Adventures in medicine: ‘I journey through the body every day’

Gavin Francis in The Guardian:

BrainThrough my encounters in the clinic, I’m often aware of the ways humanity’s finest stories and greatest art can resonate with, and help inform, modern medical practice. Doctors do their jobs better when they are up to date with the science behind the treatments they prescribe, but also when they acknowledge the importance of culture, metaphor and meaning in the way we make sense of our lives. Sometimes I feel the need to take a step back from the white-tiled walls and jargon of the clinic and see medical practice in a broader context: embedded at the heart of human lives, with all their complications, disappointments and celebrations. The body is a kind of landscape after all – the most intimate one – and a storehouse of almost indescribable marvels.

There was a time when if you wanted a good day out you might go along to see a public dissection – the bodies of criminals would be laid out in a public space and anatomised. The popularity of these events was not just educational, of course – it was partly about voyeurism, but it also spoke to a deep need to glimpse deeper into the mystery of our own humanity. It was considered entertainment to see life and death stripped back to essentials; the physician-anatomist was like a guide exploring inner space. These events became popular in the 16th century but had their roots in public spectacles of the Romans. Public dissections fell out of fashion around the time doctors were growing in power: no longer guides to a mysterious inner kingdom, but autocrats protecting secret knowledge. That paternalistic attitude reached a high point perhaps two or three decades ago, but is increasingly out of fashion. The time might be right to bring back public dissection, but instead of using scalpels and saws, I prefer to cut up the body using stories, literature and art.

More here.

Sunday poem

Lake Isle of Innisfree

I will arise and go now, and go to Innisfree, And a small cabin build there, of clay and wattles made: Nine bean-rows will I have there, a hive for the honey-bee; And live alone in the bee-loud glade.  And I shall have some peace there, for peace comes dropping slow, Dropping from the veils of the morning to where the cricket sings; There midnight’s all a glimmer, and noon a purple glow, And evening full of the linnet’s wings.  I will arise and go now, for always night and day I hear lake water lapping with low sounds by the shore; While I stand on the roadway, or on the pavements grey, I hear it in the deep heart’s core.


by W.B. Yeats

Want to Get Out Alive? Follow the Ants

Conor Myhrvold in Nautilus:

PanicSome animals evolved to clump together when threatened because it increased their chances of survival. “Predators have the ability to focus and concentrate on individual prey,” says Ralph Tollrian, a professor in Germany who has spent his career studying the predator confusion effect. “When they handle one prey, they can’t hunt the next.” Birds and fish form groups that move chaotically in the presence of a predator, giving it “cognitive overload,” says Randy Olson, who builds computer models of predator and prey behavior at Michigan State University. The predator’s cognitive overload can be so strong that it may give up on its pursuit entirely. “A confused predator can sometimes become frustrated and not hunt at all,” Tollrian says.

Humans, too, developed a tendency to clump together in the face of danger. There are many advantages to that, Tollrian says—from defense (it’s easier for a group to fight off a threat) to safety in numbers (people can hide in a crowd). When humans moved to agrarian and urban lifestyles, our dangers changed—but our responses didn’t, says Randolph Nesse, a professor of psychiatry at Arizona State University who studies the evolutionary reasons behind anxiety. “We continue to be afraid of things that were dangerous to our ancestors,” Nesse says. When we panic, ancient instincts kick in. In a room with six exits, it seems like the most logical course of action would be for the crowd to divide evenly among all six. Instead, we stampede to just one. We disregard logic and get injured. While we may not be able to unlearn our instincts, we might circumvent them if we better understand the nature of escape panic. Since studying panicking humans is difficult, scientists are turning to an unexpected source of inspiration: ants. “Humans and ants are hugely different animals,” says physicist Ernesto Altshuler at the University of Havana, Cuba, who studied how ants escape in emergency situations. “But when you are in panic, humans behave in a very elementary way, and we may look a little bit like ants.”

More here.

