She wears her faith but as the fashion of her phone.

Everything is a matter of time, isn’t it? Everything changes. Like the apocryphal monkeys typing away infinitely, everything will be written. Everything will be transmogrified somewhere. Some time. Somehow. I suppose that should be a comfort, but I can’t escape the nagging feeling that there is something unrequited in all that: an imbalance between now and then -no bridge to mediate between what is, and what some nebulous future may unfurl for our children’s children.

And yet, an article I found offers some hope that I might have missed the entr’acte, missed a vital link in the ever lengthening chain of progress –or at least underestimated its importance. I’m talking about the smartphone. I grow old… I grow old… I shall wear the bottoms of my trousers rolled, as T.S. Eliot wrote –that, at least, may be a suitable mea culpa for my inattentiveness, perhaps.

I should have seen that with all of the changes occasioned by the phone, other subtle philosophical alterations might well hide within its shadow. ‘He wears his faith but as the fashion of his hat; it ever changes with the next block’, as Beatrice says in Shakespeare’s Much Ado About Nothing. Who would have thought that religion itself might live the same fate? The mobile phone Bible seems to be replacing the book Bible –at least with many of the younger religious crowd. And the result may have been a loss of context –no thumbing through the pages looking for something, just an arrival at whatever nugget was requested –like looking it up in Wikipedia. In other words, an information Christianity, a virtual religion. ‘“A new kind of mutated Christianity for a digital age is appearing,” says Phillips [director of the Codec Research Centre for Digital Theology at Durham University in the UK]. “One that follows many of the ethics of the secular world.” Known as moralistic therapeutic deism, this form of belief is focused more on the charitable and moral side of the Bible – the underlying tenets of religion, rather than the notion that the Universe was created by an all-seeing, all-powerful leader.’

Although I hold neither religious affiliation, nor any particular interest in the Bible, I have to say I am intrigued by the philosophical machinations the smartphone seems to be engendering –the moralistic therapeutic deism, as it is increasingly being referred to. The results of interviews with three thousand teenagers were summarized in (sorry) Wikipedia, and seem to establish the tenets of this theism. First of all, ‘A god exists who created and ordered the world and watches over human life on earth.’ And ‘God wants people to be good, nice, and fair to each other, as taught in the Bible and by most world religions. The central goal of life is to be happy and to feel good about oneself.’ But what I found particularly interesting was the idea that ‘God does not need to be particularly involved in one’s life except when God is needed to resolve a problem.’

And why do I find this  so-called ‘moralistic therapeutic deism’ so interesting? It seems to me it may be the early phases of an evolution of religious thought engendered by the way we are beginning to assimilate information. Or perhaps I should say they are –the millennials. I suspect that we elders –or should I say just ‘olders’- still adhere to the belief that data does not necessarily spell knowledge.

But, as the article points out, ‘[…]a separate strand of Christian practice is booming, buoyed by the spread of social media and the decentralisation of religious activity. For many, it’s no longer necessary to set foot in a church. In the US, one in five people who identify as Catholics and one in four Protestants seldom or never attend organised services, according to a survey conducted by the Pew Research Centre. Apps and social media accounts tweeting out Bible verses allow a private expression of faith that takes place between a person and their phone screen. And the ability to pick and choose means they can avoid doctrine that does not appeal. A lot of people who consider themselves to be active Christians may not strictly even believe in God or Jesus or the acts described in the Bible.’

I doubt that this phenomenon is exclusive to Christianity, either. Any religious doctrine which has a credo that can be digitized, is susceptible -nuggetable into bite-sized digestible portions. Wikipediable.

I think that is what two girls were talking about at the bus stop a few days ago. Both wearing delightfully colourful hijabs, they were huddled around their smartphones giggling.

“Where did you find that?” the taller of the two said shaking her head. She was dressed just like any other teenager –running shoes, jeans, and a bright orange leather jacket- but a dark blue hijab seemed almost tossed onto her head and barely draped over her shoulders. Perhaps it was the wind, but the almost-studied disarray was charming.

The other girl, stouter and wearing a long black coat, also sported a red, hijab-like scarf that barely covered half her head despite her constant readjustments. “It’s Al-Quran [an app, I later discovered],” she answered as if that should have been obvious.

The taller girl tapped on her screen for a moment and then nodded her head. “But, you know that’s not what Abbad said…”

The other girl just shrugged. “He always thinks he knows everything, Lamiya.”

“Well…” I could see Lamiya sigh, even though I was trying not to watch them. “He usually gets it right, Nadirah… I mean, don’t you think…?”

