Month: March 2017

The political climate surrounding the issue of healthcare reform which has been charged for some time, seems to be reaching a climax in the United States. Reading and hearing the opinions voiced (sometimes shouted) by others one thing becomes apparent. (1) We all agree that the system is less than ideal. However, I have also found it troubling that everyone is concerned about what the government should do. Interestingly both sides leverage the same religious principles and ideals to justify opposing positions. The argument is that if we love our neighbor as our loftiest religious ideals describe, we would support one form of government healthcare reform or another. And herein lies the problem. Instead of taking responsibility for loving our neighbor, for giving to the poor, and to caring for the sick at the personal level regardless of the healthcare laws, we push the responsibility of loving onto the government.

Interestingly, neither group seems to be seeking out ways to give. The government is not the only way to give. Neutral analysis shows very clearly that the government programs are not the most efficient ways to be charitable. The government simply has the power to do what other charities cannot- force people to give*. What we need is not a revamping of a government program forcing people to give, but rather a change in how people see others and how willing they are to give. If members from both sides of the spectrum spent their time trying to figure out how to give more of their money away more effectively, healthcare reform would not be a problem. But instead members from both sides hold signs, give speeches, sign petitions, and make posts on social media about their political cause.

Charities have rapidly realized that the best way to get people to give is not by giving impressive statistics but by sharing personal stories. When we push all of our charitable work onto the government, we lose any personal story and see only statistics. When we engage with one another, when we let our needs be known and get to know other’s needs, that is when we are most charitable and affect the greatest change. Dollar for dollar and hour for hour it would be far more effective to fund every gofundme healthcare page or fund the private charities than to fund large healthcare programs with high overheads and little good will towards those they help. But the problem is us. The problem is you. The problem is me. We don’t give willingly, and rarely generously. Instead, we need to be forced to give. So we resort to large programs, with high overheads, and political battles that cause little change. It is our hearts, not the programs, that need rewriting.

If you believe that the affordable care act should be rejected and rewritten you have a responsibility to give to the sick, to feed the poor, to help the needy because that is not the government’s job anymore; it’s your job. It’s my job. If you believe that the affordable care act should be kept or expanded you have a responsibility to the sick, to feed the poor, to help the needy because the government cannot take care of all the hurt in the world. If you believe that money should be redistributed to the neediest, start now, there is no need to wait for a government mandate. Love now, give now. This is your job. It’s my job. Only when we love, when we care, when we give at the personal level, seeking out opportunities to give generously instead of waiting to be forced to give by an inefficient government program, can any real change happen.

* and borrow large amounts of money without a plan to repay-but we will save that topic for another time

Considering our place in evolutionary history, one of the most interesting, yet confusing ideas is the fact that we are the result of billions of years of evolution yet are also the substrate upon which natural selection is currently working. This is interesting in the fact that one can think about our bodies and minds as being perfected by all those millenia, yet being so imperfect as to require many millenia more of perfecting. In reality, there is no perfect organism in an environment that is continually changing. What is ideal one decade may be highly unideal the next if the environment changes quickly.  Humans have managed to step outside of this constraint in some ways as we are, of all the other species on the planet, the most able to change the environment around us. In many ways, this enables us to shape the natural selection being applied to our species. This should terrify us. 

Reworded, our ideas, turned into actions, are now the actual force changing how our species evolves. In many aspects this is good. Many people benefit from the ability to wear eyeglasses, stay warm when it is cold out, or store food for long periods of time. However we must realize that anytime we alter the environment, we change the course of evolutionary history. The risk of unintended consequences, no matter how good the intentions, is high. However the opportunity to do good for our species and the other species inhabiting our planet is also immense. To crib Uncle Ben from Spiderman, “With great power comes great responsibility.“

Because it works. Although there are some medications with functions nearly definite and specifically designed (such as imatanib), many of the medications used in the clinics and hospitals of the world are used because they are effective in treating disease and have tolerable side effects not because we fully understand how they work. Aspirin was used for many years in many forms before a good idea of how the medication was likely exerting an effect was worked out. Cancer chemotherapies were originally cocktails of cytotoxic drugs used in varying combinations and concentrations until a more or less effective recipe was obtained (for more on the history of cancer, Emperor of All Maladies is an excellent read). The gold standard then for determining medication is (1) Is the medication safe? (2) Does the medication treat the disease as well or better than the current standard of care? While researchers elucidate the details of how the medication is working, a well understood or worked out mechanism is not required for use in patients. Success through clinical trials requires a demonstration that the medication is safe in small and large groups of patients and demonstrates a therapeutic effect greater than the therapies which are currently available.

