May 27, 2022

Liberate Psychedelics

Many mental illnesses are characterized by feeling stuck, trapped, or helpless. The sufferer cannot imagine recovery. It is entirely unsurprising that recreational drugs, which people take to give themselves a different perspective, may have use in shifting this feeling of stuckness. Thus researchers have experimented with a range of psychedelics to assist in psychotherapy over the last ten years, and trials show the psilocybin from magic mushrooms can help shift depressive symptoms and MDMA can do the same for post-traumatic stress disorder (PTSD). 

The Therapeutic Goods Administration (TGA), the medicines regulator in Australia, is considering rescheduling psilocybin and MDMA from schedule 9, prohibited, to schedule 8, heavily regulated but prescribable by doctors. For this we owe credit to the extraordinary folks at Mind Medicines Australia. What follows is my submission to their public consultation. 

Millions of Australians suffer from treatment-resistant depression or post-traumatic stress disorder, impairing their quality of life as well as participation in our society and economy. It is an indictment on our system of medical and pharmaceutical research that our development of better treatments has been so slow. Worse still is the interference in this quest by politicians privileging culture war over the alleviation of suffering. The history of drug prohibition is clear - the restrictions on psychedelics for both recreational and therapeutic use had no evidence base as a matter of public policy or medical regulation. It is thus darkly ironic that advocates for undoing this historical wrong are now required to meet high standards of evidence to shift this cultural inertia - evidence that has been near-impossible to gather given the restrictions themselves.

Nonetheless, the need is so dire and the therapeutic potential so clear that brave researchers from around the world have indeed amassed a significant body of evidence showing promise in treating depression with psilocybin-assisted psychotherapy and particularly PTSD with MDMA-assisted psychotherapy. The phase 2 trials on the former in May and November 2021 and the phase 3 trial on the latter in May 2021, as referenced in the proposal, are only the latest additions to this research renaissance. They show these therapies are superior to existing treatments to such an extent that they prompt paradigm shifts in our conceptions of what psychiatric treatments can achieve. As well as dramatic reductions in our psychometric scores of symptom severity, patients report that their experiences are among the most meaningful and valuable moments of their lives, and help them reconnect with their loved ones and themselves.

The provisions b and c in the proposed rescheduling, which require the authorizing psychiatrist to undertake specific training in the use of the substance as part of therapy, as well as obtain approval from two independent psychiatrists, would establish an unprecedented level of oversight, greater even than regulations allowing doctors to give involuntary electroconvulsive therapy or proposals for voluntary euthanasia. It is an eminently conservative step that allows treatment of those who need it most while minimizing the potential for abuse, diversion, or improper use. In the unlikely event that diversion does occur, the public can take heart in the knowledge that these substances pose minimal acute, chronic, or social risks, especially compared to alcohol, as well documented by Professor David Nutt.

These minimal risks, the accumulation of supportive evidence, and the enhancement of regulatory protections make the overwhelming case that the benefits of rescheduling outweigh the risks. Our regulators should show that regulation can be evidence-based rather than reflexively punitive, future-focussed rather than change-phobic, and compassionate rather than coercive. Australia has the opportunity to show world leadership as a humane and pragmatic country. The TGA should  help us take it.

Dr Tomas Heard

Psychiatric Registrar, Metro South Addiction and Mental Health Services, Queensland Health

Trainee of the Royal Australian and New Zealand College of Psychiatrists

Associate Lecturer, University of Queensland

NB. my opinions are my own and do not represent the official positions of the above organisations, though I believe they one day will.

Jan 5, 2022

Goals Group: a system for improving your life

Reading Atomic Habits by James Clear convinced me that discipline may not exist. Disciplined people are actually just experts at structuring their lives to make it easy to do the good and avoid the bad. 

Example 1: a bowl of chocolates on your kitchen bench might empty in 2 days, with those empty calories transformed into your body fat. A clear jar might last 4 days. An opaque jar, 10 days. A jar inside a cupboard, 20 days. Store the jar in your garage and only bring it out for parties, and the loss to mindless snacking approaches zero. "Disciplined" people know it's better not to rely on willpower, and that out of sight is out of mind. 

Example 2: you want to go to the gym every morning, yet after an initial burst of training you struggle to get out of bed and motivate yourself and start hitting the snooze instead. Instead of trying to white-knuckle your way through dozens of temptations, you make it easy to go to the gym and hard to stay in bed. You leave your phone on the dresser so you have physically get out of bed to hit the alarm. You leave your gym clothes out and ready, and your work clothes in your car, so it's easy just to throw on your activewear and drive to the gym, and hard to put on your gym clothes, go get your work clothes, bring them in, change clothes, and put away your gym clothes. You sign up for a class, put down money, make friends to compete with, and post about it on Strava to get some juicy social media dopamine reinforcement. You have made it easy and rewarding to do the right thing and weird and annoying to do otherwise.

Sounds great, but what if you don't know how to set goals, and need some pushing to stick to the project of restructuring your life? Here's where a goals group can help.

