Never Mind the B#ll*cks, Here's the Science E-Book

Luke O'Neill

• Herausgeber: Swift Press
• Kategorie: Wissenschaft und neue Technologien
• Sprache: Englisch
• Veröffentlichungsjahr: 2021

Seitenzahl: 487

Beschreibung

A number one Irish bestseller, and winner of the Popular Non-Fiction Book of the Year at the Irish Book Awards In this fascinating and thought-provoking book, Professor Luke O'Neill grapples with life's biggest questions and tells us what science has to say about them. Covering topics from global pandemics to gender, addiction to euthanasia, Luke O'Neill's easy wit and clever pop-culture references deconstruct the science to make complex questions accessible. Arriving at science's definitive answers to some of the most controversial topics human beings have to grapple with, Never Mind the B#ll*ocks, Here's the Science is a celebration of science and hard facts in a time of fake news and sometimes unhelpful groupthink. 'A celebration of scientific fact in an era characterised by nebulous subjectivity' Irish Times

Leseprobe

SWIFT PRESS

First published in Ireland by Gill Books 2020

First published in Great Britain by Swift Press 2021

Copyright © Luke O’Neill 2020, 2021

The right of Luke O’Neill to be identified as the Author of this Work has been asserted in accordance with the Copyright, Designs and Patents Act 1988.

Original design by Graham Thew

Design origination of this edition by Bartek Janczak

Edited by Djinn von Noorden

Proofread by Neil Burkey

‘Bed Blocker Blues’ from The Luckiest Guy Alive by John Cooper Clarke reproduced with permission of the Licensor through PLSclear

Typeset in Freight Text pro Book

A CIP catalogue record for this book is available from the British Library

ISBN: 9781800750760

eISBN: 9781800750777

For my sister Helen, who has spent her life caring for all the lonely people.

ACKNOWLEDGEMENTS

Thanks to Sarah Liddy of Gill Books, who asked me to consider writing a book about how science can inform big questions (but who, I imagine, never thought that ‘b#ll*cks’ would be in the title …). Thanks, as ever, for your support, Sarah. Thanks also to Aoibheann Molumby, editor at Gill Books, for excellent editing and many insightful comments.

Several people read the text for me to check facts (and took glee in correcting me) and made some great suggestions: first, Andy Gearing, a fellow immunologist. I met Andy when I was working in the UK and we began a scientific collaboration on an immune cell type he discovered called NOB cells (I won’t go into it). More important, one day I went to his flat for lunch and he said, ‘See what you can find in the fridge.’ All I could find there was a bottle of champagne and a jar of lime pickle. I knew I’d found a lifelong friend. Andy read the whole book twice and came up with so many great suggestions that he should be a co-author. Tough luck, Andy – no royalties for you.

The following people read various chapters: my sister Helen and my wife Margaret both made excellent suggestions for the chapter on men versus women. Cliona O’Farrelly (another fellow immunologist) was a great sounding board for some of the topics in this book. Zbigniew Zaslona (post-doctoral scientist in my lab) made several suggestions and was always great to bounce things off. Brian McManus (who apparently was once a GP, although I find that hard to believe) suggested I include material from The Matrix and The Hitchhiker’s Guide to the Galaxy, as well as suggesting that the list of occupations in the bullshit jobs chapter should include only academics. Brian also made important suggestions for the chapters on euthanasia and racism. Duncan Levy (climate engineer) checked the climate change chapter. My colleague and fellow immunologist Kingston Mills made great suggestions for the vaccines chapter. Aongus Buckley (economist and Thomas Paine fan) and Neil Towart (lefty Australian) made suggestions on the bullshit jobs chapter. Aongus also checked the chapters on racism and on control in life, as did fellow ‘Bray-ite’ Frances Gleeson (who has more degrees than me). Ken Mealy (surgeon) and Colm O’Donnell (physician) both made suggestions for the chapter on euthanasia. Colm also read the chapters on drug legalisation (he knows a lot about drugs …) and on racism and made important suggestions. Donal O’Shea (physician) made great comments on the dieting chapter and suggested that I include ‘fat-shaming’. Chris McCormack (Trim gentleman and former prison governor) made suggestions for the chapters on jail and drug legalisation. And my old mate John O’Connor (neuroscientist) made suggestions for the chapters on addiction and depression. Finally, a big thanks to Stevie O’Neill and Sam O’Neill, who didn’t read this book at all, but thanks anyway, lads.

CONTENTS

Introduction

CHAPTER 1: What makes you think you’ve control over your life?

CHAPTER 2: Why won’t you get vaccinated?

CHAPTER 3: Why are new medicines so expensive and who should bear the cost?

CHAPTER 4: Why do you believe in diets?

CHAPTER 5: Why don’t you just cheer up?

CHAPTER 6: Why can’t you stop doing things that are bad for you?

CHAPTER 7: Why shouldn’t drugs be legal?

CHAPTER 8: Why aren’t you in jail?

CHAPTER 9: Why do you still think that men are from Mars and women are from Venus?

CHAPTER 10: Why do others scare you?

CHAPTER 11: Why are you working in a bullshit job?

CHAPTER 12: Why won’t you give all your money to charity?

CHAPTER 13: Why are you wrecking the planet?

CHAPTER 14: Why shouldn’t you let people die if they want to?

CHAPTER 15: What have you got to look forward to?

Endnotes

INTRODUCTION

—

Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less.

Maria Skłodowska Curie

—

WELCOME TONever Mind The B#ll*cks, Here’s The Science. The title captures exactly what this book is about. It’s about the science behind the biggest issues that confront our species today. These issues intrigue me, and hopefully you: control over your life; vaccination; dieting; mental health; addiction; legalising drugs; racism; men and women; bullshit jobs; climate change; euthanasia; the future. Using my scientific training, I’ve examined the science in each of these topics. I have, in the inimitable words of Matt Damon in the The Martian, literally ‘scienced the shit’ out of them. B#ll*cks and shit? There’s two rude words already, and in a science book!

