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Seeking New Models for Clinical Medicine

Published August 1, 2014

A new Social Science Matrix seminar is focused on finding radical new approaches to clinical health care.

In Fall 2014, Nancy Scheper-Hughes, Professor of Anthropology at UC Berkeley, and Sam Dubal, MD/PhD candidate (Harvard Medical School/UCSF-UC Berkeley), co-organized a Social Science Matrix seminar called “Envisioning Radical Experiments in Social Science and Clinical Medicine.”

This seminar sought to bring together not only scholars from multiple disciplines (including public health, clinical medicine, anthropology, sociology, history, geography, information, economics, comparative literature, public policy, and social work), but also physicians, psychiatrists, patients, and community members, with a goal to create “a collaborative crucible for a new form of medical practice,” Dubal explains. “We ask: how can we envision and design innovative ways of addressing inequities and inequalities in clinical medicine, as informed by critical theory as well as clinical and personal experience?”

Scheper-Hughes explains that her interest stems from longstanding concerns with the criminalization of poverty and madness based on her research on the relationship of ‘schizophrenia’ and historical traumas (e.g. the ‘Great Famine’ in Ireland, and dislocation, camp life, and genocide during and after WWII) and the presence of the severely psychotic in prisons and jails in the U.S. Her work in radical psychiatry was strongly influenced by psychiatrists who were willing to question the norms of biomedicine and come to the aid of the so-called “criminally insane”.

Dubal is completing his dissertation on the reintegration of former militant rebels in northern Uganda; based on his work, he has developed a “deep suspicion of a philosophy of humanism that serves as the lynchpin for humanitarian intervention,” as he explains, and maintains “an enduring concern with the hegemony of liberal humanist philosophy as a paradigm of care in clinical medicine, and the way in which it depoliticizes clinical care.”

“We teach our clinicians to care for the individual suffering of the patient in front of them,” he says, “but we don’t teach them to care for or about a politics which generates social suffering.”

From Radical Psychiatry to Community Health

One of the goals of the seminar, says Scheper-Hughes, is to create a dialogue among “critical psychiatrists, critical anthropologists, ethno-psychiatrists, critically engaged psychiatric social workers, and other providers, together with the psych-survivor community,” who share a “strong sense of dismay at the failures of the dominant psychiatric paradigm that reinforces cognitive and emotional differences by reducing them to ever-changing and refashioned diagnoses and submitting them to powerful and often damaging drug regimes.”

Another theme: the search for autonomous solutions to local crises that stem in part from economic and medical globalization. “Sam and I are both dissatisfied with the global health agendas: the humanitarian aid that is a Band-Aid for diseases caused by poverty, political conflict, violence,” Scheper-Hughes says. “We are looking for solutions beyond “drugs for all” and “Doctors without Borders”, etc.” We hope to identify solutions that acknowledge and respond to the sick-making issues of institutionalized racism, economic inequality, environmental exploitation, gender violence, and other forms of injustice and inequality that manifest themselves in the clinical encounter.”

The two anthropologists witnessed first-hand the clinical care-delivery challenges facing local communities in Spring 2014, when they visited Timbauba (pop. 55,000), in Northeast Brazil, where Scheper-Hughes has conducted multi-decade anthropological research. While participating in a training session for 120 community health agents (local citizens trained by the state to provide basic medical services in the absence of resident doctors), they heard complaints such as, ‘We are frustrated,’ ‘We have the most difficult job with no backup,’ and ‘We don’t know what we will run into when we walk inside a home. Sometimes it is a raving madman or a violent drug dealer, and sometimes it might be a woman in labor without time to get her to a public hospital in Recife [the capital city].”

Scheper-Hughes served as a community health agent in Timbaúba during the 1960s, when she delivered babies, immunized babies, administered injections, treated infectious diseases (TB and schistosomiasis), and bandaged wounds. “Today’s community health agents are not allowed to put salve on a baby’s skin, let alone to ‘catch’ a baby,” Scheper-Hughes says. “The poor people living in hillside slums (favelas) in the area are forced to either travel to the capital for a pre-arranged C-section or to give birth at home just as their grandmothers once did because there are no resident obstetricians in the public health sector.”

Through their Social Science Matrix seminar, Scheper-Hughes and Dubal brought together an array of perspectives to find solutions to such challenges. “We realized that to be able to transcend the limit of existing interventions on healthcare inequalities, we needed a different approach—one based in praxis and organized by horizontal collaboration,” Dubal says. “We could not rely on the experiences of patients and physicians alone, relatively detached from critical theory; nor could we base our interventions on the dizzying theories of critical scholars, relatively detached from lived experience….We are united by a common goal of creating a social medicine proper: a healing of the illnesses of not only individual patients but also society itself. Our approach to this goal, and the central problem of this seminar, is to co-design possible experiments whereby critical theory may come to inform clinical practice.”