Goals groups are 3 or 4 people who meet to hold each other accountable. Any more and the meeting gets too long. They must be people you can be totally honest with, about sensitive issues, from your mental health to your relationship troubles to your wildest dreams. They have to be comfortable calling out your bullshit excuses and vice versa. 

Start by setting goals over 5 years, 1 year, and 3 months. Goals should be SMART: specific, measureable, achieveable, relevant, and timely. Dumb goal: get super fit. SMART goal: run 5k in under 25 minutes by July. To identify goals, you can write out your strengths, weaknesses, opportunities, and threats (SWOT analysis). You can write headings like fitness, nutrition, finances, social, educational, work, psychological, moral, spiritual and brainstorm ideas in each. You can write down everything you do in a typical day and look for the good and bad - James Clear style Habit Scorecard.

You write down your goals the night before the first meeting and post them to a Facebook group or private blog. At your first meeting you take turns reading your goals. You give feedback to keep them SMART. You each pick a quarterly goal to focus on for the next 3 months. This should be an outcome goal (run 5k in <25 minutes by July) and attached process goals (run 5k >=4 times/week, tracked on Strava so others can check and provide positive reinforcement). It's easy to tend towards fitness goals because they're easily quantified, but with some creativity you can do anything:

  • Bench press your bodyweight via 4x weight sessions a week
  • Cut alcohol to once a week via removing stores from the house
  • Waist measurement below 80cm via 10% calorie deficit on My Fitness Pal
  • 10 minute meditation daily via app with streak-counting and reminder notifications
  • Write two blog posts weekly via 20 minutes writing a day
  • Reduce social media use to <1h / day via app blocker
  • Save 10k by Christmas via budget app
  • Make 2 new friends via calling once a week, seeing once a month
  • Achieve intermediate Spanish via 4x Duolingo lessons/day
  • Read one book a week via 30 minutes bedtime reading
  • Quit smoking via NRT and self-determined rules

The group then meets once a week at a regular time. Can be virtual. The night before you post on your goal progress. In the meeting you read this out and the team reinforces your successes, calls out excuses, and helps you figure out how to structure your life for better adherence. Why haven't you run? Haven't been getting up early enough? Why not? Tried the distant alarm trick? Getting to bed too late? Why? Try setting a bedtime? Cutting down on TV? etc. 

Soon enough you anticipate this and start calling out your own excuses and structuring yourself so you don't have to write an embarrassing report. But the group is still there to hold you accountable.

Ideally, your post should include a visual representation of your progress like this.
Though it doesn't have to be as fancy:

Every quarter you have a special meeting to report on the final outcome of the goal. You should comment on whether and how you intend on keeping your new habits. Set a new goal. Usually from the 5 year 1 year 3 month goals you brainstormed last time, which you might choose to revise. 

There's many variations. The above is just what my group does. We have also become dear friends and supports in other ways. We often add a weekly life update of non-goal material to our post. We sometimes set multiple goals, or carry one over to the next quarter, or finish a goal partway through a quarter. What matters is that the group examines any change, ensures it is well thought-out and not impulsive, and makes a joint decision. 

Do you want to be the designer of your life, or just a consumer? If the former, read Atomic Habits, and also The Elephants by Nick Crocker, the blog post from which we stole this idea.  

Sep 3, 2021

No one knows shit: The Black Swan by Nassim Nicholas Taleb

This book was a challenge for me because the author is such a repellant narcissist. His self-assurance and contempt for anyone that doesn't confirm his theories oozes from every page. He structures the book as a hero's journey, explaining how his life perfectly prepared him to uncover the truths of the world and subjecting us to sagas of his victories over fools and charlatans. He creates fictional characters, puts his words in their mouths, and tells stories of their vindication against all odds and triumphs over naysayers. But I'm glad someone made his points:

1. We all predict the future by the past. But imagine the turkey who is fed and housed every day by a farmer. He will grow more and more confident the farmer has his best interests at heart. Then one Christmas Eve, he will undergo a radical revision of belief

2. Imagine all the self-satisfied economists and politicians on September 10th 2001, or in December 2019, issuing projections about the future of stockmarkets, geopolitics, and Western society. Few admit the possibility of rare impactful events - Black Swans

3. Most of their predictions and models are based on extrapolations of linear trends, Gaussian modelling, and bell-curved outcomes, which cannot account for Black Swan outliers, despite their oft-enormous impact in history and economics. Think of the massive impact of individuals like Muhammad, firms like Amazon, or technologies like the steam engine

4. Many inventions and discoveries come from serendipity. Many are the result of lone tinkerers. Rarely can they be directed, planned, or predicted. Think penicillin or microwave ovens

5. Pundits and leaders are no better than cab drivers at predicting the future, they are just better at propagandizing and cherry picking their past pronouncements and narratizing their ideas. We all retrospectively find ways to explain total surprises and forget that unknown unknowns exist, and that we could be the turkey

6. The beauty of capitalism is that CEOs don't need to know the future - the evolutionary system will select for firms that fit new circumstances. The fragility of central planning is that planners don't produce a whole ecosystem of strategies that can respond to outlier events