Science is so great because it’s based on information that comes from experiments and data that have been independently checked and ultimately reproduced by different scientists. Scientists are competitive and love scientific combat and, when they work together, they are unbeatable. The best want the truth. Science is the antidote to fake news, so we need it now more than ever. We are all astounded by what’s happened with COVID-19, the disease caused by the virus SARS-CoV-2. That pandemic has revealed how we need science more than ever, and I discuss several of the topics through the lens of that particular malicious virus. My goal is to get as close to the truth as I can on all of these topics, using science as my only guide.

To be a scientist is to be a sceptic. This is why they argue with each other. I read a great quote recently from a 1924 issue of the Massachusetts Institute of Technology’s Tech Engineering News magazine (that’s how much of a sceptic I am – checking back issues of MIT newsletters). It said, ‘The predominant feature of the scientifically trained mind is the ability to associate cause with effect. It is not content with the knowledge and application of facts, but it seeks the reason therefore. It is continually in a state of unrest, turmoil, irritation. Moreover, it manifests a natural inclination and willingness to know the reason “why”.’ Unrest, turmoil and irritation? Sounds great, doesn’t it? But it makes an important point. Scientists obsess about associating cause with effect. Or to put it another way, determining the link between correlation and causation. Vaccines correlating with, but being responsible for protection against, an illness. A diet correlating with, and hopefully causing, weight loss. An antidepressant correlating with, but being the reason for, improved mental health. A genetic variant correlating with and causing criminal activity. Being female correlating with, and being the reason for, increased empathy. Human activity correlating with, and causing, global warming.

The correlation/causation issue is critical in science: you might well correlate one thing with something else, but that doesn’t mean that what is being correlated is the cause of something else. For example, there is a correlation between smoking and cancer. For a long time, tobacco companies claimed that this was just a correlation. But then the science became irrefutable – smoking causes cancer. This can be proven with rigorous statistics and by coming up with a mechanism, which proves the link. In the case of smoking, the mechanism is chemicals in the cigarette smoke: these cause mutations in the genes that produce proteins which, when mutated, cause cancer. The case that smoking causes cancer took off when in 1953 scientists showed that mice painted with tobacco tar developed tumours. Study after study confirmed this observation and extended it, providing the mechanistic link. Game over. This led to panic at tobacco companies who met secretly in New York’s Plaza Hotel to start their campaign to counter the bad publicity, dubbed ‘the most astonishing corporate deceit of all time’.1

Another example of how correlation and causation can become entangled is a study which showed a correlation between the number of babies being born and numbers of storks nesting nearby.2 This was done to illustrate how we shouldn’t jump to conclusions. The investigators found that there was a correlation, and the correlation passed a stringent statistical test. This indicated that storks deliver babies, right? Not so fast. Close inspection revealed that the reason for the correlation was that storks were nesting near larger villages (which had more chimneys for them to build nests on), where the number of newborn babies was greater. So even though there was a correlation, it wasn’t occurring because the storks were delivering the babies. The correlation was actually with village size. The bigger the village, the more chimneys; the more chimneys, the more storks but also the more babies being born. The final proof of the claim that storks deliver babies would have been a mechanism, which means showing how it would work: stork scientists observing storks actually delivering babies. You never know – and, as a scientist, I must remain open-minded (and slightly crazy) to even countenance the possibility. And the most important scientists were often crazy because they could think laterally. There’s even a study that correlated the places where mad cow disease occurred in the UK with where Brexit voters lived.3 This one was satirical. We scientists laughed and laughed. But for a split second, we all wondered …

People don’t really want to know that scientists are sceptical. What they want is for scientists to nail their colours to the mast, based on the evidence at hand. Anecdote and snap decisions are the enemy of science – what is needed are experiments, data, statistics and a considered response. Sadly, these criteria can be inconsistent with what politicians or media editors and sometimes even editors of scientific journals want, which is where the problems can begin. Donald Trump’s championing of the drug hydroxychloroquine for COVID-19 gives us another egregious example of what can happen when politics and science meet. For political reasons, Trump wanted a rapid treatment for COVID-19. He said the evidence behind hydroxychloroquine as a treatment for COVID-19 was ‘great’ and ‘powerful’. He also asked, ‘What do you have to lose?’ The president of the American Medical Association, Dr Patricia Harris, answered, ‘Your life’. Hydroxychloroquine can damage the heart, and had never been tested against COVID-19, a disease that can involve heart damage. This made doctors very cautious in its use against COVID-19, although it can be used safely for diseases such as rheumatoid arthritis. Dr Anthony Fauci, eminent immunologist and lead member of the Trump administration’s White House Coronavirus Task Force, said, ‘The data are really just, at best suggestive. In terms of science, I don’t think we could definitively say it works.’ Who do you agree with? If you’re a scientist only one thing matters: data must trump politics.

Deliberation is key to science: it helps us see where the truth lies, as opposed to responding with our intuition. Susceptibility to fake news is due to lazy thinking (you can just hear your old teacher saying that, can’t you?) as opposed to inherent bias.

Most of the topics I cover are serious. If we make a wrong decision, we end up destroying the earth. Or killing people on a clinical trial. How does science inform our decisions when it comes to these issues? Each chapter is a question that I address with data and/or experiments to help us (science loves both of these). I’ve done my best to give you the best evidence to support conclusions drawn. You might want to check the facts yourself, and that’s fine. I may have gotten some things wrong. You should correct me – with evidence. That’s how it’s supposed to work. Now, more than ever, people need to believe in science and scientists, as opposed to what you might read on the side of a bus.

At the start of each chapter, I include a quote to inform the topic from artists, writers or comedians that I love. At the end of each chapter, I give my own bottom line. You could be lazy and just read these, because they capture the essence of each chapter. Or you could do the right thing and delve deeper to find out the science that led me to my conclusions.

