Toward the end of the year in which I was working on my thesis, my supervisor had me write up a shorter version of my thesis for an attempt at publication. This was no small feat—imagine trying to compress a 90-page master’s thesis into 2 pages!

After my RA-ship ended, my supervisor, Jonathan Kimmelman, and Alex John London took the paper, made some substantial edits, and submitted it to a couple journals. The paper was accepted, and as of this week, it was published in Science.

So far, I have seen the following references in the media to the paper:

• The Wall Street Journal Market Watch
• Health Canal
• McGill University news release
• Canada Business Review
• Central Coast News
• CBS8
• WKRN-TV Nashville
• WMC TV
• KTEN
• KMPH Fox 26
• KOTA Territory ABC News
• Scientific Computing
• North Central PA
• Bio-Medicine
• Sacramento Bee
• Gnom.es News
• Carnegie Mellon University

These are just news tickers and a press release from McGill, but my supervisor is hoping for the article to be picked up and actually commented on by others in the field of bioethics.

Needless to say, I’m thrilled. :D

Recently Stephen Woodworth, a Conservative MP, has made a push to open a debate about when it is that human life begins. He wants parliament to consider granting personhood to foetuses. This is surprising for a couple reasons: First, this is a very transparent attempt to re-open the debate on abortion (something that Stephen Harper promised would not happen) and second, a debate on the issue of the personhood of foetuses seems to miss the point in the issue of abortion completely.

I don’t know what sort of training in ethics you have had in your career as a space-man, but among philosophers, there is a reasonably famous argument by Judith Jarvis Thomson, which I have linked to. I recommend that you read it in full.

The argument is based on a thought experiment. You imagine that you wake up one day, having been attached against your will to the kidneys of a famous unconscious violinist, and you are told that if you disconnect yourself at any time, the violinist will die.

“Tough luck. I agree. but now you’ve got to stay in bed, with the violinist plugged into you, for the rest of your life. Because remember this. All persons have a right to life, and violinists are persons. Granted you have a right to decide what happens in and to your body, but a person’s right to life outweighs your right to decide what happens in and to your body. So you cannot ever be unplugged from him.”

Thomson, JJ, “A defense of abortion,” Philosophy & Public Affairs, Vol. 1, no. 1 (Fall 1971)

You can probably see how the argument goes from there. She argues that even if it is conceded that a foetus is fully a person (not just a human being, but a person who has a serious moral and legal claim to a right to life), abortions may still be morally permissible in certain cases, and laws against abortions would be inappropriate. I am reasonably convinced by this line of reasoning, and think that Thomson offers a fairly nuanced framework for thinking about this issue.

Since the debate has been re-opened, I have heard a great deal of noise and bother about whether or not a foetus is a legal person. I have yet to hear any MP’s ask the question about whether or not this matters. A debate seems unavoidable at this time, so could you propose that parliament asks whether the personhood of foetuses matters to the issue of abortion, instead of asking whether foetuses are people? I look forward to your response.

Best regards,
Benjamin Carlisle MA (Biomedical ethics)

Cc: The Rt. Honourable Stephen Harper, Stephen Woodworth MP, Niki Ashton MP

We never received any official notice from the IQA—we found out about this when one of my teammates noticed a reference to the design on the IQA site. Anyway, we’re honoured, and this has inspired us to put some more work into it. Also, one of the members of the McGill Quidditch team has asked us to re-think the bases for the hoops this summer.

Hence, we plan to build, test and release the Mark II Carlisle-Desroches Quidditch Hoop over the course of the summer. The new design which will be the same as the original, but with an alternate base that’s probably made of PVC rather than the current bucket-o-concrete. For the record, I like the bucket-o-concrete, but some have raised concerns about safety. They’re afraid that people will hit their heads.

This is supposed to be more of a question regarding political philosophy than a polemic against prohibition, so try to read it in that light. The purpose of most laws I can fairly easily trace back to reasonably acceptable premisses. For example, in Canada, I’m pretty sure there’s a law against murder. The reason for that is because we don’t want to allow a person to be able to harm another person in that way. Similarly with theft, speeding, assault, etc.

