Looking Good, Mate!

Is it more important to look good, or be good?  Here’s an excerpt from Fourth World, in which Benn Marr unravels a knotted debate over the use of recombinant genes purely for cosmetic purposes:

When the crowd noise had settled, Dr. Neelin shook his head and said, “I confess, I would never have thought of applying the principle of Natural Selection.”  He sighed at the sea of vacant faces and added, “For those unfamiliar, it’s the passing down of genes which increase survivability, for the good of the species.  For a thousand years, outward appearance has replaced survivability as the driving criterion in choosing a mate, has it not?  What did you so aptly call it, Benn- “Unnatural De-selection”?  Thanks to cosmetic procedures, Mr. Marr is telling us, genes that weaken the species are just as likely to be passed along as genes that promote survival of the fittest.  It’s hardly better for the human species than, say, choosing mates by the attractiveness of their clothing!”

Richard Prum, an ornithologist and evolutionary biologist at Yale, argues that female birds choose their mates (a process called sexual selection) based on beauty- not because an attractive appearance reflects underlying health and fitness, but for the sake of beauty itself.  This is a challenge to the mainstream understanding of natural selection.  As proposed by Darwin, good genes encoding beneficial physical traits, such as speed and strength, increase survival and are therefore more likely to be passed on to the next generation.  It seems to me that selecting mates by their beauty, which does not help birds fly faster, hunt more successfully or detect predators better, may actually dilute survival of the fittest.  On the other hand, among humans, an expensive suit and large blond comb-over may attract potential First Ladies, so cosmetic appearance can be a Darwinian advantage!

As we evolve in the Information Age, survivability becomes further and further removed from what our genomes dictate.  With the aid of prostheses (eyeglasses are an early example), medical advances, internet avatars of ourselves (no, not just online dating services), and of course robots, survival is now vastly multifactorial.  And we’re just talking about surviving to childbearing age.  Our physical deficiencies have become less crucial to our chances of having offspring, whereas a nearsighted, clubfooted caveman would not have survived long enough to attend the Junior Prom.

In light of this departure from Darwin, perhaps my characters in Fourth World are too humanoid.  In 2196, people may be closer to moles on wheels:  inarticulate, nearly blind, not beautiful in any sense, hybridized with cybernetic parts, texting one another with tiny hands but massively hypertrophied thumbs.  Bizarre, maybe- but still having kids!

 

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Another Day, Another Dolor

When does it stop?  I mentioned earlier that reading and blogging about these daily outrages has become quite exhausting, and now the increasing abuse of journalists is in all the news, including the NYT and NPR this morning.  Ben Jacobs, grabbed by the neck and body-slammed to the floor by Montana GOP candidate Greg Gianforte for asking him a question about the Republican health plan.  And Gianforte still won the election!  John Donnelly, pinned against a wall by security men for trying to ask FCC Commissioner Michael O’Rielly a question.  Dan Heyman, jailed for shouting a question to HHS Secretary Tom Price about pre-existing conditions under the House healthcare bill.  Never seen a reporter shout a question, in a noisy room?  Journalists harassed by Trump supporters, shoved and punched, pepper-sprayed, verbally abused and arrested for doing their jobs.  Are we to accept this as normal now?  Well, Heyman did raise his voice…

There’s the well-known Reporters Committee for Freedom of the Press, which works to protect First Amendment rights.  But, in the face of all this violence, reporters may need to be more concerned about protecting their Second Amendment rights.  That might seem self-evident when they are assigned to cover news in the heart of Trump Country, but apparently even government buildings in Washington DC can’t be considered safe zones for the press.  You can’t blame one person for the entire toxic environment, but our Chaos President has been blowing mightily on that dog whistle, for example calling the press the “enemy of the people,” and there has been a trickle-down effect.  Under Trump, the range of options that pop into the minds of erstwhile public servants when approached by a journalist has widened to include physical assault.

By the way, I was gratified to hear that, as a sort of olive branch to the press, the White House is looking for flight attendants to take special care of the Press Corps aboard Air Force One.  A long process, but why drag it out:  can’t United Airlines spare a few?

Just Win, Baby!

In my novel Fourth World, there is one world government in the year 2196, and the United States survives as an underground organization.  Benn and Lora meet the android Protem Two in a secret bunker on Russian Hill.  Protem Two, who has been the acting President for over 82 years, since the fall of the US government, is an autocratic, remorseless, coldly-calculating computer which, at times, experiences technical glitches:

“My predecessor Protem was destroyed.  8979323.  By blanket cyber-attack.  9298752491.  Launched by the Pan-World Electorate against the Quarantine Zone.  0112358132134.  The remnants of Protem’s files were emergently transferred to Protem Two. 594720386.”