I hope the book helps and informs you in your deliberations on these weighty matters. I hope you come away positive about your own life if the topics are especially relevant to you. I hope you will feel more comfortable about these topics: not wholly, of course, because we are built to be uneasy. It’s part of our innate nature. Hopefully, you will achieve enlightenment through science. It’s only through dialogue and challenges that we make progress. And I hope you feel more positive about the future – a future where we are all headed, with science as our one true friend.

So, with your glass half full, join me on this mission to reaffirm your vows as a scientist if you are one already, or if you’ve lapsed (no shame in that) to remind you why science is great. And if you’re neither of these, I welcome you most warmly. Together we can navigate our way through enormously important questions. And you will see why we should all be scientists: always questioning, always trying to work things out, but ultimately turning darkness into light.

CHAPTER 1

WHAT MAKES YOU THINK YOU’VE CONTROL OVER YOUR LIFE?

–

‘We operate on autopilot and end up, whatever, with a house and family and job and everything else, and we haven’t really stopped to ask ourselves, “How did I get here?”’

–

David Byrne on his song ‘Once in a Lifetime’

YOU PROBABLY THINK you’re reading this book because you chose to. You probably think you’re free. You move through your life weighing up options and deciding what to do. Which football team will I support? What career will I pursue? Will I get married? Will I try for a baby? Will I drop out, wear a nose ring and promise myself never to own a lawnmower?

On the face of it, we seem to go through life in control of our own destinies. And yet, when you scratch the surface, it’s not quite so simple. For instance, there may be a parasite in your brain controlling your behaviour. Or if conspiracy theorists are to be believed, you’ve been controlled since childhood to ensure you end up a productive tax-paying citizen. Certainly, you are being played by social media, but then you know that, don’t you? The truth of the matter is your life is governed not so much by the stars but by random statistical fluctuations in a universe that is cold and unthinking. Or by Google. Cheering, isn’t it? And look what happened with COVID-19. That particular bundle of random statistical fluctuations put paid to so many of your plans. But it’s not too late – we will win the war against it and you will be able to take back control of your life and be truly free. Won’t you?

Free will is an important concept in western civilisation. It’s defined as the ability to choose between different options unimpeded. Many philosophers have tied themselves up in knots debating it. In some ways, it is the central question of philosophy.1 Some contemporary philosophers gloomily complain about how little progress has been made on the issue over the centuries. Maybe philosophers have lost the (free) will to explore it further. We all have a strong sense of freedom, which makes us intuitively believe that we have free will. Spinoza felt that we are conscious of our actions (and interpret this as free will) but are unconscious of the causes by which our actions are determined. Also, if prior conditions determine everything that happens to us, then our future can be predicted with accuracy – we have no control over our future at all. Is it all predetermined? See what I mean by philosophers being troubled by all of this?

If you grew up in a stable family, with a parent who had a professional occupation, and if you are sent to a certain type of school and then on to a reputable university, all of these pre-conditions will most likely lead to you having a professional occupation and living a life predetermined by the circumstances you grew up in. If you are part of a religious community with strict laws, say, the Amish community in the US, then you will grow up to lead a life consistent with those laws. You will marry another Amish person. You will never own a car. On average, no free will. Some religions believe that we live in a world that is predetermined or predestined, where all events are determined in advance. Lutherans believe that Christians live a predetermined life, with salvation after you die being predestined for those who seek God. Calvinists take a more extreme view. They believe that God picked those who will be saved before the earth was even created. Hard luck if your soul wasn’t picked – you might live a blameless life, but you still won’t make it.

The German philosopher Friedrich Nietzsche, hero to many a disaffected teenager, didn’t believe in free will at all and, judging from his writings, was annoyed by the range of teachings on the matter.2 He put free will down to the pride of man (he didn’t say much about women). He called the whole idea of free will ‘crass stupidity’. Even though he declared ‘God is dead’, he wrote about how free will absolves God (if there is one) of responsibility when humans misbehave: if humans are free, they can be deemed guilty by God if they sin. Nietzsche was also a fan of chance. He was of the view that much of what happens to us is governed by chance, as opposed to us deciding things. One of his big arguments was that ‘if both humans and God actively will good things to happen, why is evil a constant in the affairs of man?’ This question then led him to ask: where is this ‘freedom of will’ and why aren’t we doing more with it?

And so, science enters the fray. Physicists are all about laws of nature – everything in nature can be predicted based on these laws. So all subsequent events, even those involving us humans, should be wholly predictable from first principles if we know the rules of the game: this was one of Newton’s great insights. Science allows you to predict the future if you know the prior conditions. If you fire a cannonball of a particular weight, with a particular force, you can predict, using equations, exactly where it will land after you’ve fired it. The ability to predict what will happen (usually using mathematics) gave science primacy for many people. One problem is that in the spooky quantum world, predictions are made based on probabilities. This counters the notion of things being fully deterministic. Some philosophers have suggested that the quantum world and free will are somehow entangled, but trying to explain that is well above my pay grade. And some physicists believe in parallel universes, where every decision leads to two alternative universes.3 So why worry? You’re living multiple alternative lives somewhere else.

Neuroscientists have studied what it is that makes people make decisions and take action and agree that – guess what? – free will does not exist.4 A good illustration of this conclusion was an experiment performed in the 1980s by neuroscientist Benjamin Libet.5 He asked people to choose a random moment to flick their wrist while measuring electrical activity in their brains. Specifically, he measured something called ‘the readiness potential’, which is brain activity in the lead-up to a voluntary muscle movement. It was well known that the readiness potential could predict the subsequent physical action (in this case, the wrist flick). Libet wondered if he could record this activity before the conscious intention to move. He asked the subjects to record the time when they felt they were about to move (as in, when they became conscious of the move that they were about to make). He noticed that brain activity preceded the conscious awareness that a movement would be made: the person’s declaration of intention to move occurred after the brain had decided to move, which the person wasn’t aware of. The person thought they were making a decision to flick their wrist (and to exert their free will), but the movement was being controlled subconsciously. How this subconscious control might extend into other behaviours is not known, and although both the design of the experiment and the interpretation are controversial, it remains a fascinating experiment.

