19 October 2015

Fixing the Earth: Piece of Cake

[Hope in a Changing Climate]

We've done a lot to this planet to make its future habitability somewhat precarious. If printed out, the amount that has been written on the hows, whys, wherefores and whereuntos would probably itself contribute significantly to climate change. But is there a way back? Is there a path we can choose that can restore our Earth's vast areas of degraded land, that can improve food production, that can improve incomes and support economic stability? Can we find hope in a changing climate?

If you're one of the many people who has given up that hope, this documentary by environmental researcher and film-maker John D Liu may just be what you need to help you reassess the situation. If you feel you can't make a change, or you don't even care that much, perhaps you've let the blinkers drop down over your eyes. But lift them up, because all is not lost.

The example of the Loess Plateau in China - a harshly degraded area the size of Belgium - shows that it is possible to design, install and encourage passive natural systems that can restore landscapes, with effects local, distant, and possibly even global. Incomes for local people increase, quality of life increases, agricultural productivity increases, rainfall (yes, rainfall) increases - and all the while the system locks carbon up into the cycle of biology and into the very soil itself. The Loess Plateau project, funded by the World Bank Institute, has been in operation since the 1990s, and has achieved astonishing success, indicating that restoration is possible, and in the process, climate change itself can be significantly mitigated, or even reversed.

In many ways we've known the techniques for years - careful water management, minimising run-off, slowing it down, spreading it out, sinking it into the ground (thereby replenishing wells and aquifers), growing plants to shelter the soil, slow the wind, prevent evaporation - these are all well established techniques, although the permaculture techniques of putting them all together may require something more than local enthusiasm.

This is where a heavily top-down state like China can flex some muscle, but in the documentary John shows how other areas, such as Jordan, Rwanda and Ethiopia have taken steps to rebuild the paradises (yes, I did say that) that once existed where centuries of relentless exploitation have created desert.

In a recent Facebook post I cheerfully and cheekily suggested that the problems weren't all that hard, and John immediately protested that I was underestimating the challenges involved. Not for the first time in my life, my Irish sense of the ironic did not translate well onto social media. Because John is absolutely right - what needs to be done is indeed hard. And it's hard in the John F Kennedy sense, that this is why we choose to do this and the other things.

But you'll note that it's not impossible. It has been done, so it can be done. In the McKee Lexicon, something had better be damn near impossible before it earns the label "hard". So I'm going to go with "challenging". You've watched the documentary, so you'll appreciate some of these challenges. As it turns out, these are applicable to a large number of things, and as so often in life, if you want to achieve something amazing, you need to meet those challenges head on. Often planning will help, but sometimes you need to do it on the fly. But let's have a look at some of these challenges - this list is not exhaustive.

We're often limited by our lack of vision. We think that "challenging" means "impossible" - or we make it so. We lose sight of the ultimate goal - or we can't even conceive an ultimate goal. We lower our targets, we accept something less than what we really want. Lifting our vision can be hard. Even when we have a vision, we have to go out and transmit that to others, requiring communication and visualisation skills that we may have to improve.

Vision itself is pointless unless you also have a plan for achieving it. Many ideal scenarios founder on the rocks of reality because you can't get there from here. However, very often what is required is thoughtful study of the problem and, with the appropriate application of our acquired knowledge, we can plot a path to where we want to get to. As Matt Damon's character Astronaut Mark Watney in the blockbuster movie "The Martian" puts it, "I'm gonna have to science the shit out of this." More prosaically, in the Loess Plateau, the designers put forward the solution of placing a "hat" of trees at the tops of the hills, a "coat" of terraces on the slopes, and "shoes" of dams in the run-off channels. A design-based solution, and a brilliant metaphor to tie that design to the vision, allowing the highly-sceptical residents to relate to what they were being asked to buy into.

$300M is not to be sniffed at - that was the grant awarded by the World Bank Institute, and a considerable amount was injected by the Chinese Government, and I imagine some other NGOs were involved too. Paying for land, labour, compensation, equipment, plants and seeds and many other items - you could argue for an area of that size it's pretty cheap, but you don't come up with that sort of cash without some serious commitment. And you don't come up with that sort of cash unless you can also sell the vision in point 1. You need fiscally-minded people who are committed to the project. You need due diligence and careful financial governance. You need transparency, equity and the prospect of paying back your investors.

