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Wednesday, February 1, 2017

To Boldly Go Beyond Barriers

In the 1964 picture below, the computer is on the right, and her name is Melba Roy She went on to become Program Production Section Chief at Goddard Space Flight Center. The machine next to her was referred to as an IBM then.
pic from 
commons.wikimedia.org/wiki/File:Melba_Roy_-_Female_Computer_-_GPN-2000-001647.jpg

Melba Roy does not appear in the film Hidden Figures, which concentrates its attention on just three of the African-American women who worked as computers in the space program, though she is mentioned in Margot Lee Shetterly's book on which the movie is based. The book covers a much longer span of time and more characters than the main three: Katherine Johnson, Dorothy Vaughan, and Mary Jackson.

One female of color who doesn't make it into either the film or the book is Janez Lawson. In fact, it's hard to find anything about her at all beyond what has already been unearthed by Nathalia Holt in her book The Rise of the Rocket Girls.  In truth, I found Shetterly's book a faster read, but there is more information in Holt's about women in the industry and how the role of computer became a sort of pink collar career.

In fact, though,, you need to go even further back in time to see women emplolyed as computers. And they were also focused on the stars. That's the topic of  Dava Sobel's book The Glass Universe: How the Ladies of the Harvard Observatory Took the Measure of the Sky . Working painstakingly through photographs of telescopic view of the heavens, these computers observed differences in spectra and worked out the classification system that shifts the alphabet around. The mnemoic device became "Oh be a fine girl, kiss me." New discoveries have contributed to new letter placement, leaving some question as to how to complete that famous mnemoic. I have to admit this book can be slow going, though it does have some nice photographs to illustrate the history, something that is also in Holt's book but missing in Shetterly's.

Another thing in those two books that Shetterly doesn't detail are some details about what the women were paid. One of the key women in the Observtory notes that she was only paid $1500 when men in comparable positions were paid $2500. Other women employed as computers were paid hourly, at the rate of 25 - 30 cents. This hourly rate must have remained the standard, as Holt says that's how the women working at NASA got paid. As a result, some of the women earned more than their husband because of the long hours they had to work. In contrast, Shetterly's book always states their earnings in yearly amounts, and the film indicates that Katherine would not have been paid any more for staying later at work. It is possible that her pay grade was changed even though she was still called a "computer."

As the Hidden Figures  book picks up the history of the computers in the 40s, it includes Miriam Mann, a contemporary of Vaughan who is described as a woman as petite and fearless. Mann repeatedly ripped down the paper sign designating a section of the cafeteria for the "colored" women. It would go back up, and she'd rip it down again until it stayed down.

Katherine Johnson with celestial Training Device
Pic from https://www.nasa.gov/image-feature/katherine-johnson-at-nasa-langley-research-center

 If you've seen the film, you'd realize how her defiance was translated into a somewhat different context with a great deal of dramatic license. For instance, Katherine Johnson achieved major recognition as the first female computer to get her name on a report as early as 1959 (published in 1960) that predates the movie. But as the center of the film, her character is subjected to Jim Crow practices in ways that didn't happen in real life. In the book, she is the "unflappable" Katherine who was never driven to an outburst about the bathrooms because  didn't question her own right to use the restroom in the building in which she worked. In light of the fact that Shetterly comments on the myths that have arisen about what Johnson encountered because the film ends up reinforcing some of them and inventing new ones.

In point of fact, it was Jackson who experienced that kind of humiliation. But she only put up with it once (Shetterly 108). Once was enough to get her to rant about her situation (not in a room full of people) in front of one man who offered that she work for him. She accepted. One really cool thing about Jackson's achievement as an engineer was not  breaking the color barrier at the school for her classes, but serving as an inspiration for her children. It's a pity the movie didn't include this episode in the book. When Jackson's son won the Virginia Peninsula Soap Box Derby, he declared, "'I want to be an engineer like my mother'" (200).

Dorothy Vaughan gets a lot more coverage in the book than in the film, as she began her computer career about two decades before the the movie opens. She actually did earn official recognition as head of the West Ara Computers unit" but lost it at the end of the decade when the unit was disbanded.  It's ironic to note that near the end of the book (264) Shetterly notes that Vaughan never learned to drive, making the carpooling scenes thrown in to show the closeness of the characters to have been historically impossible.  The library book event is not in the book either. FORTRAN was actually taught to the employees, and the on-site classes were open to all races (139). But again, that's dramatic license for you.

Dramatic license isn't necessarily bad, one just has to realize that events were a bit different in fact. On the plus side, the film is very engaging and actually presents the story in a way that works well as an introduction of the subject that can work even for young children. They would not be subjected to hearing racial epithets and they won't even see a single character smoke, though the sixties was a time when most people held a cigarette at some point during the work day.

BTW the title's Star Trek reference is deliberately placed because Shetterly refers to the popularity of the show with the NASA set as well as with Dr. Martin Luther King, Jr. She refers to his encouraging Nichelle Nichols to stick with her role as Lt. Uhura  when she wanted to quite the show because he saw her as such a positive role model. That's somethine the actress recouted in her autobiography and even gets quoted the Wikipedia entry about her. Fictional characters can be inspiring, but sometimes real people prove equally impressive.