Does the Libet experiment extend to social engagement? Say you’re in a bar and see someone you like the look of and engage them in conversation: you think you’re making a decision to approach them for a chat and take the matter further, but perhaps your brain just fired a readiness potential. So it’s not you that makes the decision at all; it’s your brain. This is a hot topic in neuroscience, and the jury is still out because of issues with the design of some experiments.6

We spend much of our adult lives working in jobs we don’t want to do and wasting our money buying things we don’t need. We eat way too much even though we know that half the world is starving. If free will were real, surely we would make better decisions? How we make decisions is governed by a complex mix of external events and our own internal world. The mixture of influences on us is vast – chief among them are our evolved natures, our genetics, our hormones, how we were raised as children and the kinds of things we were exposed to and maybe even whether we have recently eaten. A Swedish study demonstrated that a hormone called ghrelin, produced by the digestive system when the stomach is empty, makes rats much more impulsive.7 Studies have also shown that when we are hungry, we are inclined to make decisions that will lead to instant gratification, rather than weighing up the situation and making a decision based on a long-term gain.8 You might think to yourself, ‘I am making this decision by using my free will’ whereas you are actually making it because you are hungry and ghrelin is making you change your behaviour.

Psychologists advise that before making a decision, you should keep a few things in mind. First, sleep on it: this will give added perspective. Second, never make a decision if you are feeling overwhelmed or low in energy: these feelings often give rise to a decision you will later regret. Third, it’s probably best to make a decision on a full stomach.9 And then there is the Irish proverb ‘A man should never make a decision without consulting a woman.’ Another version might be ‘without consulting a scientist’. My wife Margaret is an outstanding biochemist. I often consult her on scientific issues (smart of me, huh?). Science tries to provide clarity for decision-making by using statistics, verifiable sources and conclusions based on evidence. Compare this to politicians, who might just write something on the side of a bus.

So even when we decide to act on something, the decision might be governed by how hungry or tired we are. But what if there were a parasite in your body controlling you? Toxoplasma gondii is a common parasite in cats,10 and fascinating to microbiologists. It infects the brains of many species, including humans, all over the world, but cats are the only animals that can support the sexual stage of the parasite. To Toxoplasma, the cat is the love shack. Once a person or animal is infected (from the faeces of the cat, or from eating an infected animal), the parasite can remain in the host body for life in the form of latent cysts. These cysts are found in the brain, heart and muscle. When mice become infected, something curious happens: their behaviour changes dramatically. They become more reckless and are actually attracted to the smell of cats, which usually ends badly for the mouse. Darwin would love this example – a complex interplay between three species: cat, mouse and parasite. The mouse’s behaviour has been modified by the parasite in order to promote transmission to the cat and also provide a tasty snack.

Humans infected with Toxoplasma are more prone to outbursts of aggression.11 Those with a latent infection also do better in cognitive tests.12 The level of infection also differs between countries: around 7 per cent of Irish people are infected, whereas 67 per cent of Brazilians are.13 Might this make Brazilians more hot-headed? Men and women also respond differently to the infection: men become less risk-averse but more dogmatic, while women become more outgoing.14 Yet again, you might think what you’re doing is based on your own free will, but in reality, you are the pawn of a parasite in your brain.

Or maybe a pawn in a world governed by statistical probability. When something happens to us, we often say ‘What are the odds of that happening?’ We are often amazed by coincidences or apparently random events determining our lives: ‘If I hadn’t picked up that newspaper on the DART and read about that job, I wouldn’t have applied’ or ‘If I hadn’t gone to that party, I wouldn’t have met the person who I ended up marrying.’ The road not taken might have made all the difference, but there is a probability of these things happening, and they may not be as unpredictable as you think.

Our amazement with coincidence largely comes from a poor understanding of probability. If you meet someone with the same birthday as you, you might say, ‘Wow! That’s a huge coincidence!’ The probability of that happening is 1 in 365. And here’s an interesting piece of maths: how many people need to be in a room for there to be a 50/50 chance that two will have the same birthday? The answer is 23 people,15 which looks like a tiny number. But there are seven billion people on earth and, given that large a sample size, there is a large probability of outrageously unlikely things happening somewhere. If lots of people buy a lotto ticket, one will win – no surprise there. The surprise is only for the person who won.

What happened to Violet Jessup is extraordinary because she survived the sinking of three famous ships.16 Violet was on board the Olympic when it crashed into HMS Hawke in 1911. The following year, 1912, she survived the sinking of the Titanic. Then in 1916 she survived the sinking of the Britannic. How could this be? Surely the probability of one woman being in three of the most famous sinkings in history is vanishingly small? It is, until you learn that she was a nurse who worked for the White Star Line and was assigned to these three ships.

What all this means is that things will happen to you based on probability, so just sit back and let them happen. You might change your fate if you actually do the lotto, or if you join a club in the hope of meeting new friends. Both appear to involve you expressing your free will, but they really aren’t. You are drawn to the lotto because the adverts are aimed at you and you think you might have a chance and we could all do with extra cash. Choosing to do the lotto is almost out of your control. Your penchant for the lotto may be part of an addictive personality that you partly inherited from one of your parents. Addiction is, in fact, sometimes seen as evidence for free will, since it robs us of the capacity to make a choice, say, not to take a specific drug. However, another viewpoint is that people who are addicted are making choices every day to avoid the distress of withdrawal and to choose the pleasure of the drug. You might well make new friends at a new club, but that’s highly likely because you’ll be with like-minded people. Your interest in the club may have been preordained from your childhood. It was inevitable that you joined that club – your life history led you to it.