Here's where the Loess Plateau job got really hard. The people who had lived in and farmed this ravaged land for centuries had to gang together and put in some serious work. This is not a trivial thing. John's film shows how they grabbed tools and physically dug the terraces out of the steep slopes. How, with the aid of skilful landscape designers (operating at a level far beyond the small-scale garden designers we employ to beautify our back yards and neighbourhoods), they planted trees, fenced off areas from livestock, built dams to check water flow - this was civil engineering on a massive and truly civil scale. They had to be paid, and (perhaps crucially) paid better than they could make from farming the land as before.

You can't achieve change overnight. The Loess Plateau has taken almost 20 years to regenerate to its current state, but (and this is the important point) it's still changing, still improving. Like an ion drive rocket engine, the acceleration rate is slow, but it's steady and prolonged and keeps building. The important thing is to set out in the right direction and commit to spending that time to get things right.

There are of course many other challenges, and as you can see, the ones I've listed aren't even mutually exclusive. Is there one principle which is paramount? Perhaps. This gets back to my exchange with John D Liu - it's VISION. Vision should be easy, right? It should be straightforward to explain the benefits of change to people, and they'll jump on board, and all those other issues will get sorted out along the way, right?


Vision is hard. Vision is so susceptible to the corrosion of cynical small-mindedness, failures along the way, direct opposition, fatigue. But it's also exquisitely rewarding. We need people to grasp the vision, to get out there, and to transmit it. It needs to be a meme infecting other brains. And it's the meme that, if successful, might just save civilisation, restore lands to productivity, and lift people out of poverty.

As it turns out, terraforming the Loess Plateau can be easier than changing the landscape between our ears.

15 September 2015

What will it take to get us to Mars?

A novel and an upcoming movie about an astronaut stranded on Mars may have injected a considerable dose of momentum into actually making a manned Mars mission happen.

It's confession time. I am a massive fan of space. OK, anyone who knows me is not surprised by this. I was in utero when Neil Armstrong and Buzz Aldrin stepped onto the lunar surface; as a youngster my bedroom walls were adorned with posters of the Apollo crews, shuttles, landers and planets, and I read everything I could get my hands on. My child-like view was one of optimism and progress. I devoured books by Arthur C Clarke, Robert A Heinlein, Isaac Asimov - I was sure that humanity's future lay off-Earth, and that there was something indomitable about the human spirit that would take us to the stars.

Now in my 40s I am thrilled that humans are living continuously in space; I still regard myself as fortunate that at least some humans were on the Moon in my lifetime, but I feel that we should still be there, and we should have moved beyond the Earth-Moon system to Mars and the asteroids - that's where all the fun took place in those books I read. And the fun wasn't unalloyed - it came mixed with danger, tragedy, terror (sometimes including aliens, but let's set them aside for now) - it represented adventure in its truest sense. 2001 came and went, and we don't have anyone orbiting Jupiter. Gerard K O'Neill's mighty space colonies remain unrealised. We send our robots to the planets and to comets, and they send back stunning pictures of worlds that are diverse, dangerous, exciting and beautiful. And we want to go there.

Andy Weir's best-selling novel "The Martian" is something new. Or maybe it isn't. It's an awesomely intelligent thriller, where our hero Mark Watney is an astronaut stranded on Mars, while his departed crewmates and the people of Earth think he is dead. Mars turns out to be a somewhat challenging planet to stay alive on, and, while he waits for the next planned mission in four years, Watney has to cobble together his meagre resources to survive. As he says, "I'm going to have to science the shit out of this."

And science the shit he (literally) does, growing potatoes in his poo, among other things. He has to get rovers and radios working, make water, conserve oxygen, repair his habitat - all the normal stuff for a smallholder on Mars. He also has to figure out how to communicate with Earth to see if there is any way he can be rescued, or work out whether he is doomed to die (properly this time) on a desolate frozen planet that seems intelligently designed to kill him.

The book is pacey and exciting; it's well written in that it avoids overloaded prose, and in some ways doesn't paint pictures of the Martian landscape, other than treating it as a practical hazard. This turns out to be a good thing - by now we have grown used to the incredible photos beamed back from the superbly successful rovers Spirit, Opportunity and more recently Curiosity. We know Mars is beautiful and terrible, and we don't need Andy to waste too much paper telling us that - tell us how Watney is going to solve his problems, dammit! And this he does in full-on geek style.

This works. At least, it works for geeks like me. The Martian has been called Macgyver on Mars, and that is pretty apt. But I think that here we have something more significant than that. I'm even going to stick my neck out and suggest that The Martian may end up being a work of enormous significance. For one thing, it is an unashamed blast of geekery that takes us right back to the giants of sci fi before things started getting all mushy and sentimental, before psychology and even paranormal nonsense started polluting our clear positivist stream.What we have here is a hero. A geek like us geeks. He doesn't give up, he uses this brain that evolution has worked so hard to give us, to stay alive, and the whole of Planet Earth sees itself in him and is rooting for him.

