Truth or Dare

Truth or Dare

Written by Adrian Wu

Hi readers, Frank has kindly asked me if I would like to write more articles for Copper. This is a real honor, as most of the contributors are veterans in the audio and music industries. However, I think I might have some value to add to the magazine, as a passionate amateur with a scientific background.

Some of you might have read my first three articles in Issues 120, 121 and 122, which laid out my journey as an audio fanatic (I prefer this term to plain-vanilla “audiophile”). People become interested in audio for all sorts of reasons. They could be music lovers, tinkerers, experimenters or in it for purely business reasons. Everyone has their own biases and beliefs based on their own understanding of what good sound means.

We all believe certain things to be true for a variety of reasons. It could be because of conventional wisdom. It could be because someone more authoritative than ourselves has said so. It could be because of what we deduce from knowledge we already possess. It could also stem from actual personal experience through experimentation. In this day and age, when information is so easy to come by but truth is as elusive as ever, how do we know what is the truth ? As an outsider looking in, I might even have an edge over the professionals, as I don’t have any skin in the game and I can look at everything with an open mind and a fresh perspective.

I would therefore like to address some of the controversial issues in our hobby, and I can already name a few off the top of my head; measurements vs. sound quality, high-end cables, digital vs. analogue, tube vs. solid state, boutique electronic components, etc. I might not know the truth any more than the next person, but the idea is to stimulate discussion and hopefully open some minds in the process.

Before I start addressing these issues, I thought I would go into a little more detail about my professional background. I studied math, physics and chemistry up to A-levels, which is the equivalent of grade 13 in the US, with an original plan of taking up physics or engineering at university. There was a change of plan halfway, and I went to medical school instead, which was possible to do straight from high school in the UK. I took a year out during med school to do laboratory research. After graduation, I did my basic physician training in the UK, and then went to La Jolla, California for further training in clinical medicine and immunology research.

My first mentor was a basic scientist, and after two years, I switched to a lab doing translational research. This means trying to turn the fruits of basic research into something that is clinically applicable. I then returned to Hong Kong and joined the staff of the University of Hong Kong as a faculty member, continuing with teaching, clinical work and translational research. I left academia in 2003 after the SARS epidemic to concentrate on clinical work, and also took up clinical research. Therefore, I have experience in research from the laboratory to the bedside. This is relevant to audio, since engineers are also doing translational research, trying to translate the latest developments in design, materials and component technology into better products.

Audiophiles are like patients; we often operate on trust. There is an information asymmetry between the designer/manufacturer and the customer (unless the customer is also a professional), much like that which exists between a doctor and a patient. Although I try to explain to my patients why they should take a certain medication or undergo a certain treatment, most of the time the patients don’t have enough information or understanding to refute my recommendations. As an audiophile, my situation is reversed. I don’t know nearly enough to determine if the technology used in the latest DAC or cable darling is really as good as they claim and worth the money. And there are many situations where the truth is not always obvious for a variety of reasons. In healthcare, there are as many snake oil salesmen as in any other business. Students take the Hippocratic Oath, to always act in the best interest of patients, before they can become doctors. This is not the case for anyone else involved in healthcare business and it is important to bear that in mind. Some charlatans take advantage of desperate people with problems modern medicine has no answer for. Others exploit the knowledge asymmetry and cloak their fraudulent claims in pseudoscientific terms. It is often difficult to separate the wheat from the chaff. Sometimes, genuine mistakes are made due to ignorance or hubris. Do such things happen in audio?

The professor of biochemistry who taught me was credited for discovering the link between cholesterol and coronary heart disease. The entrance of the biochemistry building had a giant cholesterol molecule engraved into the stone flooring. Ironically, he dropped dead suddenly of a heart attack, which was not all that uncommon in Scotland, in that same building where he made the discovery.

Following his discovery, a prominent group of US nutritional scientists published results from population studies that pointed to high-fat diets as the culprit for cardiovascular disease. Results of studies from a rival group of scientists in the UK, pointing to refined carbohydrates as the more important contributor, were largely ignored by the scientific community. The same US scientists sat on the advisory board of the US Surgeon General and published dietary guidelines recommending a low-fat diet for everyone. Fat in packaged foods was therefore substituted with carbohydrates. Low-fat products and animal fat substitutes (such as margarine) became all the rage.

During the period from the mid-1970s to the mid-2000s, the average daily intake of fat calories per person in the US dropped by 30 percent, and was more than made up for by carbohydrate calories, while the incidence of ischemic heart disease, stroke, diabetes and obesity skyrocketed. Nobody questioned the veracity of the belief that high-fat diets caused cardiovascular disease until the last decade, when evidence showing that these scientists were in fact financially supported by the snack food and beverage industries came to light.  This obvious conflict of interest was never declared during their lifetimes, and when someone went back to examine the raw data of their studies, a major scientific fraud was uncovered. Later generations of scientists raised on this belief never questioned it even in the face of glaring inconsistencies, because everybody thought the facts were cast in stone. You can read about it in the book The Case Against Sugar by Gary Taubes.

Laboratory analysis diagnostics. Courtesy of Pixabay/Michal Jarmoluk.

