ethics Archives - Hormones Matter

The Ethics Of It All

Published on April 4, 2023

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What if there is no future? We have always assumed that there would be a future, that somehow no matter what we did to ourselves or to the environment, life would go on. What if we were wrong? What if the very actions we embrace to prolong life, the technologies and conveniences that make modern living palatable, actually shorten it and shorten not just our lives, but life in general. What if the possibility of future life is not automatic but something that demands active consideration lest it disappear completely?

I had never thought about the possibility that a future might not exist. Sure, I recognized that I would not exist at some point, but I never considered the possibility of the death of humanity, until recently. Now, it seems as though it is everything I can do not to think about it. The magnitude of the environmental crisis that we face is compounded daily by the inability of contemporary leaders and thinkers to frame the crisis in a way that might allow us to address it. If we think about these toxicants, honestly think about them, it is difficult not to wonder how we did not know that all of the chemicals that we dump into the environment and into our bodies would lead to a poisoned environment and poisoned bodies. Seriously, what did we think would happen when we release poisons into the environment daily, year in and year out? Did we think they would somehow magically be absorbed and detoxified by the environment, and thus, effectively disappear? I believe we did and many still do.

I know that until I began the work here, I never gave this notion much thought. I, like most of us, embraced synthetic chemistry and all of the cool things we could concoct and manipulate. It was not until I began seriously investigating the mechanisms of these chemicals, outside the confines of academia, that I began to question the rationale behind these conveniences. I was taught that the dose makes the poison. This suggests that so long as the dose is low enough and administered in a controlled fashion that we can control the outcomes. In reality, however, the poison makes the poison. Small doses are just as deadly as large doses, the only difference is the time scale of the reaction. The body recognizes these poisons and adapts accordingly; so too does the environment. We simply cannot see those reactions until they reach a critical threshold and even then we have to be willing ‘see’ what is before us.

Let us consider glyphosate, which among its many deleterious effects on health, is a potent endocrine disruptor. That is, glyphosate overrides endogenous hormones systems in the organism exposed to the chemical. Per the Environmental Protection Agency’s (EPA) safety standards the maximal ‘safe’ exposure of glyphosate is 2 milligrams per kilogram of body weight or about 140 milligrams per day for a 70kg/154lb adult, which on the surface, seems like a minute amount and too small to worry about, but is it? If we buy the dose makes the poison approach, then we need not worry, but if we evaluate the chemistry and the math a little more closely, then an entirely different picture emerges.

Synthetic hormones, endocrine disrupting chemicals, exert influence in the body at staggeringly low dosages. A well-known researcher in the field of chemical endocrine disruptors describes this aptly.

“The issue of the amount of hormone that actually causes effects is very difficult for scientists to talk to people about because we’re dealing with numbers that are outside of the frame of reference that anybody is going to be thinking about. We see changes, profound changes, in the course of development of essentially the whole body of experimental animals, and we’re working with mice and rats, and we see these changes at fifty femtograms [a femtogram equals a quadrillionith of a gram] of the hormone per milliliter of blood. That’s 0.05 trillionths of a gram of this hormone in a milliliter of blood.
But what you have is the entire field of toxicology thinking of a millionth of a gram of a hormone or a chemical as being this staggeringly tiny amount, and to most people if I said there’s only a millionth of a gram of it here you’d say, ‘How can it do anything?’ A millionth of a gram of estradiol in blood is toxic. The natural hormone is actually operating at something like a hundred million times lower than that. So when you have a physiologist thinking of a millionth of a gram, you have that physiologist thinking this is a toxic high dose. When you are raised in the field of toxicology you are looking at that from the other perspective of ‘My gosh, that’s such a tiny dose, it couldn’t do anything.’” – Fredrick Vom Saal, PhD

If we thought 2 milligrams per kilogram was a small enough dose to be considered safe, how do we even conceptualize something that operates in femtograms per milliliter of blood, especially when 1 milligram = a trillion femtograms? That amount is inconceivably small, and quite literally, beyond comprehension, and yet, that is all it takes to disrupt hormone systems and cause illness; hormone systems that control not only reproductive capacity for the exposed individual but also affect the outcomes and health of the offspring across multiple generations. These chemicals directly affect the possibility of a future. One has to wonder if this is all it takes to disrupt critical hormone systems, what happens when we blanket the environment with tonnes of chemicals like we have done over the last 50 years or so.