Additional online resource: http://omeka.macalester.edu/humancomputerproject/ 

 Interesting link about other women's roles in space: http://www.neatorama.com/2013/04/15/Women-in-Space-The-Mercury-13/

On the Hidden Figures Exhibit https://www.nasa.gov/feature/langley/museum-exhibit-highlights-nasa-langleys-human-computers-from-hidden-figures

Tuesday, January 17, 2017

Decisions, devices, data, and doctors: should you keep them away?

Some time ago, I read Eric Topol's  The Patient Will See You Now: The Future of Medicine is in Your Hands.  I also read the somewhat less bullish on technology  Robert Wachter's
The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age. Now I've just completed H Gilbert Welch's Less Medicine More Health: 7 Assumptions that Drive Too Much Medial Care with its even less sanguine view of the possibility of generating a lot more data on one's health.

It's good to read all three to get a sense of the developments in the brave new world of digital health (see Healthcare Analysis: Doctor vs. Deviceand why it's not all good.  When someone first told me about Welch's book,I envisioned something like this:

Dr. W: One of the best things you can do to improve your health is to engage in regular exercise. My father, for example, walked 2 miles to and from work each day.
Random person: That's great, how old is he?
Dr. W: He died at 60 from pneumonia he developed after becoming sick from colon cancer.
Random person: ??

That may be your intitial reaction, but if you think about it, you realize his father's early death doesn't disprove his general guidelines for health, which also include the old wisdom of "everything in moderation and nothing in excess." Dr. Welch wasn't claiming that anyone who walks is guaranteed a long life. It is just one of the factors that contributes to good health. Cancer can happen to anyone, and that doesn't disprove the fact that walking is good any more than the smoker who lives to 100 proves that smoking is not at bad for you. People have to remember that there are general rules and loads of exceptions. Dr. W. bets on the rules and what you can do for your health without taking extreme action or obsessing over every bit of health data you can access. 

He certainly offers a contrast to Topol's celebration of increasing patient access to their health data with technology. For example, Topol was thrilled with the fast blood lab analysis offered by Theranos, which has since the book's publication fallen very much out of favor with the public and the law. Topol also consider Angelina Jolie effect a very good thing, a sign of women taking charge of their health. While Welch doesn't say the star was wrong for her own situation, he argues that that kind of testing and pre-emptive surgery doesn't make sense for most people.  

Welch devotes a great deal of his book to the downside of too much data,  not just because of the irrevelant noise, but also because the information it provides can prove more harmful -- in raising anxiety level and prompting invasive actions that don't really improve one's health or wellbeing -- than helpful. This is particularly the case with breast cancer which has been selling "early detection saves lives" to push yearly mammograms on the entire female population, screenings that often raise alarms, prompty biospsies, and sometimes lead to removal of what would not have spread to pose a real threat in any case. 

Some of these issues have already been explored in books like Pink Ribbon Blues: How Breast Cancer Culture Undermines Women's Health (Oxford University Press, 2011). They also have gotten those in the know to change the recommendations for women's mammograms. Nevertheless, the most recent government guidelines for women's health still push that outdated information in its guidelines that allow for regular mammograms for all women 40 and up and that states unabashedly, "The good news is that mammograms can help find breast cancer early. Most women can survive breast cancer if it’s found and treated early." This dangles a false promise of saved lives that often were not in danger at all and completely ignores the harm that can result, something more and more experts are admitting as studies like this one covered by PBS, "One in three women may receive unnecessary mammograms, study says" come to light.

What's true of screening for breast cancer is also true for other forms of screening that lead to invasive tests and treatments in the attempt to "fix" problems that would not cause any ill effects if just left alone.  But even when the screening doesn't necessarily entail harm, Welch says, we should ask if it does actual good. This is important to know because the right to say "no" to  a suggested test  because there is no benefit to be derived because the information is not going to be actionable in any case is empowering for patients or their caregivers.

Here's a case in point: a couple of years ago, I brought my son in to a doctor when he had signs of a cold just to be sure it wasn't strep or something else that would require medication. The doctor decided to also test him for flu. Though both rapid tests were negative, he wanted to be sure and put in for overnight lab test for both. They, too, were negative. Now here's the thing: it may have made sense to do the strep test in case the rapid was inaccurate because someone with strep should take antibiotics, but the extended flu test made no sense at all because the results take days, and by then 1) it's too late to try to take Theraflu or any other prescribed medication to mitigate symptoms and 2) you'd know you'd have the flu or not yourself at that point based on the extent of your suffering. So the doctor had put in for a test that cost over $10

0 (not covered by insurance because after ACA went into effect, it added on a deductible for all diagnostic labs)  with no tangible benefit for the patient. The only ones who stood to benefit from the lab data are the people in NY state who collect data on flu. But they were not the one given the bill.  

It's very hard for some of us to resist the recommendations of doctors for tests, treatments, etc. That's because we have to break through our own biases that convince us the doctors know what they're doing and always acting in our own best interests. That's not to say that doctors are completely ignorant or that they are deliberately jacking up their incomes with more procedures (though some are or do them to cover themselves in case of suits)  but that they are conditioned to automatically run these tests and make the standard recommendations in a one-size-fits-all approach to medicine. It's up to individuals to get informed and empowered.