In 1914, a Hungarian scientist named Robert Bárány was awarded the Nobel Prize for his discovery of the vestibular system in the ear. He determined that the three semi-circular canals in the inner ear, arranged at right angle to each other, were key to the brain perceiving the position of the head. He demonstrated that by injecting water of different temperatures in the ear, the subject’s eyes would rotate as if he was being spun round and round, the direction of the rotation depending on whether the water was hot or cold. He reasoned that the water heated up or cooled down the fluid in the canals, causing a convection current and fooling the brain into thinking that the head was moving. This is known as the caloric test. He was using basic physics knowledge to explain an observed phenomenon. This experiment was repeated by astronauts in space decades later. The purpose was to prove Bárány’s explanation, since without gravity, there would be no convection. However, the result was the same, proving that convection had nothing to do with the phenomenon. This shows why we should be cautious when making assumptions by deduction from basic principles. This is the reason why we need controlled experiments.

My own field of allergy and immunology has not been immune (pun intended) to controversy either. Peanut allergy was once upon a time a rare disease, but when people started noticing an increase in the incidence during the 1980s, there were demands from worried parents that something must be done. Doctors often feel compelled to give an answer when asked a question, and that the answer should never be “I don’t know.” Even though there was a knowledge gap, they decided to poll all the experts to come up with an answer, in what is known as a consensus opinion.

Since peanut allergy is an acquired immune response, which requires prior exposure, they concluded that not exposing young children to peanuts should be the way to go. Therefore, the American Academy of Pediatrics and the American Academy of Allergy and Immunology issued guidelines recommending parents not to feed their children peanuts and tree nuts until at least the age of five years. Their counterparts in other Western countries followed suit. Over the next 25 years, the prevalence of peanut allergy more than tripled in these countries.

Peanuts are a common food for infants in Israel, and parents feed their babies with a popular snack called Bamba during weaning. The medical establishment there never followed their American colleagues’ advice. The prevalence of peanut allergy in Israel remained very low, at less than one-tenth of that of the Western countries, throughout this period. When an Israeli scientist went to work in London, he was fascinated by this difference and convinced his boss, Prof. Gideon Lack, to investigate. Prof. Lack recruited a large number of pregnant women willing to feed their new babies peanut-based foods. After two years, almost none of these babies developed peanut allergy.

It turned out that the babies in the Western countries were indeed becoming allergic due to exposure, only not to ingested peanuts but to peanut allergens in house dust. Eating peanut-containing foods could have mitigated the problem, which makes sense, because our body normally tolerates any food that is ingested. Deprived of ingested peanuts, however, the immune system’s only exposure to peanut came from the remnants left behind in household dust (mixed in with other undesirable things such as fungus and bacteria), and therefore the immune system considered peanut as harmful and therefore should not be eaten. As a result, an immune response was generated for the purpose of discouraging the individuals from eating peanuts.

The whole debacle arose due to groupthink. Each expert felt that his or her opinion was validated when other experts agreed with it. They no longer felt the need to look more deeply into the issue, when they could have easily devised an experiment to test their hypothesis before making any recommendation.

When I was a medical student, stomach and duodenal ulcers were commonly treated with surgery.  They found that after removing the part of the stomach that produces acid, the ulcers would heal.  Therefore, the conclusion was that peptic ulcer disease was caused by overproduction of acid.  These partial gastrectomy surgeries led to horrendous problems for the patients. The cure was truly worse than the disease. They then developed a technique to only cut the nerve that stimulates acid secretion.

Sir James Black, a Scottish physician scientist, worked out the mechanism for gastric acid production, and invented a drug to block the process. He received a Nobel Prize in 1988 (he also invented the first beta-blocker) and his drug, cimetidine, and then ranitidine from a rival company, became the first and second billion-dollar a year drugs, respectively. These drugs propelled the two companies into the ranks of the most valuable enterprises in the world. Patients needed to take these drugs for a long time, sometimes for life, providing a cash cow for the companies.

At about the same time, two young Australian researchers called Barry Marshall and Robin Warren identified a hitherto unknown bacteria in the stomach of ulcer patients. They called it Campylobacter pylori, which has since been renamed Helicobacter pylori. Marshall infected himself with the bacteria and confirmed that it causes gastric inflammation. When Marshall and Warren published their findings, they were not prepared for the animosity that was about to be unleashed upon them. Senior opinion leaders of the field poured scorn on their hypothesis. They were either ignored or ridiculed at scientific meetings. Their funding dried up. Whether it was because these experts wanted to salvage a theory they had staked their entire careers on, or that they were acting on behalf of the drug companies, we will never know. Marshall persevered in his quest, with an unwavering belief that he was right. He finally found a cocktail of drugs that would eliminate the infection, and when this was shown to cure the ulcers, the medical community could no longer ignore his hypothesis. Now, patients can take antibiotics to cure their ulcers, and no longer need a lifetime of acid-suppressing medications. In retrospect, the acid theory was always suspect, since the stomachs of most ulcer patients produce no more acid than healthy stomachs. The Helicobacter damages the protective layer of the stomach lining, thus allowing the acid to penetrate and cause ulcers.

The above examples show why we should always view everything with a healthy dose of skepticism, especially when it comes to opinions from experts. Often times, there are ulterior motives in any opinion or recommendation, especially when it is freely given. Next time, we will examine some of these issues as pertaining to our hobby.

Header image courtesy of Pixabay/Ernesto Eslava.

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