2016 Think Tank Dinner Keynote: You are all at risk

July 21, 2016

This speech was delivered by Dr David Caldicott, an Emergency Consultant at the Australian National University. He presented it to a group of early- and mid-career researchers as part of the 2016 Theo Muphy Think Tank—‘An interdisciplinary approach to living in a risky world’

You are all at risk…

Mr President, distinguished guests and speakers, ladies & gentlemen—Welcome to Canberra!

I would like to start by acknowledging the traditional custodians of the land on which we meet. Canberra is named after an old Ngunnawal word for a ‘meeting place’. This museum stands on the very site that the Ngunnawal and the Ngambri people would gather for the annual feed of ‘goree’, or the Bogong moth. And here we all are, meeting, and feeding, and about to have a yarn….

I can’t begin to tell you how exciting it is to be in a room with so many ‘risky’ experts! The fact that I’ve lasted this long into a fantastic meal is actually a bit of a surprise to me—by this stage, I had anticipated at least one spontaneous combustion, and you’ll excuse me if I keep nervously glancing around for snipers’ laser sights trained on anyone in the audience. Because let’s be honest—it’s that sort of gig. I don’t know if any of you saw Secret City, a tremendous Australian-made Canberra-based television thriller—I did, and I LOVED it. If you haven’t watched it, do. Those of you who have seen it will understand that it’ll be big a credit to the Academy if you all get home alive tonight.

In truth, I’m equally apprehensive and honored to have been asked by as prestigious an entity as the Academy of Science to address an assembled company of folk as clever as yourselves. I was having a look at the program when it first came out, and frankly, I would much prefer to be a delegate in your shoes than up here, being scrutinised by your collective and enormously well-endowed hive-mind.

That we appear to be living in risky times is not really a matter for debate, but between you and me, 2016 is turning out to be a bit of a shocker. There was the opportunity doing the rounds on social media recently to sum up the year to date in 3 words, and my contribution was simply ‘control alt delete’. So many of the problems that we are faced with, as a species, have been deftly distilled into the topics identified for your perusal over the next few days, and I would congratulate the organisers for composing such a haiku of catastrophe-in-waiting. As an Irishman living in Canberra, with a deep and child-like fascination for (some would say understanding of) the human state, perhaps you’ll indulge me a few observations on these topics, as you make room for your desserts. Common etiquette suggests that I shouldn’t mention sex, politics, religion or money, but I’m pretty uncommon, and so I’m not making any promises.

‘International security’ has become almost the oxymoron that that we used to attribute to ‘military intelligence’, especially after the Gulf War. There are huge global opportunities for trade in a global economy, but it would be stunningly naïve of us to assume, or indeed accept the dominant political narrative, that those opportunities come risk-free. Depending upon whom you ask, the Trans Pacific Partnership will herald in a new era of unrivalled prosperity (particularly for shareholders), or result in vital medications becoming unavailable because of an American-style patent frenzy. There’s no doubt that a global economy has contributed substantially to the expansion of my own little hobbies, namely the illicit drug trade and transnationally-funded terrorism.

I notice that some of you have been discussing ‘Risk entanglement’ in the context of our regional neighbours. I see the modern synergies of risk as being inevitable, even here in Australia. Like its unique native fauna, Australia’s future ‘entangled risks’ appear to be inextricably tied up with its longstanding geographical, and perhaps growing social, isolation.

It’s probably fair to say that the credibility of those providing political leadership, not just in Australia, but also from overseas, has taken a major hit this year, and we’re long overdue for a makeover. 20th century politicians don’t appear to be governing for a 21st century electorate. You’ve been discussing whether or not we need international organisations—I’d be very interested in hearing more about your conclusions. This is particularly in the context of Australia’s reputation of not paying a great deal of attention to these organisations when it’s Australia’s behavior being criticised. It seems like a somewhat diplomatically conflicted position to defend, when Australia rightly condemns international human rights atrocities, or modern day land-grabs overseas, to only become hostile when our own treatment of refugees comes under international scrutiny.

It was a pleasure to see an environmental theme on your agenda, not one that has traditionally featured at the forefront of Australian political interests, despite the clear public mandate. I note that despite the scepticism of our new Minister of Resources regarding anthropogenic CO2 emissions, and his clear enthusiasm for coal, this is likely to be a local issue of tremendous import for all Australians before the end of this century.