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Science

Mind Readers At Work

Published July 29, 2014

Think mind-reading is science fiction? Neuroscientists have made remarkable progress in decoding imagined speech from the brain.

As detailed in Frontiers in Neuroengineering, a team of American and German neuroscientists led by Stéphanie Martin at UC Berkeley and Peter Brunner at the New York State Department of Health have made significant progress in reading imagined speech from brain activity.

To achieve this remarkable feat, participants were first instructed to read text from a computer screen while researchers recorded electrical activity from their brains. The recordings were made using a technique called electrocorticography (ECoG), in which electrode arrays are implanted directly on the surface of the brains of patients awaiting brain surgery. These ECoG recordings were matched with simultaneous audio recordings of the patients reading the text out loud.

By finding patterns of brain activity that correlated with particular speech sounds, the researchers were subsequently able to predict what new voice recordings would sound like from brain activity alone. They were able to reconstruct the imaginary inner voice of participants instructed to read the text silently. (Listen here for an example of speech reconstructed from brain activity, from earlier research).

This builds significantly on Martin and Brunner’s previous research, which had already shown they could reconstruct speech from the brain activity of participants who were talking out loud.

“A major inspiration [for this research] was the success that has been seen in developing neural prosthetics for restoring movement function—for example, operating a prosthetic limb by decoding brain signals from the motor cortex,” said Brian Pasley, a UC Berkeley postdoctoral fellow and corresponding author on the study. “The long-term goal would be to develop neural prosthetics that can restore communication by decoding signals from speech cortex.”

Progress in motor neural prosthetics has also been propelled in part by UC Berkeley researchers, who most recently developed a cursor-controlling device that reciprocally learns from the brain as the brain learns to control it.

Of course, the question remains: is this technology capable of decoding thoughts more generally? Pasley is cautious to say yes. “A ‘thought’ may or may not be associated with an auditory imagery component—for example some people silently repeat words to themselves as they read, while others do not,” he says. “Our approach is only capable of picking up signals associated with auditory imagery. So we might pick up vivid sound imagery associated with a thought, but likely not the brain signals associated with the thought itself.”

Still, when put together with other recent neural decoding efforts by researchers at UC Berkeley and elsewhere—demonstrating, for example, that brain activity alone can be used to generate rough semblances of face images and film clips people are looking at—it seems only a matter of time before brain recording devices can be used to peer more holistically into the mind.

Engineers have already begun predicting what brain reading devices might be capable of in the future. A group of UC Berkeley engineers recently envisioned a future neural interface system that would rapidly accelerate progress in neural decoding—they call it neural dust, an array of thousands of microscopic sensors that could be sprinkled onto the surface of the brain. In addition to its prosthetic capabilities, a neural recording device with such resolution might make it possible to reconstruct memories, imagination, and even dreams.

Although this technology is in its infancy, scholars can already begin thinking more about the broader scientific and societal implications. Just be aware that some of those thoughts may be audible to others.

Research Highlights

Arroyos and Socionatures

Published July 29, 2014

A UC Berkeley geographer explores a mystery to better understand the relationship between human-caused and natural phenomena.

Is climate change the result of human activity, or is it a natural phenomenon? For Nathan Sayre, Associate Professor and Chair of UC Berkeley’s Department of Geography, this frequent framing of an important modern question is misleading, as it fails to take into account the fundamental fact that humans are part of nature. “I’m struggling with efforts to link ecological and sociological processes,” explains Sayre, whose research largely focuses on the management and ecology of rangelands in the western United States and northern Mexico.

To delve deeper into the connections (and gaps) between human-caused and natural phenomena, Sayre teamed up with Social Science Matrix to lead a seminar focused on integrating methods, systems, approaches, and data from both the social and natural sciences. The goal is to improve researchers’ ability to holistically understand social-ecological systems, or “socionatures”.

As a case study, Sayre and fellow seminar participants examined arroyos, large gulches typically found in dry climates that intermittently fill with water during heavy rains. Sometimes called “washes” or “gullies,” arroyos typically have steep banks and can be hundreds of miles long. “Arroyos are not a particularly sexy topic among academics, but for a long time, they were a big deal,” Sayre explains. “They are also something of a puzzle because in about 1850, most of the watersheds in the southwestern U.S. did not have arroyos in them. Then in a very concentrated moment of time, between 1880-1905, every watershed in the southwest developed these arroyos.”