The justification is (more or less) that as many people should be as free as is feasible. Put another way, everyone should be free to swing his fist, unless that’s where another person’s nose is.

So let’s assume for the moment that the use of recreational drugs actually does harm to the person using the drug. (This is true for some of them, probably not true for marijuana, but for the sake of argument, let’s concede this point.) That itself can’t be the reason for prohibition, because we allow alcohol, which causes many health problems. We also allow the use of tobacco, which causes other health problems. You might argue that tobacco and alcohol use are both restricted—there are certain times and places they can’t be used—but the reason for that isn’t concern for the smoker or the drinker’s health. The reason that someone can’t smoke within 9 metres of the hospital or school doors is for the benefit of other people, not the smoker. It’s because people who don’t want to smoke shouldn’t be harmed by those who do. Same thing with the drinker who wants to drive.

Similarly, access to other drugs is (rightly) restricted. For example, you can’t just go to the pharmacy and buy penicillin. It has to be prescribed to you by a doctor. But again, this is not because of some harm you might cause yourself, but because the unrestricted use of antibiotics would create more resistant strains of bacteria, which would be harmful to everyone.

Even if the use of recreational drugs was exactly as bad as the worst fear-mongers would have you believe, I’m not sure that’s a good reason for prohibition. The philosophy that we take toward alcohol, tobacco, TV consumption, or high-fat/high-sodium diets is the same. We allow anyone over 21 to buy cigarettes and drain money out of our healthcare system when they need treatment for emphysema. We allow anyone to buy potato chips, and the healthcare system pays for their treatment when they have a myocardial infarct. The position that we have taken as a society is, As long as you’re not hurting someone else, who are we to tell you to stop?

So here’s my question: Why do we think differently about recreational drugs?

This is a serious question. Can someone tell me what the reasoning is behind prohibition? Have I missed something? Is there some justification beyond paternalism?

Key area: d-

i-V43/V-viiº-i64-III6 (or I6/iii—it’s a pivot chord to the relative major, F+, the key in which the remaining chords will be written)-IV-I64-V7/vi-vi

I resolved it to a vi chord, but often it’s left unresolved.

If you wanted to keep it all in the key area of d minor, you could write it more simply like this:

i-V43/V-viiº-i64-I6/iii-IV/iii-I64/iii-V7-i

I have been sceptical about this mode of evaluation since last semester for a couple of reasons. First, I have a problem with the idea that one has to exceed expectations in order to receive full marks in a class. If I were to exceed expectations in certain ways, it would be very bad. Imagine if I took it upon myself to exceed expectations in the area of my technical skills and administer an IV medication. (This is something I have not been trained to do.) I would probably be expelled from the programme on the spot. But the biggest problem with this philosophy of evaluation is that you can’t, by definition, expect someone to exceed your expectations.

Setting that aside, my other major worry was that all the categories of evaluation were very subjective. I had no way to know if the marks I received were anything more than a reflexion of how much my clinical instructor liked me.

Fortunately, at the end of last semester, I noticed that there was one item on the checklist that was completely objective: The third box under “professionalism and responsibility” is an evaluation of punctuality—whether or not I showed up to clinical on time. This particular evaluation admits of absolutely no subjectivity or judgement on the part of the evaluator. It is something that I should be able to self-evaluate with complete accuracy, and there should be no variation between the mark I gave myself and the mark my teacher gave me. After all, my mark in this section should be a function of the time at which I arrived for clinical.

And so, I decided to do an experiment. I arrived at least a half hour early for every single clinical day this semester. There was not a single clinical day where I showed up on the floor and in uniform less than half an hour in advance of our starting-time. I didn’t do this in secret either. I made sure that my clinical teacher knew that I was there before she was, and that I was reviewing the chart before the day began.

My thinking was as follows: if I get anything less than “well above expectations” on my evaluation for that category, it means that there is some major disconnect between my actual performance and the grade I was assigned.

I received a mark of “meets expectations” from both my obstetric and paediatric teacher in that category. This was doubly shocking, because they had both explicitly commented on the fact that I was always early for clinical in the “comments” section.