I couldn’t help but smile when Nadirah rolled her eyes. “He only gets it right when you don’t know! If you don’t check on it…”

Lamiya seemed to pout. “I just, like, took his word for it…”

“You can’t do that blindly, Lami… Not anymore.” She made another attempt to readjust her hijab in the biting wind. “Not when you can look it up!” She shivered deeper into her coat and I could see her breath whenever the wind died down. “Things just aren’t what they used to be for our parents… We can actually, like, check,” she said as their bus pulled up and they got on, leaving me still informationless in the cold.


Pleasing Her: sexual evolution?

I came across an interesting article in the magazine Science a while back. I am always intrigued when a paper tries to place an issue in its ontological context, although I have to confess that the title had something to do with catching my eye. It was a scientific theory from seemingly reputable sources about the evolutionary significance of the female orgasm.  The article to which it refers is more detailed and helpful, but somewhat difficult to read; to get a more comprehensive description of the process however, I will include it here for reference:

Orgasm is a topic that seldom surfaced through all the years of my gynaecologic practice; it was something that many women felt too embarrassed to mention –especially to a male doctor. It was also a subject that I felt ill-prepared to tackle –apart from standard psychological advice of dubious merit, the only benefit seemed to be that of a sympathetic, nonjudgmental hearing. Little was known about either the function or the physiology of orgasm, so advice about its production was more anecdotal than beneficial; it was therefore usually the purview of sexual dysfunction clinics rather than that of the general gynaecologist.

The only thing that seemed on a firm basis with regards to orgasm was that it was essential in males for sperm transfer. Clitoral stimulation is usually required for the production of female orgasm, and since the penis and clitoris share a homologous origin perhaps it was simply a fortuitous consequence of this –a secondary adaptation (exaptation) for the purposes of bonding, or the like.

But to place female orgasm on a more secure footing, the authors have looked at reproduction in other animals. ‘The essential condition for the success of internal fertilization is the timely maturation and release of the oocytes from the ovary into the female reproductive tract, that is, ovulation, for the egg to be accessible to sperm. These events need to be coordinated with the availability of males and favourable environmental conditions for raising the young.’ And for such, there are roughly three factors that might influence induction of ovulation in mammals: environmental –cues that suggest it would be a favourable time for successful rearing of offspring such as weather, food sources, etc.; copulation induction –only produce valuable eggs when they’re needed –i.e. when a mate is available; and spontaneous ovulation –no matter the availability of mate or suitable environment. Humans, it would seem, utilize the latter option –spontaneous ovulation.

In copulation-induced ovulation, a surge of two hormones in the female are required –prolactin, and to a lesser extent oxytocin. Interestingly, these are also produced during human female orgasm, although with spontaneous ovulation in humans, they are not specifically required. As the authors suggest: ‘The orgasm in women does not obviously contribute to the reproductive success, and surprisingly unreliably accompanies heterosexual intercourse. Two types of explanations have been proposed: one insisting on extant adaptive roles in reproduction, another explaining female orgasm as a byproduct of selection on male orgasm, which is crucial for sperm transfer.’ In other words, ‘Human female orgasm is associated with an endocrine surge similar to the copulatory surges in species with induced ovulation. We suggest that the homolog of human orgasm is the reflex that, ancestrally, induced ovulation. This reflex became superfluous with the evolution of spontaneous ovulation, potentially freeing female orgasm for other roles.’

There is another aspect of the study that fascinated me –something that had not registered despite my years as a gynaecologist: ‘With the evolution of spontaneous ovulation, clitoral stimulation lost its role in ensuring fertilization simultaneously with the removal of clitoris from the copulatory canal, likely causing a variable association between copulation and orgasms for the female.’

Think about it. Why would the homologue of something important for ovulation in some species, and so important for orgasm in ours have moved away from the action? The clitoris is now located quite a distance from the vagina and is only inadvertently stimulated with human heterosexual intercourse. I think the Science article expressed it well: ‘Humans and other primates don’t need intercourse to trigger ovulation—they evolved to a point where it happens on its own—but the hormonal changes accompanying intercourse persist and fuel the orgasms that make sex more enjoyable, the biologists hypothesize. And because those hormonal surges no longer confer a biological advantage, orgasms during intercourse may be lost in some women. This explanation “takes away a lot of stigma” of underwhelming sexual relations, says one of the authors, Mihaela Pavlićev, of Cincinnati Children’s Hospital in Ohio.’