The question of arroyos has “significant implications—for the water table, farming, and flooding,” Sayre says. “For much of early 20th century, many geographers studied these arroyos with a certain amount of alarm that something dreadfully wrong had happened that must have to do with human impact, pointing to grazing, timber cutting, or mining. But the peculiar thing they learned is that some of these arroyos have existed for thousands of years. Whatever we did, arroyos are not unique to these intensive human activities. Arroyos are less important now, because we don’t rely as much on flood plains and have deep wells and can drill for water, but scientists never figured out a solution.”

Together with Assistant Professor Laurel Larson, an eco-hydrologist, Sayre is working to apply modern tools, such as radar and isotopic dating methods, to understand where and how arroyos formed. He notes that the project could have significant economic and legal implications; for example, if arroyos came from an irrigation system put in place by Native Americans thousands of years ago, it could re-shape modern water rights. More broadly, though, Sayre is interested in the mystery of why these massive gullies formed in the first place, as well as what it says about how scientists should think about socionatural phenomena.

“It’s a great example of, is it human or is it not human caused?” he explains. “People who studied arroyos have paid little attention to the social dimension of the causes behind them. They might say, it’s about deforestation of the uplands, or it’s about grazing. They don’t have a more sophisticated understanding of, what drove that? How can we think about underlying causes, as opposed to just proximate causes?”

In keeping with the mission of the Social Science Matrix, Sayre seeks to break down the walls that have traditionally kept the social and natural sciences from working together. “A lot of science has worked from the premise that there is nature and there are people, and they are separate,” he explains. “That undermines their ability to think about these things in more integrated way. Everything written about arroyos is based on whether they are natural or human-caused. The idea that there is no difference there—that people are part of natural systems—is a difficult line of inquiry when everything that has ever been launched started from the idea that it has to be one or the other. But humans are part of this landscape just like the rain is part of this landscape.”

Research Highlights

When Companies Manage Cities

Published July 29, 2014

UC Berkeley political scientist Alison Post’s new book explores the consequences of privatizing urban infrastructure.

Should a city trust a private corporation to deliver its water and remove its waste? This question looms large in the minds of an increasing number of city officials and urban dwellers across the world. Currently, about 80% of U.S. water delivery services are public, but growing numbers of debt-ridden municipalities like Detroit have contracted out basic services and infrastructure during the past twenty years.

Private control of urban water and sanitary infrastructure is not new in the U.S. or elsewhere. As UC Berkeley political scientist Alison Post explains in her new book, Foreign and Domestic Investment in Argentina: The Politics of Privatized Infrastructure (Cambridge, 2014) much of the urban infrastructure in the U.S. can be traced to cozy relationships between local companies and corrupt 19th-century political machines.

“Crony capitalism helped underpin the growth of our cities,” Post explains. “It is incumbent upon us to understand the circumstances under which these private infrastructure contracts have been more and less viable in political and financial terms.”

To research her book, Post examined infrastructure contracts between states and companies in 61 developing countries. Some contracts ended in “water wars”. Others improved water and waste services and garnered significant public support. Why the variation? Post’s book puts forth a simple but path-breaking answer: privatized infrastructure proved a political success when it remained a local affair.

Local companies that invested in their communities enjoyed greater public support when acquiring a water or waste system. When a conflict arose over prices or services, domestic companies also tended to exhibit more patience and negotiate informally with officials to resolve the issue. Both the cities and companies avoided costly lawsuits, and relationships between the companies and locals with whom they interacted regularly remained strong.

Privatized infrastructure proved a political success when it remained a local affair.

On the other hand, infrastructure contracts brokered between local governments and distant multinational companies did not fare so well. Urbanites often resented the takeover of public goods by powerful, foreign firms. When faced with a conflict, multinationals often threatened legal action or involved third-party institutions in lengthy disputes, embittering local officials and residents. As a result, services were interrupted and costs rose. Infrastructure suffered from erratic investment. Many contracts were ultimately cancelled.

In one case, the French water and sanitation firm Saur formed a consortium with the American company Enron and secured a water contract in Mendoza, a province of Argentina. Relations between the firm and the governor quickly soured. Facing a tight upcoming election, the governor asked the firm to postpone a new property valuation scheme that would raise rates. The company refused, referencing the contract’s provision for higher rates. The governor’s party lost the election, the company increased rates, and affected customers protested loudly and publicly. After months of political turmoil, lawsuits, and time in international courts, the government cancelled the contract and the firm pulled out of the country at a loss.