Returning to glyphosate for a moment, as of 2014, over 826 million kilograms/1.8 billion pounds were used worldwide; a 12 fold increase since 1995. That is staggering amount of chemical exposure, and yet, it is just one of thousands of chemicals we are exposed to daily. Just one. There are currently over 83,000 different chemical entities being ‘monitored’ by the EPA. So, on the one hand, we have standards for safety that only partially recognize the dangers of small exposures (kg/mg) but are yet ineffective inasmuch as they are still several magnitudes greater than the dosages where the damage begins. On the other hand, however, none of this matters because the economic drivers push exposures well above those minimal safety standards and what any reasonable person would consider safe. And finally, neither the toxicology, nor the ethics consider what the cumulative body and environmental burden is with regular exposures to thousands of chemicals daily.

This brings me back to my original question, what if the possibility of the future is something that we should have been protecting all along? What if it isn’t a given? Shouldn’t there be some discussion of the ethical implications of using chemicals that damage not only the current generation but subsequent generations? Even if we ignore the chemistry or plead ignorance to the mechanisms of transgenerational effects, shouldn’t we at least consider whether it is ethical to release chemicals into the environment and into our bodies that potentially pose risks to future generations? Those who come after us inherit the world we have left. Shouldn’t we consider their health and the health of the environment that we leave to them? I think we should. Indeed, I think this ought to be part of any discussion of safety. It is not; partly by choice and partly because we have bought into this notion that the dose makes the poison and ignored the fact that the poison is the poison. We have eliminated the poisonousness of the chemical from the equation and out of any cogent discussion of danger. This allows us to proceed as if we have everything under control, as if we can recognize and mitigate any and all dangers that a particular chemical poses. This allows us to ignore the prospect that current actions influence future health and well-being. This allows us to reap the rewards of our technological prowess now and kick the costs of our ignorance down the road. Where are the ethics in this?

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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Image: Dicklyon, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons

This was published originally on March 7, 2019.

A Crisis of Responsibility in Modern Medicine

by Chandler Marrs, PhD

Published on March 29, 2022

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crisis of responsibility in modern medicine

Sloshing around in my brain over the last several months has been the notion that science, especially medical science as it is currently contrived, is suffering from a great crisis of responsibility. We see the lack of responsibility over and over again in the all-too-frequent, multi-billion dollar settlements and fines against pharmaceutical and medical device manufacturers. Neither the injury settlements nor the fines admit culpability; not from the scientists who developed the drug, not from the manufacturer, the salesmen, the ad men, or anyone along the production chain. We see no culpability from regulatory agencies who approve and, in many cases, market these medications. Neither the physicians who prescribe these medications nor the insurers who finance their availability are responsible either. No one, it seems, is ever responsible for medication-induced injuries or illnesses; a manifestation of magical thinking that makes the dark ages appear positively rational.

In financial terms, these settlements represent the cost of doing business, no more or less important than any other cost. Since there is no admission or assignment of responsibility, the drug or device in question remains on the market, and the cycle of injury, lawsuit, and settlement, begins anew. If enough time passes, the treatment in question becomes inured into evidence-based medical practices. The side effects are expected but disregarded. In much the same way as the settlements disregard responsibility, the side effects are simply the cost of doing business, an acceptable cost at that.

Bathed in the Safety of the Familiar

Indeed, the more familiar a drug becomes, the less we recognize that it is a medication at all. Think birth control pills, NSAIDs, and even antibiotics, so pervasively used, we often forget these are medications with actual side effects. Our familiarity with these drugs breeds a false sense of safety. We trust all that is known about these drugs, is all that can be known. We assume that after 20, 30, 40 years or more on the market, there would be sufficient time to reveal any risks. We forget, however, that more often not, we never bothered looking.

That is the thing about familiarity, it breeds complacency and a false sense of understanding. As Ignaas Devisch and Stuart Murray write in their brilliant deconstruction of evidence-based medical practice:

“There is something sinister about familiar concepts … The more familiar or ‘natural’ they appear, the less we wonder what they mean; but because they are widespread and well-known, we tend to act as if we know what we mean when we use them.”

With familiarity, it is easy to abdicate responsibility. We are familiar with medications, and therefore, the side effects must be flukes, anomalies, chance events. How can anyone be responsible for a chance event?

They cannot.

And that is the problem.