In a similar manner we make decisions in our life based on these two questions: (1) is it safe?  and (2) is it effective, does it work? We select anything from over the counter medications, to grocery stores, to restaurants, to friends, to cars, to occupations, to schools, to hobbies based on these two questions. Often we don’t require an in depth mechanistic knowledge of how these things work (how good of a car mechanic, pharmacist, or chef are most of us?) The strange thing is, that if you ask most people they will assume that we have an in depth knowledge of these things. This assumption makes it easier to function in a system where the real answer is very likely because it’s safe and because it works.

Competition is a great motivator of productivity and new discoveries. However, differentiation of competitors from comrades can often be more difficult than it appears at first blush.

One important aspect to elucidate to determine whether or not the goal you are pursuing is part of a zero sum game or if room for growth all around exists. Does you making a dollar mean another person losing a dollar? Or vice versa, does their success cost you an equal amount of success?

It often appears that as human beings we envision competition where there is none and assume a zero sum game when in reality the playing field can be widened allowing for success all around. One reason this seems to be the case is that it is easy to see those with whom we interact the most as the greatest problem. Researchers at the same institution see one another as competition instead of collaborators. Medical students, residents, or physicians see one another as challengers instead of fellow team members. Employees working on the same project see the success of fellow employees as detrimental to their own success instead of recognizing the success of the team. In everyday activities it is often helpful to carefully consider and identify the competition and recognize the collaborators. Often we limit ourselves by confusing collaborators with competition and lose out on valuable opportunities for mutual gain. From intellectual, industrial, technological, and economic standpoints our societies rely on expansion of what is not competition within. Therefore far more opportunities for collaboration exist than competition. Taking a moment to recognize and appreciate our collaborators can be instrumental in propelling our progress personally and societally. There are enough real competitors out there that we need not create imagined competition in our minds. 

Often we think about what could be, the perfect way to solve a problem, the most ideal way to solve a problem. This sort of speculation can lead to new solutions to problems or can serve as an excuse to avoid hard work and making a difference in the ways that we are able at that point in time. I was recently talking with a researcher who was bemoaning some of the limitations associated with recent gene editing technologies such as CRISPR-Cas9. There are three different paths that this thinking can proceed. The first is to motivate one to discover and invent something new, something better, something that will address the deficiencies which one has identified. The second is to refuse to use what is available focusing on the downside instead of the potential. The third is to use what is available at that point in time to make as great of a difference as one can.

These three different paths define who  we are, how we live, and whether or not we will make a difference. Most of the time we must choose between the second and third choice. Use what is available to do what we can or relegate ourselves to the sidelines citing how less than optimal conditions for progress are. Perhaps the best option is to do what we can now while pressing forward to something better. That is the best of medicine and biomedical research. Using the tools we have now to treat the disease confronting patients in the present while also seeking new therapies and treatments for the patients who will present to us in the future. Pushing for better should no limit us to doing our best now with what we have. Let us make it our goal to do what we can with what we have while relentlessly pursuing better together. 

One of the desires of the human heart is for the promise of eternity. We hate watching one chapter of life end so much so that often we are dreading the end even while still in the beginning. Our hope is to achieve some form of eternal security, something that cannot be taken away from us. A state in which striving is unnecessary and our status is guaranteed. Yet while this is the goal for many, the actual realization of that goal is enough to drive many mad. Take retirement for example, phase of life which is as close to the striving free existence as one can get. For many, the sudden absence of a reason to get moving in the morning can be disconcerting. Often alternative objects and goals to strive after are sought. Few things about the human condition are as agreed upon by writers and thinkers across cultures as constant striving as a definition of the human condition.

 

However, while we are striving for more, bemoaning our finitude and pursuing the infinite, it rapidly becomes apparent how unfit we are for the infinite as well. Our minds and bodies make enjoyment of the infinite an impossibility. Life desensitizes us to the things around us, both pleasant and unpleasant. Bad odors which initially gag us upon entering a room no longer bother us after a few minutes. Exciting roller coasters or delicious treats which initially enthralled us become nauseating. Part of the human condition is the pursuit of new experiences. We want to hear new music, see new places, meet new people, eat new food. Expand this to the infinite. We are so bound to living in a finite place and time that we cannot think of an eternity with any form of accuracy, however let us make a few points. However one could think of an infinite life in this universe as a form of groundhog day. One may be able to change some things, go visit a new place here or there, learn a new skill, but over billion, or trillion, or more years, nothing new would exist. No new ideas, nothing new to experience. One would become inured to everything.