Jun 25, 2021

Intelligence, Academia, and other scams: Who Gets To Be Smart by Bri Lee

Reading Bri Lee is like savouring scintillating dinner party conversation with your sharpest friends. She defies genre and traditional structure to weave together anecdote and research, formality and wit, the literary and the scientific, the historical and the bleeding edge contemporary. The essential conceit in this book is Lee finds herself growing up smart, but insecure about geniuses around her. What do they have that she doesn't? Is it brainpower, or superior education? Or is the whole edifice of intelligence and academic heirarchy a sham, constructed by rich white men to justify their position and entrench their privilege? Lee makes a detective story out of her quest to find answers. This style is unusual for a nonfiction, but unsurprising to those who know her first book Eggshell Skull. I've read a small number of reviewers expressing their disappointment that she didn't, in the end, figure out whodunit, and that she tarries too much collecting clues. Demanding a point is to miss the point, which is that this book is a question. An enormous, ringing, urgent question, of how knowledge is constructed and who gets the hardhats to be on site. It's right there in the title - a grand query, not a grand theory. 

I get the temptation to blast Lee for omitting a line of enquiry or neglecting one's favoured theories. I felt that she spent too long on the dark side of Western Civilization. Of course it had its chauvinists and genocidaires. So did every civilization. But the West birthed liberal democracy and the scientific and industrial revolutions, creating a world quantifiably hundreds of times more peaceful and prosperous than ever before. Those ideas could have arisen in China or India or the Islamic world, but by historical contingency, they came from Europe. They are now embraced the world over, and are the common inheritance of all people, monopolized by no group. In my view that's the most important development in human history, and it is inseperable from questions of production of knowledge. I see the scientific method as a radically emancipatory and revolutionary process, breaking biases, scourging supremacists, and enriching our lives to boot. Lee explores mainly the ways elites have attempted to coopt science for the purposes of kyriarchy and colonization. 

But one can't fault a dinner party conversation for skipping over one's private preoccupations, and it would not be smart to discard this book for not conforming perfectly to my expectations. Lee's voice is compelling and lyrical and she is using it to advance an important conversation. Her generosity in letting us in to her life and mind brings the political down to the personal.

I will attempt to do the same, in my own small way. I too grew up wondering a great deal about what it meant to be smart or educated. I vainly cultivated my most showoffable intellectual talents and grasped at glories. Eventually I realized that this was making me unhappy and unsociable, and also that intelligence barely exists. IQ was designed as a measure of intellectual impairment, and is not normalized to measure genius. Scores are not fixed but laughably malleable (see Calvin Edlund) and correlate with outcomes only if you use dogshit statistical tests and reason circularly (see Nassim Taleb). My MBBS, supposedly the most prestigious degree, was essentially a scam, whereby a corporation-university took my money and the public's, fed it to fatcats and erected shiny buildings, then made us teach ourselves medicine. True, in my field it was a ticket of entry to a privileged career. But in most others, from tech to business to the public service, qualifications mean little more than signalling your commitment. Even in the production of knowledge, the internet is democratizing information and tearing down ivory towers. The greatest contributors to the human project usually work outside the academy. What you do matters, not who you are. Perhaps Lee and I would have realized this earlier if were praised for effort, not ability (see Carol Dweck). 

Lee ends the book with a poignant meditation on love, gratitude, and self-acceptance. She may have been too humble to make the following rather different point, so I will. The nucleus of her doubts was her Rhodes Scholar friend Damien, studying English literature. She praises his position at the apex of intellectual achievement. He denies thinking that way about learning. She is enraged that he's winning the game without even even valuing the rules. But in literature, as in all human striving, the game is *not* scholarships or plaudits. The building you write in or the gown you wear means nothing. Damien realizes this, chafes at his pompous dons, and longs to live the life of a writer and give back to the real world. Lee is already there. She is now a three-time bestselling author, her books read and enjoyed by many thousands. I think Damien would forgive me for saying that this is a bigger contribution than he has made or likely will make. Her example shows what a person can achieve with little more than curiosity, determination, and generosity of spirit. Screw the ancient halls of Oxford and the ivory towers of the Academy. I'd rather sit at Bri Lee's dinner parties. 

Jun 22, 2021

My 2021 effort to brighten the world

 If you walked past a child drowning in a pond, would you leap in to save them? Would it matter if it ruined your expensive clothes? Good news: you *can* save lives with a small sacrifice: donating to effective charities. Givewell is one group who finds charities with the strongest evidence base for effectiveness and the best accounting and antifraud practices. It's an incredible investment opportunity, but one where the gains are paid forward, turning your hundreds into thousands gained in productivity via healthier, more peaceful, and better educated societies.

I'm making a commitment to invest at least 5% of my pre-tax income in high-impact charities. I hope to make it eventually to 10%. I'm privileged to be able to give this much, but most of us are, and you can afford to invest 1 or 2%.

