The New York Review of Science Fiction Issue #296 April 2013

by Kevin J Maroney

  The story also has, I should mention, a socially progressive conclusion. Rusty gets over his incipient male chauvinism, determined that, however much the other boys in the neighborhood might object, Susan will be allowed to join his Space Patrol, even if she is a girl, because she’s the only other person he knows who has any experience out there. Could the notion of a female astronaut be far behind?

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  Darrell Schweitzer grew up in the suburbs of Philadelphia and somehow never managed to see an episode of Captain Video or Space Patrol as a child.

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  A Third Sampling of Medical Myths and Errors in Genre Fiction

  Christopher S. Kovacs and Susan M. MacDonald

  The September 2011 and March 2012 issues of NYRSF featured our two prior essays on medical myths and errors perpetuated in genre fiction. This third essay has been prompted by our recent reading and viewing of new and older works. As before, the guiding principle is that getting the facts correct is a fundamental rule of writing. Our intent is not to ridicule anyone but instead to educate authors and readers about some of the medical myths, misconceptions, and errors perpetuated in fiction. We give illustrative examples largely from well-known authors in order to show that even best-selling writers perpetuate the same mistakes. Our main message is that background research should include double-checking significant medical/surgical facts for plausibility and correctness. Relying on the Internet or Hollywood depictions may lead to perpetuation of myths and errors, whereas running ideas by a physician with expertise in that area may rescue the author from potential embarrassment. A significant factual error can cause laughter at the wrong moment and throw a reader out of the story.

  Getting the medical facts wrong or exaggerating a rare outcome so that it seems probable can have damaging consequences for readers and viewers. A vivid example is the 1989 mainstream motion picture Steel Magnolias in which Julia Roberts played a young woman with type 1 diabetes. She has a dramatic hypoglycemic seizure at the beginning of the movie and later becomes pregnant despite being warned that pregnancy is hazardous for a diabetic. She develops kidney failure, goes on dialysis, has a kidney transplant, rejects it, and dies. Even today, nearly twenty-four years after the movie’s release, mention of this film frequently resurfaces during prepregnancy counseling sessions. In many instances “helpful” mothers-in-law or aunts have recommended and loaned this terrifying eye-opener to a diabetic woman in order to “prepare her” for pregnancy.

  The facts are that preexisting kidney or eye damage can progress in pregnant women with type 1 diabetes, especially those with very poorly controlled disease. For this reason, routine monitoring is important. Uncommonly there is measurable deterioration of kidney function or change in a retina sufficient to warrant laser treatment. Progression to dialysis or blindness during or soon after pregnancy is an extremely rare outcome and nearly impossible in a woman who begins pregnancy with normal kidneys and eyes. Most diabetic women have gestational or type 2 diabetes, both of which are far less likely to be associated with significant kidney or eye damage during pregnancy.

  Overall, although what happens to Julia Roberts’s character in that movie is not impossible, it is an extremely unlikely series of events that occurs over an even more improbably rushed time frame. It is far more likely for her to succumb from causes unrelated to diabetes, such as a car accident, a blood clot, or cancer. This movie created an unnecessary nightmare for many diabetic women contemplating pregnancy.

  Treating dehydration with ocean water or urine

  In Yann Martel’s The Life of Pi , the titular character is shipwrecked at sea and recognizes that although he is surrounded by water, he cannot drink any of it, whereas the tiger that shares the lifeboat is not so restricted. Real-life accounts have described how consumption of seawater caused mouth and throat burns from the salt, swelling of the throat, severe thirst, confusion, delirium, and rapid death. But in Thor Heyerdahl’s autobiographical Kon-Tiki , he recounted how he consumed seawater and freshwater in a 40:60 ratio while traveling 5,000 miles in a raft across the Pacific Ocean. And Alain Bombard of France claimed to have survived 65 days at sea while consuming a pint and a half of seawater daily. The World Health Organization, various navies, and ocean survival manuals all warn not to drink seawater. But some survival guides claim that consuming up to 32 ounces of ocean water per day is perfectly fine. What is the truth among all these conflicting claims?

  Blood contains salts, nutrients, and waste products, and the levels of these are carefully regulated in order to maintain normal health and function of cells. The most abundant salt in ocean water and blood is sodium chloride. A high blood sodium level dehydrates and shrinks cells, leading to progressive lethargy, confusion, seizures, coma, and death. The kidneys must excrete water in order to excrete sodium, and there is a limit to how concentrated the urine can be made. The concentration of sodium in ocean water is so high that if someone relies on this as the only source of water, then about twice the amount of water consumed must be excreted to get rid of the excess sodium. If you’re becoming dehydrated and drink one liter of ocean water but have to pee out two liters to compensate, that accelerates the dehydration and downward spiral toward death. And if you’re dehydrated enough that you can’t pee out those two liters, the retained excess sodium causes a more rapid rise in the blood sodium, and that hastens death too. [See Sidebar for more details.]