Why birds don’t crash

Peter Reuell in the Harvard Gazette:

PigeonInFlight605Navigating a cluttered environment at high speed is among the greatest challenges in biology. Yet it’s one virtually all birds achieve with ease.

It’s a feat that David Williams is working to understand. A former postdoctoral fellow in the Harvard lab of Charles P. Lyman Professor of Biology Andrew Biewener, and now a postdoc at the University of Washington, Williams is the lead author of a study that shows birds use two highly stereotyped postures to avoid obstacles in flight.

The study could open the door to new ways to program drones and other unmanned aerial vehicles to avoid similar obstacles. The study is described in a paper recently published in the Proceedings of the National Academy of Sciences.

“This was somewhat surprising to us,” Williams said of the results. “In lower-order animals like insects, we think of these very stereotyped motor programs where you stimulate your muscle, and the passive dynamics of your exoskeleton or the tendons attached to that muscle control most of the motion.

“But when you look at higher-order animals, it’s common to expect that those motor programs are going to be more complex, and there’s going to be more subtle gradations in those programs. So it was surprising to see a very high-order animal like a bird using very simple motor programs. Biology is optimized to be just good enough to work, so what that indicates is those are very effective motor programs.”

More here.

Why we need physical books

William Giraldi in The New Republic:

ScreenHunter_1171 May. 02 21.47Not long into George Gissing’s 1903 novel The Private Papers of Henry Ryecroft, you find a scene that no self-respecting bibliophile can fail to forget. In a small bookshop in London, the eponymous narrator spots an eight-volume first edition of Edward Gibbon’s The History of the Decline and Fall of the Roman Empire. “To possess those clean-paged quartos,” Ryecroft says, “I would have sold my coat.” He doesn’t have the money on him, and so he returns across town to his flat to retrieve it. Too broke for a ride on an omnibus, and too impatient to wait, he twice more traverses the city on foot, back and forth between the bookshop and home, toting a ton of Gibbon. “My joy in the purchase I had made drove out every other thought. Except, indeed, of the weight. I had infinite energy but not much muscular strength, and the end of the last journey saw me upon a chair, perspiring, flaccid, aching—exultant!”

A pleasing vista onto the early twentieth-century life of one English writer, Gissing’s autobiographical novel is also an effusive homage to book love. “There were books of which I had passionate need,” says Ryecroft, “books more necessary to me than bodily nourishment. I could see them, of course, at the British Museum, but that was not at all the same thing as having and holding them”—to have and to hold—“my own property, on my own shelf.” In case you don’t quite take Ryecroft’s point, he later repeats “exultant” when recalling that afternoon of finding the Gibbon—“the exultant happiness.”1 Exultation is, after all, exactly what the bibliophile feels most among his many treasures.

More here.

How we lost touch with animals, life and death, and learned to find butchery repulsive while eating more meat than ever

Amanda Giracca in Aeon:

ScreenHunter_1170 May. 02 21.29The skin did not come off like a sweater, as I’d been told it would. I’d looked at how to do it in the classic Joy of Cooking, figuring the directions for squirrel couldn’t be much different from rabbit: hook it through the heels, yank the skin down to its paws. I didn’t have a hook, but even the falconer, Chris Davis, who had given me this squirrel, made it seem so simple – use scissors, he’d said, and snip horizontally into each side from the gaping hole where he’d gutted it, grab the corners of the soft fluffy pelt and pull up. Pull down. Voilà.

Sitting out by the fire pit in my back yard on a late November evening, my fingers grew stiff and numb as I pulled at layers of epithelial tissue I could not see so much as sense, subcutaneous membranes of iridescent silver visible only when I shone my headlamp just right. I could see places where the talons of the hawk that had caught the squirrel had punctured into the muscle, bruising it. Little by little, I worked the rich gray pelt down and away from the purple muscles, snipped away the durable membranes, and turned the small mammal from one piece into two.