And also: ‘Pavlićev and Wagner’s theory helps explain why female orgasms during intercourse are relatively rare. “It is new to use [this] innovative, Darwinian approach to understand one of the mysteries of human sexuality—why the male orgasm is warranted, easy-to-reach, and strictly related to reproduction and the female counterpart [is] absolutely not,” says Emmanuele Jannini, an endocrinologist at University of Rome Tor Vergata. The nonnecessity of orgasms for reproduction may also explain why women’s reproductive tracts vary a lot more than men’s—there are fewer constraints, he adds.’

I have to admit that this was all terra incognita to me. And a clarification and reassurance for those few women who confided concerns about their difficulties or even inability to achieve orgasm with heterosexual intercourse seemed impossible if it was supposed to be part of the process. Surely they weren’t all psychologically liable… So-called foreplay was clearly important –if only to stimulate both the clitoris as well as interest in the procedure- but was there something wrong with them if he couldn’t be persuaded?

Satisfactory sexual experience is clearly important and helps to provide the glue that bonds a relationship. But does the changed anatomy tell us anything? Might we be permitted a secular Darwinian postulate that pleasure may, after all, be divorced from the procreative imperative? A sort of anatomical excuse? Much can be done to wrap this in a more attractive package -the counselling of both partners as well as suggestions on technique- but at least from an evolutionary perspective that seeks to propagate our species, we’re doing just fine. Maybe too fine, in fact…





As I Age

As I age, it becomes increasingly clear to me that Life is far more complicated than I could ever have suspected. It is like a stew where I keep finding new ingredients –some to my liking, and some… Well, let’s just characterize them as unexpected -mysterious strangers that surface from time to time, wreak havoc, then disappear again like shadows on a moonless night.

Social movements are often like that –or, rather, social solutions. Society changes over time and it has been the fashion of late, to see this as an evolutionary adaptation to underlying conditions –the slow but steady metamorphosis of caterpillar into butterfly. And yet, sometimes the change is more abrupt -a mutation- and we are forced to deal with the consequences. When things around us change, we attempt to keep up –or at least, like the Red Queen in Carroll’s Through the Looking-Glass, find ourselves running faster and faster to stay in the same place.

And one manifestation of this is the need to preserve a thin weft of values as a template during the inchoate and often thread-bare interregnum. I’m thinking, of course, about the age-old philosophical conundrum of whether we should tolerate the intolerant –and if so, then how? And at what price the compromise? One example from many: the need to establish special female-only transportation in the city of Zhengzhou in eastern China to help women feel safe from sexual harassment. To guard them.  Of course, the problem is by no means unique to China -other countries have discovered the same need and arrived at similar solutions.

But it seems to me that the issue is far more complex than these solutions might suggest. This gender issue, in some ways is not dissimilar to the racial problems that surfaced so violently in the last century in America. To think that having different buses for people of colour would salve the problem was proven to be naïve, and in itself discriminatory.

It comes down to the difference between toleration and acceptance: putting up with something that might not actually be approved of –enduring it: ‘toleration is directed by an agent toward something perceived as negative. It would be odd to say, for example, that someone has a high tolerance for pleasure’; versus  Acceptance: acknowledging and welcoming something as itself; permission versus approval. A power struggle either deferred, or shared.

To equivocate for a moment, should we tolerate mere tolerance, or accept it…? As an interim solution, of course. In other words, is it better to have the segregated buses for women, say, than groping and intimidation on more inclusive public transit? To say that there should not be sexual harassment is all well and good, but it ignores the present reality –there is, and to ignore it would therefore be akin to tolerating it. So are we  trapped in a never-ending game of chase-your-tail, forever condemned to wander the Mobius strip looking for an exit?

Perhaps it might be helpful to distinguish the component parts of the issue (I have adapted some principles from the peer-reviewed Internet Encyclopedia of Philosophy:  It seems to me that there is a difference between the more superficial and emotional response to whatever is being tolerated (Let’s call this the Reactive Stage) –the need to separate the aggrieved from the aggressor, for example- and the Rational Stage: the more dispassionate and reasoned analysis of the problem –if indeed such an analysis is feasible, or could even be rationally justified. In other words, on what grounds does the prejudice in question continue to exist? Is it remediable, or inevitable? Should we be forced to retreat behind our own societal boundaries and accept the relativistic excuses proffered that we simply can’t superimpose our own values on those who are not like us? That we, in fact, do not understand –nor likely ever will, since we are other?

