Of Nuclear Energy and Adenoid Glands

The first part of the title (Nuclear Energy) has not much of a future, at least in the advanced economies of the West. Which is a pity, and just shows that we as a species (or is it just the social arrangement we gave ourselves in the last three hundred years?) are not very good at taking decision collectively, as once and again what may make sense for a minority of individuals, and is vocally advocated by them, ends up curtailing the prospects of the majority (not exactly breaking news, I know). I want to share with my readers (in this post or in a future one) why I think nuclear energy (the industry to which I devoted most of my first university career, and a good deal of my professional life) has no future, and why I think that is a terrible, terrible decision. But before that, I want to undermine my own argument (we contrarians are intellectually masochistic like that) with an example taken from an entirely different field. As usual, it will require a longish detour, so bear with me patiently.

You all know that physicians are between the most admired professionals in our society, a recognition that translates in the very hefty salaries they command (it may vary slightly by medical specialty, but becoming a doctor is, in every country, one of the surest ways towards accumulating great wealth, almost regardless of individual ability or likeability in other areas). Which is only fair, because they have to spend very long years in medical school actually studying and practicing (not like, say, journalism students, which devote almost 100% of their university lives to partying and abusing recreational drugs, also almost universally) AND health is one of the most coveted goods, and people show once and again that they are willing to pay whatever it takes to maintain it or recover it if (heaven forbid!) they lose even a tiny fraction of it. Good. Now let’s turn our attention to what it is that those devoted and self-sacrificing students learn during those long years, based on a couple recent experiences I had (disclaimer: I may be one of the most medicine-averse human beings currently on Earth, I routinely skip my med check-ups, consistently fail to read the results when I undergo them, am averse to any kind of pill, drug or concoction -xcept the ones containing alcohol for internal use, that is- and when I feel physically ill I try to soldier on with good spirits and good ol’ fashioned stoicism… the result is that I’ve not lost a single work day due to illness in the past 25 years… all of which I bring up to say my exposure to medics is really, really limited, and four little anecdotes I’m about to present may well be very little representative):

·         I’ve always been terribly allergic. Probably a genetic condition, as my mother also is, and most of my brothers are afflicted by the same intense hay-fever when spring come. In my childhood it was so bad I tried to stay indoors most of the time between April and the Beginning of June, and even there I spent between four and six boxes of Kleenex and had a conjunctivitis so sever I could barely read. It receded a bit during my university years, but worsened again when I started working, so I did what everybody else does: went to the allergologist , who made the typical test (piercing my forearm in 26 points, and pouring a droplet of pure allergen in each point to watch the funny shapes of the reactions) and gave me the typical diagnostic and prescribed the typical treatment: a vaccine with those substances I had shown a highest sensitivity to. Back then, those vaccines were pretty expensive (they were not covered by social security for young, wealthy workers) and a royal pain in the ass: they had to be kept in a fridge, injected once or twice a week for months on end and seriously curtailed the possibility of international travel (at least back then you could pass a thermally sealed bag full of glass vials through airport security, as I had to do a number of times). Be it as it may, I endured it for a couple of years, as the damn allergy was making my life really miserable for at least three moths every friggin’ year. And the first year it worked like a charm! I had one of the finest springs I could remember! Eyes mostly OK, little rhinitis, little sneezing, I could almost lead a completely normal life! Man, I was elated and in awe at the power of modern medicine! But then the second year came. Probably the worst spring I’ve experienced, ever. My colleagues at work told me to go home and die every single day. My nose was like an open faucet, as were my lacrimal glands (when my conjunctive was not so swollen it blocked them), and it was almost impossible for me to finish a single sentence without multiple loud sneezes. My head ached horribly because of all the sneezing and blowing my nose… and no medication seemed to make any effect, doesn’t matter how many anti-histamines I popped. So I went to the doctor to complain, telling him that the vaccine didn’t seem to be making any effect. “Well”, he told me, “you have to understand that this spring we are seeing historically high pollen levels, and so your reaction to them is being very severe… if the next spring is normal you will continue seeing some improvement”. “Wait a minute here, Doc” I retorted, “So these pollen levels vary, according to how rainy the fall and winter have been and all that, that makes sense, but how much pollen was there last spring?”, “very little indeed” he answered, “a very dry winter, with a lot of frost and many late hailstorms caused a spring with one of the lowest pollen levels ever recorded”. Aha! So the vaccine had very little to do with my perceived improvement, I just got lucky with the weather, and all the fuss with the darn injections was almost for naught. I lost my faith in it, never again injected the damn thing, and have never regretted it (if you are interested, my symptoms have greatly improved since then, but allergies seem to recede with age in many cases)  