In this book, there are no bad guys - there are some bad decisions, but everyone is at heart decent. The bad guy is Mars, but even then, that's just Mars being Mars. It's good clean heroism, good clean fun, and has come at a time when people need to be thrilled; we need to look up at the night sky and see our home. What is going to get us there is precisely the sort of attitude that suffuses The Martian.

In a few short weeks, Ridley Scott's film of The Martian will hit the screens, with Matt Damon playing our hero (and he's a hero, OK? That's the point). The trailers have me hooked already, even though I've read the book. And the preliminary reviews have been very favourable. This is all to the good - there have been some real stinkers of Mars movies in past years, and something that can capture the spirit and power of Andy Weir's book will surely help inspire the generation that ultimately will make that voyage. NASA has laid the roadmap for the "Journey to Mars", but the most perilous parts of that journey lie in getting funding through Congress and winning resource from international partners. This will have to be a journey that Planet Earth undertakes, not just one country.

The privately funded, and still very much Earth-bound, Mars One Project plans (at least on paper) to establish a human base on Mars in the 2020s using funding from media buy-in and angel investment. So far there is deep scepticism among many that such a project can work, and, despite my positivist nature, I don't see how they can raise the cash to make it viable. But with The Martian, book and movie, the Red Planet is going to get a lot of exposure. Elon Musk, he of Space-X, Tesla and Solar City, has said that he wants to die on Mars - just not on impact. Maybe Bas Lansdorp from the Mars One was right. Maybe the way to build the impetus to actually land humans on the Red Planet is, to paraphrase Mark Watney, to media the shit out of this.

10 September 2015

Precision Medicine is here. Now. So let's use it.

New tests come along in medicine all the time. Our machines get bigger and faster. The range of things we can test for gets wider. Patients find out about new developments, and quite reasonably wish to benefit. Companies identify new biomarkers that can inform management or act as a marker for disease progression. The last few years have seen a veritable storm of progress as the Christmas tree of patient management becomes adorned with ever more sparkly, impressive and costly ornaments. But the underlying tree remains the same.

We doctors are conservative creatures - while we wax lyrical about change and progress, deep down we like to keep things the way they have always been. Yes, this new thingy is amazing, but it won't change that fundamental way we like to do things. Yes, our new knowledge of the collywobbles will radically change things, but it won't really radically change things - at least as far as our comfort zone is concerned.

I'm not alone in thinking that this sort of attitude is holding us back. Let me give you an example of a situation where lack of imagination and inherent conservatism is not just holding back progress, but wasting loads of money as well as patient time. But first a little background.

What you may not know is that when a new test comes along that can save a lot of money, it very frequently saves money for someone other than the person carrying out the test. So if I'm a GP who gets a lot of patients in with skin disorders, I might refer them to a dermatologist who examines them, carries out a load of tests, and makes a diagnosis. So if I refer 100 patients, and it costs me £50 to see each one, that means that my dermatologist colleague has 100 patients on her books that she has to examine and test. This process costs, say £200 per patient, including outpatient costs. Maybe 90% of patients can be reassured (after waiting on a waiting list to be seen for god-knows how long) and sent away with a prescription for some moisturising cream. 10% go on to get some more expensive treatment that costs £1000 per patient. Overall costs: 100x£50 + 100x£200 + 10x£1000 = £35,000, not including patient wait: £350 per patient.

Now, say my dermatologist friend develops a new test - the X-Test. The X-Test costs £50 (ouch, say commissioners - that sounds expensive), can be carried out in the GP surgery, and means that 80% of those patients can be immediately discharged, and only 20 need to go on to the dermatology list for further assessment. Now the costs are 100x£50 + 100x£50 (for the X-Test) + 20x£200 + 10x£1000 = £24,000, i.e. £240 per patient. That's a huge saving of £11,000 and the patients don't have to sit for ages on a waiting list. Brilliant, isn't it? It's almost a THIRD less expensive to manage patients along this pathway than the previous pathway. What health commissioner in their right mind would not want to do this?

Here's the problem. The specialists and the commissioners never see the savings, and the people paying for the service at one point in the path are not the same people paying at another point. The dermatology list is so long that there always remains some waiting activity to fill in the slack, so they're working as hard as ever, and the money never appears back on their bottom line. The patients are still pitching up to the GP, and now the poor GP has additional costs of 50% more than they were before! So it doesn't get approved. Yet overall the money spent per patient would be greatly decreased.