I snipped off the head and feet with a pair of shears and buried them in my compost pile. Yesterday, when Chris had given me the squirrel, the eyes had been wide-open and filmy white. I was grateful that they’d shrunk to nearly closed overnight. I’d hardly noticed the face as I skinned, but I might have if it still had the demon-ish pale glare. The task was engrossing, a science project, or dinner preparation, a little of each I suppose.

More here.

Introducing The Bookist, Amitava Kumar’s column on books and the art of writing

Amitava Kumar in the Hindustan Times:

10801876_10100241739898185_6331622585153343227_nI am writing this on a train. It is dark outside, the dark window reflecting the interior of the bright-lit train car, the beige plastic seats, the metal overhead racks. I can see in the dark glass the girl on the seat across from me.

I cannot discern her face but I see her reflection holding an iPod in her hand. Her nails are painted silver. We are on the 5.34 Metro North from Poughkeepsie to New York City.

I’m going to a party at a writer-friend’s house but the real reason I’m on this train is because I wanted to write this column. I wanted the time alone on the journey down to the city and back.

The writer Patricia Highsmith once said that she was rarely short of inspiration; she had ideas, she said, “like rats have orgasms”. I cannot make the same claim. I don’t think writers need ideas so much; what they really need is time.

Or, more accurately, the need is for those conditions of work, the meeting of place and habits, that allow the right words to emerge. I say this because I have beside me on the seat here a book called Daily Rituals.

It offers short accounts of how writers and artists work. The above quote from Highsmith is something I came across in this book. And the detail that, probably to keep distractions to a minimum, she ate the same food every day: American bacon, fried eggs and cereal.

More here.

Sam Harris exchanges emails with Noam Chomsky

From Sam Harris's blog:

April 26, 2015

From: Sam Harris
To: Noam Chomsky


Noam —

I reached out to you indirectly through Lawrence Krauss and Johann Hari and was planning to leave it at that, but a reader has now sent me a copy of an email exchange in which you were quite dismissive of the prospect of having a “debate” with me. So I just wanted to clarify that, although I think we might disagree substantially about a few things, I am far more interested in exploring these disagreements, and clarifying any misunderstandings, than in having a conventional debate. 



If you’d rather not have a public conversation with me, that’s fine. I can only say that we have many, many readers in common who would like to see us attempt to find some common ground. The fact that you have called me “a religious fanatic” who “worships the religion of the state” makes me think that there are a few misconceptions I could clear up. And many readers insist that I am similarly off-the-mark where your views are concerned.

In any case, my offer stands, if you change your mind.



Best,

Sam

April 26, 2015

From: Noam Chomsky
To: Sam Harris

Perhaps I have some misconceptions about you. Most of what I’ve read of yours is material that has been sent to me about my alleged views, which is completely false. I don’t see any point in a public debate about misreadings. If there are things you’d like to explore privately, fine. But with sources.

More here.

on ‘SSES”‘SSES”“SSEY’ by Chaulky White

SSES-vol-0-1-front-cover_500Jesse Kohn at The Quarterly Conversation:

In 1990, Kevin White composed a piece of writing called ‘SSES”‘SSES” as his thesis for a master’s degree at Art Center College of Design in Pasadena. In it he used the structure of Joyce’s Ulysses as a lens to refract and reflect on his own travels through Asia in search of his (and Derek’s) father, who committed suicide in 1982. ‘SSES”‘SSES”, along with Kevin’s journals and notebooks, came into Derek’s possession when Kevin died of a drug overdose in 1997. Derek describes SSS on what might be page one (as we shall see, where the book begins and ends are not clearly delineated), as “a dilated (+belated) expansion of that book, a deconstructed REDUX w/ further recapitulations by me searching recursively in parallel for: my brother searching for: our father.” Embedding ‘SSES”‘SSES” within carefully but chaotically assembled pages composed of Kevin’s journal entries, fiction fragments, reproductions of his paintings, and designs for conceptual art pieces, Derek has created, or curated, something much more complex than an homage to his brother or an archive of his creative output. In Derek’s hands, and with recourse to the guidance of the structure of Homer’s Odyssey, what could have been a sort of Collected Writings of Kevin White becomes instead a labyrinthine and polyphonic odyssey of its own wherein Derek’s chronicling and deconstructing of his curatorial and editorial processes become as integral to the collection as what it collects. This is also, by the way, only half of it: Books 0 and I, “En-Telemachy (In Absence)” and “In Pursuit of Higher Art In.” Book 2, “The Homecoming,” remains in progress and will comprise Volume 2.