Apart from random events (which have a probability of happening) and decisions we make based on our history or perhaps our genetic makeup or maybe even a parasite we are carrying, how else are our lives controlled? Think about an average day. You get out of bed (after a solid seven hours sleep), choose what to eat (a fibre-based cereal with extra goji berries), choose what to wear (big meeting today, so a neat suit), go to the gym before work (because you’ve read it will make you more effective in your working day, not to mention that your Fitbit tells you to do so), go to work (to make money and achieve self-actualisation), have a glass of wine with friends on your way home (one glass only) and then binge-watch Game of Thrones to de-stress. You constantly make decisions as you go about your day, but on what are those decisions based? Many are based on advice you’ve read or heard. You can always choose not to heed the advice, of course, but most of us do, at least most of the time. We can live our lives by numbers if we choose:17 we’re told we need five portions of fruit and vegetables per day and if we don’t get them, all kinds of awful things will befall us. We’re told not to drink more than 14 alcohol units a week for women and 21 for men. We’re told to get at least seven hours of sleep per night. We need 30 minutes of exercise, five times a week. These numbers are well supported by science in terms of being highly beneficial to us. It makes sense to follow them. Many millions of people try to follow them, usually falling off and then back onto the wagon. An alien looking at human behaviour when it comes to these health-based activities would conclude that the directive of a higher order is at play here, rather than people exercising free will.

If children are raised in a certain way, they will turn into adults with particular traits, governed as much by their upbringing as the choices they apparently make using free will. This belief, of course, lies at the heart of many religions. As Aristotle famously said, ‘Give me a child until he is seven and I will show you the man.’ (St Ignatius Loyola, who founded the Jesuits, plagiarised the phrase.) The resulting adult may well think that all their decisions have been conscious, when they were in fact preordained. In a study of 700 people from across the US aged between kindergarten age and 25, a significant correlation was found between the social skills of children and their success two decades later.18 Children who could cooperate with their peers without prompting and who were helpful to others were far more likely to obtain a college degree by the age of 25 than those with limited social skills. The study shows that helping children develop emotional and social skills is key to future success. In another study, it was shown that daughters of working mothers went to school for longer and were more likely to have a job in a supervisory role and earn more money – up to 23 per cent more – compared to peers who had stay-at-home mothers.19 Sons of working mothers pitched in more with household chores and also childcare later in life. And in a study that deserves the label No Shit, Sherlock, it was shown that the higher the parents’ income, the better the child does in school, especially in a metric called the SAT score, which is the result of a standardised admissions test done by students who wish to go to university.20 Another major predictor for gaining a college place was encouragement from parents at an early age. This is known as the Pygmalion effect – what one person expects of another can come to serve as a self-fulfilling prophecy.21

Advertisers exploit the fact that childhood influences can shape adult choices. A number of studies in the US show how children under the age of seven who are exposed to advertisements for fast food or sugary drinks develop a habit for these foodstuffs that becomes hard to break. If you give 3–5-year-olds identical foods, they will identify those in the McDonald’s wrapper as tasting better.22 The World Health Organization (WHO) has said that food giants are exploiting loopholes in regulation to advertise fast food to children through adverts on YouTube and Facebook.23 A recent study in the UK found that 75 per cent of under-16s are being exposed to such adverts on social media.24 It’s a serious issue and the WHO has concluded that there is unequivocal evidence that exposure to fast food and sugary drinks in childhood is a major cause of the current obesity epidemic.25 In the UK, products high in fat or sugar can only be advertised if the audience is at least 75 per cent adult,26 and a poll in Ireland recently concluded that 71 per cent are in favour of completely banning advertising fast food to children.27 There is conclusive evidence of a causal link between fast-food marketing to children and childhood obesity. One former advertising executive who has since joined the effort to ban fast-food advertising said that ‘junk food advertising has become a monster, manipulating young people’s emotions and their choices’.28 As yet, there are no rules governing the advertising of junk food in Ireland. Even worse, the consumption of fat and sugar can cause behavioural changes, including an increase in impulsivity,29 which is likely to lead to yet more bad decision-making.

The battle to control advertisers has moved to social media – the directive of a higher order mentioned earlier. Social media is a relatively recent and exponentially growing influence on our lives. The overwhelming evidence is that we are ceding control of our lives to the machines we use to access social media sites. Our smartphones are insinuating their way into our lives and consciousness. They are having a greatly disruptive effect on our sleep. Again, we seem to have control over this (just turn it off), yet many of us are addicted to our iPhones and check them constantly, including when we should be asleep. An amazing 40 per cent of teenagers report checking their phones twice during the night.30 This means severely disrupted sleep with all the obvious negative consequences, including increased risk of anxiety and depression. The most insidious way social media controls us is through advertising. The economic model of companies like Facebook and Google is blatantly obvious – and enormously lucrative. These companies collect data on their users and then sell it to advertisers who use it to target likely customers. It’s the one thing advertisers have always wanted: to target their ads at the right person. This is a good thing, right? You get to see ads you actually want to see and buy products you really want. Well, not quite, as it turns out. There is mounting evidence that advertisers can determine all kinds of things about you – things you may not want them to know (such as, say, the fact that you like Italian food because you order a pizza online every Friday night).

You unwittingly reveal an awful lot about yourself on social media, including personality traits and political leanings. In a recent study, Facebook users’ ‘likes’ were examined and, from that, people could be categorised into ‘extrovert’ or ‘introvert’.31 Ads were then tailored to each group. For instance, beauty companies sent ads to the introverts with phrases such as ‘Beauty isn’t always about being on show,’ whereas to extroverts they sent phrases like ‘Love the spotlight and feel the moment.’ The campaign reached 3.5 million users, attracted 10,346 clicks and ultimately 390 purchases. Those who saw an ad tailored to their personality type were 1.54 times more likely to make a purchase. This technique is known as psychological mass persuasion. The selling of beauty products is one thing, but what if it’s sending ads for gambling to people who might be at risk of gambling addiction? Or what if you’re a Russian agent and you want to stir up trouble by sending ads or messages to people who you feel might be sympathetic? It’s difficult to know what to do about all this. Once you’ve revealed who you are (which is what social media is all about), you are open to being exploited.