Can you see the issue? This is the standard way things operate in the NHS where budgets are allocated to silos (specialties, departments, health sectors, directorates), rather than having "the money follow the patient". Sure, we all pay lip service to that concept, but in reality it does not work nearly as well as it should. If we set up internal markets, it creates a morass of bureaucracy that turns potential savings into additional expenditure (a charitable term for "waste"). We set up criteria and proformas that get in the way of doctors and nurses doing their jobs. We audit pointless measurables simply because they're measurable, to see how they stack up against guidelines and ideals, rather than using data to get a feel for how the engine of health care is ticking over.

That's not to say that audit is a bad thing, however much audit in healthcare is poorly targeted and done "for audit's sake". Rather, what we need are meaningful analytics that help health care professionals and management get a feel for what is actually going on in their services, but much more importantly, how things are working out for the patients across their interaction with our health service as a whole.

The toy example I have given above, however, is when it's working well! What actually happens in practice is much worse, and comes back to what I mentioned up at the top. In practice the patient pathway remains much the same as it was before, and the X-Test is bolted on in such a way that it is in addition to the other elements of the path, rather than a lever to change the path. So for example the 100 patients get the X-Test and they're all referred to dermatology anyway. Then they get all the additional investigations, whereupon the welter of information is assessed at the end of the process, and only then is a decision taken. Maybe it allows some streamlining of patients at that stage, but by now the full potential benefit of the test has been squandered, and we have wasted copious amounts of patient time and taxpayers' money.

A real world example from my own area of practice is a technique known as microarray comparative genomic hybridisation (array-CGH or aCGH). This is a test that will pick up small regions of imbalance in a patient's chromosomes. The most common reason for a geneticist doing this test is in a child with learning disabilities or congenital abnormalities, and the pickup rate is about 15%. However before these children get to my clinic, they all (in an ideal scenario) have a karyotype (where we look at the chromosomes down the microscope - it's laborious, misses lots of problems, often non-specific, but it's relatively cheap) and maybe a Fragile X test (Fragile X is a fairly rare cause of learning disability - not "common" as some of the old textbooks used to tell us). Between the chromosomes and Fragile X, we'll maybe find a cause for a child's disability in 4% if we're lucky. So this 4% get referred to Genetics.

However a large proportion of the other 96% also get referred to Genetics (usually from community paediatrics), in order for us to carry out the aCGH test to make sure we're not missing anything. This includes children where, if the array is normal, the likelihood of finding a cause is very low - and we know that from the outset. But because a proportion of these kids will have an aCGH diagnosis, they get the enormous privilege of sitting on a long waiting list, then seeing a geneticist, only to get another test done and wait several weeks for the result of that. Our commissioners get cross because this new test which we've bolted on costs a fortune (actually only about £120 per patient, but hey austerity).

The solution is obvious - stop doing karyotype and Fragile X in community paediatrics, and roll out the aCGH test at that point. This would result in fewer children being referred to Genetics, the ones that do get referred get seen quicker, the results of the aCGH can be used to target their management much more efficiently, additional tests that would otherwise be carried out while they are waiting are avoided, anxiety is decreased, etc etc.

So to have the desired effect, we need to change the pathway. But remember our old friend the siloed budget? Yes, if we bring in such an obviously good change, it is going to cost more in the upstream part of the process, and although the overall costs per patient are much lower, and the benefits per patient are readily apparent, the savings (and they are substantial) get swallowed up or rendered invisible in the throng of unrelated problems further down the stream. So commissioners don't want to fund that new-fangled nonsense because they don't get to benefit.

But what if - what if - we had the courage to think outside our little boxes, to look at the overall patient experience as what we're really trying to improve? What if we realised that our pathways are part of the problem, and all we're doing is putting more ornaments on the Christmas tree? We need to invest in the disruptive, and carry that through. In this case, I mean we need to dramatically expand aCGH out to community paediatrics and change the pathway. We're making an ever-more gaudy and expensive spectacle, but not achieving the benefits we really want to see. If we're serious about reaping the benefits of medical progress, we have to throw out a load of the old stuff. De-clutter patient pathways, design them rationally, and in conjunction with our patients. Use the science of personalised medicine to properly personalise it - we're supposed to be helping our patients in decision-making processes. So let's actually make some decisions and get streamlining. Yes, it may cost more within some "silos", but the overall gains are there to be grasped.