Somewhere, somehow, we’ve bought into this model of medicine where familiarity equals safety and efficacy, where ill-health comes by chance, and any evidence to the contrary is met with a deeply ingrained and willfully sustained ignorance. We find the roots of this sinister familiarity across all of medicine. We think we know what disease is and is not. We have meticulously defined and categorized hundreds, if not thousands of diseases, (save except the iatrogenic illnesses that we are loathe to recognize). We have defined gold standards by which to assemble the truths about these diseases and determine the best courses of action. We know all there is to know about many of them, and what we don’t know, we often willfully dismiss as unimportant or cleverly attribute to the idiopathy of random chance.

The Rise of Random Events

We see evidence of this everywhere. Take, for example, the certainty propounded by the authors in a recent study published in the esteemed journal Science (below). Cancer is a familiar topic, one that researchers have been studying for decades, and although we have made great strides in increasing awareness about cancer, identifying it early (before it is actually cancer and requires treatment in fact) and even some progress in surviving cancer (though that is debatable), we know almost nothing about preventing it. Our increasing familiarity with this disease process has bred a sinister type of ignorance – one that thinks it knows all that can be known; an ignorance completely unaware of its own limitations. According to the study’s authors, what we don’t know can be chalked up to random chance.

“Some tissue types give rise to human cancers millions of times more often than other tissue types. Although this has been recognized for more than a century, it has never been explained. Here, we show that the lifetime risk of cancers of many different types is strongly correlated (0.81) with the total number of divisions of the normal self-renewing cells maintaining that tissue’s homeostasis. These results suggest that only a third of the variation in cancer risk among tissues is attributable to environmental factors or inherited predispositions. The majority is due to “bad luck,” that is, random mutations arising during DNA replication in normal, noncancerous stem cells. This is important not only for understanding the disease but also for designing strategies to limit the mortality it causes.”

Here, the researchers are so entrenched in the current and very familiar paradigm of cancer research, that any evidence to the contrary can mean only that the nature of this disease process is incomprehensible or random.

To an outsider, some obvious questions arise, along with more than a little indignation and disbelief. Upon reading their work my thoughts:

Really? Cancer is caused by random chance? And the rise in the rate of cancer over the last generations is random chance also? It has nothing to do with the toxic soup we are born from, bathed in, and live within, breathe, and consume? It has nothing to do with medications or vaccines adducting to DNA, limiting DNA repair, and/or totally dismantling mitochondrial structure and functioning? Cancer has nothing to do with the medication and toxicant-induced epigenetic damage or nothing to do with a lifetime of heavily processed, calorie-rich, nutrient-poor, food-like substances? Nothing to do with any of that? Just random chance?

Fealty to the Shrine of Our Hubris

I have to say, attributing cancer to random chance is one of the most stunning combinations of godlike hubris and willful ignorance that I have ever observed. Equating cancer or anything else in medicine to random chance assumes that all appropriate questions have been asked and answered, all of them, every last one of them. It assumes that those asking the questions and the tools employed to find those answers are flawless and hold no biases. It assumes that everything that can be known is already known; that the science is settled in some way, and that all we can do, as mere humans, is to figure out how to mitigate the aftereffects. I don’t know about you, but I think this is an absolute load of crap.

If cancer or any other disease processes are caused by random chance, then we have no responsibility in either the initiation or prevention of disease; no personal responsibility for the lifestyle choices we make, no corporate responsibility for the myriad of common medications that are likely carcinogenic or the environmental chemicals that are known carcinogens. If cancer is mostly random, then we have no impetus to identify and then eliminate the root causes of cancer. The only impetus is to detect early and treat once recognized.

Define cancer as random, define drug side effects as random, define any illness as random, and we summarily abdicate all responsibility for that illness and foreclose the possibility of prevention. Worse yet, we foreclose upon knowledge in favor of a fantastical state of willful ignorance, where no one is responsible for anything.

Absolution: Is That Really What We Want From Our Physicians?

The lack of responsibility and human agency in health and disease absolves us from making difficult choices – smoke, drink, eat garbage – it doesn’t matter. Disease happens randomly. It is beyond our control. We might as well live it up.

Oh, but when it does happen when we are randomly struck by the disease gods, no worries, there are more pills for that, familiar pills, many that have been in use for decades; so familiar that their safety and efficacy are not questioned.

When those pills initiate side effects, even severe ones that cause death, well, because we have abdicated all responsibility, those side effects too must be seen as random and unattributable to any one person, medication, or institution. And this is where our previous trust in the randomness of disease inevitably kicks us in the butt. When side effects happen, when cancer strikes, and especially when these events happen in clusters where obvious associations between a drug or an environmental toxicant and the disease emerge, we want someone to be held accountable.