The issue becomes especially important when we look at democracy. There have been accusations that Russian intelligence officials manipulated people in the US via social media during the last presidential election, and that Cambridge Analytica also influenced the election. Cambridge Analytica was a British consulting firm that combined data analysis (largely gleaned from social media) with strategic communication during electoral processes. This company was paid £5m by the Trump campaign to help them target swing voters.32 The Cambridge Analytica website boasted, ‘We collect up to 5,000 data points on over 220 million Americans, and use more than 100 data variables to model target audience groups and predict the behaviour of like-minded people.’ There is also evidence that Cambridge Analytica did work for the Leave campaign and UKIP ahead of the 2016 Brexit referendum. What is alleged to have happened is that Cambridge Analytica obtained data from millions of Facebook users, without their consent, and used that information to target them with pro-Brexit advertisements.33 Facebook has since been fined $5 billion for its role in the data scandal, standing accused of not sufficiently protecting its users.34 The controversy led to the closure of Cambridge Analytica in 2018. What they did is actually part of a growing trend for political groups to use digital political campaigning – targeting people with highly sophisticated messages – as a key strategy. And Cambridge Analytica is not the only culprit: both Barack Obama and Hillary Clinton employed behavioural profiling companies. But the big question is: does it work? Simon Moores, a world expert on cybersecurity, is of the view that behavioural modelling that involves big data analysis has passed an inflexion point. He says we can ‘look forward to a future that’s made up of equal parts Orwell, Kafka and Huxley’.35 When you go to the ballot box, then, will you be voting with no free will at all?

When we read about the likes of Cambridge Analytica, we have to wonder about the level of control we have over our lives. It seems that we’re being manipulated by algorithms. iPhone users of the world, unite – you’ve nothing to lose but your devices. Alternatively, you could try net-based services that avoid the metadata miners and free yourself from their clutches. Whatever about the decisions we make and the lives we lead, many things in our lives are for definite beyond our control. We blame fate for events such as serious illness, loss of loved ones, accidents, macro-economic downturns, famine and war. We can, of course, try to limit the risk of these things happening if we, say, look after our health and follow advice from experts, but we need to escape the hold social media has over us. We need to use science to help us make the right decisions, including when it comes to the threat posed by COVID-19. The bottom line: don’t get married to a stranger in Las Vegas while jet-lagged after bingeing on social media. In all probability we can regain control over our lives and a brighter universe will be around the corner. Now, keep reading. Go on, go on, go on, you know you want to.

CHAPTER 2

WHY WON’T YOU GET VACCINATED?

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‘I knew they wouldn’t play it when I wrote it.’

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Ian Dury, who had polio, on his song ‘Spasticus Autisticus’

IHAVE TWO SONS, Stevie and Sam, and they have both been vaccinated with every vaccine available. It’s simple. I love them and want to protect them. No doubts, no fears.

If you really want to annoy an immunologist, tell them that you haven’t vaccinated your child. Vaccines against infectious diseases have saved more lives than any other single intervention in medical history.1 They prevent an amazing two to three million deaths per year around the world. This is a scientific fact.2 So is the fact that before vaccination, around 500,000 people caught measles in the US, with three in ten having permanent hearing damage as a result.3 And yet growing numbers of parents and guardians are refusing to vaccinate their children. The situation has become so bad that the WHO, which has the health of people as its main concern, listed vaccine hesitancy as one of the top ten threats to global health in 2019, as dangerous to our health as pandemic influenza, Ebola virus and antibiotic resistance.4 We can add the latest member of the virus rogues’ gallery, SARS-CoV-2, the coronavirus that causes COVID-19, but at least we now have several safe and highly effective vaccines against it.

How could vaccine hesitancy have happened in the first place? How could one of the greatest advances in medicine have become so problematic for many people, especially when the evidence in favour of vaccination is so overwhelming? How can we convince parents who are reluctant to vaccinate their child that they risk not only their own children becoming sick, but also that they are putting others at risk? And what difference has COVID-19 made? Will the greatest pandemic since the Spanish flu of 1918 win over hearts and minds, and decrease vaccine hesitancy among worried parents?

In some ways, a distrust of vaccines is understandable. A young mother goes into her GP’s surgery, carrying her lovely, healthy baby. She tells her GP, whom she likes and trusts, that she doesn’t want a needle stuck into her baby, who isn’t sick. She’s heard scary stories. She wants none of it. At the height of the MMR (measles, mumps and rubella) vaccine scare, friends of mine asked if they should vaccinate their children. Friends with law degrees and business degrees. My answer: unequivocally, yes. Where’s the evidence that made me say yes, I hear you ask? Well, here it is.

Take measles. This disease is caused by a highly contagious virus. Initial symptoms are a fever (which can run as high as 40˚C and cause convulsions in children), a runny nose, a cough and inflamed eyes. A flat red rash then appears and spreads all over the body. Common complications include diarrhoea and ear infections. Less common ones include blindness and death; one to two in 1,000 will die.5 Nine out of ten people sharing a living space or a school with an infected person will catch measles. In 1980, 2.6 million people died of measles. They were mostly under the age of five. By 2014, following global vaccination programmes, this number fell to 73,000.6 The introduction of the vaccine has had a remarkable effect. In the US, before vaccination, the annual rate of measles stood at 3–4 million cases per year. After vaccination, this number fell to almost zero.7 All that sickness, lifelong complications and even death, prevented by a simple jab in the arm.