I'm going to post proof every year. This year I'm paying almost 2000 women $5 to get their kids vaccinated in an area of Northern Nigeria where jab rates are low, diseases prevalent, and evidence strong that cash incentives improve uptake. When humans wipe out polio, I've played a tiny part in that.

Does this come across a little preachy or grandiose? Possibly. Would it be more noble to do it anonymously? Maybe. But I'm convinced we need to create a public culture of philanthropy (human-loving) that encourages us all to participate.

All of this is reasoned out and evidence-backed in The Life You Can Save, a short book by our greatest living philosopher, Peter Singer. I now have a box full of copies. Comment or message if you'd like a copy, or any advice or encouragement about making the world a better place.

May 24, 2021

A fresh look at depression: Lost Connections by Johann Hari

 "You aren't a machine with broken parts. You are an animal whose needs are not being met. You need to have a community. You need to have meaningful values, not the junk values you've been pumped full of all your life, telling you happiness comes through money and buying objects. You need to have meaningful work. You need the natural world. You need to feel you are respected. You need a secure future... All these depressed and anxious people, all over the world - they are giving us a message. They are telling us something has gone wrong with the way we live. We need to stop trying to muffle or silence or pathologize that pain. Instead, we need to listen to it, and honor it. It is only when we listen to our pain that we can follow it back to its source - and only there, when we can see its true causes, can we begin to overcome it." 

This book is a magnificent call to arms to build a society that nourishes the human potential of every one of us. Hari slightly overstates the case against antidepressants and medicalized approaches to depression, but I think he is essentially right - most of our focus should be rallying around distressed people and helping them build lives of connection, purpose, security, love, and health (sleep and exercise especially). If someone you love suffers from depression, I heartily recommend this book and this prescription.

May 20, 2021

The utter failure of the war on drugs: Chasing the Scream by Johann Hari

 A thrilling and gut-wrenching history of the war on drugs. Hari shows why it failed on every level - from moral to practical, individually to societally, economically to scientifically. I've long held that prohibition is a crime of historical magnitude against the people of Latin America and deprived corners of the first world. Hari shows that the war on drugs really amounts to a war on addicts, the only real beneficiaries the narco kings, and the true cost the endless collateral chaos and murder of innocents.

Most importantly he reports the stunning evidence that addiction is overwhelmingly not a root cause but a symptom of trauma, abuse, hopelessness and loneliness, and the solution is care, connection, and support. Hari carefully documents the historical and scientific experiments and makes a careful, measured, and realistic case for a new era of sanity. If you want to build a safer, more compassionate society, and break the back of organized crime, read this book and speak your mind.

Apr 16, 2021

Confucian science fiction: The Three Body Trilogy by Liu Cixin

I just finished this stunning series, enormous in scope, powerful in imagination, and notable in bringing a Chinese voice to the forefront of science fiction for the first time. The following snippet excited me more than any fiction in decades. Mild spoilers:

An advanced alien invasion fleet approaches earth. In desperation, they shoot the brain of a single man named Yun to intercept. The hope is they will revive him, and he will negotiate or trick them to save humanity. The ship fails and flies off course. The invasion is cancelled for unrelated reasons, yet humanity finds itself in the shadow of a more terrible doom. Then it receives a message from Yun, not lost after all. He is a guest of aliens who allow him to talk once with his former lover, but he is warned against sharing any technology or strategy. So he tells her a long and intricate fairy tale from their childhood, with troubled kingdoms and strange magic. Except they didn't grow up together. Humanity begins a race against time to decipher this coded metaphorical message, hoping for a deus ex fabula.

This is but one example of Liu's talent for weaving together history and theory, the poetic and scientific. If you're anything like me, or Barack Obama, you'll be thrilled.

I will nitpick on one point. I felt the author's voice as universal, and humanist, and cosmopolitan, with one laughable exception:

"Rey Diaz was the current president of Venezuela. He carried forward the Bolivarian Revolution instigated by Hugo Chavez: In a contemporary world ruled by capitalism and market economics, he promoted in Venezuela what Chavez called Socialism of the Twenty-First Century, founded on lessons drawn from the experience of the international socialist movements of the previous century. Surprisingly, he had achieved considerable success, boosting the country’s power across the board and—for a time—turning Venezuela into a city on a hill, a symbol of equality, justice, and prosperity for the world. The other countries in South America followed suit, and socialism briefly caught fire on the continent. Rey Diaz inherited not only Chavez’s socialist ideology but his strong anti-Americanism, which reminded the United States that its Latin American backyard could become a second Soviet Union if left unchecked."

Only a Communist Party education could make a smart person write something this dumb.

Apr 15, 2021

A revolution in understanding how and why humans came to be: The Selfish Gene by Richard Dawkins

Did you know Richard Dawkins invented the concept of the Meme in 1976? He meant it as an idea that rides around in human brains, can replicate by spreading between us, and can be beneficial or detrimental to its host. It can also mutate, and those mutants could be better or worse at spreading, or better or worse at promoting the survival of its host. It therefore can evolve, and will tend to become better at spreading over time, and usually favour the survival and reproduction of the host, but not always - if it can spread across many brains by sacrificing the current host brain, it may evolve to do so. Observe ideas like technologies in the first category, and religious martyrdom or military self-sacrifice in the second.

