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.

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.

Yield Sign Ahead

Much to worry about this week.  North Korea tests missiles to deliver nuclear warheads; the era of patient diplomacy is over, announces the VP, and the US fleet steams into the area; Syria steps up bombing of civilians in the aftermath of 59 US cruise missiles hitting their airbase.  Violent confrontations from the Philippines to South Sudan saturate the news.  In my mind is the image of John Wayne and Clint Eastwood, standing in front of one another exchanging mighty blows- back and forth and pow and bang, until one man finally collapses in a bloody heap.  The one who remains standing, suffering huge blood loss, a ruptured spleen, multiple broken bones and a concussion, is the winner.  Our Chaos President has promised us “so much winning we’ll be sick of it.”

I took Tai Chi lessons way back in college, and although I’m just a hack, one lesson that stuck with me is that yielding to an oncoming force can be more powerful and effective than running headlong into it.  We were taught that the energy of the opponent can be used to take him down (as was demonstrated on us repeatedly).  One evening after Tai Chi class, I almost stepped in front of a car, when suddenly a girl in the class, who was standing behind me, shouted, “Yield!”  Tai Chi saved my life.

Here’s an excerpt from a scene in Fourth World, in which Leader Chou of the PWE (the one world government) reflects on world domination:

One group, whether ethnic, political or religious; whether a tribe, a nation, or a civilization; would make advances on various fronts, only to see those advances destroyed by the next group.  True, the PWE itself had been compared to an oppressive empire, but that was unavoidable in the first two or three centuries of establishing a truly unified human race:  a frictionless and efficient engine which would allow mankind to achieve its full potential.

During this transitional phase, it would be simple enough to arrest the petty saboteurs and protestors, banishing all the opposition immediately to the Quarantine Zones.  But the PWE Council had wisely adopted the Thousand Steps policy, based on the enlightened concept that yielding- in a strictly controlled way, of course- to the opposition would actually hasten the transition, whereas an overpowering show of force could prolong the resistance indefinitely.  The power of the state was not without limits, and history provided many cautionary tales.  Attempts to brutally crush insurgencies in Northern Ireland, Vietnam, the Middle East, South Africa, and China itself, had all led to catastrophic domino effects, throwing fuel onto smoldering fires.


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!

The Latest On Fourth World

My science fiction novel Fourth World came out 6-7 months ago as an e-book, but now is available in paperback, on Amazon:  there is a link to the Amazon site on this blog.  Hope you enjoy it!  I want to thank readers of this blog, and of Fourth World, for all your interest and support.  Who knew there would be so many aficionados of medicine, genetics, geopolitics and Mars in the year 2196?

An update on the sequel, Fourth World Nation:  I know a sizable number of readers are anxiously wondering (and have given me grief over) what happens to Benn and Lora.  Well, the wait is almost over- I am nearly finished with the first writing of the sequel, and re-writing will take a couple of months.  Then it’s onward to the dramatic conclusion to the trilogy!