intelligent agency.

Now, virtually everyone recognizes there are many things in this universe which look like they're designed. Obviously we know things like computers, cars, and buildings have been engineered by humans. Likewise, various works of art, literature, music, movies, computer games. Similarly, we could say many inorganic materials like various plastics have been artificially designed. We could further include nanoparticles and arguably the synthetic elements in the Periodic Table too. Almost everyone including atheists like Dawkins would probably agree most if not all of these have been designed by intelligent agents i.e. humans.

But when it comes to living organisms, while everyone agrees life looks designed, atheists like Dawkins think actual design is an illusion. (I suppose in some ways similar to how some atheists think of consciousness.)

Worse, they practically become apoplectic if anyone so much as hints the design may not be an illusion but may in fact be actual design by an actual intelligence of some sort. That it may not have been unguided and purposeless after all. Or to put it another, if anyone casts doubt on the neo-Darwinian paradigm.

As an aside, it often seems as if it's all but a thought-crime to question Darwinism. This isn't hyperbolic language for effect, I don't think. There have been very real and unfortunate consequences. For example, many people's reputations have been unfairly marred. Many have lost their jobs and thus livelihoods and/or been blacklisted from future jobs due to their dissent from Darwinism. For starters, check out what happened to Richard Sternberg and Guillermo Gonzalez.

Getting back to the point, given living organisms appear designed, the next logical question should be: are living organisms, in fact, designed? Not: how or by what mechanisms have living organisms come to appear designed? Nor: who or what designed living organisms? (Dawkins, Coyne, Wolpert, and their kind react as equally irked by theistic evolution as they do by ID theory.) Yet neo-Darwinists often get ahead of themselves and confuse and/or conflate these and other questions and their related issues. They proceed, for example, to shout down ID theorists as Young Earth Creationists (YEC) in disguise, even though it's clear to anyone with a modicum of fair-mindedness and an ounce of familiarity with the movement that ID most decidedly is not. (Sometimes to the chagrin of many actual YECs!) Of course, these are good questions to ask, and questions which we should ask. But my immediate point is ID doesn't strictly speaking deal with these questions, not as their first port of call.

So, how can we tell if a living organism is truly designed? This is where intelligence comes in. Indeed, intelligence is what makes the crucial difference between the mere appearance of design vs actual design. In other words, there's a significant distinction between unintelligent design vs intelligent design, for unintelligent design means an unguided and purposeless natural process (i.e. neo-Darwinian theory), while intelligent design is, as I've already noted, the reverse.

Specifically, according to ID theorists, intelligence is a causal power that can arrange and adapt means to bring about teleological ends. This stands in distinction both to brute necessity which does not arrange or adapt means as well as to random chance which is not teleological or goal-oriented.

What's more, ID theorists have come up with ways to detect intelligence. I think Dembski's scheme is the most analytically rigorous. It'd be beyond the scope of this post to go into detail, but Dembski does point out three marks of intelligence: contingency, complexity, and specificity. By contingency he simply means if an object or event is unnecessary or, if you like, optional; if it occurred, even though it need not have occurred. Complexity refers to the fact that an object or event is difficult to reproduce by chance alone. And specificity is if an object or event exhibits an independent pattern. Dembski terms his theory of intelligence detection, specified complexity, and argues only intelligence can originate or generate specified complexity when prior to intelligence there was no specified complexity. Note this isn't the same as unintelligent natural processes making use of specified complexity.

If specified complexity is successful, then at a minimum it means we have sound and reasonable scientific and mathematical criteria to detect intelligent design in nature.

Parsing Parsons

Keith Parsons recently wrote:

neurons are classical not quantum objects

What's Parsons attempting to say here? Is he referring to classical mechanics in physics as opposed to quantum mechanics?

If not, I'm not sure what he's talking about.

But if so, then presumably he's attempting to say something like (in his own clumsy way) the physiology of neurons or neurophysiology isn't best explained by quantum mechanics, but rather by classical mechanics?

If so, for starters we can say that, generally speaking, quantum effects are more pronounced the smaller an object is. But just because neurons (i.e. nerve cells) aren't, say, atomic or subatomic particles doesn't necessarily mean QM has zero effect on neurons. A quantum effect could still be present but simply not observable. At least not by our current instruments or technology.

Further, neurons are obviously comprised of smaller constituents which could be measurably subject to QM (e.g. perhaps some proteins, perhaps the electron transport chain in the mitochondrial membrane).

Besides, isn't Parsons a reductionist who also subscribes to emergent phenomena in their lower level constituents? If so, wouldn't Parsons think lower level constituents in neurons could influence the higher level neurons themselves in some fashion?