"People don't have ideas, ideas have people" - Carl Jung

The extraordinary part is that this is only the final chapter and cherry on top of The Selfish Gene, probably the most important scientific book of the 20th century. In it he provides the definitive update to Darwin, showing that genes are the true replicators, and we are merely a confederation of them. He shows how our most complex traits and behaviours, from childrearing to warfare to the construction of societies are game-theoretical strategies pursued by our genes to maximize their individual success. Unifying genetics with evolution in this way is a similar in importance to unifying quantum mechanics with general relativity, which humanity has not yet achieved.

Dawkins is careful to note that our legacy is not our destiny. We have now achieved the intelligence to cut our own path away from the narrow survival interests of our genes or our memes. But first, we must understand what we are, how we were built, and the nature of our hidden desires. This book is a torch in the cavern of self-discovery, and it is now up to us to carry it forth.

Mar 17, 2021

The greatest risk to humankind: Superintelligence, by Nick Bostrom

Machines are getting ever-smarter at more and more tasks. Eventually they will get better than us at the task of programming smarter machines. At this moment their intelligence could explode as smarter machines make themselves smarter at increasing rates. Because they think thousands of times faster than us, within a few days they could dwarf us more than we dwarf ants.

In this shocking book, Nick Bostrom lays out a comprehensive account of the types of AI that might cause this, when, and how quickly they might take-off. He shows that there are terrible dangers inherent to AI. First is that even with a simple goal, like making as many paperclips as possible, the AI could obey by turning the whole world into paperclips, and colonizing the universe with self-replicating probes to best fulfill its mandate. It could predict human opposition and interpret that as a threat to its goal and preemptively wipe us out with nanofabricated drone fleets. If we ask it to produce 1000 paperclips, it will create a method to estimate how many it has produced. But if even a tiny uncertainty remains about whether it has reached 1000, it will keep producing ever more to increase the chance. If we ask it to produce 999-1001 it will unerringly strive to increase the chances of landing within that range, and it might turn the entire universe into a computer in an effort to best calculate that. It is actually very hard to work out a way to specify goals in programming language that avoids these problems, and even harder to program rules like "don't harm humans" or "minimize your impact on the world as much as possible" - think of the impossibility of concretely defining harm, human, and possible, or weighing up that minimization with the maximization of its primary goal.

It could be even worse than extinction. If we ask the AI to make us smile, it could pin our mouths back. If we say do so without directly interfering with our facial muscles, it could implant brain stimulators that cause contraction of those muscles indirectly. If we ask it to make us maximally happy, we have to define that mathematically. If we do so by activity in our pleasure circuitry, it could turn the universe into stimulated pleasure circuits in vats. Even if we devise a goal that seems to lack any hideous means or ends, we can't guarantee that a superintelligence wouldn't find a devious, perverse way to fulfill the goals, which it judges easier than the route we intended.

Bostrom is masterly at cataloguing many strategies to reduce this enormous existential risk. It is a foundational text of a movement to save humanity. If you care about the world as we know it, read this book and spread the word of AI safety.

Mar 3, 2021

The most important book ever: On The Origin of Species by Charles Darwin

 "Nothing in biology makes sense except in the light of evolution" - Theodosius Dobzhansky

I can't believe I let myself get to my fourth decade of life before reading this. This book is the foundation of all modern biology and all my professional knowledge as a doctor and a scientist, and it's available for free and in a readable style.

Darwin takes the limited knowledge of the 19th century and links it all together to build an unassailable conclusion. He begins by noting the powerful effects of selective breeding on crops and livestock. Humans spot small, natural differences in animals and breed them for that trait. Over the decades this creates new varieties. If small, natural differences in wild animals arise that affect their ability to survive and reproduce, nature could obviously select for new varieties too. He traces this argument through the fossil record and the tree of life. He shows how the distribution of species around the world only makes sense via a story of migration and speciation to fill ecological niches.

What's truly remarkable to me is that from these humble beginnings Darwin begins questions that biologists are still talking about today. He lays out a new view of heredity, parasitism, and insect sociology. He creates the concept of sexual selection and shows some of the strange consequences, such as the peacock's tail. He notes the similar bony structure of the wing of the bat, the fin of the whale, and the arm of the ape, building the first models of divergent evolution of homologous structures.

Always the gentlemen scientist, Darwin was modest and suitably self-skeptical. He therefore spent many years refining his theory before publishing. He notes difficulties with his theory that remained to be investigated, including gaps in the fossil record and complex structures and behaviours that are hard to break into intermediate steps. He models plausible paths for the gradual development of such irreducible structures as the wing and the eye.

“If it could be demonstrated that any complex organ existed, which could not possibly have been formed by numerous, successive, slight modifications, my theory would absolutely break down. But I can find no such case.”