I pointed this out to each of them in turn, and they were both very willing to change my mark. In the end, the difference between “meets expectations” and “well above expectations” doesn’t matter that much for this course. Clinical is pass/fail, and so if I had received a 100% in the course, I would get the same “satisfactory” mark on my transcript as if I had received a 65%.

That said, it’s hard for me to take evaluations seriously now. If even the grade I received for punctuality was coloured by the biases of my teachers, how much more were the grades I received in the more subjective categories affected by their prejudices?

Recently, two of my classmates gave a class presentation on the subject of autism, which included the following video on the subject of Carly, a child with autism, who uses technology to communicate for the first time.

Carly is able to express herself by typing on the computer. This is a huge breakthrough for her and her family, and I think it worked because typing is a very linear and discrete form of communication—that is, you only type one letter at a time. Typing abstracts away many of the difficulties of verbal conversation and can be accomplished without the same level of motor coordination and timing that writing with a pen requires.

What struck me in the video was when Carly was asked, “Why do autistic kids cover their ears, flap their hands, hum and rock?”

She answered, “It’s a way for us to drown out all sensory input that overloads us all at once. We create output to block out input. … Our brains are wired differently. We take in many sounds and conversations at once. I take over a thousand pictures of a person’s face when I look at them. That’s why we have a hard time looking at people.”

Google’s augmented reality glasses

Recently, Google published a video about Project Glass (which I’m pretty sure isn’t another of their April Fool’s jokes) and it gave me an idea.

The principle behind augmented reality glasses is that you can add context-relevant input to your visual experience of the world.

Diminished reality glasses

So here’s the idea: I think that this technology could be adapted to help children like Carly. In the Project Glass video, the glasses are used to add extra information to one’s already busy visual field. But imagine that we first filtered out most of the busyness of the visual world with darkened glasses (not too dark—she should still be able to walk properly). Then we could use the same glasses to give pixel-by-pixel control to Carly over what she sees. We could also include noise-cancelling headphones that play white noise.

Carly says that she takes “a thousand pictures” of a person’s face, and so she has a hard time making eye contact. A single image, icon or word could replace a person’s face when Carly meets someone.

I think the way that the augmented reality glasses are demoed in the video would be ill-suited to helping Carly, but I think that they could probably be adapted so that they only display the information that Carly wants to see at the time.

That said, I have no idea if this would work in real life.

First, some definitions: A Nash equilibrium is a set of strategies that the players in a formalised game adopt such that the utility that each player receives for her chosen strategy is the greatest, given the choices of strategies of all the other players in the game.

This could be formalised as follows:

A Nash equilibrium exists when u_i (a_i, a_-i) ≥ u_i (a_i′, a_-i) for all a_i′ and all i, where:

• u_i is a function whose range is utility values for player i and whose domain is an ordered n-tuple of strategies taken by all the players in the game
• a_i is the chosen strategy of player i
• a_-i is the set of chosen strategies for all the other players, and
• a_i′ is some alternate strategy that player i might adopt.

What’s interesting about Nash equilibria is that given a particular formalised game, other non-Nash sets of strategies are “unstable”—that is, if a player finds out that given the strategy choices of the other players, she could have made a better decision, she will change her strategy accordingly.

The famous Prisoner’s Dilemma (look it up if you haven’t heard of it) is a great example of a Nash equilibrium where the outcome for each of the players is not optimal, even though they are in equilibrium.

What’s interesting to me about things like this is how it can be applied to medical research, if we make certain simplifying assumptions. Let’s imagine that medical research is like a two-player game. The players are the pharmaceutical industry on the one hand and some other participant in human research on the other.

In the tables below, Big Pharma has two strategies open to it—developing a “seeding” study or developing a “quality” study. The other participant (who could be a research subject or a physician-investigator or a journal that publishes medical research papers) also has two strategies available—participating in the study developed by Big Pharma, or not participating.

If the other stakeholder in the research project doesn’t participate, neither Big Pharma nor the participant receive any benefit. The utility outcomes for Big Pharma and the other stakeholder are 0, 0, respectively.