The radical demands and strategies to be found within SSS—and Derek White’s publishing project as a whole—spill out onto the cover page.

more here.

Einstein’s Dice and Schrödinger’s Cat

41x7Md17jEL._SY344_BO1,204,203,200_Jennifer Ouelette at The New York Times:

On a cold January day in 1947, Erwin Schrödinger took the podium at the Royal Irish Academy in Dublin and triumphantly announced that he had succeeded where Albert Einstein had failed for the past 30 years. Schrödinger said he’d devised a unified theory of everything that reconciled the general theory of relativity with quantum mechanics. His announcement caused a sensation in the international press, which shamelessly played up the David and Goliath angle, much to Schrödinger’s discomfort and Einstein’s irritation. It nearly destroyed their longstanding friendship. Matters became so acrimonious at one point, with rumors of potential lawsuits, that another colleague, Wolfgang Pauli, stepped in to mediate. A full three years would pass before the estranged friends gingerly began exchanging letters again.

This tale of two physicists, their shared quest for unification and the media frenzy that tore them apart is the focus of Paul Halpern’s latest book, “Einstein’s Dice and Schrödinger’s Cat.”

The men were natural allies. Both were Nobel laureates, recognized for foundational work in the earliest days of quantum mechanics. Each had a strong philosophical bent, which shaped his worldview.

more here.

the French Author Who Has Happiness Figured Out

David Marchese in NYMag:

HappyIs American culture too time-consuming for happiness?That's the problem of modern life! I’ve noticed that in New York, people say, “Yes, I'm searching for happiness,” but they don't then do what is absolutely necessary to try to be happier — and the most important thing is to observe yourself, to practice meditation, to be very aware of what you're doing, not thinking of the bad things or the pressures you’re under. I stayed recently for a month in New York, and it was very interesting, because I asked all the people I met, “Are you happy?” And everyone says, “Yes! I’m great!”But if you observe them, it’s clear they’re always under under pressure — to work or succeed or produce in some fashion. Advancement is all they have time for. It doesn’t seem like they’re enjoying life. And I thought maybe they always say “I'm happy” because it feels necessary to say that. If you say “I'm not happy,” people might think you’re a loser. So in America there’s even pressure to be happy, which is not the case in other countries.

On a scale of 1 to 10, with 1 being suicidal despair and 10 being full-body bliss, how happy are you? Seven. But when I was a teenager, I was maybe a four.

Most teenagers are probably about a four. Yes, but it gets better with time. I saw a very interesting study that said that most people feel happier between 50 and 70 years old. With time, with the experience of life, we can know ourselves better, and that leads to happiness. There’s a part of the book where I explain that sociologists do experiments where they ask people to rate their happiness, exactly like you just did. And they’ve observed that if people don't work on themselves, if they don't try to change their minds, to practice the meditation, to do something special to improve their happiness, then the rating they give will always be the same. It’s like how lottery winners revert to their old levels of happiness over time — the external, material circumstances don’t affect their happiness in the long-term. It takes mental work. Like scientists say, we as individuals may have fixed natural levels of happiness. But you can change it if you work on it. So in all senses, your happiness depends on you.

More here.

