Category: Paradigm Shift
A long time ago I preceptored with a naturopath who was fond of having his handouts typeset by a local printer. He was an older style ‘nature-cure’ type healer, and his handouts contained some very far out stuff. When I asked him why he went to the great expense of having a printer typeset his advice, he replied that ‘when people see something in print, especially a format that they know is not homemade, they take it more seriously.’
Twenty years later we now would appear to know better. The easy availability of laser printers and desktop publishing software can make any would-be Hemingway look the part. Of course there is a price to pay for the ubiquity of it all. Nice-looking documents have become the very essence of banality and reader confidence further eroded by the inclusion of misspellings, bad punctuation and terrible font choices.
Many readers will remember that absolute reverence by which one beheld the evening news in our childhood. Walter Cronkite and The Huntley–Brinkley Report not only acted the part of impartial newscasters; they looked it as well.
Having just seen the most recent Democratic debate on ABC-TV, I am even more convinced that the end is near for what might be called ‘filtered broadcasting.’ Instead of any sort of important discussion about issues which are of paramount importance to this country (and indeed the world) we were treated to a long inquisition about whether wearing an porcelain American flag pin is a sign of patriotism in a two hour long Calvary of he-said, she-said.
In the arts we have recently seen the emergence of a new kind of artist. The conventional record labels, having seen their profits eroded by downloading and lack of consumer interest, can only play by the numbers and hope for another Britney Spears or similar mega-mediocrity. The industry crowns artless (but safe and cute) adolescents “American Idols” when in fact they have demonstrated no skills beyond what one would expect from a decent karaoke bar singer.
Composers and musicians who actually do have something to say have opted instead to release material direct to the public, often with a payment-optional policy. Although this would appear to be financial suicide, surprisingly, many of these ventures have been economically successful.
Three decades ago Steward Brand said ‘information wants to be free.’ Brand’s WELL (Whole Earth 'Lectronic Link) was a precursor of the Internet, the greatest source of unfiltered information in human history.
When information is free, people get to choose what they want to hear and read about. When it is filtered, news organizations, corporations, professional societies and political parties choose it for them.
Years ago doctors would never think of explaining their premises and motives. To whom? The village blacksmith? What does he know of chemistry? Now consumers can harness the power of the Internet to research their health issues to any depth they desire. Yet most doctors still function in filter mode, thinking that the deck is still stacked in their favor.
Doctors have to learn about everything. A patient has to just learn about what is wrong with himself. You would be surprised by the speed in which a motivated patient can become a virtual expert in their condition.
In my vision of the future we will all become our own ‘aggregators,’ selecting information sources from an abundance of highly specific and single purpose ‘channels.’ Once aggregated into our lives, all these channels will fuse into a Multiverse of realities shared between like-minded individuals.
For example, you’re currently on the ‘Peter D’Adamo Channel.’
This will not stop filtering. Evidence suggests that we all filter out information that we disagree with. In True Enough: Learning to Live in a Post-Fact Society, Farhad Manjoo cites an experiment in which smokers and non-smokers could vary the amount of interference in static filled recordings of speeches. When smokers heard a speech about smoking and cancer risk, they did not try to improve the clarity of the recording. But they did push the button to get a clearer version of the recording when a speech was playing that said that there was no link between smoking and cancer. In non-smokers the exact opposite was true.
Maybe I’m just a libertarian (or just an aging hippy) but I would opt for choosing my own filters --versus having information filtered for me—- especially when the filtering is being done by individuals and organizations that I do not trust and for which I have no respect.
The class I currently teach in generative medicine uses a content system called Blackboard. Blackboard allows me to upload material and pose questions to a forum-like discussion area. One of my students, upon reading the assignment in the textbook made the following comments:
You talk about the division between classical science and naturopathic science, which you equate, respectively, with reductionism and emergence (p. 30). Do they necessarily have to oppose one another and can they not coexist. And does not naturopathic medicine incorporate some degree of reductionism and classical science some degree of emergence?
I guess this goes back to the old question of: can't we all just get along but, further, isn't it sort of imperative that we not categorize conventional versus naturopathic medicine in such black and white terms? Or maybe it is a more useful distinction than I'm discerning?