If the other stakeholder participates and the study is a high-quality study that provides socially valuable medical information, Big Pharma and the other stakeholder receive utilities of 1, 1, respectively.

But, if it turns out that the pharmaceutical company has produced a “seeding” study—one that is designed for narrow ends, namely those of being a marketing tool to get physicians used to prescribing a drug that has already received licensure—the pharmaceutical company receives a utility of 2 and the other stakeholder receives a utility of -1. That is to say, Big Pharma gets a big payout, because hundreds of doctors are now prescribing the drug, but the other stakeholder incurs a net harm in some way. (If she is a study participant, he may feel used or cheated. If she is a doctor, it may be a source of professional embarrassment. If it is a journal that published a “seeding” study, that journal will lose some of its reputation, etc.)

So if we go through each set of strategies that the players in this game can take, we find that the one with the asterisk is the only one that is a Nash equilibrium. This is because if you are Big Pharma in this game, given that the other stakeholder has chosen not to participate, you are indifferent between strategies, and if you are the other stakeholder, given that Big Pharma has chosen to develop a “seeding” study, your best choice is to not participate.

It’s interesting to note that this setup is analogous to markets for financial products and other “confidence goods,” where the buyer has a really hard time telling the difference between high and low quality products.

But what if no one caught on that the study was a “seeding” study? Let’s imagine that Big Pharma got away with running a seeding study and no one ever figured out that that’s what it was. We would end up with a game that can be represented as follows:

Here, the equilibrium has shifted. This explains why pharmaceutical companies try to develop “seeding” studies, and why they try to hide it.

So the question becomes, how can we set up the “rules of the game” of medical research in order to shift the equilibrium such that other stakeholders will participate and the pharmaceutical company will develop quality studies?

Or to put it another way, if we assume that the utility for non-participation for all players is 0, and that both the pharmaceutical company and the other stakeholder should both come away from a quality study having received some utility, what value for x will put the Nash equilibrium where the asterisk is in the table below?

The value of x must be less than 1 in order for the Nash equilibrium to fall where the pharmaceutical company develops a “quality” study and the other stakeholder participates. This is because if x = 1, Big Pharma will be indifferent between its strategies, given the choice of the other player, and if x > 1, as we saw in Table 1, the equilibrium will shift to where Big Pharma produces a “seeding” study and the other stakeholder declines to participate.

So in real life, how do we make x to be less than 1? There has to be some sort of sanction or penalty for pharmaceutical companies for producing seeding studies that makes their expected utility less than that of a quality study. This can be done by either putting a tax on seeding studies or by making regulations against seeding studies outright.

For those of you who don’t remember high school English class, in Macbeth, the title character learns early in the play that no one who is “of woman born can harm Macbeth,” which he takes to mean that he is invincible. Later on, Macduff reveals that he was “from his mother’s womb untimely ripp’d.” And then he kills Macbeth.

In January, I assumed that at some point over the course of this semester, I would have had the opportunity to refer to a child born by C-section as one “from his mother’s womb untimely ripp’d,” but it never happened. I even got to see a Caesarian birth from inside the operating room, but I didn’t think about it at the time.

Life slips away far too fast. If you’re not careful, all the opportunities you think you’ll have will pass you by.

I took an actual university course for credit in Decisions Analysis when I was an undergrad, which was one of the best educational experiences of my life. Decisions Analysis is the science of making rational decisions under conditions of uncertainty. The way that the profs for the online Game Theory course describe Game Theory is that it is the science of describing the actions of idealised actors within a particular system, given certain simplifying assumptions. Decision Theory, they say, is like a subset of Game Theory—it is like Game Theory where there’s only one player. This is very exciting to me.

I have already learned how to formalise a number of things that I investigated during the course of my thesis. Further, I now know what the actual definition of a Nash equilibrium is. It’s a concept that I had a sort of fuzzy handle on before, but now I think I could express it formally using proper notation and apply the concept to ideas like the medical research enterprise or smartphone application development systems.

I’ll keep you updated with regard to some of the more interesting results that I find. :)