‘There Is Simply Too Much to Think About,’ Saul Bellow’s Nonfiction

Martin Amis in The New York Times:

Bellow“The flies wait hungrily in the air,” writes Saul Bellow (in a description of Shawneetown in southern Illinois), “sheets of flies that make a noise like the tearing of tissue paper.” Go and tear some tissue paper in two, ­slowly: It sounds just like the sullen purr of bristling vermin. But how, you wonder, did Bellow know what torn tissue paper sounded like in the first place? And then you wonder what this minutely vigilant detail is doing in Holiday magazine (in 1957), rather than in the work in progress, “Henderson the Rain King” (1959). It or something even better probably is in “Henderson.” For Bellow’s fictional and nonfictional voices intertwine and cross-pollinate. This is from a film review of 1962: “There she is, stout and old, a sinking, squarish frame of bones.” Two decades later the image would effloresce in the story/novella “Cousins”: “I remembered Riva as a full-­figured, dark-haired, plump, straight-legged woman. Now all the geometry of her figure had changed. She had come down in the knees like the jack of a car, to a diamond posture.”

In 1958 a Gore Vidal play was adapted into the famous western “The Left Handed Gun” (which starred his friend Paul Newman); and it has often been said that when writers of fiction turn to discursive prose “they write left-handed.” In other words, think pieces, reportage, travelogues, lectures and memoirs are in some sense strained, inauthentic, ventriloquial. In Vidal’s case, literary opinion appears to be arranging a curious destiny. It is in the essays (or in those written ­before Sept. 11, 2001) that he feels right-handed. His historical novels, firmly tethered to reality, have their place. But the products of Vidal’s untrammeled fancy — for instance “Myra Breckinridge” and “Myron” — feel strictly southpaw. Bellow, by contrast, is congenitally ambidextrous.

More here.

Saturday Poem

Niagara River

As though
the river were
a floor, we position
our table and chairs
upon it, eat, and
have conversation.
As it moves along,
we notice—as
calmly as though
dining room paintings
were being replaced—
the changing scenes
along the shore. We
do know, we do
know this is the
Niagara River, but
it is hard to remember
what that means.

by Kay Ryan
from Persimmon Tree.org

Why Telemedicine Needs to Redesign the Doctor’s Appointment

Kyle Vanhemert in Wired:

Dot_doc4-582x608Talking to doctors via video chat is the future. Talking to doctors via text message is the even better future we should hope for after that. A new partnership between insurance provider UnitedHealthcare and three leading telemedicine companies will make virtual doctor’s visits a reality for many Americans. The insurer is putting telemedicine on par with a trip to the doctor’s office, effectively saying a video visit is as good as brick-and-mortar check-up. It’s a significant step into the future of healthcare, and it points to an interesting design challenge. Setting aside for a moment the complex thicket of regulations governing telemedicine: When it comes to staying healthy, what’s the ideal user experience? NowClinic, Doctor on Demand, and American Well, the companies partnering with UnitedHealthcare, focus on a fairly straightforward brand of telemedicine: Letting patients confer with doctors over video. Their apps aim to virtualize the doctor’s appointment as it’s existed for decades. There are reasons you might want that. Video visits can make quality health care more accessible to people in rural areas. For the rest of us, they may simply be more convenient. An on-demand video appointment means no leafing through germy back issues of People in a waiting room. Brian Tran, product lead for Doctors on Demand, says he wants patients to think of the experience as “FaceTime with a doctor.”

Still, this version of telemedicine isn’t as easy as pointing a web cam at a physician. “We want to balance the elegance of a consumer app with a real clinical encounter,” says Katie Ruigh, American Well’s VP of Product. By “real clinical encounter,” Ruigh means all the stuff that make you feel you’re in the hands of an expert: the formal setting, the white coat, the stethoscope in the pocket. Ruigh says American Well encourages doctors who work at home to create a suitable back drop for video appointments, even suggesting in some cases that they hang their framed diplomas on the wall within the frame. She also points out that American Well looks for “webside manner” when evaluating doctors; when you’re not meeting face to face, things like eye contact and attentive listening become more important to the overall experience.

More here.