The way I tend to think of it is that the aim of stratified medicine is to do exactly that - stratify the stream to achieve laminar flow. Remove the eddies and turbulences that are making our patient journeys more of a white-knuckle white-water rafting experience, rather than a more comfortable cruise to exactly where they want to go. Holding back is a false economy, it's costing us more money and causing our patients harm.

Specifically (in case I have not been clear enough) invest in precision medicine and genetic diagnostics, and have the guts to use this information to redesign and prune patient pathways for improved outcomes and patient satisfaction.

08 March 2015

Shane on BBC's The Big Questions

Should you know what's in your genes? That was the central (literally and figuratively) in BBC's popular Sunday Morning debate programme "The Big Questions" on 8 March 2015. My goal, as your humble scientist and doctor person - to explain how the Human Genome Project and the work surrounding it has brought a wealth of information and real tangible benefit to patients with rare diseases.

As any of you who are regular viewers of #BBCTBQ (as its hashtag goes) will know, there often follows a fairly dyspeptic exchange with more heat than light frequently generated. My principal "opponent" was a psychologist by the name of Oliver James, who takes the view that genes don't really tell us very much about variation in human psychology or IQ, and therefore it's a waste of time. I disagree on both points, but even if he was right about his first point (and he's not), it would be like saying bananas are no good because you can't use them to make marmalade.

Medicine marches on, and as we uncover more about our genes, we are learning how to make life better for people. That strikes me as a worthy goal. However there are tons of examples that we can point to right here and now that show that sequencing the human genome was perhaps one of the best investments that science has ever made. We are reaping the benefits of the genome right now, despite the naysayers.

Gastric juices a little too alkaline? Fix that by watching the YouTube of my section (kindly uploaded by that nice lady from Catholic Voices). Enjoy!

[Thanks to Mentorn Media - they own the screen grab]

26 February 2015

From the ends of the Earth to a clinic near you

Well, the inaugural Northern Ireland Science Festival (@niscifest, #niscifest) is in full swing! As part of the programme, we've had the NI Final of the wonderful international FameLab competition - a chance for scientists, engineers and medics to crawl out from our daily grind and regale a venue full of slightly tipsy but highly enthusiastic punters with three concentrated minutes of scientific brilliance. Here is my effort:

The winner was the wonderful Emer Maguire from Strabane, so well done to the Tyrone contingent! I'll post her video too - you'll like it. Trust me.

20 January 2015

The Fine Tuning Case AGAINST Theism

It has to be a set-up job. It can't have appeared this way by chance alone. The odds against it are 10^130 to one. If you vary just one of the initial constants of the Universe just a teensy little bit, stars, galaxies, planets, life and humans could not possibly have arisen. Therefore there must be an intelligent designer - a God - behind the whole thing. For these circumstances to have arisen without a designer stretches credibility to its breaking point. The most likely explanation of the exquisite degree of fine tuning we see in our vast universe is that God is real; (as philosophers rather quaintly put it) the Universe is more likely under Theism than under Naturalism.

So the most common variants of the Fine Tuning Argument (FTA) go. And, I have to say, I think it is a pretty good argument - at least at a visceral level. It feels right. There are of course numerous objections available to those of us who do not believe in gods. For one, we don't know what the distribution of life-permitting universes looks like within whatever parameter-space of universal constants we choose to set up. This makes it very hard to set probabilities based on a naive linear model. Maybe if you altered two or more universal constants (such as the speed of light and the strength of gravity) at the same time, rather than one or the other, you might slide to a place on the graph where life is back in business again. Maybe there are gazillions of life-permitting points or zones in this space, and "our" one is just a fairly small one among many. Or perhaps ALL possible universes "exist" in some vast hyperreality or multiverse (and there are good physics-based reasons for thinking this may actually be the case). Or (as many physicists now think) some of the constants are not independent, but constrain each other into a certain range. Maybe the rate of expansion of the universe is tied in some fundamental but undiscovered way to the speed of light, so the number of degrees of freedom a cosmic knob-twiddler would have to play with could be severely constrained. And there are more objections, some of which seem sensible to me, but others seem a little far-fetched.

However, in this little post I am going to take it as accepted that Fine Tuning is a real thing, however it is to be explained. And I am going to show that Christians who use the Fine Tuning Argument (FTA) are actually making a fundamental whopping error - they are undermining their own case substantially. By Christians, I mean those apologists who typically try to press the FTA into service as an argument for a personal God who intervenes in the world and impregnates virgins and sends his son to die for our sins and resurrects him and finds parking spots for believers and delivers nice weather for church barbecues. That sort of God. You know the type.