Also, even if we don't head down to a low level like the atomic or subatomic level but instead stick with the molecular or cellular level, we know nerve signals are transmitted via nerve cells or neurons electrochemically (i.e. via electrical action potentials and chemical neurotransmitters). And I don't see why certain events in this electrochemical transmission process between neurons couldn't be explicated in terms of QM? (Well, maybe only if the time scale isn't short enough.)

Of course, none of this is at all to suggest I agree with the position that QM fully explains consciousness. Rather, I'm just responding to Parsons on his own terms.

This article from the Stanford Encyclopedia of Philosophy may also be of interest to some.

Background to pop gen

Here's some quick and dirty background info for those curious about population genetics. It'll be simplified for wider popular appeal, but hopefully not overly simplified. I won't talk about population genetics itself, per se, since that'd be a bit too time-consuming for me to provide right now. But the background should provide enough knowledge to get people started on learning about population genetics on their own.

1. DNA. The first thing to know is that we're made up of DNA. DNA is a molecule that resides in us and encodes all our genetic information. We can think of it as containing all the instructions for how to make a human being.

2. Genes. DNA is composed of genes. Genes are segments of DNA that give humans form and/or function. Genes are also passed on from one parent to their child.

3. Allele. An allele is an alternative form of a gene. A variant. For example, different eye colors (e.g. blue, brown).

4. Genome. A person's genome is all the genetic info in a single person. This is all the DNA in a person.

Usually when we refer to DNA, we're talking about the DNA in a person's chromosomes aka chromosomal DNA. But there's also what's called mitochondrial DNA. That is, DNA in a person's mitochondria as well.

There are further distinctions but this should suffice for our purposes.

At any rate, a person's genome would include all the DNA.

5. Population. A population is all the organisms in a given set that can interbreed with one another. Actually, this is a very basic definition. It isn't perfect by any means, and debatable. But we'll just stick with this for now.

6. Evolution. A basic definition of evolution is a change in the frequencies of genes/alleles in a given population. Again, somewhat debatable, or at least requiring more elaboration, but we'll move on.

7. According to neo-Darwinian evolutionary theory, there are at least five factors that can influence the frequency of the genes/alleles in a population:

a. Natural selection. This is based on fitness. This is when the fitter or fittest individuals of a population survive (e.g. thick coated foxes are more fit to survive in the Arctic than thin coated foxes), pass on their genes/alleles, and thus their genes/alleles become more frequent in a population.

b. Sexual selection. This is based on sexual attractiveness. This is when the more sexually attractive individuals of a population mate and have the most offspring, thus passing on their genes/alleles, and thus their genes/alleles become more frequent in a population.

c. Gene migration. This is based on movement. This is when new individuals with new genes/alleles migrate into or out of another population, thus changing the frequency of genes/alleles in a population.

d. Genetic drift. This is based on chance. This is when random chance events (e.g. bugs getting stepped on, floods wiping out half the population) lead to changes in the frequency of genes/alleles in a population.

e. Mutations. This is based on anomalies in the genetic code. This is when mistakes in DNA lead to new genes/alleles.

7. Equilibrium. Specifically, Hardy-Weinberg equilibrium. A population is said to be in (Hardy-Weinberg) equilibrium when none of the previously mentioned factors are in operation. It also assumes all individuals in a given population capable of breeding are breeding and each produces the same number of offspring.

That is, natural selection is not at work. Sexual selection is completely random. There are no new migrants into or out of a population. There is a huge population size in order to moot random chance events affecting the frequency of genes/alleles in a population. Finally, no mutations ever occur.

8. Finally, as the cornerstone of population genetics, we have what's called the Hardy-Weinberg equation. The equation is: p² + 2pq + q² = 1.

We can think the equation in the following way.

Consider three basic types of genes/alleles. Say we have XX genes/alles representing dominant genes/alleles, xx representing recessive genes/alleles, and Xx representing mixed dominant and recessive genes/alleles.

Accordingly, the "p²" in the equation refers to what's called homozygous dominant genes/alleles. The "q²" refers to what's called homozygous recessive genes/alleles. And the "2pq" refers to what's called heterozygous genes/alleles.

If we know 40% of a given population posses homozygous dominant genes/alleles, then we know p² = 0.4.

If p² = 0.4, then p = 0.63 (approx).

That means q = 1 - 0.63 = 0.37.

While q² = 0.137.

And 2pq = 0.466.

Thus, since we know p² = 0.4, 2pq = 0.466, and q² = 0.137, then we know 40% of the population possesses homozygous dominant genes (e.g. XX), 46.6% of the population possesses heterozygous genes/alles (e.g. Xx), and 13.7% of the population possesses homozygous recessive genes/alleles.