Very close to home for me is the issue of antimicrobial resistance. Not a lot of people know this, but once upon a time, I was training to be a microbiologist. This issue truly is a crisis—happening right now. I see people dying of sepsis every week. I have read many accounts of an era before Alexander Fleming’s discovery of penicillin (and its subsequent theft for Australia by Howard Florey) and believe me when I tell you, the emergence of a pandemic of antibiotic resistant bacteria over the next 2 decades will make the election of Donald Trump look like a passing inconvenience. I actually find the estimate of 10 million dead by 2050 surprisingly conservative. Like global warming, this is a crisis of our own creation—but those who broke it have neither the wit, nor the inclination to fix it. It’s your generation that is being asked the impossible.

Finally, the issue of risk calculation itself, something that I find equally fascinating and elusive, particularly in the context of the multiple unknown unknowns that fill my academic life. Perhaps more of a tool than a topic, it is a field that will become as important in the next 50 years as molecular biology has been in the last 50. As someone who is biologically innumerate, I am in awe of those who can accurately predict and anticipate the probability of high risk scenarios. Socially, I circle you folk like primitive man, circling fire for the first time, not quite sure what you are, but pretty convinced of your utility.

For those of you who have not had the pleasure of interdisciplinary work in the way that that these 3 days have been set out for you, I am jealous. I’m am not so old that I don’t remember my first time…. Working with those cleverer than myself, but from other disciplines, is one of the greatest intellectual pleasures in my simple life. As a simple emergency physician—let’s be honest with each other here, its one step above a veterinarian—I am invariably collaborating with someone cleverer than me. The benefits of this sort of cross-pollination have been known since the Renaissance, and beautifully articulated by Frans Johannson in his book, The Medici Effect.

What do these thorny issues have in common? They are ‘Wicked Problems’, a term which I hope you will come to relish. Wicked Problems are organic problems, problems that move when you poke them. Wicked problems are almost the opposite of calculus, with too many variables. Wicked problems are the problems that are left, because they have been too difficult to solve; the problems that no one discipline can address on their own. And as such, they are the best problems, worthy of high-flying minds.

To reiterate, the invitation to speak at such an august gathering left me not only a little intimidated, but also a little bit bemused. I’m told that I’ve been asked to have a bit of a yarn on the subject of ‘risk’ because my own interests, so I suppose I’d better start by telling you a little bit about what I do … You can be the judge of whether what I do is risky or not.

Day to day, I’m a simple emergency doctor, which I suppose, in and of itself, can be a fairly risky business. To start with, we are exposed to several of the risks that your think tank has been addressing. The most obvious and immediate are the issues of antibiotic resistance, but any one of them could be massaged into my line of work, especially for those of us with an interest in working outside the ‘cotton soft confines’ of the emergency department.

There are numerous types of risk available for a standard model, 5 litre emergency physician. The conditions that we treat are often very risky indeed for the patients we treat—they can be risky for the patient’s life, or risky for their livelihood. Similarly, the emergency department can pose risks to those who work there. Professionally, the fact that there are such risks imposes litigation risks upon us. Canberrans especially have expectations of emergency medicine that wildly exceed its capabilities. Our levels of risk are also augmented by the many junior padawans we have under our tutelage, which, like mutated softshell Daleks, feel the need to keep us on our toes by attempting to exterminate everything within their enthusiastic reach, often in the most dramatic of ways. For my sins, which at some stage must have been biblical in scope, my responsibilities include being the Supervisor of our Junior Medical Officers.

These are the issues of risk, as they pertain to my day job, a job that I love. I wouldn’t say that as a species, all emergency doctors are adrenaline junkies—in fact, far from it. Most ED docs are risk averse, at least to the extent that they can reduce avoidable risk. But neither are there that many who are anaphylactically allergic to risk—they wouldn’t last long in our Great Game!

 I am doubly lucky that I am also able to pursue my research interests, which I’m also told some find ‘risky’. I’m again puzzled by that, because I don’t regard what I do for work or for fun as being particularly ‘risky’.