While I'm at it, I'm going to show that the crazier sort of Christian - the Young Earth Creationist - is so spectacularly undercut by the FTA that they really should step as far away from it as possible - they don't know it, but it's creationist kryptonite. Yet like little moths to the flame, they flutter closer and closer... It kills the other forms of creationism too, but more on that anon.

Let's look at the fundamental premise of the FTA. I haven't set this out as a formal philosophical argument - I'm not a formal philosopher, but I've played enough of 'em on TV to have a smattering. If I ever decide to write this up for a proper journal (ha!), I'll put in bullet points and specialist jargon, or maybe a nice philosophically literate person will do that for me. But I'm sitting on the sofa with a whisky (a very nice 12 year-old Glenfiddich) and I'm feeling relaxed. Anyway, the relevant premise is that the constants of the universe are arranged just so - from the beginning - that if they had been even a tiny tiny bit different, a life-permitting universe could not have formed, and we could not be here to wonder about it. Maybe the universe would have collapsed immediately after the Big Bang. Or it would have blown out too fast for hydrogen to form into clumps leading to galaxies or stars. Or gravity would have been too weak to allow galaxies to form - or too strong, resulting in a universe full of nothing but black holes. Or if the Strong Nuclear Force had been any different, everything would be neutrons. Or if the Weak Nuclear Force had been different, there could never have been carbon or oxygen.

If we accept that premise, we are in an interesting position. IF such fine tuning is true, then the arrangement of matter we find in the universe is a natural outworking of those initial constant or conditions. God did not have to intervene. Praise the Lord, our theists might say. He's a lazy bastard who doesn't like to do more work than necessary. Our creationist chums would do well to feel distinctly uncomfortable here, because this only works if the universe really is as old as scientists say it is - about 13.7 billion years. If the universe is, say, 6000 years old, as most creationists assert (including several members of the Stormont Assembly in Belfast, which it pains me to note), then they have a truly INCREDIBLE problem explaining how, if God made the world in 6 days at any time in the last few thousand years, the very cosmic settings they appeal to to prove the existence of God happen to fit exquisitely into cosmological models that point back 13.7 billion years - and only work if the Universe is indeed that old. If creationism were true (fantasise with me a moment here), it is utterly inexplicable why (say) the rate of expansion of the universe and the strength of gravitation should be so closely balanced. I'll perhaps develop this further in a subsequent post, but it should be immediately obvious that a creationist faced with the FTA is forced to resort to the most absurd and pathetic special pleading that can be imagined.

But let's leave Ken Ham and his creationist cronies - what about the more sophisticated theists who want to have this naturally-evolving universe with knobs on - those knobs being specific timed interventions by God that are outside the normal natural run of things? Interventions that we might term "miracles"? One theist I discussed this with suggested that perhaps there is no route to life existing, even in this lovely life-permitting universe, without God pinging it over the barrier and then letting it evolve. The evolutionary system needs to be set up by God for it to work.

But we can't let this slide - for one thing, we don't really know how life actually began, but we have some very good ideas that constrain our hypotheses. It is considered very likely by most biologists and physicists that conditions suitable for life exist on other planets, and that conditions suitable for the *origin* of life exist too. While it is entirely possible that we are the only intelligent life in our galaxy, there is nothing about life as we know it - at least at the bacterial level - that makes it seem inherently unlikely. However, let's assume they're right, and God needed to give life an extra kick over the line to get it going. And perhaps another kick to get it to evolve multicellularity. And another to get mammals. And another to get apes. And then another to make a Man out of an ape, in the image of the creator.

We can't exclude all these little fine tuning tweaks or kicks or miracles or whatever we want to call them - at least not out of hand. However, here is the key problem. IF God (a "theistic" interventionist god, mark you!) is willing and able to make these little adjustments to the universe on-the-fly, then we are back to the same problem the creationists have - WHY are the *initial* constants so *ridiculously* fine tuned to mean that 300,000 years after the Big Bang electrons would be recaptured by protons to form hydrogen from the primordial plasma, and the gravitational force strong enough to form galaxies over the next few million years, but not too strong to collapse the whole Big Shebang back into a black hole or singularity? Why did those first stars burn for a few million years, and go supernova, spewing out their carbon and their oxygen and their iron etc into the interstellar dust clouds, only to reform into more stars and planets to recapitulate the cycle?