Or, closer to home, can we ever hope to change attitudes such as disrespect and insensitivity to aspects of personal autonomy that have been entrenched –and indeed accepted- for countless unquestioning generations -that, until recently, were not even considered problems requiring solutions?

Well, societies do alter as time and members change; I’m not sure we could characterize the alterations as necessarily evolutionary, or teleologically driven, but certainly the initial reactive and then the more rational stages can often be discerned. The societal attitudes towards Gay rights, for example, have undergone major shifts within the past few years –even the initial toleration, which was rare in past decades, is now remodelling itself as acceptance.

So what -if anything- has Age taught me? What has the passage of years and the successive unfolding of events disclosed? Well, it has become clear that in the long run, our enemies become our friends; that we seek and find compromises satisfactory to each –bargains that in due course cease to be seen as concessions by either party, but rather as amicable balance; that Force only suppresses while it is being applied; and that discussion is inevitable and infinitely preferable to confrontation. We may not be able to evince our much-touted rationality in all things, but we are all eventually susceptible –amenable even- to accommodation.

Omnia vincit amor, I suppose.



Food for Thought

There’s something encouraging about the fact that we are not simply our genes. We’ve moved on -evolved, I guess. They are still the recipes, the instructions, but as every chef knows, you don’t always have to include all of the ingredients to get a good result. Genes are perhaps more akin to a first draft for a project. Suggestions. Options. They are, in effect, travel guides -road maps- that tell you what you could do and how you might go about doing it, but although the tickets are bought, you don’t have to get on the bus. Who we are –what we are- is not as pre-ordained as we previously thought. Just because there is a light switch on the wall, doesn’t mean it has to be turned on unless it’s needed. There is a mechanism, as Wikipedia puts it, for ‘cellular and physiological phenotypic trait variations that are caused by external or environmental factors that switch genes on and off and affect how cells read genes instead of being caused by changes in the DNA sequence.It is called epigenetics.

Genetic evolution usually takes a long time –often a very long time- and circumstances can arise that were not originally anticipated. But there are several mechanisms to silence or inhibit those genes from carrying out their initial instructions and these allow extra opportunities for an organism to survive and adapt to circumstances perhaps not present during its initial evolution. Unfortunately, it can be a two-way street…

Food, food, glorious food -well that’s how I remember the words anyway (apologies to Flanders and Swann). It’s something that is often as pleasant in retrospect as it’s anticipation is in prospect. Something that transcends the here and now. Like culture, it involves feelings and judgments. It is a part of the fabric of our realities, part of the habits that are difficult to change without conscious effort and strong motivation. We wear our preferences as uniforms -identities. Food is not simply what we consume -it reflects a train of thought. There are allegiances, unspoken loyalties that pass from generation to generation. And it is often how others see us -evaluate us. To change or vary, risks awkward questions at the very least. So it’s fascinating to reflect on the importance of food in defining not only who and what we are, but also on it’s influence on what we might become. And what our children might become as a result…

It is not a trifling matter. Food has always had a central role in culture and what a mother eats in her pregnancy has long inspired myths about the child she will deliver. Famines have been instructive: in more recent times, the Dutch Famine of 1944 during World War ll led to intrauterine growth restriction and subsequent chronic diseases such as coronary heart disease later in the offspring’s life.

A similar twist on the importance of prenatal nutrition was highlighted in an article in BBC News:  ‘.A team from Britain’s Medical Research Council, which has been collecting data on births, marriages and deaths in Keneba since the 1940s, discovered some years ago that in this part of The Gambia when you are conceived makes a huge difference to your chances of dying prematurely.’

This seemingly bizarre finding is corroborated in animal experiments in which, ‘it is possible to make the genes in an embryo more active, or turn them off entirely, simply by varying their mother’s diet.’ And indeed, as the author explains, ‘the studies done in The Gambia certainly provide compelling evidence that these so-called “epigenetic changes” may also happen in humans in response to a change in diet. That if, during very early development, a mother eats a diet rich in leafy green vegetables, then this will change forever just how active some of her child’s genes are.’

There are other epigenetic ramifications that are also important: this ‘happens through a process called methylation and researchers in The Gambia have recently shown that babies conceived in the wet season have very different levels of activity of a particular gene that’s important for regulating the immune system. As Matt Silver, part of the MRC team, says: “Variation in methylation state in this gene could affect your ability to fight viral infections and it may also affect your chances of survival from cancers such as leukaemia and lung cancer.”