Post’s book offers rich insights into the debates over private and public ownership models while avoiding polemics. As she explains, the process of privatizing itself provokes public backlash, and frequently transforms longstanding complaints over prices and access into more visible, political issues. Whereas state-owned service providers might be criticized by opposing political parties, private service-providers come to represent a common enemy for all sides to disdain. “Both governing and opposition politicians can earn points with voters by championing consumers’ short-run interests,” Post explains. Public reproach can be “particularly strong in sectors like water, where access is increasingly viewed as a human right.”

Post’s book warrants reading by anyone interested in investment law, as her findings upend some of the most fundamental understandings of how property rights and contracts work in a globalizing world. For example, some scholars have claimed that contracts work best when they are enforced by strong legal institutions, reasoning that investors pour money into projects when they trust that governments will protect property rights enshrined in written law and strict contracts. Companies interested in international investment were thought to place particular value in legal recourse, and international treaties seemed to provide their only protection against volatile politics and the unknown intricacies of foreign legal regimes. Yet Post found the opposite to be true: multinationals protected by international institutions were more likely to sustain heavy investment losses. Supposed legal safeguards actually made contracts more vulnerable.

Professor Post’s book has already garnered praise from leading scholars of foreign investment and political economy for redefining common understandings of property rights. For her part, Post hopes the book will offer useful lessons for those considering privatization as a solution to infrastructure and service problems, as her book sums up a simple cautionary lesson: “privatization does not depoliticize.”

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Research Highlights

Social Networks from History

Published July 29, 2014

A new tool developed by a team at UC Berkeley can help build “prosopographies,” social networks based on names, affiliations, and other historical data.

Social scientists working to study modern society have an array of data sources available, from government censuses to digital social networks. But for researchers trying to study people who lived, say, 2500 years BFB (before Facebook), trying to figure out who was friends (or business associates, of family members, or political allies) with whom can pose significant challenges.

Enter “prosopography,” the practice of gaining insights into individuals based on attributes of their families, business associates, or other affiliates, based on information preserved in historic documentation. Prosopography has long been an important tool for the study of all kinds of past societies; the name stems from the Greek prosopoeia, or “face created,” suggesting how this methodology enables researchers to “put a face on” individuals about whom little is known based on information about their connections to other people.

For Laurie Pearce, lecturer in Near Eastern Studies at UC Berkeley, prosopography has been a crucial resource for understanding the relationships among elite individuals in ancient Mesopotamia. Pearce’s research entails using approximately 700 clay tablets written in cuneiform script to tease out the lives of people who lived in southern Iraq during the fourth century BC; many of these texts detail real estate transactions or small transfers of income. “It’s a challenge, because people were usually named after their fathers or grandfathers, so they had names like, ‘Joe Son-of-Fred Son-of-Joe Son-of-Fred’,” she explains. “Straightening out who lived where and when, and what they did, is a non-trivial problem.”

Pearce has been working together with Patrick Schmitz, Berkeley’s Associate Director for Research IT and Strategy, to establish Berkeley Prosopography Services, or BPS, which has created an XML-based tool to help map out relationships and discern individuals from each other. “The texts that I work on seemed like a good demonstrator corpus to explore a set of tools for a common research problem: that is, identifying individuals mentioned in text of any sort and trying to establish the social networks in which those individuals appear,” Pearce explains.

The BPS tool applies methods from the fields of natural language processing (NLP) and social network analysis (SNA) to extract the names and basic familial relationships of people mentioned in texts, and weigh the probabilities that individuals were connected to each other. The resulting graph model can be used to produce reports and visualizations ranging from simple name lists and family trees to interactive models. “There is a lot of uncertainty in these historical records,” Schmitz says. “The tool can represent that uncertainty explicitly. We can say, it is 70 percent certain that this name corresponds to this person, but it could also be one of these three people.”

Once you know who was working with whom—for example, who was in the same location at the same time—you can see how ideas might have spread and become more accepted in the community.

To further refine this tool, Pearce and Schmitz are working with the UC Berkeley Social Science Matrix to coordinate a seminar focused on exploring how historical social networks might be used by researchers working in different domains. “Prosopography has traditionally been used in the humanities, but it became clear to us that social scientists and some natural scientists are facing similar challenges of disambiguation and understanding relationships,” Pearce explains. “In the Matrix seminar, we’d like to explore how our approach and tools might benefit them. The point is not just to get together people from Near Eastern Studies who want to do this; it’s to say, what can we learn from other disciplines? We are specifically searching for people who want to understand how they would use a tool like this.”