The problem is when we abdicate responsibility for our own choices when we fall prey to the unquestioning safety of the familiar, and when we buy into the random events theory of disease, there can be no culpability – even from those who are clearly responsible.

Kick and scream as we might, unless everyone assumes at least a modicum of responsibility, no one is truly responsible for anything. Encouraging ignorance and freedom from responsibility – don’t worry, be happy – is a great sales strategy and an even better method to garner political and ideological power, but it doesn’t bode well for health and well-being (or really anything that has to abide by laws of physics). And it is certainly not a model for medicine or medical science.

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter.

Photo by Paulette Vautour on Unsplash.

The article was published originally on Hormones Matter on October 7, 2015.

The Angry White Man: A Warped Culture Laid Bare

by Chandler Marrs, PhD

Published on February 15, 2018

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I wrote this in the days following the Las Vegas Massacre. I did not publish it then because it was too raw. I had friends there. I also did not publish it after the Sutherland Church massacre or the other school shootings that have happened since. Now, we have yet another massacre and I cannot hold this back any longer. While not all mass shootings are carried out by white men, the vast majority are. I would argue that no matter the race, the ethos remains the same, that of an aggrieved man. This is not an article I would normally publish on this site. It is angry and it is political but I cannot help but speak out. These shootings will not stop until we look honestly at ourselves and our culture.

Another day, another massacre. Like so many other American tragedies, this one was neither for political cause nor for religious or ideological reasons. No, not really, though try as we might to disguise it as such. It was just another disaffected, angry white man, searching for his truth through the barrel of gun. Another angry white man who believed that his existence, his happiness, his ‘reason’ whatever that might be, was an end unto itself. Another angry white man imbued with the false moral imperative of his own incontrovertible heroism. Another angry white man possessing certitude of his reasoning paired with inculcate selfishness. It was not mental illness. It was not even gun access. Those are mere symptoms of a much broader problem. It was an angry white man. One among many.

We have bred a generation of angry white men here in America. Men, who despite being in power, despite controlling all aspects of civic life, feel aggrieved by the otherness of everyone else. Whether those others are women, of different races, religions, of simply of different geographic regions, makes no matter. He is right. We are wrong. His rightness is morally justified, and thus, so too are his actions.

It is a common theme across history, that of angry and aggrieved men lashing out. Unlike miscreants of yesteryear however, today’s angry man, particularly the angry white man, is completely unbounded by the constraints of social, cultural or political mores. The right to ugliness and violence, the right to believe untruths, indeed, to construct one’s own, independent truth detached from reality or meaning, is sanctioned, politically, economically, culturally. For the decades since Ayn Rand put pen to paper every teenage boy’s dream, to be rightfully master of his own universe, an ordained narcissism of sorts, has been the core principle of American life.

And we sanctioned it. Perhaps not overtly, but tacitly and gradually we commandeered the moral authority to pursue comfort above all else. What permits these massacres is not a matter of a warped mind per se, but of a warped culture laid bare. A culture where no heed is paid to the destruction of environment by corporate entities, so long as profits are derived. A culture where no heed is paid to the deaths of children and young adults by pharmaceuticals, where no heed is paid to the deaths of thousands in the 17 years of war, our state sponsored violence against other countries, or to police brutality on African American men, or to domestic violence or rape; where no heed is paid so long as ‘my’ profits, happiness, or goals remain unimpeded by the consequences of my actions. The bubble of my self-serving justifications must remain intact. And it can, but only in a culture that prizes ‘my’ happiness over all else.

In a culture of laundered, indeed, bleached hate, against the otherness of others, we can be free of fear and discomfort, so long as the ever-increasing, bifurcating and dissonant justifications of our own supremacy over all that is other or foreign holds fast. “It’s okay to dump toxic chemicals into the rivers and oceans, because it doesn’t affect me directly,” we think to ourselves. “It’s okay to ignore poverty and suffering of those people, because they are not ___” (fill in the blank). “It’s okay to turn our backs on refugees, my safety might be imperiled.” It’s okay to ignore, vilify, and therefore, discriminate against all that is other. With our boundless dominion, we neatly, eagerly, and completely place all that is uncomfortable or inconvenient into boxes of otherness; boxes devoid of humanity, and thus, unburdened by ethics or even reason. Like Russian nesting dolls, our worldview becomes smaller and smaller, until we are left with a dominion over no one and nothing. For the long simmering angry white male, the only truth that remains is his truth, meted through a barrel of a gun. It is his last bastion of control, the last barrier between him and the realization that he is utterly impotent. Bang.