Taste, Sickness, and Learning

Davidson and Riley in American Scientist:

GirlImagine that you are dining at a familiar restaurant, and you order a new item on the menu—something that you’ve never tried before—and later that night you become violently ill. What caused you to get sick? Your illness could have been caused by a touch of the flu, a familiar food that was poorly preserved or prepared, an exposure to a toxin, or a favorite cocktail interacting badly with some medication taken earlier in the day. But even if you are aware of these and other alternative possibilities, there is a high probability that you will blame the novel dish for your illness. Indeed, the taste, and even the thought, of that new menu item may subsequently make your stomach turn, and you may decide never to eat that food again.

No doubt many of us have had this type of experience. Why are we so quick to place the blame for sickness on a novel-tasting food instead of blaming many other equally plausible possibilities? You may be thinking that blaming the unfamiliar food is the most logical response, but why does it seem that way? We’ve eaten new things many times before without becoming ill, and we’ve become ill before without eating anything new. What makes the connection between a novel taste and illness so strong that it can override these other types of experiences? Answers to these questions, as well as evidence for the reality of the phenomenon itself, were found not in anecdotes but in the results of experiments. Those results shook the foundations of psychology as it existed at the time, and led to a paradigm shift in thinking about how humans and other animals learn in general, and about the conditions under which learning occurs.

More here.

Who Will Pay Reparations on My Soul?

MI0001930751Jesse McCarthy at The Point:

In German, the word schuld means both guilt and debt. In the context of the American debate about race relations, “reparations” likewise reflects both sides of the coin. The principal difficulty with reparations, as with black history in America more generally, is that guilt is an unpleasant feeling, susceptible of clouding judgment. Guilt colors the whole conversation. Today nobody can deny that being charged with racism is one of the most incendiary charges one can levy in public life. People are genuinely mortified by the accusation; many fear to even approach racial topics, or tread though them like a minefield. This legacy of political correctness has proved double-edged. On the one hand, a certain kind of public discourse is far less poisonous and injurious than it was a few decades ago. On the other hand, we have made race a relentlessly personal issue, one that often shields and distracts us from the harder questions of structural inequality, racial hierarchy and social control.

Ta-Nehisi Coates, an editor for The Atlantic, has recently joined a long tradition of black American writers stretching back to David Walker by calling upon America to live up to its moral promise; to reimagine itself, in Coates’s words, through “the full acceptance of our collective biography and its consequences.” His essay “The Case for Reparations” has renewed the enduring debate about the possibility of reparations as payment for racial injustice in the United States.

more here.

Pine Ridge Indian Reservation Struggles With Suicides Among Its Young

Julie Bosman in the NYTimes:

29SUICIDEWEB1-master675Two teenagers hanged themselves in December. In the next three months, seven more young people were found dead, including Alanie Martin, 14, who was known for her love of basketball, cheerleading and traditional Indian hand games. When Santana killed herself in February, she followed another recent suicide of a boy who attended her school, Wounded Knee, so named for the 1890 massacre that occurred where the reservation stands today.

Many more youths on the reservation have tried, but failed, to kill themselves in the past several months: at least 103 attempts by people ages 12 to 24 occurred from December to March, according to the federal Indian Health Service. Grim-faced emergency medical workers on the reservation, which is the size of Delaware and Rhode Island combined, say they have been called to the scenes of suicide attempts sometimes several times a day.

Tribe officials, clergy members and social workers say they cannot remember such a high rate of suicides and attempts in such a short period of time on the reservation, which is already overwhelmed with high rates of unemployment, poverty, domestic abuse and alcohol addiction.

In 2013, five people, including adults and children, killed themselves in a single year, according to the Oglala Sioux tribe. But officials at Pine Ridge said they were mystified by the far more pronounced increase in the past several months and had searched, unsuccessfully, for answers.

As the suicides began to mount in February, the Oglala Sioux tribe president, John Yellow Bird Steele, declared an emergency on the reservation. In response, the Indian Health Service deployed additional counselors, but many people here say it is not nearly enough: There are only six mental health professionals on the entire reservation, which has a population of 16,000 to 40,000 members of the tribe.

Read the rest here.