Or take polio, another viral disease. Infected people can have minor symptoms that clear up quickly, including sore throat and fever. However, for one person in every 150 people infected, the virus enters the nervous system, where it can wreak havoc. Initial symptoms include headache, back pain, lethargy and irritability. Some people will go on to develop paralysis, with muscles first becoming weak and floppy before complete paralysis. The virus is usually spread in faecal matter or via mouth-to-mouth transmission. The famous rocker Ian Dury contracted polio at the age of seven from, he believed, a swimming pool in Southend-on-Sea during the 1949 polio epidemic. In endemic areas (i.e. areas where the virus is common) it infects everyone in the population. It was a disease that every parent feared. Author Richard Rhodes has written, ‘Polio was a plague. One day you had a headache, and an hour later you were paralysed. Parents waited every summer to see if it would strike. One case turned up and then another. We all stayed indoors, shunning other children. Summer seemed like winter then.’ Again, the introduction of the polio vaccine had a remarkable effect. Before vaccination in the US, there were around 15,000–20,000 cases of paralytic polio per year. After vaccination? That number fell to fewer than ten.8 No more people were becoming paralysed. No more summers like winters. In 2002, Europe was declared polio-free, and that remains the case. Today, only three countries are not free of polio: Pakistan, Afghanistan and Nigeria.

Clearly, then, if safe and effective vaccines are developed, they can spell the end for infectious diseases that were a cause of much fear, suffering and death. So what are these wondrous things called vaccines? A vaccine is defined as a biological preparation that provides immunity to disease. The term ‘immunity’ comes from the Latin word immunis, meaning ‘exemption’. In Roman times this usually meant an exemption from paying taxes, which was granted to certain Roman citizens (for example, returning soldiers). In the case of infectious diseases, immunity means exemption from getting the disease again. This had been noticed in ancient times. After someone got sick from a disease, they rarely got it again, and so would care for those who had the disease for the first time. The first written description of the concept of immunity might have been by the Greek historian Thucydides, who in 430 BC wrote that when a plague struck ‘the sick and dying were tended by the pitying care of those who had recovered, because they knew the course of the disease and were themselves free from apprehensions. For no one was ever attacked a second time.’ This was believed to be magical or God-given. An early clinical description can be found in the writings of Islamic physician al-Razi, who described smallpox and how exposure to smallpox conferred lasting immunity. Smallpox was feared because it was highly contagious, killed one third of people who contracted it, and badly disfigured another third (and left the final third unharmed because their immune systems fought it off effectively).

The effort to prevent smallpox is important for the history of vaccines and the science of immunology, because it revealed a way to prevent infections. Around 1000 CE the Chinese began using dried crusts from skin lesions of patients with smallpox, which, when inhaled, provided some protection. Inoculation (meaning using a needle to insert material from smallpox lesions into the skin) was used in India and East Africa and introduced to the West in 1721 by Lady Mary Wortley Montagu.9 Lady Mary was a remarkable woman. She was the daughter of a duke and had been due to marry an Irish aristocrat named Clotworthy Skeffington. Poor Clotworthy was dumped, and Mary eloped with Edward Wortley Montagu, who became the British ambassador to Turkey. While in Turkey, she recorded how smallpox inoculation was practised; the procedure involved taking pus from a smallpox blister in a mild case of the disease and then applying it to a scratch on the skin of an uninfected person. She had two of her own children inoculated in this way. To bring inoculation to the attention of people in England, she gave seven prisoners who were awaiting execution in Newgate prison the chance to undergo inoculation instead of execution. All seven survived and were released. The disease would have been close to her heart as she had a brother who had died of smallpox and she herself had survived it. Yet in some cases this method of inoculation actually gave people smallpox, because it sometimes contained live infectious virus.

In 1798 Edward Jenner, a Gloucestershire doctor, tried a far safer method by deliberately infecting people with cowpox, which caused a mild infection but showed remarkable protection against smallpox. The idea of using cowpox in this way probably originated in the observation that milkmaids (as women who milked cows were called at the time) often had beautifully smooth skin. This was put down to the fact that they rarely got smallpox and so didn’t have the so-called ‘pockmarks’ on their skin, but yet would have caught cowpox from the cows they were milking. Might having cowpox somehow have protected the milkmaids from contracting smallpox? In fact, people who had cowpox usually cared for people with smallpox, since they were known to be unlikely to catch the disease. This approach of using cowpox to protect against smallpox was tried by at least five other investigators, including a farmer named Benjamin Jesty, who was a neighbour of Jenner’s and who might have given him the idea.10 When Jenner subsequently became famous for vaccination and had been granted £30,000 as a reward, Jesty sought compensation and was finally given two golden lancets as his reward. The credit had gone to Jenner partly because of an experiment he performed on an eight-year-old boy called James Phipps. Jenner scraped pus from the cowpox blisters on the hands of a milkmaid called Sarah Nelmes, who, history records, had caught cowpox from a cow called Blossom. He inoculated Phipps with the pus, which gave Phipps a mild fever. Jenner then injected Phipps with material from smallpox lesions (which would have been used for inoculation against smallpox) and the boy developed no symptoms of any kind. Normally that would have caused mild symptoms of infection. Jenner’s key contribution here was the demonstration that cowpox pus could be used from one human to another and that the boy was protected from disease when challenged. Jenner used the term ‘vaccination’, from the Latin vacca, meaning ‘cow’. Rather unexpectedly, scientists now think that Jenner might have used horsepox that had infected a cow – something Jenner himself believed. So perhaps we should call it ‘equination’? He followed up the Phipps study with 23 more cases, including his 11-month-old son Robert. This is an important part of medical science: to repeat an anecdotal observation with a study in multiple patients. Whatever the original source of the cowpox vaccine, vaccination was adopted widely in England. Jenner became famous all over Europe. The Empress of Russia sent him a diamond ring out of gratitude. Napoleon said he ‘could refuse this man nothing’ even though France and England were at war.