  Thor Heyerdahl chose to mix seawater and freshwater in a 40:60 ratio. This created a sodium concentration about one-third higher than the normal blood sodium concentration and about four times the salt concentration of athletic rehydration drinks (e.g., Gatorade). Although it would taste quite salty, Heyerdahl’s concoction is a manageable sodium load for the kidneys of a well-hydrated individual; the excess sodium can be excreted. It wasn’t necessary for Heyerdahl to do this, but if his freshwater supply was running low, it would enable him to make it last longer.

  Alain Bombard wanted to prove that a man could survive for weeks by drinking seawater, and he later claimed to have survived 65 days at sea while consuming a pint and a half of it per day. Whether he actually did consume that amount remains in dispute. He certainly could not have consumed seawater exclusively because doing so would have killed him within days for the reasons explained above. What is overlooked by many who refer to this account is that he readily admitted to drinking rain water and the liquids from raw fish, and so his intake of freshwater may have been more than enough to compensate for any intake of seawater. He was quite dehydrated and ill when he finally reached port. It is this apocryphal tale that has caused some survival guides to recommend that shipwrecked individuals consume up to 2 pints of seawater per day in order to stay hydrated. But it’s not something that most experts recommend ever trying; as the sole fluid source, it will lead to a quick death. If seawater is consumed, it must be mixed with freshwater in a manner similar to what Heyerdahl did.

  Drinking urine is also proposed as a way to maintain fluid balance in someone who has no access to freshwater. As an emergency short-term source of fluid, it is acceptable. As the sole fluid source, it will rapidly become as concentrated as seawater but even more toxic due to high levels of urea and other waste products. And so drinking urine exclusively is also strongly discouraged as a means of survival.

  Frank Herbert’s Dune features the Fremen stillsuit which reclaims water from sweat, urine, and feces and then makes it available for the wearer to drink. Importantly, the name stillsuit refers to the suit’s ability to distill the reclaimed water to the equivalent of freshwater, in part by use of “salt precipitators.” A properly fitted and functioning stillsuit reduces moisture loss to less than a thimbleful per day. Other sf authors have described recreational consumption of urine, and in such occasional doses the only toxicity will be from any alcohol or drugs consumed by the donor. See Samuel Delany’s The Mad Man or Rudy Rucker and Bruce Sterling’s “Storming the Cosmos.”

  Taste and smell

  The fam
ily of gustatory experts in Isaac Asimov’s “Good Taste” repeatedly extol the importance of taste buds and tongue in discriminating among hundreds of thousands of different molecules that contribute to the flavors in a single dish. “My tongue wearies. I can no longer taste anything,” declares Chawker Minor, to which Elder Chawker replies, “taste buds blunt when not used.” Chawker Minor also lectures that “it all ends with the tongue no matter where you start.”

  But it is a misconception that only our taste buds taste the foods we enjoy. The taste buds sense sweet, salty, bitter, sour, and umami (glutamate, also called “meatiness”). The tongue also senses other aspects of food such as temperature, texture, astringency, and so forth. But it is our sense of smell (olfaction) that gives us about 90% of what we appreciate as “taste.” The olfactory nerves operate in the nose and upper palate. A wine connoisseur appreciates the importance of clear nasal passages and a keen sense of smell in order to fully taste a wine. Anyone who has ever eaten while suffering a severe cold or clogged sinuses can appreciate that the taste of food becomes blunted. Smokers have a reduced sense of taste because of the deadening effect that smoke has on the olfactory nerves. A renewed sense of taste after smoking cessation contributes to overeating and weight gain. These nerves are also fragile and easily severed by a blow to the head, which is why boxers and head injury victims can abruptly lose the ability to smell and taste.

  The sense of smell’s role in controlling taste is evident in Kallman’s syndrome, a condition that primarily causes failure of puberty to onset. In about 20% of people with Kallman’s syndrome, the olfactory nerves fail to form, and such individuals have complete inability to smell (anosmia). They are left with only the rudimentary aspects of taste provided by the taste buds and tongue. For the anosmic individual, the inevitably bland taste of food mandates other approaches to create flavor, such as the extreme use of salt, vinegar, mint, or sweetness. Varying textures, colors, and temperature of foods also add appeal to anosmic individuals.

  We have informally polled our anosmic Kallman’s patients on whether they can recall how they first realized that they could not taste or smell. In all affected men, it was the realization that some unperceived aspect of farting, rather than the sound, that caused their sisters to run screaming from the room or hurriedly open the car windows. In the affected women, it was the repeated pleas by girlfriends to smell their perfume and learning to say “Mmm, you smell nice,” without ever sensing what the other girls seemed to delight over.

  Speed of infections and poisonings

  Infections generally spread quite slowly because they are held in check by chemical signals, antibodies, cells of the immune system, and physical barriers within and between cells and tissues. Once an infection becomes blood-borne, it can spread faster. Tuberculosis is a particularly slowly developing but persistent infection caused by a mycobacterium. It normally enters an individual through inhalation and develops very slowly at first. Left untreated, it can gradually destroy the lungs. But in Robert Downey, Jr.’s, latest portrayal of Sherlock Holmes (A Game of Shadows), Dr. Moriarty laces Irene Adler’s kerchief with spores of a highly virulent form of almost instant tuberculosis. She inadvertently inhales deeply from the kerchief, manages to walk a few steps, coughs, collapses, and dies. There is no known infection that could convert from spores to live bacteria and then spread and kill, all within a minute of inhalation. What’s even more idiotic about that scenario is that the grieving Holmes breathes deeply from that discarded kerchief. Bacterial spores from “instant tuberculosis” should still be present, but Holmes remains completely unaffected.