Image credit: Necker; Goodfon.com

If We Are Unaware of Human Suffering, Does It Exist?

by Chandler Marrs, PhD

Published on May 22, 2017

3742 views

Of Forests and Fallen Trees

If a tree falls in the forest and no one is there to hear it, does it make a sound? The age old philosophical riddle posited by George Berkeley and debated by philosophy students for generations has profound ethical connotations for medicine and life. At the root of this question is whether awareness predicates existence. If we are unaware of someone’s suffering, does suffering exist? Missing from the question, however, is to what degree our cognitive and emotional faculties influence our ability to perceive. Aside from outright sensory deprivation, does choice have a role in what can or cannot be perceived?

In the case of modern medicine, if the suffering is invisible to current diagnostic tests and intractable to medical therapeutics, it is not real. Indeed, whether cognitively or reflexively, every time a physician dismisses a patient’s complaint or prescribes an anti-depressant for pain, he denies the existence and veracity of their suffering. He denies the tree in the forest, because he does not see or hear it himself in the context necessary to recognize it – e.g. by currently available diagnostic technologies and taxonomies. Here, medical technology, and the physicians who wield the technology, assume an infallibility that precludes the existence of realities beyond their sight lines, beyond their control.

In many ways, it is as if we have lost the ability to recognize suffering by our common humanity, and instead, have adopted, perhaps unknowingly, a perverted medical ‘awareness predicates existence’ philosophy of care.

That’s a little harsh, right? Well, yes and no. How else does one explain why so many physicians can stand face to face with pure, unadulterated agony and dismiss it without so much as an attempt to uncover the cause and alleviate the pain? Callousness? Perhaps, but I don’t think so. Most who go into medicine do so with honorable intentions.

Certainly, there is some degree of cognitive dissonance and quite possibly, ignorance at play; but I think there is more to this issue than simply holding contradictory views and choosing the more palatable or the lack of understanding that ignorance would require. I think for many the suffering simply does not exist; not cognitively, not intuitively, not at all. It has been trained out them, and out of all of us, quite possibly, carefully and continuously by those who seek to profit from product sales or a particular political ideology. Whatever the cause though, in medicine, if the particular flavor of suffering is not identifiable by standard testing and does not fit into the big book of diagnoses, it is assumed to be feigned and, for all intents and purposes, feigned suffering does not exist. In these instances, suffering becomes the fallen tree in the forest with no sense apparatus to perceive its sound or recognize its reality.

I ask again: if we are unaware of human suffering, does it exist? Of course it does, just not within the boundaries of modern medical science.

Of Choice and Hubris

Perhaps a more salient question, can we ever be truly unaware of suffering unless we choose to be? Medical training paradigms aside, choice may be at the crux of this philosophical riddle. In everyday life, we choose to believe that our world exists continuously and beyond our recognition, whether we are actively perceiving it or not. It would be quite difficult to construct an alternate reality. Imagine the hubris needed to rest the existence of anything on one’s own perception of that object – a continuous perception, no less. And yet, in medicine, we do this all the time. We say with certainty that this or that disease exists or does not exist; that this or that patient is truly ill and suffering while others are not and are feigning their pain. We trust, wholeheartedly, the infallibility of the lenses through which we recognize suffering, even when this means ignoring our own sense perceptions of the human being in front of us. Those are choices, perhaps not entirely active and conscious ones, but choices, nevertheless.

In this regard, our behavior is akin to believing the world begins and ends according to our perception of it. That’s a pretty weighty task – being central to all existence; one I am certain no rational individual would admit to. Except that, this is what we do daily in medicine when we ignore the suffering of patients who have difficult, if not impossible, to diagnose and treat conditions. Rather than admit our fallibility, admit that trees, do indeed, fall in the forest absent our observance, we become the arbiters of reality. In doing so, we ignore the existence of their suffering, and more importantly, deny our common humanity.

I cannot help but wondering if it would not be easier to admit simply that trees do fall in the forest when we are not around; that existence is not predicated on our awareness, and that we don’t, in fact, know everything there is to know about medicine and medical science. It seems to have worked out okay for the rest of science. Oh, and if we can bring our common humanity back into the equation, who knows, we might even discover that we can relieve the suffering that we have been so keen to deny.

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter.

This article was published originally on Hormones Matter on September 30, 2015.

ethics

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