Of most interest to me in my new study of the human mind, he notes that instinct and behaviour are selectable traits just as important as anatomical and physiological ones, and shows how complex behaviour such as ant enslavement and beehive construction hexagonal cells can arise gradually. I'm so grateful to Darwin for this beautiful theory, which may be the most important idea ever.

"...from so simple a beginning endless forms most beautiful and most wonderful have been, and are being, evolved"

Nov 23, 2011

Ride and Prejudice

Written as a travel missive to family and friends while en route to my first medical exchange in Oxford

Just got off my transit flight to Abu Dhabi. Saw Water for Elephants (like The Notebook but with Hans Landa the Jew Hunter from Inglourious Basterds). Also Thor, based on the premise any sufficiently advanced technology appears to be magic (thus Norse gods=aliens), and any sufficiently awesome animation appears to be a ticket seller.

My third movie deserves the dignity of a paragraph all to itself. Midnight in Paris, despite the uninspired title, was marvellously camp and clever. Imagine a Being John Malcovich-esque surrealist plot about a mild-mannered American writer in Paris who gets transported back to the roaring 20s to hang out with Hemingway, Picasso, Dali… Now imagine it with Owen Wilson in the main role and directed by Woody Allen. Fascinating without getting too snobby or complicated.

But what I really wanted to write about today was an experience I had on the plane that shook my very beliefs to the core. A true saga for a post 9/11 age. But first I will provide some context.

I have a particular affinity with the Arabic people and language. For my after school trip I spurned Europe in favor of Egypt, Jordan and Syria. In that time I picked up a few words and I’m the sort of busybody asshole that uses a tenuous connection like that to attempt to engage in conversation any and all potential Arabs I meet, in what is probably an attempt to gratify myself about how worldly I am.

My second preface is that I am a political junkie, amateur student of international issues, and broadly speaking a man of the left. So of course I scoffed with a liberal air of cultural superiority when Juan Williams admitted fear of Muslims when flying. Didn’t he know that international Islamic terrorism was almost entirely confined to a small subset of Salafis?

And so it was that I boarded my flight en route to my university medical elective. With boundless enthusiasm I prepared, packed, and departed, and I was delighted to find myself sitting next right in between three gentlemen of what I could only assume to be of the Muslim faith on account of their impressive beards. When one stood up to allow me access to his chair, I smiled and thanked him in Arabic. Impressed, we struck up a conversation which fortuitously turned to why I was travelling, thus allowing me another opportunity to show off by boasting about the prestigious professor with which I was placed on elective. We chatted about the weather. I was introduced to young Abu on my right, Mohammed on my left, and an older gentleman over from Mohammed who mumbled and whose name was thus lost under the hum of the turbines.

We drifted back and forth into lightly stimulating chit-chat, Mohammed especially being friendly and educated. All three were naturalized Australian with accents to match, Mohammed originating from Algeria, Abu from Ethiopia. Since they didn’t appear to be family, I asked how they knew each other. Mosque they said. How nice that they were all travelling together. Yes. At this point Abu excused himself for the bathroom.

Over time I could not help but notice how long Abu had taken. Fair enough. A man mustn’t rush himself, and it is especially important while traveling to take one’s time to feel refreshed. On his return he pulled out a copy of the Koran and the three discussed briefly how frequently and where they would pray on the flight.

Now at this point a less tolerant man than I would have perhaps felt a little nervous. A paranoid interpretation might be that these gentlemen were home grown terrorists of the like so common amongst disenfranchised young men in the West. Perhaps they hatched a plan at their local mosque and Abu was mixing liquid explosives in the toilet, which besides from my imminent death, would mean the bastard was complicit in the great toothpaste plane ban. Maybe they were concerned with getting their final prayers right because they would be their last.

But I was not a less tolerant man. My friends will know a penchant I have for overthinking things, and have a tendency to run a little paranoid while tired, drunk or otherwise incapacitated. So while the thoughts above did occur to me, I successfully chastised myself for being silly.

But the gods of air travel sought fit to test me this day. Soon enough, Mohammed went to the bathroom. And stayed. When he finally returned, Abu got up and returned to the bathroom. I remembered a CNN animation made in the wake of the original foiled liquid bomb plot. The plan was to set up a chemistry set in the bathroom and send people up to it one at a time to bring ingredients. This played through my mind when I saw Abu loading up his bum bag with things from his carry on bags and take it to the bathroom AGAIN. When he returned, again after a time, he seemed to swap with Mohammed. In fact it was probably more than half the flight that either Abu or Mohammed was out of his seat. After one return, Abu asked if he could swap seats with me so he could talk to Mohammed before the latter disembarked at Singapore. Ice shot through me as I realised that Mohammed said earlier he was the trip “organiser”. Did that mean he was the organisational mastermind? Was he getting off early so he could avoid martyrdom to help “organise” again? It’s worth noting that at this point I was severely lacking sleep from a misguided attempt to stay awake to fight jetlag.