  The same film also makes several other glaring medical blunders. It features a curare-laced dart in the calf that causes near instantaneous paralysis and death. A sufficient dose given intravenously could do that within one minute, but not a needle in the calf. Instead it would cause paralysis that begins in the calf muscle and spreads upward with a window of at least 20–30 minutes before total paralysis sets in after a high enough dose. The victim would certainly realize that something is wrong, confess critical facts to Holmes, and perhaps even receive the antidote in time. Dr. Watson also uses an intracardiac injection of adrenaline to resuscitate Holmes after he’s succumbed to massive blood loss. We’ve dealt with Hollywood’s fascination with the intracardiac injection and the “stay awake don’t die” scenarios in the earlier essays, but we’ll add here that if one’s heart has stopped because there’s no longer enough blood to pump, the adrenaline will just make that stopped heart quiver a bit faster while still having no blood to pump. The movie climaxes with Holmes surviving a multi-story plunge down a mountainside waterfall. He does this by being armed with a tiny, primitive oxygen device that will somehow keep him from drowning, aided by his powers of relaxation that will overcome gravity, thereby preventing him from being smashed to a pulp when his accelerated body meets the water, trees, or rocks far below.

  Misconceptions about cloning

  Cloning is a popular science fiction trope that is often incorrectly portrayed. In order to understand the problems, we first need to explain some background science.

  The cells of nearly all tissues and organs are called somatic cells. The tens of thousands of genes that program the development of each individual are arranged within chromosomes. The nucleus of each somatic cell normally contains 46 chromosomes. These somatic cells are diploid, meaning that the chromosomes are arranged in 23 pairs. One of each pair comes from the mother while the other comes from the father. The fertilized egg divides repeatedly and ultimately gives rise to every cell in the body, with every normal somatic cell containing the same 23 pairs of chromosomes. When a somatic cells divides, the chromosomes are first duplicated to become 92 in total (23 doubled-pairs), and then the cell splits in two (mitosis), sending a full set of 46 chromosomes into each new somatic cell.

  But within the ovaries and testicles there are specialized cells called germ cells, which create the gametes, i.e., the ova (eggs) and sperm. During the development of the gametes, a process called homologous recombination enables sections of chromosomes to be swapped between the matched pairs. The result is that, for example, each copy of chromosome 14 in the gametes becomes a unique mosaic or fusion of maternal and paternal parts; it is no longer identical to either of the original pair of chromosome 14 within the somatic cells. The developing gamete cell then divides in two (meiosis), with each daughter cell taking just one from each pair of chromosomes. Consequently, ova and sperm are haploid, containing just 23 unpaired chromosomes. When a sperm fertilizes an egg, two haploid sets of chromosomes come together to create a unique diploid cell with the 46 chromosomes (23 pairs) normally needed for human development. The mixing and matching of parts of chromosomes during egg and sperm production and the combination of maternal and paternal chromosomes in one fertilized egg mean that the child will be genetically distinct from either parent.

  In contrast to normal reproduction, cloning implies that a somatic cell with its 46 chromosomes has been used to create a new organism that is genetically identical to the original. This can be done by replacing the chromosomes of a newly fertilized egg with those from a donor somatic cell or by forcing a somatic cell to behave as it were a newly fertilized egg. In theory a clone could be made from any somatic cell (skin, blood, etc.). The cloned offspring will be genetically identical to the original. Much like twins, a clone will resemble but not be completely identical to the original, because certain aspects of physical features and personality arise from environmental influences (nutrition, exercise, sun exposure, injuries and scars, education and experiences, etc.). Fingerprints change due to environmental influences and would differ between clones just as they differ between identical twins. Lois McMaster Bujold made an error by having the clones Miles and Mark Vorkosigan share identical fingerprints. Although detective Sidney Hurst in Peter F. Hamilton’s Great North Road wonders why someone bothered to cut off the dead clone’s finger tips—“it might make sense for a normal crime vic
tim, but not [a clone]”—a murdered clone should be identifiable by its fingerprints. The clone of Duncan Idaho in Frank Herbert’s Dune sequels won’t have the memories of the original because memory is stored in networks of specialized brain cells and not in the chromosomes or mitochondria of somatic cells.

  Probably the most famous example of a hard science fiction writer getting cloning wrong was Arthur C. Clarke’s Imperial Earth. The original Malcolm Makenzie and his wife have a daughter who is born mindless—“no one at home in the lovely shell their bodies had fashioned”—and dies at six years of age. He is devastated by this, and his marriage breaks up as a result. Further investigation reveals that “the fault lay in Malcolm’s genes. . . . Sometime during his shuttling back and forth between Earth and Mars, a stray photon that had been cruising through space since the cosmic dawn had blasted his hopes for the future. The damage was irreparable, as Malcolm discovered when he consulted the best genetic surgeons of four worlds.”