“Um, how reliable do you think Protem’s records are, Maggie?” asked Benn.

“There are problems with spontaneity, random memories popping up, as you can see…”

Protem, noting Benn’s drifting attention, gave its voice a ringing, metallic edge and abruptly interrupted Benn’s ruminations.  “Benn Marr, CIA has brought you here to undergo complete analysis.  The first step in this analysis is to measure your ability to read energy signatures, and to determine its strategic implications for the resistance movement.”

Startled, Benn looked up.  How would the measurement be taken, and its strategic implications determined?  These sounded like passive procedures, but so was having one’s teeth pulled.

In today’s NY Times column The Stone, Robert Burton, a neuroscientist at UCSF, notes that conventional psychology (e.g. labeling someone a narcissist, megalomaniac, psychopath, attention-impaired, etc.) has failed to predict what our Chaos President will do when presented with new, unforeseen circumstances.  So instead, Burton suggests thinking of Trump as a rudimentary artificial intelligence-based learning machine, like Watson or IBM’s Deep Blue, whose goal is to win at all times, without regard to moral, ethical or ideological considerations.  No regrets!  Such a machine, says Burton, “isn’t saddled with any confounding principles such as what constitutes socially acceptable or unacceptable behavior or which decisions might result in negative downstream consequences.”  Relentless, single-minded self-interest; self-selected data; widely-fluctuating criteria of success; no lines of reasoning driving the AI network’s actions:  it sounds just like science fiction.  In the words of Al Davis:  “Just win, baby!”

I couldn’t help but notice the similarity between Burton’s AI learning machine Trump and my robotic President Protem.  But which one of us is right (and which option is less scary)?  Is the President a simple-minded, first-generation AI machine (a product of the past), or is he a severely virus-damaged but wily and sophisticated android (a product of the future)?  Either way, we can hope that he holds his exalted position- as denoted by the term pro tempore- only until a real President comes along.

Gimme A Vowel

My ambition, as Author, my point, I would go so far as to say my fixation, my constant fixation, was primarily to concoct an artifact as original as it was illuminating, an artifact that would, or just possibly might, act as a stimulant on notions of construction, of narration, of plotting, of action, a stimulant, in a word, on fiction-writing today.

Postscript from A Void, by Georges Perec

 

Deconstruction rules in cuisine, but sometimes in writing, too.  This morning, while lying in bed, I thought of the following; it just popped into my mind.  Georges Perec wrote his entire novel without once using the letter E (in his other book of this type, Perec dismissed the very first letter, which rhymes with Eh, like I did in this blog post).  It seems incredible, like it would be impossibly complex, but in truth it’s not difficult.  You keep your eye focused on the big theme or motif; find the guilty letter (glowing red on its Pilgrim outfit) within your prim sentences; ruthlessly remove it wherever found; then come up with synonyms for the words involved.  The process works pretty well, if you don’t mind relinquishing control over whole sets of key words- some of the most powerful concepts, too.

“He’s going nuts,” you suggest (I know, your intent is humorously innocent).  Losing sleep over these kinds of thoughts is, I suppose, one weird effect- one huge price- of being unemployed, i.e. retired from Medicine, with excess time to spend on such things.  Plus, I suspect this sort of nervous pre-sunrise exercise is brought on by the Trump News:  the numerous eye-popping events of this fortnight.  Now Trump is fleeing the country on his religious World Tour- well, good luck World, we’ll genuflect for you when he gets to Rome!

In the context of the sinking presidency, it seems I’m experiencing the urgent need to deconstruct, to expel specific offensive thoughts, even chunks of memory.  I’ve cut out the first letter, the first vowel.  Oh, if only it were possible to reverse history, to possess such fine control over life!

Sanctuary III

Meantime the “Big Ditch” is alive with teams and scrapers, and the canyon resounds with blasting.  It awes me to see how big this scheme is….  The finished section, so far hardly more than a half mile, eighty feet wide at the top, fifty at the bottom.  The twelve-foot banks slope back at the “angle of repose,” which means the angle at which dirt and pebbles stop rolling.