·         As I’ve reported in this same blog, at some point a couple years ago I tore my left biceps tendon doing moderately heavy deadlifts (as narrated here: I (barely) dodged this bullet). I went through a number of doctors, one of which, with a somewhat crude sonogram machine, “saw” that the biceps tendon was fine, and many others that saw clearly it was broken and had to be surgically reattached. The second group relied on the images provided by a much more precise, state-of-the-art sonogram, plus a magnetic resonance that left them in no doubt my tendon was gone for good. Only of course it wasn’t, and thanks to a series of entirely unintended circumstances (the successful surgeon that had to operate on me was so busy he couldn’t seem to find a spot for my little intervention, and in the meantime I realized my arm was entirely fine) I barely avoided a surgery that would have caused me countless inconveniences (between them, the almost certainty of an elbow with less mobility and less stability than the one I was born with), for exactly zero benefits. Is there any difference between the first doctor and the rest? Well, there happens to be one: the first doctor I saw, the one that clearly “saw” my tendon was alright, was a friend of my father-in-law, and examined it as a favor, knowing he would not be the one to operate (and thus gain a financial benefit from the intervention), whilst all the others had a strong incentive to “see” an opportunity to intervene. I am not saying they were a bunch of scoundrels wanting to make a quick buck from an unnecessary surgery (well, maybe I’m strongly implying that), I’m just pointing at how difficult it is to value and judge things impartially when you have a clearly identifiable stake in one of the possible outcomes

·         All my three sons have had a lot of health problems having to do with the nose and throat: the usual colds, some snoring (more when down with the flu), persistent coughing. Now, I know “a lot” is a very relative term, and I would be surprised if there is any parent out there who thinks that their children are outstandingly healthy and have never given her any trouble. Pediatricians manage to do nicely in a society where there are less and less children overall for a reason (they have successfully managed to extract much more needs for treatment from each individual child, that’s how). My two eldest sons have had tonsillectomies, like almost every other child I know of, as after the second cold (or episode of sore throat) the doctors always look inside their little noses with an endoscope and dictate the need to remove the adenoid glands, as they unfailingly “see” they are clearly “too big”, a definite cause of uncounted problems, entirely unnecessary and the life of the kids will substantially improve after the removal. I probably could have been more statistically savvy and formally test such prediction registering the amount of episodes of rhino-pharyngeal illnesses experienced by my sons before and after the surgery, but I have the strong hunch that the effect of it would show up to have been exactly zilch. Indeed, I probably grew savvier no matter what, as recently we took our younger one to the pediatrician (after a prolonged episode of dry coughing that didn’t allow neither us nor him to sleep), he referred us to the otorhinolaryngologist, who used the usual endoscope and, lo and behold! Found (“saw”, as clearly as my own doctors had before) that the adenoids of my little one were some of the biggest he had ever seen, and that a tonsillectomy was absolutely recommended. Back to the pediatrician, she agreed (how could she not, specialists are for general practitioners like the voice of God, they’ve been trained all their lives to defer to them). Well, this time I put my foot against the wall, “specialist schmecialist” said I, and (that’s the magic of it) convinced my wife to wait and see. Obviously, the kid improved all of his own, he has had other episodes (just like his tonsillectomized brothers) but so far seems to be growing perfectly fine. And just today I found this little gem in the NYT: turns out on of the most common surgical procedures may not be worth it ... it’s difficult not to read it as “we have been inflicting pain (or wasting surgeon’s time and anesthetics) in little kids for decades for no apparently valid reason… other than said surgeons, and the people referring patients to them, have been nicely paid for it”.

