Saturday, January 2, 2010

Zoom Lense for Thought

It's a bit unnerving to be sick. OK, it's a lot unnerving. Maybe it's like being lost, suddenly realizing that you might not know which way to turn, and that if you don't get some clue or guide you might starve or die of thirst. On a boat, say, or on the highway coming back to awareness after getting off the cellphone. Now, where am I?

There can be a kind of vertigo or nausea in a fog at sea without your compass. Rocks loom. Other vessels. And so now researching why I might have suffered an acute episode of clots to my lungs, I start to think back to other things which happened in my past. I start to orient myself to lesser events which might have been related. But even as I orient myself, there are new fears represented by exotic names. Diseases which kill people or change their lives, leaving them living in a kind of constant panic maybe, or mutilated by surgery.

I want a guide. I don't want someone to make all my decisions for me. I'm still the sailor, but in uncharted territory for me. 

I'm pretty sure I myself mistook one previous pulmonary embolism for a panic attack. I lay down in bed and couldn't catch my breath. There was plenty of reason to credit the panic attack theory, or at least there is retrospectively since it came in some proximate relation to losing my mind at the time. Funny that I can't remember if it was before of after the big out-of-mind event, which would create an interesting causal chain in lots of ways.

The situation makes an interesting crossing of emotional and physical disturbance. Not being able to breath is pretty anxiety provoking, but then the kind of anxiety which you might experience living in the middle of nowhere in fear or actual danger of losing your mind might also make it hard to relax your breathing.

And then there is the whole field or concept or notion of psychogenic disease, the placebo effect and more. It's convenient, for the sake of research, to segregate the mind from the body, just as it's convenient for the study of the cosmos to keep mind apart from matter. I've been arguing in rather prolix fashion for quite a while now that these are artificial distinctions without any real difference.

But I'm not trying to make the case that there isn't any difference; only that along the boundaries - in the liminal zone - things get really interesting. That's where they always get interesting. That's where new life always forms.

In the case of cosmoslogy or physics, the liminal is the realm of the really really small or really really distant or large or long term. But you know, in the realm of the body, the placebo effect is really relatively huge. We're not talking infinitesimal fractions of reality here, but life altering interactions.

In the field for engineering artificial life, the hot new pursuit is Bayesian statistics. The most famous recent illustration of its importance is the breast cancer screening fiasco, where almost all doctors make the wrong mental calculation/assumption that since 80% of women with breast cancer have a positive mammogram, therefore if you test positive on the mammogram, your chance of having cancer is approximately 80%. In fact, since 1% of the population has cancer, and since 9% of the population without cancer tests positive, which is a much higher absolute number than the ones with cancer who test positive, getting a positive result only indicates that your probability of having cancer is 7.8% compared to 1%, and isn't necessarily a good reason to do something drastic. It's a good reason to get another test.

But the other test has to be theoretically distinct from the first one. In other words, even though you expect the two tests (or more) to be correlated, they can't be proxies for one another. They can't be testing the same "mechanism." Otherwise, you're just doing the same thing over and over and expecting different results.

So, suddenly, it does seem obvious that the fields of medical research and practice might need to become more cognizant of Bayesian reality. Even more important would be that this kind of thinking gets translated to the public.

This is the same distortion of reality, not incidentally, which causes us all to get really exercised when a plane crashes, but feel both disinterested and unconcerned that there are orders of magnitude more deaths from clinical mistakes in hospitals.

We panic about releasing hardened terrorists from Gitmo, even though they will never do so much harm as we do each day on our highways. We dismiss collateral damage from the smartest bombs, as though there were never any choice about taking the shot in the first place. We confuse science and religion and call abortion murder, and assassination war.

There is clearly a money connection to how this kind of thinking gets promoted. Heart attack almost never happens among people with low cholesterol. A drug is found to lower cholesterol. Damn the side effects, put the whole world on it. But no study is ever done in the way of making money, to determine what the cholesterol might be proxy for. Inflammation?  Generalized propensity?

Lots of TV ads now depict theories, below which are disclaimers that these only represent the way things "might" work. Mostly, we're only interested that the treatments do work, and not why or how.

Allopathic medicine - so called by its homeopathic detractors - of the sort which is almost exclusively practiced and compensated in these United States stands in a relation of nearly perfect analog to the exclusion of the subjective mind from the study of physics. The body is treated as an autonomous system, relative to which the mind must remain removed and calm if optimal outcomes are to be achieved by medical intervention.

Or perhaps the mind can be harnessed as an ally, if trust can be earned, and a progression toward well-being can be believed in. But somehow, thinking oneself well feels a bit like levitation as the result of meditation. As though gravity could be defied by thought (notwithstanding that polling shows that lots of people do and always will believe such outlandish things).

Still, there is no way to measure the benefits of medicine without taking the placebo effect into account. That's what double-blind means, though I still want to know if they do proper Bayesian statistics in calculating the therapeutic benefits of various drugs and treatments. Especially with the psychotropics, where the underlying issues of being out of work or homeless are excluded as being that far beyond the reach of medicine. Medicine money for jobs, jail costs for education. Why do these remain such radical ideas?

I have fun these days among friends with various autoimmune diseases alerting them to the possibilty that the re-introduction of such parasites as hookworms might have a salutary impact far beyond symptom-fighting approaches. The theory is simple enough: our immune system co-evolved with parasites, and in their absence targets itself. OK, I don't exactly have fun, but it strikes me as a promising area for further research.

Of course, there's no money in it - the doctor who supplies the hopeful with hookworms makes enough for lots of people from his own poop. And then there's the gross out factor, like debriding wounds with maggots. We seem to want to live in a world of cartoon clean. Even while our animated entertainments are moving in the direction of more life-like and messy. Go figure.

Well anyhow, I have nothing terribly profound to say here. Only that we shouldn't be so terrified of extrinsic threats to our nation when its we, ourselves, and us who have and are destroying whatever we once meant by America. We shouldn't set ourselves up to see healthcare as a consumer good if we want to be partners with our physicians. We should treat health insurance a the commonwealth property of all citizens who live here, and get the money out of science to the extent that we can.

And we should never let blowhards who push our buttons overrule the good science. But of course that means that we have to work to establish better means of communication and to establish trust across the various educational and class divides. For that, I'd have to say the burden is on the privileged, who deserve what they get from the Palin followers, anti-global warming conspiracy theorists, and faith healers everywhere.

Oh, and Happy New Year!! I've survived another blue moon episode as if it were only a dream.

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