– Wallace Stegner, Angle of Repose

At our Immigrant Sanctuary meeting last night, we heard about the 700-1,000 new arrivals per year in Alameda County, the terrifying situations they are forced to flee in their home countries, deep traumas compounded by their abysmal living conditions now, and the unshakable anxiety with which their days pass.  Either because of government restrictions or their own fear of deportation, these immigrants receive no cash aid, food, housing or education.  They do have access to medical care, but, unwilling to reveal their illegal status and risk being torn away from their families, they will avoid showing up at a public clinic until illness has progressed to a desperate stage, often beyond treatment.  The safety net for them is thin, and in many cases, nonexistent.

The ramped-up detention and deportation aimed at these people by ICE and our Chaos President is based on the perceived threat that they pose to our national security.  So ICE is cleared to blast away, and let the rocks fall where they may.  Their bosses in Washington are willing to risk the pain and suffering these immigrant families will go through:  when the dust clears and the pebbles stop rolling, they say as objectively as a canal engineer, we’ll just see what angle of repose results from all our blasting.

In a way, the President is performing the same operation in Washington DC:  the explosive developments in just the past eight days have sent dirt and debris flying in all directions.  Not a day goes by without some new, spectacular revelation, and it’s exhausting just to write about them.  Suspicious firings, false and contradictory explanations from the White House, mis-directions via the Justice Department, threats of “tapes,” attempts to obstruct justice, and on and on:  it awes me to see how big this scheme is.  What will be the angle of repose?  The news has been jaw-dropping, really.  And how ironic is it that those poor immigrants are seen to pose some sort of threat to national security, when, the day after firing the FBI director who is investigating his campaign’s links to Russia, the Chaos President is spilling national secrets to known Russian spies right in the Oval Office?

Excuse me, I dropped my jaw in the other room- be back soon.

Ringwraith Sightings

At Rivendell, Gandalf the Grey explains to a frightened Frodo:

“There are many powers in the world, for good or for evil.  Some are greater than I am.  Against some I have not yet been measured.  But my time is coming.  The Morgul-Lord and his Black Riders have come forth.  War is preparing!”

“Then you knew of the Riders already– before I met them?”

“Yes, I knew of them.  Indeed I spoke of them once to you; for the Black Riders are the Ringwraiths, the Nine Servants of the Lord of the Rings.”

 

Out here in the Shire, we’ve been hearing hoof-beats for a while.  The Secretary of State galloped out into the world with the warning that the US has placed too much emphasis on morality, human rights and other values, and too little on wealth and power.  To him, our dealings with the rest of humanity should be more transactional, like running a business, and that sends a chill to the oppressed masses who have long counted on the US for support.  Not that things are much better in our own secure homeland, where we have seen immigrant families hiding in a ditch while the tall Rider on his black horse stops in the lane, sniffing the air for his prey.  The Secretary of the Interior (who rode a horse to work on his first day on the job- honest!), is now heading out West, under the instructions of his dark Lord, to find protected national monuments that the Administration can un-protect, opening them up for gas and oil exploration.  Meanwhile, back in Mordor, the head of the EPA has ridden out with orders to dismantle environmental protections and programs that fight climate change.  The Secretary of the Treasury charges down Wall Street, hacking away at consumer protections.  The Speaker of the House, from his high saddle, oversaw the passage of a bill removing guarantees of coverage for pre-existing conditions, takes people off Medicaid, and which will eventually deprive 24 million people of health care altogether.  And yesterday, following the suspiciously-timed firing of the Director of the FBI, the Senate Majority Leader swore to obstruct the appointment of a special prosecutor to investigate Trump-Russian connections.  During the previous Administration, although not at the level of Ringwraith, he showed himself to be a ferocious orc indeed!

According to Gandalf,

“Not all his servants and chattels are wraiths!  There are orcs and trolls, there are wargs and werewolves; and there have been and still are many Men, warriors and kings, that walk alive under the Sun and yet are under his sway.”

Their works seem to be always destructive, negative, taking away all sorts of protections and quality of life, rather than building anything positive for the nation.  No, Sauron, the Great Wall of Mexico does not improve infrastructure; and no, hiring 1500 more ICE agents does not count as job creation; and also no, throwing more people in prison is not a strategy for fighting homelessness.

But let’s not take the Ring analogy too far.  Mordor is nothing like Washington DC or the Shire.  For instance, Sauron- even with only one Eye- sees reality more clearly than our Chaos President, and does not rely on a swirling fog of lies and deflections to get his way.  Our president’s Nazgul, or Ringwraiths, wear business suits instead of long black robes (well, there is the Supreme Court…)

And one more big difference:  here in the Shire, we get to vote in the 2018 midterm elections.  To paraphrase Gandalf:  Against some we have not yet been measured.  But our time is coming!

