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!

 

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.

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.

The Way We Were

It’s great that a disproportionate number of millennials follow this blog.  Maybe it’s because at my age- as we used to say in the good old days- I can wax nostalgic.

Used to be, when some guy came walking right at you, waving his hands in the air and shouting, “Yeah, right?  #%&@*!  Know what I’m sayin’?” you knew to cross the street ASAP.  Now he’s probably talking to someone real.  I sure miss that excitement!

Used to be, on a New York subway train, everyone’s eyes were not focused on their smartphones and iPads for the entire trip.  They were riveted instead on the ads for St. John’s University or for McDonald’s posted above the passengers you faced.  Between Manhattan and Queens, you could read those ads a hundred times or more, avoiding eye contact at all costs.

I thought about the distortions of nostalgia yesterday, when a Trump supporter in her 50’s at a Berkeley demonstration said, “I grew up in Berkeley; it was a beautiful place in those days, without all of these violent protests.”  Ah, yes:  no violent protests in Berkeley.  That must be why the Bank of America on Telegraph Avenue finally gave up and replaced all its windows with brick walls.

Sorry- nostalgia shouldn’t be sarcastic.  It should be warm and glowing, self-affirming, a reward for making it through all those challenging times.  Just look out for selective memory’s tendency to distort facts and history, especially if applying nostalgia (many of us do) in deciding how you feel about the present.

As we so often joked amongst ourselves in those golden, giddy, halcyon days, “Nostalgia just ain’t what it used to be.”

Less distorting, I think, is the memory of a style, or a mood, from the old days:  that feeling we had listening to Stairway to Heaven, or the Eagles, or anything from Woodstock.  Digesting the writings of Yevtushenko, Russell, Rilke, Ellison, Brecht, Baldwin and Buckley as we formed our world view.  Except for Bill Cosby, I remember the comedians of those days with special fondness.

Here’s a conversation between Benn and Lora from Fourth World, at a baseball game in the fall of 2196:

“Say, Lora.  You can stop studying now.  Take a break and watch the game,” Benn pulled her cap back up with a grin.

“That’s all right.  This is really interesting, multi-species therapeptides boosting athletic performance.”  She read in silence for several seconds, then smiled and pointed at the program screen.  “Say, you should enjoy this, Benn- there’s a quote from Lupe Rincon- you know, the retired first baseman who became a comedian?  He admits to using illegal peptides and signing up for a detox program:  ‘No twelve-step program for me:  I joined a thirty-six step program to quit drugs!’  Then he says, ‘One step forward, two steps back!’”

“Ha!  Hahah!  Ba-da-Boom!”

Badaboom?  A crash of drums:  a theatrical sound from twentieth-century vaudeville.  Poor Benn.  He really loves these corny, old-fashioned jokes, thought Lora, a feeling of warmth touching her cheeks.

See, she really does have a sense of humor after all, thought Benn with equal affection.

March for Science II

It was fun– and I don’t mean that in a trivial sense.  For me, the March for Science rally in San Francisco yesterday had the right mix of whimsy and angst, of hilarious satire and hard facts.  There were the white lab coats.  The DNA models.  The signs saying, “Remember polio?  I don’t,” “Science Not Silence,” and “If you think science is expensive, try guesswork!”  Although the march was supposedly non-partisan (one sign said, “Science is not Democrat or Republican” and another “Science is not an ideology”), it was hard to skirt the fact that our Chaos President’s administration has been Ground Zero for the unleashing of virulent attacks against scientific principles and evidence-based policies.  In the Trump White House, GOP partisanship and corporate financial interests are favored over data and facts, even if the consequences might threaten the world.  I saw a decidedly partisan sign with just ten characters:  OMG/GOP/WTF?

The speakers ranged from the humorous-but-pointed to the earnest and personal.  Gauging the applause level was my “eardrum approach” to surveying audience sympathies.  When it came to climate change and the denial thereof, the reaction was the most prolonged, almost angry in its intensity.  Then quoting Niels Bohr, who won the 1922 Nobel Prize for describing the atomic structure and later contributed to quantum theory (“Science is the gradual elimination of prejudice”) drew loud approval.  Other topics: support for NASA; the Clean Water Act on the chopping block; fear of a post-truth world in which evidence doesn’t matter; teachers of science and math as the first line of defense- all of these received wholehearted applause.  With the debunking of vaccine-induced autism, there was a slight but perceptible drop in volume.  How about genetically engineering crops to feed the world?  There was definitely a moment of uncertainty when folks had to decide how they felt about GMOs, and whether to clap at all.  Just as the Women’s March in January demonstrated divisions between those supporting women’s rights, the March for Science showed that belief in science does not translate in a homogeneous way to setting policy.

Maybe there should be a March for Science Fiction.  Poets and writers of fiction often set a stage for the interplay of multiple points of view.  This hypothetical staging leads to a grand conclusion, but also allows layering of multiple take-home messages, as I’ve tried to do in my novel Fourth World.  Even in science, there are shades of gray, when you take into consideration ethics, inclusivity and social justice, geopolitics and so on, and sometimes it takes imagination to untangle these factors.  “Science is Hope,” I read on a placard.  Science fiction, which projects current science onto a hypothetical stage by the power of imagination, is also hope.

March for Science

I don’t have any scientific data on this, but it seems to me that there has been a sharp rise in marches and other public demonstrations since the election of our Chaos President.  So many widely-accepted ideas and established programs/policies have come under fire from the Administration that an increasing number of alarmed citizens have felt the need to rise up in protest.

Now there’s a March for Science scheduled for Earth Day, Saturday, April 22nd at the Mall in Washington, D.C. and many other sites around the world (locally at Justin Herman Plaza, SF, 11 AM).  As a physician, I grew up steeped in biology, chemistry, physics, physiology and other scientific disciplines; relied on well-designed clinical trials in order to practice evidence-based medicine; applied the fruits of medical research and technological advances to improve or save lives; and feared the encroachment of financial interests which overshadow doing what’s best for patients.  I have simply taken for granted that the scientific method is essential, that data and evidence are critical, and (mistakenly) that everybody knows these things.  So it came as a shock that Science needs a march!  No-one would claim that all scientific studies are accurate and free of corrupt influence, but even the satirical movie Animal House allows (as a university motto) that Knowledge Is Good.

Since higher education is usually the path to scientific knowledge and expertise, it’s hard to avoid the false equivalence of science and elitism, in the minds of many.  And the way to counter such elitism (vigorously aided by the above-mentioned financial interests) is to deny the importance of science, or even set up the idea of fake science as a straw man.  Deny the conclusions of climatologists, and dismantle agreements to fight climate change on a global scale.  Deny that CO2 is a cause of global warming, and put the chief denier in charge of the Environmental Protection Agency (see my earlier post, So Who Asked You?).  Cling to the false belief- many times disproven- that vaccines cause autism, and appoint the chief clinger to oversee vaccine safety.  Propose a budget that cuts funding for cancer, immunologic, genetic and other vital research at the National Institutes of Health.  Allow the use of pesticides that have been shown to harm children.  Deny the benefits of forensic science programs that increase accuracy in enforcing the law.  Apparently you can simply choose your beliefs without evidence, as they did in the Dark Ages.

So Science does need a march.  But it won’t end there, as a symbolic gesture; the march will shift public discourse, inspire blog postings like this, prompt letters and calls to Congress, and, more locally, it will bring a wide variety of influential people together in the progressive/technological/academically-heavy Bay Area.  Is the march elitist?  I doubt anyone will care.  See you on the 22nd!