In a forerunner of the modern anti-vaccination movement, many spoke out against the smallpox vaccination.11 Clergymen felt that smallpox was a God-given fact of life and death, and any attempt to subvert this divine intention was blasphemy. Some religious people felt that smallpox was a force sent by God to cull the poor. Doctors also joined this nascent anti-vax movement. Many made a good living from quack treatments for smallpox, and vaccines threatened their livelihoods. Strange reports began to appear in medical journals, telling how vaccination could transmit bovine traits, such as children making mooing noises and running around on all fours. The ridiculous contention that vaccination turned children into cows became widespread.

In 1906 a woman called Lora Little, who was described as a ‘natural therapist’, claimed that vaccination was a scam set up by doctors, vaccine-makers and the government. She described 300 cases where vaccination against smallpox had been harmful, including the tragic case of her seven-year-old son who died after being forcibly vaccinated. (He actually died of diphtheria.) In England, notable people spoke out against vaccination. Even George Bernard Shaw was against it, describing vaccination as ‘a peculiarly filthy piece of witchcraft’. In another precursor to what is happening today, parents who refused to vaccinate against smallpox were fined or sent to prison. So antivaxxers are not new, and neither are attempts to deal with them.

Following Jenner’s success, many other vaccines were developed. In the 1880s French scientist Louis Pasteur introduced vaccines for chicken cholera and anthrax, infectious diseases that afflicted farm animals. It was Pasteur who suggested in 1891, in honour of Jenner, that the term ‘vaccination’ be more widely used to describe inoculation against infectious diseases. Other vaccines soon followed: in 1884 for rabies, in 1890 for tetanus, in 1896 for typhoid fever and in 1897 for bubonic plague, also known as the Black Death. That disease had been the scourge of Europe, killing as many as 60 per cent of the population in the fourteenth century, but a vaccine finally vanquished it. From the late 1800s, vaccination became a matter of national pride, with countries boasting about protecting their people from horrible diseases. In the twentieth century, new vaccines came thick and fast: for tuberculosis, or TB (another scourge of many countries, including Ireland where it killed at least 10,000 people per year in the early part of the twentieth century), for diphtheria, scarlet fever, yellow fever, influenza, polio, measles, mumps, rubella, meningitis and hepatitis B. One by one, diseases that killed millions were beaten by the power of vaccines.

It’s abundantly clear why vaccines are seen as the greatest contribution to medicine. Following on from Jenner’s work, the scientific question became: how do these wondrous things work? Inoculation with smallpox was viewed as a folk remedy of uncertain provenance. The study of what Jenner and Pasteur had achieved gave rise to the field of immunology. The efficacy of cowpox as a preventive against smallpox provided the first clue as to how a vaccine might work. We now know that the cowpox virus is similar to the smallpox virus and yet doesn’t cause that disease. The similarity means that when injected with cowpox, the body mounts an immune response to it and clears the mild infection. When someone is subsequently infected with smallpox, the immune system has been trained by its prior exposure to cowpox and kills the smallpox, because it recognises the parts of smallpox that are similar to cowpox. If the body hasn’t seen cowpox, smallpox will run amok as the immune system hasn’t been trained to recognise and kill it, causing disease. It’s a bit like a nightclub where, let’s say, boisterous fans of a football team wearing their team colours try to gain entry. The bouncers stop them. More fans then turn up wearing the same colours as the previous fans, but this time perhaps carrying weapons. They are immediately stopped from gaining access because the bouncers recognise them by their team colours. Cowpox and smallpox wear the same colours (meaning they have similar components) but smallpox is better armed and can cause more severe disease. Cowpox and smallpox are in the same family of viruses and so can be recognised by the same parts of the immune system.

Vaccines today are mainly of two types: dead or inactivated infectious organisms (weakened football fans wearing their team’s shirt), or purified products from them (the shirt alone). Pasteur was the scientist who came up with inactivation as a method. He was studying chicken cholera, an infectious disease in the poultry industry at the time. In one experiment, he infected chickens with a batch of cholera, mixed into a broth, that had been left out and had spoiled. When he then tried to infect the chickens with fresh cholera, he noticed that they were protected. The cholera bacteria that had gone off had been weakened in some way and no longer caused disease but had components in common with the regular bacteria: it trained the immune system to respond to the more virulent bacteria. The first vaccines were therefore similar to the chicken cholera that had spoiled. They were somehow inactivated, or as it is usually termed ‘attenuated’, by chemicals or heat. These include vaccines against polio, hepatitis A, rabies, yellow fever, measles, mumps, rubella, influenza and typhoid. Jonas Salk inactivated the polio virus with the chemical formalin, whereas Albert Sabin discovered in infected animals a weakened version of the polio virus, which was less toxic. Both of these worked well against polio. The vaccine against typhoid was invented by Almroth Wright, who had studied medicine in Trinity College Dublin. It saved tens of thousands in World War I: before the vaccine was introduced, more soldiers had died of typhoid than in combat. For TB, a vaccine termed BCG (named after its inventors Calmette and Guerin; the B stands for ‘Bacillus’, the genus of bacteria that TB belongs to) has been used for decades, and it was introduced into Ireland by Dorothy Stopford Price in the 1950s, again saving many lives. BCG also causes a non-specific boosting of the immune system, meaning that it can put up a barrier (involving immune cells called monocytes) that can repel other infections, including viruses (e.g. the measles virus) and possibly SARS-CoV-2. BCG may well be useful as a way to protect against COVID-19, and at the time of writing, is undergoing testing.

A wide range of vaccines use component parts from the infectious agent. This can include inactivated toxic components (called toxoids) and includes vaccines against tetanus and cholera. Subunit vaccines comprise proteins from the infectious agent and include vaccines for hepatitis B, influenza and human papilloma virus (HPV) – the latter protects against cervical cancer, which is caused by HPV.12