 

 

 

 

 

Does Not Compute

What’s that nagging pain, you ask?  In today’s SF Chronicle, there’s an Open Forum piece on crowdsourcing medical diagnoses, a new and trendy way to find out what’s bothering you.  Patients submit their symptoms to an online forum of diagnostic enthusiasts, some of whom are medical professionals, and they respond with a list of potential diagnoses, the most popular one listed first.  Imagine Wikipediatrics.  Or Family Practice Feud (“our survey said…?”).  Any set of symptoms or data will generate a bell-curve of answers, and the theory is that the peak of the curve is most likely to be correct.

My first reaction on reading this was to choke on my coffee.  As a rheumatologist, I was impressed by how many diseases in my field present with almost exactly the same constellation of symptoms:  for example, fever, joint pain and rash.  Much more testing is usually needed, and even then, the power of every test is limited by its sensitivity and specificity.  For decades, I taught medical students and residents about the importance of subtle variations in the patient’s history and physical exam which could lead to the diagnosis and treatment, even in the face of contradictory and misleading test results.  To steer through a complicated landscape, it helps when the physician is dedicated not just to finding the answer, but to the larger goal of helping the patient.

Dr. Lisa Sanders, who teaches at my old medical school, has a column in the NY Times Sunday Magazine, in which she presents a challenging diagnostic case weekly.  Based on her description of history, physical and preliminary tests, readers suggest possible diagnoses.  And, predictably, the suggestions are all over the map:  remember, many diseases look remarkably similar!  Now this crowdsourcing of diagnoses brings the whole enterprise to a different level- for a fee, of course.

There is an analogy to how the practice of medicine is currently evolving:  diagnosis by computers.  Given a set of symptoms, a diagnostic algorithm can pop up a set of answers, with the most likely one on top.  But the old expression “Garbage in, garbage out” applies when subtle points of the history and physical are passed over, or when irrelevant data are swept into the equation.  Someone still has to decide what data to enter or leave out, and wouldn’t it be better for that person to have expertise, judgment and the goal of not just finding the answer, but the larger goal of helping the patient?  In other words, a good (non-cybernetic) doctor?

Here’s an excerpt from Fourth World, in which an intern, Kai, presents a puzzling case to his attending, Dr. Hol Chan:

Kai continued, “I have put W.P. through the Probot twice, and both times the results were identical:  signals of tissue injury or regeneration, inflammation, pre-mutagenesis and metabolic derangement are completely absent.  Epigenetic expression, including at the micro-RNA level, is normal.  Risk loci mapping and haplotype structure are unremarkable.  You can see on the next screen that the central and peripheral chi are not in any way obstructed.  I entered the patient’s history, systems review, family history, physical exam and lab data into the analyzer and found no matching diagnosis.  And so, without a suitable coding of his diagnosis, there is no way to initiate the billing process.”

Dr. Chan, studying the wall screen, nodded in agreement.

Kai looked up from his da-disc and shrugged.  “In fact, W.P. is perfectly healthy, even though obviously he is persisting in his illness behavior.”

W.P. stared fixedly downward at his legs, now pale and mottled in the cold room.  Unsure what “illness behavior” implied, at least he knew that his pain was very real.  It was excruciating, every minute of every day; the sleepless hours of each night passed exquisitely slowly…  His wife finally shattered the silence:  “Healthy? Perfectly healthy?  What are you talking about?  Can’t you see he’s in pain?  What’s perfectly healthy about that?  Can’t you just rearrange his genes and end this once and for all, instead of giving him all those… those therapeptides to control pain but only make him more lethargic than he already is?  You doctors and your damned machines:  scanning and probing here and there, coming up with nothing.  Epigenetic expression is normal.  Oh, so everything’s just fine then, is it?  Well it’s not, and I am at the end of the line, people!   I can’t stand it anymore- you find the problem, and you find the solution…you find it.”  She suddenly began to sob, her shoulders shaking, her arms folded tightly across her chest.

Kai had panic scrawled on his face.  “But the Probot is accurate within ten-to-the-minus-seven-percent!  As I said, there’s nothing wrong with your…”  Dr. Chan cut in abruptly:  “Kai.  Excuse me.”  Then, addressing everyone in the room, she said in her most calming voice, “I think we’d better break here, and collect our thoughts.  Why don’t we go to the conference room and review our findings?

“If you don’t mind,” she said to the patient’s wife, who had just as suddenly stopped her crying but shook her head slowly back and forth, unwilling to accept that she and her husband were going through this yet again.