The sensible lefty in me kept telling me to remain calm. But the evidence was stacking up. Even the older gent was taking turns in the bathroom, and he looked nervous. In an attempt to relax myself (and convince Abu of the goodness of humanity if my suspicions were true) I started talking to Abu about his life. Guess what he studied. Just guess. Think of the field most likely pursued by a budding terrorist.

Dude was studying aviation mechanics. With a dry throat, I queried what the deal was with the window covers and why we had to close them on take off and landing. He replied that it was to do with passenger orientation.

“Passenger orientation?” I gulped out, “Why do passengers need to be orientated?”

“Because in the event of a crash, they will be able to see outside better and know how to escape” Then he looked into my eyes with a stare that chilled my soul, before he chuckled quietly, “Like that’ll help”

At this point I excused to the bathroom myself, sobbing quietly. Abu was in one of the stalls. I decided I should hide around the corner so I can use his stall and search it for incriminating evidence. I would save this plane myself if I had to. When he finally got out I crept in and pored over every square inch of this stall looking for god knows what chemical stain or something. Nothing. I calmed myself down, brushed my teeth and freshened up.

What is the moral of this story? Needless to say, I was not murdered by Mohammed and Abu. Also obviously, they were just normal guys. It started to make sense later when Mohammed said they were going on Haaj (pilgrimage to Mecca) together. Abu was just young hopeful student (probably going to suffer in his field because of discrimination the likes of which I had just perpetrated). That also explained the prayer. Apparently the bathroom visits were to keep clean for the purposes of ritual purity.

I was driven to an act I’m not proud of. Searching the bathroom had no negative consequences for them, but what if I had the ability to inflict more damage with my prejudices? Like, say, declaring a war on the basis of little evidence as estimated by major national intelligence agencies? We’re all open to bigotry, no matter how open minded we think ourselves. And we’re all a little bit silly when sleep deprived.

True story.*

*May be slightly embellished. Names changed for the sake of poor Abu, who had a distinctive one. Didn’t really need to change Mohammed’s name.

Oct 27, 2011


As a first year medical student who spends lots of time in neurosurgical operating theatres, I’ve become very good at standing around. I don’t even mean that in a self-deprecating way, because standing around can be a complicated business. To understand the hostile standing environment that is the operating theatre, one must first understand the species present in this surgery safari.

The most dangerous species in the OT is the scout nurse. The scout nurse is responsible for the sterile area containing the instrument trolleys. These she guards like a lioness her cubs. Woe betide the unfortunate medical student who leans over a trolley, they will receive a snarl or mauling at the hands of the scout nurse.  The scout nurse has a less aggressive variety in the scrub nurse, who is too busy handing weird and wonderful instruments from the sterile area to the surgeon to have the time to protect her den.

The surgeon is a more complicated beast, sometimes grumpy and controlling of his theatre space, sometimes willing to dispense pearls of wisdom and opportunities to participate. It can also be disconcerting when a neurosurgeon wants to discuss the rugby world cup or the Tory policy on gay marriage while his instruments are deep inside some poor sod’s brain.

The most benign beast in the theatre is the anaesthetist. Anaesthetists are responsible for keeping the patient unconscious or otherwise unobjectionable and monitoring the patients vital signs. As such, anaesthetics as a profession resembles that old proverb on war, that it is long periods of boredom punctuated by brief moments of sheer terror. Fortunately the inactive times allow the enterprising medical student to pick their brains, which is usually a goldmine operation because of their excellent knowledge of physiology, pharmacology, and nearly every type of surgery you can imagine.

Cognisant of the many and varied surgery species and their behaviour, standing strategy must address the competing goals of:

a)      not pissing anyone off 
b)      getting a good view of the surgery
c)      conversing with various staff who can clarify different aspects of the procedure
d)      occasionally winning a minor participating role

Combining these is obviously difficult. Immediately after entering the room the med student must have assessed the lay of the land and selected multiple potential standing positions. They must be far enough from sterile areas and the operating table to guarantee a, while close enough and on the correct angles to achieve b.  Next to the anaesthetics equipment and seating (yes, they sit, often reading the paper) will always be useful territory for fulfilling c, but not always b and d. Securing d) is the most difficult and capricious task, by standing behind the surgeon you may sometimes be tasked with moving the gigantic telescopic light apparatus, but more exciting opportunities are rarer and must be seized by the brave student.

All this is complicated by the ever-changing arrangement of the landscape and constant transit through the theatre. The patient must be moved in and out (duh), nurses rearrange with perfect choreography, and occasionally the mammoth surgical microscope is swung into action like a narcoleptic transformer. A previously optimal standing position can be rendered uninhabitable and the med student must scurry.

I feel I can say I have become somewhat a master at this surgery squaredance. I say this without pride, as it would be far more impressive if I was actually doing something. I’m also sure this applies to many fields other than medicine, and I look forward to my law student friends regaling me with the difficulties of standing around barristers. I think Newton was close, but not quite, when he reiterated his standing on the shoulders of giants as the source of his incredible scientific vision. To truly excel one must stand over the shoulders of giants. But one must also watch out for their elbows.