If, indeed, scientific reductionism is dead (p. 20) and the biomedical community is unaware, how do you best suggest we, as NDs (or future NDs), start to make inroads into that community to convince them that the idea of emergence/holism/a generative approach is worth substantively incorporating into the larger paradigm of "modern" medicine?
I would argue that there is a global groundswell of desire among consumers of healthcare for this generative approach, but it might be up to us as practitioners of naturopathic medicine to bring it mainstream. But the path to that end is not clear. At the end of the day, not only do we have to all get along, but we need to understand what the other is saying.
To which I replied:
If we define 'dead' as having lived a life with purpose, and perhaps even being so lucky as to exhaust that purpose, then reductionism is quite dead in the sense of being 'not alive'. [Which leads to the question: if an idea has no purpose, hence no life, does it even get to die?]
There will always be a reason to think in reductionist terms when the facts do indeed fit the scenario. IMHO there will always be opportunities for non-complex thinking (and indeed one should seize them whenever one can).
My position is that, as a profession, we are perhaps running the risk of being overly seduced by the simplicity of fitting our oeuvre to the existing allopathic framework. In essence we will be moving into a neighborhood in which the prior occupants have already sucked out the life and are themselves moving on to new areas.
Moreover in doing so we may well be creating a nascent culture of new dogmatists, apparatchiks who insist on only dealing with issues on these terms. If that was not bad enough, this then runs the risk of creating its own response element, its own duality, such that a second subculture results that does the exact opposite, accepting facts a priori.
So, what about this generative medicine idea? As you so astutely point out, the goal is to blend both the complex-systems approach with the mechanistic-reductionist approach, point being that we, as naturopaths, should have a pretty good feel for where the work needs to be done and how to go about doing it. Perhaps this duality is itself a power law: we may be using an 80% reductionist formula to discern 20% of our total causalities. Certainly systems-complexity-network (SCN) medicine comprises only a small fraction of current biomedical information analysis. Generative Medicine, as I see it, should resolve that duality.
No matter what, the informational chasm does indeed lay which complexity, as well as any future potential for understanding and treating the life process itself.
Like they say, if you really want to learn something, teach it.
The year 1956 stands out in my mind for a variety of reasons, the most important being (at least for me) that it was the year I was born. It also marked the year of the only ‘perfect game’ even thrown in a baseball World Series. Music fans might remember that it was the year that Elvis Presley entered the United States music charts for the first time, with 'Heartbreak Hotel.'
1956 was also the year a scientist named Roger Williams published a book called Biochemical Individuality, which attempted to relate inherited individual distinctions to nutritional requirements. Although Williams was no small figure in medicine (at the University of Austin he had discovered pantothenic acid, one of the critical B vitamins, and had published skews of articles detailing some of the most basic biochemical discoveries) Biochemical Individuality attracted little, if any attention from the medical community, probably due to the fact, as Jeffrey Bland speculates in his book Genetic Nutritioneering, Williams expressed many of his ideas in biochemical terms, which doctors of the time were far less comfortable with compared with today.
How prescient is the following phrase:
“The existence in every human being of a vast array of attributes which are potentially measurable (whether by present methods or not), and often uncorrelated mathematically, makes quite tenable the hypothesis that practically every human being is a deviate in some respects.”
It’s a strange choice of words, but the word deviate in this context signifies a turning away from the normal or a variance of some sort. Of course, we tend to think of the word more as a term for individuals who deviate from some sort of social norm; but norms are norms.
Williams was certainly deviating from conventional medical wisdom. Nobody at the time was looking at peculiar and individual aspects of nutrition that might be predicted genetically. More importantly, in 1956 there wasn’t anywhere near the enormous genetic industry and technology that exists today; it had only been three years before that James Watson and Francis Crick deduced the basic structure of DNA, (Deoxyribonucleic acid) –the double helix-- that contains the genetic instructions specifying the biological development of all cellular forms of life.
Thus when Williams talked of “attributes that are potentially measurable (by present methods or not)” he is taking an amazingly huge step into the future.