As an example of a broader application, BPS has potential to help staff members from Berkeley’s Museum of Vertebrate Zoology, who are sifting through 100+ year-old records of the activities of collectors and researchers. “They’re trying to understand how those people related to one another, and how they collaborated,” Schmitz says. “They are facing issues … that make the identification of some of the people involved non-obvious. There’s so much data in all the thousands of records, it takes an effort to come to grips with, what were the patterns of collaboration and influence among these people?”

The power of prosopography, Schmitz explains, is that it can use these data sets to generate insights into bigger questions. “Researchers can use the network analysis to say, what are all the patterns of interaction? Who are the subgroups? Who had the most influence?” he says. “Once you know who was working with whom—for example, who was in the same location at the same time—you can see how ideas might have spread and become more accepted in the community. It has implications far beyond just mapping out a tree; it’s looking at the construction of knowledge within institutions.”

Berkeley Prosopography Services was recently awarded an NEH Digital Humanities Implementation Grant that will support this work for a two-year period. Schmitz will serve as the technical lead, and Niek Veldhuis (professor in Near Eastern Studies) will join Pearce as co-principal investigator (PI).

For more information, see the home page of Berkeley Prosopography Service, or read a research paper by Schmitz and Pearce.

Research Highlights

Do You Trust the Police?

Published July 22, 2014

How do you ask people in gang-ruled neighborhood whether they trust the police? A team of researchers are using a Matrix seminar to explore the most effective approaches for measuring communities' attitudes toward law enforcement.

For policy-makers and law enforcement officials working to address crime and insecurity, establishing trust-based relationships in local communities is essential. Yet it has traditionally been challenging to get an accurate measure of trust, especially when gang members and other criminals may threaten retaliation for cooperation with police.

To tackle this challenge, UC Berkeley Social Science Matrix is supporting a team of researchers from diverse social science disciplines to explore new approaches of measuring perceptions of law enforcement in local communities. Bringing together methods from fields such as political science, psychology, and development economics, the group hopes to examine how “sensitive survey design” methods could more accurately measure attitudes toward law enforcement in communities with organized criminal gangs.

The goal is “to understand how police departments can transform relationships with local communities in cases where community trust and confidence in the police is low,” explains the seminar’s co-leader, Aila Matanock, Assistant Professor of Political Science at UC Berkeley, who says she hopes the seminar will lead to a “cross-fertilization of ideas and methods” and “building a larger community of people who are interested in these questions moving forward.”

If people are more supportive, they’re more likely to support investigatory practices, and if they’re skeptical or cynical, they’re less likely to report crimes.

Matanock first saw the value of experimental survey design in her research measuring public perceptions of the military in Colombia. “In the survey, some respondents were asked direct questions, like ‘Would you support the military having more independence in the counterinsurgency,’ while others were asked indirect questions, like ‘How many of the items in this list do you support?’… The two methods showed very different attitudes.”

Matanock is coordinating the seminar with Jack Glaser, Associate Professor and Associate Dean at UC Berkeley’s Goldman School of Public Policy, who has worked with the Department of Justice and other institutions to address racial profiling. “In some places, norms can dictate that it’s good to support the police, and in other places, norms can dictate that people should be critical of the police,” Glaser says. “You’re not going to get an accurate read if you ask the questions too directly. It’s going to be hard to predict.”

Through the Matrix seminar, the two researchers hope to bring new methods to a local context, by working with local law enforcement officials from Oakland to assess community trust in police. “We’re thinking about how to integrate it into the U.S. context, building off a larger school of literature that’s applying social psychology techniques to political science,” Matanock says. “These are questions facing Oakland and other police departments around the Bay Area.”

Like all Social Science Matrix initiatives, this seminar is cross-disciplinary by design. In addition to considering surveying, the seminar will also consider how increased use of new surveillance technology and intervention by external actors—especially federal oversight, consultants, and private security guards—can influence community trust in the police.

“Being able to tap those community attitudes is really important,” Glaser says. “It’s important to police chiefs; they really care about community attitudes. It’s an area where scholars, policy people, the practitioners, and the community can all get together and work toward the same goal…. If people are more supportive, they’re more likely to support investigatory practices, and if they’re skeptical or cynical, they’re less likely to report crimes. It matters on the ground.”

Photo Credit: Chris Huggins.