April 5, 2010

by S. Todd Stolp MD©

We have probably all heard the description of the allegorical “experiment” in which a frog dropped in hot water will immediately hop out, but a frog in a pot that is slowly heated will recline with hind legs crossed like a vacationer in a spa until succumbing to the heat.  This tale is often told to emphasize the human tendency to ignore slow-paced social change while vehemently protesting the same change imposed rapidly.  Because April 7 through 11 has been designated Public Health Week, perhaps a close look at the “Boiling Frog” experiment will provide some insights regarding the challenges facing the Public Health sector.

Through the magic of the internet, gathering further research about the poor frog in the experiment is actually quite easy.  First, it should be pointed out that, for good reason, animal rights regulations would prohibit the above “experiment” today, and children should be cautioned not to try this experiment at home.  However, it turns out that in the 1880s a future president of the American Public Health Association, Professor William Sedgwick, conducted an extensive review of the excitability of the nerves of frogs and quoted the works of Heinzmann from 1872 who had indeed conducted the above experiment with a very slow incremental increase in water temperature in an elaborate system to measure the excitability of the frog.  The conclusion was that as long as the incremental change in temperature was slow enough, the evasive muscle movements of the frog were absent.  So how does this relate to today’s Public Health challenges, and was it just chance that the reviewer of these studies was a Public Health giant?

To summarize the implications of this experiment, incremental change is ignored if it is slow enough.  Consider the incremental change that has occurred in our world over the past 50 years.  While we often complain of the dizzying rate of social change over time, it seems that each tiny change that occurs over the short term is in fact embraced.  Consider the arrival of fast food restaurants, the ability to purchase a meal for our bodies while at the same time feeding our automobiles at a convenience store, our welcome acceptance of the latest digital device at work and play and our desire for the latest technical excuse to avoid exertion.  If we are truly alarmed by the effect these changes are having on our health – and the evidence that this is true is overwhelming – why are these concerns not reflected in our consumer and citizen behavior?  Could it be the “Boiling Frog” effect?

Perhaps.  However, humans receive much more input from and have much more impact upon our environments than frogs.  We can share philosophical views, read the news, watch commercials on T.V., adjust our investments and plan our employment.  We can design our cities with a broad range of options when resources allow, choose our meals when choices are available, and select our careers when education is sufficient.  These are what are called the “determinants of health,” and play at least as important a role in our health as our access to clinical care, and helping communities to act upon these opportunities is the greatest challenge to public health.

It is interesting to note that before Heinzmann engaged in his research, an European physiologist, Friedrich Goltz, had conducted essentially the same experiment, but Goltz had conducted his research differently.  Goltz compared normal frog responses to increasing temperature to the responses of frogs with their brains removed.  In his experiment, Goltz used such a rapid change in temperature that the normal frogs actually became irritable and made escape-like movements.  The frogs that were “destitute of cerebral hemispheres” did not.  Humans, of course, have immeasurably greater cerebral capacity to understand the effects of our environment upon our behavior and audaciously pride ourselves in wielding such magnificent thinking powers.  Whether we optimize use of our cerebral resources to use our cognitive and creative skills to keep the temperature in our pot in a survivable range or leap to a new environment will be the ultimate measure of our insight and compassion.

December 20, 2017

When I read the recent headline that our nation’s primary public health agency, the Centers for Disease Control and Prevention (CDC), has been “prohibited” from “using seven words in official documents used for next year’s budget,” I found myself stomping around the house in disbelief.

As clarified by the CDC director, the truth of this news is probably less provocative than the face value of that headline.  And yet, the preponderance of evidence points to an ongoing and relentless effort to undermine science and scientific principles by our political leaders.  The proverbial last straw has landed on this camel’s back.

In 1996, a federal budget bill stated that “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.”

Subsequently, Congress eliminated funding for Gun Violence Prevention Research at the CDC.  Funding declined from $2.6 million in 1996 to zero in 2014, 2015, 2016 and 2017, despite a request for $10 million for each of those four years.

This lack of funding prevented scientific research that may have helped address firearm violence in this country, like a 2009 study of suicide rates in California that was funded by local Tuolumne County dollars to identify that, over the prior decade, for every firearm-related homicide in rural parts of the state, there were approximately four firearm-related suicides.

A disrespect for science can cause politicians to blunder into the realm of pseudo-science in response to public outcry, designing legislation with good intentions but with disastrous results.

In 2001, AB 487 was approved by Governor Davis requiring physicians in California to receive 12 hours of training in pain management because of a perception “that physicians consistently fail to manage their patient’s pain appropriately” in part due to “…undertreatment and undermedication.”

The passage of this bill coincided with the release of new opiate medications by pharmaceutical companies.  The encouragement to prescribe long-acting narcotics provided by AB 487 in conjunction with savvy marketing by pharmaceutical companies helped pave the way to today’s opiate addiction crisis.

Pseudo-science and ideological convictions may even misguide us to oppose sound science.  The trail of scientific discovery is littered with the lives of scientists whose sacrifices have resulted in the eradication of smallpox, travel into space, the control of yellow fever and endless research that has either proven or disproven contemporary theories.

To ignore the practical benefits of new discoveries discounts the sacrifices of these modern explorers.  If such neglect aggravates global climate change or results in a chronically ill child contracting an unnecessary infectious disease in school, it is nothing short of tragic.

Scientists must also bear some of the blame for public skepticism.  Real science is humble.  While scientists are generally superb at describing their fields of expertise, they are often not so good at translating their knowledge to the masses.  Science has unfortunately abdicated marketing to the corporate world that stands to prosper from the sales of products and services that are the fruits of science.

Here in Tuolumne County we are trying to change that.  A program called the Exploratorium of Health Care Careers will visit every public school in the county this year.  It is also active in Calaveras County and will be starting in Merced County this spring.

The program is made possible by an intrepid group of volunteers from many scientific and educational backgrounds who are seeking to introduce local 7th, 8th and 9th graders to the wonders and rewards of careers in science and health care.

But to bring new generations into those fields we must encourage students to ask questions.  They must shed their fear of asking the “wrong” question.  We cannot do that if our leaders prohibit our best scientists from asking certain questions or “using seven words” – or for that matter even one word – in their quest to understand our world better and to improve our lives for tomorrow.

If we accept this kind of scientific censorship we degrade the quality and integrity of our science and lower the expectations of tomorrow’s scientists.

In today’s world, with all its diversity, we need to instill our youth with evidence-based and science-based reasoning, so that tomorrow all of us – from the vulnerable fetus to the transgender community – can benefit from opportunities that represent our entitlement.