So Williams’ phrase “often uncorrelated mathematically” should probably be reinterpreted to mean “we can’t see the connections because of our current puny computational abilities.” Nowadays we link supercomputers together into vast neural networks and process data at a speed and accuracy that just boggles the mind. It was just this type of muscular computing that allowed scientists like Craig Venter and his firm Celera Genomics to help crack the human genome in record time. Today, the combination of gene sequencing and supercomputers is a day to day event in hundreds of laboratories worldwide, and is a prime part of a vast new field called bioinformatics.
In 1956, nutrition science was still in its infancy, concerned mostly with deficiency types of diseases such as pellagra and anemia, and making sure that we all ate “balanced meals.” There was no link between diet and cholesterol or between cholesterol and hardening of the arteries and medical journals often featured cigarette ads on their back pages. Ulcers were often treated by telling the patient to drink copious amounts of milk, the so-called “sippy-diet.” In other words, nutritional thinking at the time was predominantly disease-based, which is odd, since almost everything we do with food has absolutely nothing to do with disease. This resulted in what my friend and colleague Jonathan Wright used to call "The Association Diets.'
This is not to say that pieces of the puzzle weren’t evident, or that intelligent people were not already beginning to ask the right questions. It’s just that the questions could only be based on what was thought to be known, and what was known was not very much.
I can remember taking a computer class in high school (already well into the 1960’s) where we were taught to diligently inscribe a series punch cards with a 'number 2' pencil, which were then collated and fed to a machine the size of a large refrigerator, which then hacked and coughed for a while, finally yielding a half page printout of a list of fifty prime numbers.
Unless, of course, you had the misfortune to have penciled in the wrong box, in which case you just started all over again; a frustrating experience, which lead to one of my young colleagues, in a rage of frustration, placing one of the cards on the floor and proceeding to stomp on it repeatedly with his shoed foot, sending it on to the card reader --and probably producing the first computer virus-- a trick many of us would repeat when similarly frustrated. Your home computer can do these functions in micro-seconds, and the software to do it is considered so basic that it is usually packaged for free with the operating system.
An interesting lecture on biomimicry got me thinking: With these new ways of analyzing intent by the study of naturally occurring shapes, functions and forms, we may be witnessing the 'naturopathization' of imagination in other arts and sciences.
"Now how does one know what is best? There needs to be a decent, well-developed, and endlessly exercised sense of taste for quality, of making strong choices between the excellent and the rest. An open mind but not an empty head: an intense willingness to see things and an intense willingness to make judgements about quality. "
-Edward Tufte ('Beautiful Evidence')
We need more of this 'comparative-reflective' thinking.
Someplace in the Talmud (a Jewish holy book) there is a commentary to the effect that God does not allow illness to exist until the solution or cure has first been created. What a marvelous take on time-space.
But how would we find that cure? We'd look to nature. To my way of thinking, over the course of his or her career, the good physician becomes increasingly comfortable visiting this invisible world, but only if fortified with a deep knowledge of the natural workings of things.
These excursions (really thought experiments) cannot but produce the most creative solutions to suffering, especially when guided by principles similar to those such as Tufte's (a statistician and sculptor-- not a physician-- again testifying to a certain conceptual universality.)
I'd paraphrase it as all knowing and all trusting, but also realizing that when we know very little, we should probably trust very little as well. Just contrast human intuition (usually a leap of faith) with animal intuition (genomic knowingness).
The British biologist Conrad Hal Waddington conceived of genotype (your genetic plan) passing through environment into phenotype (the physical you) as a walk through an 'Epigenetic Landscape'. He conceived a mode of visualizing this process, in which phenotype development is seen as marbles rolling downhill. In the beginning development is plastic, and a cell can become many fates. However, as development proceeds, certain decisions cannot be reversed. This Landscape has hills, valleys, and basins and marbles compete for the grooves on the slope, and eventually coming to rest at the lowest points, which represent the eventual types of tissues they become.