If we really *did* have an interventionist "theistic" God, we would have no need of such insanely delicate initial tuning - He would, as is his proposed modus operandi when it comes to life and messiahs and barbecues, fix it on-the-fly, and create life in a much larger array of universes that are more sloppily tuned. So why was the option of sorting out the carbon unavailable to God *during* the life of the Universe? Why could he not have created iron or oxygen in one of the (presumably millions) of other universe configurations available to him? Why choose to place Humans, the pinnacle of his evolved creation (because he uses evolution, remember), in the ONE configuration that didn't require any additional input from him after the Big Bang? If God is not constrained, why create a Universe that seems to show he *is* constrained? Surely the Sloppy Tuning Argument would be more convincing than a Fine Tuning Argument?

It should be clear from the above that it's not just creationists who are left flailing around by the FTA - theists are too. Of course, the most likely type of God *given* Fine Tuning is a deistic God - one who starts the whole thing off and then does not intervene. Once we postulate an interventionist God, we can't fall back on the ballistic FTA, because every additional action ascribed to God becomes hopelessly ad hoc, and suggests that the Universe didn't *need* to be fine tuned.

So Christians need to decide - IS the Universe Fine Tuned? If so, then a theistic interventionist God is highly unlikely. If not, then why are we even having this discussion? They should drop the FTA. If the God of Classical Theism exists, then the apparent Fine Tuning of the Universe is utterly inexplicable.

I, of course, don't think that any God exists. I don't think we need one. But Fine Tuning, if true, is an argument against the God of Classical Theism.

Comments welcome! I'm on Twitter as @shanemuk

04 January 2015

Thinking about peace in Israel/Palestine

Peace on the Sea of Galilee
Making peace is never easy - or, rather, it's all to easy to come up with what "should" happen, but translating that into a reality that everyone will look back on in years to come and say "That was a great idea!" is somewhat tricky. As anyone who knows me is all too aware, I have an immense affection for Israel, the Occupied Territories and Jordan - I have had the enormous good fortune to have spent a tiny amount of time in the region, but that time is all too short, and really only sums up to about 12 weeks in total over the past twenty-something years. However it has been long enough to allow me to meet some lovely people and make some great friends.

It's also sufficiently long for me to have some grasp of how difficult making a long term peace is likely to be (and boy, we've proved that!), yet short enough for me to be able to wander in with a classic Irish naïveté, and pronounce my diagnosis and recommended course of treatment to fix all woes and create a veritable paradise in, well, Paradise.

The background to the current situation should be pretty familiar to everyone by now - Israel proper currently maintains an occupation of the West Bank territory which was (along with the Gaza Strip, which is at present under blockade and has recently suffered from a disastrous bombardment from Israeli forces in response to rocket fire from Hamas) to form the basis of a Palestinian state. Much of daily life in the West Bank has been handed over to the Palestinian Authority under Mahmoud Abbas, but security remains under Israeli control. At the same time, many Israeli "settlements" have sprung up and been expanded, in contravention of international law. The Israeli government under Binyamin Netanyahu has frequently unilaterally expanded and developed these settlements in what many have seen as deliberate attempts to redraw the landscape and to prevent a Palestinian state developing. And of course there has been the ongoing violence with terrorist attacks coming from both the Palestinians and the "Price Taggers" of the settler movement. It's a lot more complex than just that of course, but that will do for now.

For many years now I have been a supporter of the "Two State Solution", whereby Israel and the Palestinians reach agreement on setting up the State of Palestine, and, using the 1967 borders and agreed land-swaps, we move to a situation of two states living side by side with a formal peace agreement, and everyone in the Middle East region uses this as the basis for a comprehensive peace that removes the Palestine/Israel issue from the grudge books forever. I have to say I still do support that plan, but repeated settlement expansion, with supporting infrastructure, Palestinian and settler violence, the "Palestine Wall", show-boating at the United Nations, corrupt politicians in both the Israeli government and the PA, cack-handed interventions from abroad, the awful tragedy unfolding in Iraq and Syria with the wars there and the emergence of Daesh/IS - all these factors seem to make a two-state solution a pipe dream. In addition there is a massive imbalance between the Israeli and Palestinian sides, with Israel very much having the upper hand. In this situation, despite the declarations of the American government and the EU, and even with the declared support of the Israeli government, it looks like the Occupation is unbreakable, and a Palestinian State west of the Jordan River simply unachievable.