It would be fair to describe the nature of the problems that interest me most as also being ‘wicked problems’. My ‘hobbies’, as my wife calls them, as they are largely unpaid, are ‘drugs policy’ and ‘the medical response to terrorism’. Given that I am currently neither an illicit drug user nor a terrorist, the subjects themselves are not likely to be a source of immediate physical risk. The company that I occasionally keep, however… maybe a little riskier? However, because of the loaded politics associated with my chosen subjects, I think that some folk regard holding an informed and public position on these topics, particularly if it flies in the face of any political consensus, as being a very risky proposition indeed.

My positions on my hobbies are a matter of public record, but I wouldn’t presume that my little areas of interest would have crossed your desks, so I’ll briefly reiterate them.

In the area of drugs policy, I contend that Prohibition has been one of the greatest medical failures of our time, responsible for far more harm than the very drugs against which it was designed to protect us. In the next decade, growing numbers of countries will continue to decriminalise illicit drug use. I believe that we are on the cusp of an extraordinarily fecund period of research into the human brain, and indeed the very elements of human consciousness, as we rehabilitate some of the many drugs that we have been unable to research to date, because of outdated moral and puritanical positions. It remains to be seen how quickly Australia will accept that the world has chosen another path—while we hear much about intellectual agility, I fear that the realpolitik of such a tightly balanced parliament will not allow for much imaginative leeway.

In this realm my research has involved designing systems to identify dangerous drugs at the point of consumption at music festivals, while using that ‘live’ data as point of persuasion to dissuade young consumers. I have been fortunate enough to be involved in both science and the politics of medical cannabis over the last 2 years, which is about to change the face of prescribing in Australia—from this year. We have still only scratched the surface of the endocannabinoid system, with so much more to learn.

I am firmly opposed to drug policy that is dangerous, unfounded, or stupid, or as is so often the case in Australia, a delicious cocktail of all 3. One of the great debts of gratitude that I owe Australia is the lifetime of anecdotes she has provided me with which to regale my overseas collaborators. One of my favourites was the cunning, almost Baldrick-like plan, back in 2007, to ban all Australian plants containing dimethyl-tryptamine, a fairly potent psychohallucinogen. It seems that within the corridors of power, not having consulted with anyone who actually knew anything, Australia came within a hairs breadth of introducing legislation to ban your national floral emblem, the wattle. Seriously—you can’t make this stuff up!

While my position on illicit drugs might be considered by some as being loud and strident, the nature of our work in the field of medical responses to terrorism has been appropriately subdued. I still seem to have been able to raise antibodies. I grew up in a country affected by terrorism, and learned my craft in London, or as my mum refers to it, “the belly of the beast”. I came to Australia in ’99, when it was still a delightful vegetarian marsupial of a country, floating in the ether, without a terrorist carnivore to be seen from either horizon. After 9/11, our group became quickly very concerned about the widely expressed belief and assumption that Australia was not in the line of fire, as this position was definitely getting in the way of appropriate medical preparation. I remember clearly watching Australians watch the horrifying images being broadcast, and thinking to myself “I am witnessing the end of an innocence”. We had the temerity to write several international articles to that effect, and create the “Bombs Blasts & Bullets” course. This course, written at no cost to the taxpayer, only served of course as an adjunct to the invaluable little fridge magnets that were distributed at the time, exhorting us to be ‘alert but not alarmed’. Someone, somewhere, in the absence of any evidence, must have thought that these magnets would be reassuring—I could not tell you what could have been done with that money had it been spent on something useful—because then I’d have to kill you.

So the risks that I may or may not have taken, have largely been in taking on the role of Cassandra, suggesting things that seem obvious scientifically, but which are politically unpalatable. The facts have always been clear. The opposition has mostly been in the form of a tantrum at being contradicted.

I would posit that the reason that many within medicine regard the field of emergency medicine as ‘risky’ is because of the perception of uncertainty. There is very little certain in my working day. But I embrace that—what is certain is that there will always be a need for doctors who enjoy uncertainty.

The issue of risk and uncertainty is one that has wider ramifications for scientists. Your great game has changed, in the latter half of the last century. There are conflicting forces facing every player. On the side of the Jedi, is the pure desire to answer great important questions, for the purposes of merely knowing. On the side of the Sith, is the call to win grant money by any means necessary, publish anything as many times as possible and wherever the written word exists, and to succeed at engaging with the public. These selection pressures mean that science and scientists become risk-averse, choosing the safe over the bold.