The Epigenetic Landscape. (After Waddington, C. H., 1956, Principles of Embryology)
Waddington was a big thinker. Not only did he visualize development as passing through the peaks, slopes and valleys of the Epigenetic Landscape, he considered this process one of increasing constraint, or as being "canalizedâ€? as he referred to it: That the early choices influence the later options. If we think of the canals of Venice, the analogy works even better; our little gondola floats from one canal into another and then another. Each choice leaves it fewer options than before, and since gondolas need water, so we can't just pick it up and put plunk it into another canal.
Now just for a moment visualize a newly fertilized egg. It already contains all the wisdom and information needed to eventually go on to produce a completely formed human being in its DNA, but over time it must develop various cell lines (called germ layers) that can then go off and further distinguish themselves as arteries, nerves and organs. Its unfolding is stochastic (a process that is non-deterministic in the sense that the current state state does not fully determine its next state.).
"Stochastic" is one of those great words that is more often misunderstood than understood. It is often quoted as being synonymous with random, but the actual Greek seems to imply something closer to "unknowable." It's often used in the arts (very often in music composition.)
In short: We know it's going to happen; we just don't know what is going to happen.
Your journey from genetic imprinting (the genes that were determined at conception) to full phenotype (the physical you) is to a great degree a stochastic process. which is why Waddington's metaphor is so great. Any architect will tell you that a house almost never winds up like that original plans. Environmental variables (cost of materials, availability) alter reality as the construction project moves from one stage to the other. We cannot always predict the eventual outcome, but we can describe and learn about the landscape in which it takes place and that, to a degree allows us to understand things.
Hindsight is always 20/20, because the outcome almost always describes the process.
That journey started long before your conception, since epigenetic gene control is hereditable.
You are in essence, not what you eat, but rather what your parents, grand parents and even great grandparents ate. Unlike defective genes, which are damaged for life, epigenetically controlled genes can be repaired. And, activation and silencing tags that are knocked off can be regained via nutrients, drugs, and enriching experiences. (1)
Conceivably the cancer you may get today may have been caused by your grandmother's exposure to an industrial poison 50 years ago, even though your grandmother's genes were not changed by the exposureâ€¦ or the mercury you're eating today in fish may not harm you directly, but may harm your grandchildren (2)
These inherited traits can continue to influence the onset of diseases like diabetes, obesity, mental illness and heart disease, from generation to generation.
All in all, the next few years should prove most interesting...
The post-genomic era, which is fueled by automation and other technologies, provokes a change in our grossly naive view of genetic determinism (that single genes govern complex traits) to the obvious reality that most human diseases are complex entities. Gene(s), although necessary, contribute only partially to disease, while environmental factors, lifestyles, epigenetics and epistasis significantly influence pathophysiology and, eventually, the expression of transient biomarkers that can be utilized for diagnosis and prognosis. Human osteoarthritis and rheumatoid arthritis are multifactorial, complex diseases. The genetic inheritance of these diseases remains elusive, although they tend to run in families wherein some siblings have a two- to tenfold increased risk of developing the diseases.
From: Future of genomics in diagnosis of human arthritis: the hype, hope and metamorphosis for tomorrow
Ashok R Amin?, Seth D Thompson? & Shailey A Amin
August 2007, Vol. 2, No. 4, Pages 385-389
Epigenetic alterations have been known to be of importance in cancer for ~2 decades. This has made it possible to decipher epigenetic codes and machinery and has led to the development of a new generation of drugs now in clinical trials. Although less conspicuous, epigenetic alterations have also been progressively shown to be relevant to common diseases such as atherosclerosis and type 2 diabetes. Imprinted genes, with their key roles in controlling feto-placental nutrient supply and demand and their epigenetic lability in response to nutrients, may play an important role in adaptation/evolution. The combination of these various lines of research on epigenetic programming processes has highlighted new possibilities for the prevention and treatment of metabolic syndrome.
From: Nutritional Epigenomics of Metabolic Syndrome
Catherine Gallou-Kabani, and Claudine Junien
Diabetes 54:1899-1906, 2005
1. Asim K. Duttaroy Evolution, Epigenetics, and Maternal Nutrition 2006 Darwin Day Celebration.
2. Montague T. A New Way to Inherit Environmental Harm. Synthesis/Regeneration 39 (Winter 2006)