 

We seem to be neither made for the finite or the infinite. Rather our hopes and desires are caught up in the infinite which propels our behaviors and actions in the finite. It is living in this tension that we continue. As C.S. Lewis writes “For the present is the point at which time touches eternity.” The only way to make a lasting impact is to live in the present. Spending time bemoaning our past and our finite nature, or conversely, only looking forward to a brighter future someday denies our humanity and robs us of our chance to make a difference with the time that we have been given.

 

Adept Adaptors

One incredible feature of human beings that I am always surprised with is the ability of the human body to adapt to gradual changes. The body does not adapt well to rapid changes but can often find a way to change in response to a slow stress. A good example of this is running. The pounding of limbs on the pavement, the increased energetic cost, the need to conserve water, and strain on soft tissue and supporting elements of the musculoskeletal system are all put under some amount of stress throughout the duration of a long run. When preparing for a long distance run, the runner generally does not increase distance more than 10% each week as a general rule. The systems of the body are generally able to adapt to this amount of incremental change. However abrupt changes shock the body and can lead to debilitating injury instead to remodeling. If a non-runner goes out and runs 20-30 miles serious injury is likely, whereas most people, if they decided to, could slowly build up to run a marathon with no serious injury.

There are many other examples both good and bad. The body can adapt to harmful eating habits if these habits are gradual. This is not to say that the eating habit becomes non-damaging, but simply that the body is able to mitigate the damage that should be done to an amazing degree. The body is able to adjust to changes in oxygen levels in the atmosphere, availability of water and nutrients, heat, and a plethora of other stressors. Once again, this is not to say that these stresses are beneficial for one’s body, but merely that the body can often compensate for the stress to some degree.

Choose your stress wisely

In modern society we have some amount of control over the stress which we put our bodies through. Whether through exercise and diet, occupation and recreation, drugs and alcohol, we maintain some control over what stress we put on our body. Chronic drug users will often have to use more of the substance they crave to obtain the desired effects or will need to switch to a different drug of choice as their bodies have compensated for the toxin being taken in. People drinking large amounts of coffee may find that it has lost the desired stimulating effect. When starting anything that could be habit, consider how your body will change in response to that stress and decide if that change is something that you desire.

Pleasure is no different
Millionaire celebrity Dan Bilzerian, by self admission not the picture of virtue, made an interesting observation about pleasure, particular that brought about by money, on a recent interview. Pleasure, in very real terms, comes down to brain chemistry. Without getting into neurobiology, pleasure is the result of the release of particular substances from specific parts of the brain in response to a stimuli. As with any neurotransmitter-stimuli relationship then, this effect can be maxed out. If you or I (or any contestant on a game show) were given a brand new BMW we would be ecstatic. On a pleasure scale of 1 to 10, most of us would be at a 9 or 10 shortly after winning that car. However, for a millionaire like Bilzerian, a brand new BMW means nothing. It would take a car worth 10-20 times as much as the BMW to move Bilzerian’s pleasure scale at all. Pleasure, just other stresses, can be something your body adapts to. One could logically argue from this that the best pleasure then is the pleasure that moves your scale, but yet does not desensitize you to future pleasure. While there are a few examples of this form of pleasure, love within family and between friends is perhaps the best. So when we pick stresses, when we select pleasures, let us choose not based on what we hope to feel, but who we hope to be. Let our stresses make us stronger, our pleasures more closely knit. As the characters of the Narnians in C.S. Lewis’s Last Battle shout, “further up and further in” may our pleasures, may our stresses propel us farther, drive us deeper, and move us beyond where we now stand.

If you were given the option would you choose to live forever?
In the life that you now know?

Or would you choose mortality?
Believing that a story with no end is no story at all.

I think that if offered immortality on this earth many people would take it.
But they would take it out of fear instead of with joy.

It would be the fear of death, of the possibilities of what comes next that would drive them to say yes.
Instead of enthusiasm and vigor it is with hands shaking with fear that one grasps that life.

So my hope is that if I were ever given the choice, I would shake my head. To choose not fear but meaning, and live the years left with gratitude.