Funding is always an entertaining topic for scientists. There is a growing expectation, which we’ve seen recently in Australia, for ‘innovation’. When someone says ‘innovation’ in the context of scientific research, I rather zone out. Because what I am usually hearing is “blah blah blah ‘commercialisation’ blah blah blah”. Truly innovative research takes time, and is rarely highly cited early on. Commercial applications can take up to 20 years to perfect, like the LED lightbulb. Scientists are being forced to compete, like rats in a barrel, for a diminishing pot of gold. Where government funds dry up, independence can be further compromised as we are forced to take industry coin. The incentives to keep science ‘open’ are increasingly occult.

Science can be a job, or it can be a vocation. I’ve been fortunate enough to work with a bunch of great scientists in the course of my research, and to my recollection, not one of them sees their work as a ‘job’. If I were to choose a word to describe the majority of them, it would be ‘audacious’. You are all here because you are bright enough to be successful in your chosen field. What will determine whether or not you will be ‘great’ will be how bold you can be in the pursuit of what gets your juices going.

One of my heroes in science was the French biologist, Francois Jacob, who in 1965, won the Nobel Prize in Medicine with Jacques Monod for his discovery that the levels of enzymes in any cell were controlled at the level of gene transcription. He, and another Nobel Prize winner, Peter Medawar, in his ‘Advice to a Young Scientist’ inspire me not only with the calibre of their science, but their generosity of spirit, their breadth of interests, their ability to communicate and their capacity for advocacy.   

Jacob thought about science, and the duality of science, deeply. Here’s what he had to say about the latter:

…when you look more closely at “what scientists do,” you might be surprised to find that research actually comprises both the so-called day science and night science.

Day science calls into play arguments that mesh like gears, results that have the force of certainty. Its formal arrangement is as admirable as that of a painting by da Vinci or a Bach fugue. You can walk about in it as in a French garden. Conscious of its progress, proud of its past, sure of its future, day science advances in light and glory.

By contrast, night science wanders blind. It hesitates, stumbles, recoils, sweats, wakes with a start. Doubting everything, it is forever trying to find itself, question itself, pull itself back together. Night science is a sort of workshop of the possible where what will become the building material of science is worked out. Where hypotheses remain in the form of vague presentiments and woolly impressions. Where phenomena are still no more than solitary events with no link between them. Where the design of experiments has barely taken shape.

So for you ladies and gentlemen, I wish you all the bright sunlight of success; the biggest grants, hundreds of publications (all original and genuine, and not derivative or salami’d up), public recognition in the streets, without the media celebrity. But I also wish for you the night—that Garden of Gethsemane that tests us before the dawn.

Because in those testing times, it is that ordeal that will forge the steel that you will need to deserve to stand on the shoulders of the giants that have preceded us. From Galileo to Vesalius, Lavoisier to Wirchow, through Einstein, to Turing, scientists have been persecuted for standing and up and representing not only for their own field, but the fields of others, and indeed the broader truth at large. When we lived in an era when policy was determined by scientific fact, it was perhaps appropriate to avoid the hurley-burley of political discourse. That era is dead. The rules have changed. To those of you who still believe that there is no place for advocacy in science, I express my deepest gratitude for the services that you have rendered, and give you …’The Internet’. I was delighted to see so many of you tweeting about your experiences and impressions today, democratising science for simple ‘low-flyers’ like myself. Your generation of scientists are learning to improvise, to adapt, to overcome. Like Skynet, self-awareness of the role that The Scientist should be playing in policy is imminent. To paraphrase Anais Nin, “the day has come when the risk to remain tight in a bud is more than the risk it takes to bloom…”

The Greek have a great word ‘metis’, Metis was a Titan, and the first wife of Zeus. The word has come to describe a quality that combines wisdom and cunning, two attributes I would also commend to our younger scientists. If we can engage the public with wit and humor, and not be afraid, like some teenager in love, to let our ardour show for what we do—there is no argument we can’t win.

I’ve bent your ears enough. I warned them that I would. It’s better that I stop now—voluntarily—before the order to take the shot is made. Let me leave you with another quote, 

In the words of Pierre Corneille, ‘À vaincre sans péril, on triomphe sans gloire—To conquer without risk is to triumph without glory.

It’s been a privilege—enjoy your desserts!

Delivered at the National Museum of Australia in Canberra, 21 July 2016

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