NB: I just realised I’ve used very much non-gender-inclusive language in this essay. I won’t amend but instead note that women do comprise at least 90% of nurses and men do comprise about 90% of surgeons. The former will change slowly with cultural shift. The latter is more of a puzzle. While around 55% of med students are female (in Aus), they tend not to filter through to the surgical specialties, as it is a herculean task to simultaneously train for surgery and raise children. While I don’t believe that raising children is compulsory for women, the fact remains that most want to. Those who do manage the juggle are invariably very impressive individuals, and I had the good fortune to observe a female neurosurgeon yesterday operate on a tumour, steel-nerved, for 10 hours straight. 

Oct 18, 2010

Cyber Warfare Has Arrived

First published at, in my capacity as a budding politics nerd, avid West Wing fan, and Vice President of the local chapter of the United Nations Youth Association

In 1981, CIA director William J. Casey was informed of Soviet plans to steal Canadian industrial software to automate gas pipelines. In response, the CIA hatched a bold plan to create a software “Trojan Horse” which would hijack pumps and valves to create a catastrophic build-up in pressure. One year later, US satellites detected the largest non-nuclear blast in history from a gas pipeline in Siberia. Thus cyber warfare was born.

Twenty-five years later, with the rise of the internet, governments are increasingly paranoid about the potential for catastrophic cyber attacks. Doomsday scenarios envisage failing electrical grids, compromised air traffic control, industrial disaster, and communications collapse all culminating in chaotic societal breakdown. The USA has established a Cyber Command, and the UK, France, Israel, China, Russia, and even North Korea have their own plans for cyber supremacy. Security wonks talk breathlessly about the “fifth domain” of warfare after land, sea, air, and space.

But to the average Joe, this all sounds vaguely comical. Even the word “cyber”, with all its 80s hacker movie connotations, is a little hard to take seriously. Cyber attacks over the last ten years have barely been newsworthy. There were rumours of cyber attacks from both sides in the 2006 Israel-Lebanon war. China has been caught with its hand in the cookie jar, once by McAfee in 2007, and twice by Google in 2009, stealing data from other nations and critics of the Communist party. The US has been the target of large data thefts by unknown powers, one downloading terabytes of data from Defence, State, and Energy Departments in 2007, the other a worm spread through Pentagon computers by flash drive in 2008. But none of these could be described as “war”. If anything, it was a natural extension of the communications espionage that has existed for decades. These “attacks” have not made physical damage, and no one knew whether it was possible.

Then, in June 2010, a small Belarusian cyber security firm identified an unusual bug. Named Stuxnet after a filename in the code, it was unusually sophisticated, and appeared to target industrial software, unlike standard PC worms. Soon after, the engineering giant Siemens realised that their Supervisory Control and Data Acquisition (SCADA) software that runs on industrial Windows systems, WinCC, was Stuxnet’s target.

Industrial systems are not normally connected to the internet to avoid attacks, but Stuxnet exploited several novel security flaws to run off USB drives. Known as zero-day vulnerabilities, these loopholes are usually identified by hackers and sold for a prize sum. Stuxnet exploited an unprecedented four such holes. Investigators from Symantec described it as “groundbreaking”, and sophisticated enough that only a nation-state could plausibly have organised and funded the effort.

What was its purpose? Originally assumed to be for opportunistic espionage, researchers eventually realised that Stuxnet wasn’t stealing data. It was programmed to lay in wait, keep a low profile, and spread until it reached a very specific target. It then takes control of the system and overrides certain files, perhaps to similar destructive effect as the CIA engineered nearly three decades ago. Thus Stuxnet has been described as a “cyber missile”.

Who would launch an attack like this, and what were they trying to achieve? The answer became clear when Symantec surveyed systems affected worldwide. The results showed 60 per cent of infected computers were in Iran. Speculation mounted that Stuxnet was the cause of ongoing, unexplained problems in the Bushehr nuclear reactor or a nuclear accident reported at the Natanz enrichment facility in 2009. The obvious candidate for such an attack is Israel, who has been loudly complaining about Iran’s nuclear program for years, and has a history of using force to prevent rivals from building nuclear facilities. In 1981 they bombed the Iraqi Osirak reactor and ended Saddam’s nuclear ambitions.

While definitive proof is still lacking, researchers have since found a tantalising piece of evidence. A line of code was found to contain the word myrtus, the Latin name for the myrtle tree. The Hebrew word for myrtus is Hassadah, also the name of a biblical Jewish queen who pre-emptively struck against the enemies of the people of Israel. Investigators have pointed the finger at Israel’s cyber division Unit 8200, infamous for press-ganging convicted hackers to work in their headquarters deep in the Negev desert.

We may never know what Stuxnet’s target truly was, or the intended effects. The stealth and the sophistication of the beast mean it has probably already hit the target. Researchers estimate it has been in “the wild” for up to a year undetected.

The implications are vast. A virus that can move under the radar for so long, achieve such wide coverage, and seize control of any system is the realisation of our cyber security nightmares. Many questions remain about the first real cyber attack. All we know for certain is that it will not be the last.