There are those within Israel, such as the current Economy Minister Naftali Bennett - a hawk if ever there was one, and many many others - who wish to see complete annexation of the West Bank, but this introduces a major problem. What to do with all those non-Jewish people who would suddenly become citizens of the avowedly Jewish state of Israel? Annexation of the West Bank would mean that the Jewish majority in the combined state could not be assured. Bennett's solution is to introduce a form of Apartheid, whereby Jewish citizens would have greater rights than non-Jews. However, not everyone sees it this way.

President Reuven Rivlin has an impeccable right-wing pedigree, and is a proponent of a single state, with guarantees of equality for all. Although he has generally been seen as a hardliner, it seems that this dream may not reflect reality. How would Israel guarantee its Jewish character if it lost a Jewish majority? Furthermore, even within Jewish people there is such a diversity of belief, practice and daily life that the category may not even be all that meaningful.

As a supporter of the Two State Solution, however, I feel it may be time to think again about all this. Let's suppose we actually get a State of Palestine based on the West Bank (plus land swaps etc etc) - what then? In reality it's going to be a pretty paltry affair; there will probably always be an Israeli army presence along the Jordan river, effectively enclosing the state. It will probably be rather poor, because it's going to be hard for it to trade, it will be forever dependent on aid from the US and Europe, and its only water will come via Israel, making it difficult to grow an agricultural sector. It's likely that the price will be "land swaps" which will effectively be border re-drafts around Arab populations close to the border, effectively dumping large numbers of Israel's non-Jewish population into the new state, while Israel will of course integrate the settlements into its share of the land. Travel will become more difficult than it already is, and many of the low-paid labourers who previously had jobs in Israel will (as is happening already) find their jobs taken by transient migrants from the Far East.

Will minorities (eg Christians and Druze) fare well in a new Palestinian State? Certainly at present there doesn't seem to be any indication that Daesh/ISIS are making much headway in the West Bank, but in a volatile region where resentment is unlikely to be assuaged by the mere presence of a state-of-their-own, I think the Palestinian Authority would have cause to be nervous, and this nervousness would hardly sit well with Israel. How would tourism fare? Would the Palestinian government be able to assure the safety of foreigners? Also, apart from "having a state", does this really address the grievances of the very many descendants of the Palestinian refugees who were forcibly expelled from their homes in 1948? A Palestinian State with a "Right of Return" for multiple ex-refugees into Israel proper seems like an organisational nightmare.

And all the while, the Occupation remains a nagging sore that taints relationships between Europe, US and the Middle East. Is it time for a re-think? I am going to make a proposal. I accept that I am not Israeli or Palestinian. However, the "Holy Land" is part of my heritage. Both the fantasy and reality of the region played a large part in making me who I am, and I feel I have a stake, however small. I offer this proposal entirely humbly, realising that it may be a pipe dream, and fully aware of many shortcomings it may have. However, I submit it with the rider that every other solution that has been suggested so far has been a failure, and the status quo is actively harming both Israelis and Palestinians.

My suggestion is this: the Palestinians should call the bluff of Netanyahu, Bennett and the UN and request full annexation by Israel of the West Bank. The state will be called Israel Palestine. Jewish settlements beyond the 1967 Green Line can stay. The capital will be Jerusalem, and there will be a single parliament. People born within the region (historic Palestine) will be citizens of the united state, but will be able to declare either Palestine or Israel on their passports. The fundamental equality of all citizens will be declared in the constitution (including race, religion, sexual orientation, gender identity etc). The state must remain the declared homeland of the Jewish people and the Palestinian people. Particular provision will be made for Jewish, Muslim and Christian people, recognising the central importance of New Israel Palestine to all these faiths - and to those who identify as secular, humanist, or atheist. All groups will have access to the holy sites (including the Temple Mount) on a negotiated basis. No-one will be discriminated against because of their religious beliefs. Hebrew and Arabic will enjoy joint official status. Jews and non-Jews will be able to serve in the army (which will be much reduced because of improvements in the security situation). All Arab states in the region will formally sign peace deals with New Israel Palestine.

Pie in the sky? Very probably. Reasons why it can't work? Probably lots (I can think of plenty). But maybe we need to think a little outside the box here. This is not a recipe - it is a scenario. But if the Palestinians were to present this to the United Nations, with a commitment to peace and co-operation within the new structures set up under the new partnership-based state, is this so much worse than continued stalling and eventual Israeli annexation of the West Bank anyway? Maybe it's time for a radical change in direction and thinking. But one thing's for sure - the status quo sucks too, and everyone will be dead before things get much better. And it will allow a much more united response to what is going on in Syria and Iraq, and that can only be a good thing.