·         Finally, a good friend of mine works for big pharma, in a work that, as I jokingly call it, consists essentially in “pushing drugs”, both retail (she visits doctors to “keep them appraised of the latest developments in pharmacology”, said developments consisting entirely in advertising of the benefits of the drugs she represents, attested by very expensive clinical trials paid for by her company, and given additional credibility by the different levels of “presents” that fall just short of what would legally constitute bribing) and wholesale (organizing “medical congresses” for doctors and their spouses to publicize the advantages of the medicines they market over those of their competitors, normally in plush settings and comfy locations so the most influential amongst the section of the medical profession prescribing the drug are sufficiently enticed to attend). Big pharma spends a godawful amount on those “direct marketing” activities because they know they work. Again, I’m not saying that the doctors are a bunch of scoundrels that prescribe the medicines peddled by the highest bidder (those that provide them with the most outrageous perks)… only that they “see” more clearly the benefits identified in those unimpeachably scientific clinical trials that happen to be (coincidentally, almost miraculously) presented to them along more attractive “gifts”.

To put things in perspective, I did not intend to say that all physicians are a bunch of sellouts and greedy bastards, in it for the money and willing to invent any imaginary illness (like ADHD, but that would be the subject of another post, probably much more critical and vitriolic than this one) to profit from the suffering and anguish of their unsuspecting, gullible patients, or that modern medicine is a sham, and that most drugs and surgeries are at best placebos (and at worst actually detrimental) with only the barest connection with the well-being of the ill and infirm. Remember, medicine in my playbook is not science, but a form of engineering, and being an engineer myself I feel a lot of respect for its accomplished practitioners, and cannot think of a higher praise that recognizing the empirical, practical nature of their profession. What I am saying is a healthy dose of skepticism is more than warranted, because all their training, from their early years of study to their professional career, imparts them with a certainty on what should be, at the end of the day, subject to interpretation and nuance. It teaches them to “see” what is not much more than a random blot of ink (I’ve many times equated sonograms with Rorschach test, and the same could be applied, it seems, to endoscope images or the results of clinical trials comparing the efficacy of different drugs, and to God knows how many more “pieces of evidence” used to diagnose and determine the best course of medical action), and to unfailingly err towards the option that will make them richer… which is not necessarily the one more beneficial for the patient (and I know, there is a deontological code explicitly forbidding doing harm, and counseling towards caution and abstaining from those actions that the natural course of the illness may make unnecessary… a deontological code that cannot compete with 6 years of schooling plus countless examples of teachers and mentors to the contrary).

Now, what has all of this to do with nuclear energy? Simple: if you ask a physician if she is aware of the unholy interests that blind her/ cloud her judgment/ bias her decisions to take first into account her financial well-being and only in a distant second consider dispassionately what is best for her patients, she will, I am sure, vehemently deny such a monstrous accusation, and defend her good faith, selflessness, objectivity and devotion to the ill and the infirm (making a very nice profit, again one of the highest paid professions absolutely everywhere, being just a happy coincidence!) And she would be telling the absolute truth in such defense. Doctors are indeed incredibly selfless and hardworking for what they have been taught is the greater good of their patients. They make tremendous sacrifices and work super-intense and super-long hours (in most countries with a “socialized medicine”, typically split between the national health service and private practice) to help the ill and infirm recover their health, which is something incredibly valuable.

You surely see where this is going: if you similarly ask a nuclear engineer (like myself) if he is aware of the unholy interests that blind him/ cloud his judgment/ bias his decisions to take first into account his financial well-being and only in a distant second consider dispassionately what is best for society in general, he will, I am sure (indeed, I’m going to do exactly that!) vehemently deny such a monstrous accusation, and defend his (my) good faith, selflessness and devotion to the power-hungry and needy, the citizens of every stripe and nation that need a reliable supply of energy that does not spew carbon dioxide in the atmosphere. Nuclear engineers, although not as well paid as doctors, are incredibly selfless (all this obsession with safety and security, with considering every potential failure that can be imagined and not sparing a dime to ensure such failure does not end releasing harmful radionuclides in the open that could adversely affect the public) and hardworking for what they have been taught is the greatest good of society in general. They make tremendous sacrifices and work super-intense and super-long hours (well, again probably not as many as your average doctor), etc.

Which means that, when I defend nuclear energy (definitely in a future post, as this one has grown beyond my wildest expectations already) and argue why its more than probable demise is a net social loss, you should take my arguments with a grain of salt…