Prenatal influences are far greater than we had ever suspected; we were naïve indeed to feel that the importance of diet was primarily to provide nutrients for the developing fetus -ingredients for the recipe. We were too narrow in our conceptions. Too dull, maybe. There is so much about the world –about ourselves- that we are only beginning to understand. We truly live in exciting times… and yet it has always been exciting times for those interested enough to open their eyes hasn’t it? We’ve always lived at the edge of some river or other. It merely takes someone curious enough to travel down it. As Shakespeare said: We know what we are, but know not what we may be.


Human Embryology -Ontologically Awkward Thoughts

Ontogeny recapitulates phylogeny: foetal development goes through the same stages as evolution would have -Haeckel’s theorem. It’s a phrase -one of the few- I remember from my embryology classes in medical school. It’s a bit simplistic, of course, and long since discredited but nonetheless illustrative of some evolutionary phylogenetic similarities. It demonstrates the potential for variation in the developmental effects of various controller genes. It also demonstrates just how far embryology has come since the days when lecturers were forced to bore their classes with soporifically-presented unpronounceable and mysterious Latin names.

In those earlier than early days, I had no inkling that I would end up as an obstetrician and be involved, however vicariously, in the process. Unfortunately, I used to fall asleep in the embryology classes -it’s where I learned to nap with my head carefully balanced upright on my shoulders. I didn’t care what I was missing; in those years, I suspect it was not very much. Nowadays, though, everybody seems to be curious, and I often get asked about baby development. Happily, I don’t have to resort to showing the parents my old, retired embryology text book with its overly complicated diagrams that puzzled me even then. Now I have a colourful chart on the wall of my examination room that illustrates -simply, and in an appropriate, real-life size- the developing foetus at various gestational weeks.

Those diagrams don’t even attempt to show any of the amazing features in evolutionary development, though, so I am constantly on the lookout for aspects of it that were not appreciated in my student days. Of course, in those heady times I well might have missed some stuff…

For example, the ear-bones of mammals (humans are mammals, remember) have an interesting history. There are three tiny little bones in the inner ear -ossicles- that serve to modulate any sound energy arriving there and to dampen the vibrations from the ear drum. Reptiles and various other creatures only have one, the stapes (‘stirrup’ in Latin). Where did our two extra bones come from? Well, those same reptiles (also including birds, dinosaurs, etc.) have a few extra bones in the joints of their jaws which we mammals have co-opted for our inner ears: the incus (‘anvil’ in Latin) and malleus (hammer). Nature doesn’t waste things -the innovation is called exaptation: the process of using structures that have already been introduced by evolution and re-purposing them. And yes, I guess that means we have to chew differently than dinosaurs, but hey…

Other things persist in us with diminished or unknown function. I’m thinking here of such structures as the appendix. Most of us only know about it if we have to have it removed. Mine had to be taken when it ruptured in first year medicine while I was in the anatomy lab -my only regret was that we hadn’t toured that far in our cadaver yet so it was still terra incognita for us. But we all figured it was once a digestive organ (I mean look where it is, eh?). There is a suggestion (C. Choi in Live Science, 2009) that even now, the appendix might contain important bacteria that can reconstitute gut flora after such things as antibiotics have changed the normal distribution and population of the micro-organisms. We know that normal bowel bacteria have many functions, including a role in the immune system, so it would be nice to think the appendix might help refurbish our defenses. Re-arm us. Unfortunately, that may mean I’m all on my own now… Naked, sort of.

And, of course, there is the caecum (Latin for ‘blind pouch’) to which our appendix is attached. In some herbivores it’s much larger and it is a hotbed of bacteria that can hydrolyse cellulose. Without them, grass is about as nutritious as cardboard and with our little dead end package, I’m assuming it’s why we no longer enjoy grazing very much.

I’m intrigued by the coccyx as well. It is the lower end of the spinal column and is what forms the tail in other animals. Believe it or not, the human foetus has a little tail between about 31-35 days into development (I had to cull this one from Wikipedia, I’m afraid, because my old embryology text was fashionably non-committal on the subject. Uncomfortable, even.). I also learned from the same source that because it is where some muscles still attach, the coccyx hasn’t yet disappeared entirely. Maybe it’ll be gone in a few millennia -if we’re still extant as a species, that is… and don’t discover that we need a tail again.

Finally, I have to confess I have a personal interest in wisdom teeth. Since I don’t have any, and never did, I have always felt cheated. Diminished, as it were, by the thought that I was given neither the wisdom to which I, as a human, was entitled, nor the teeth as a little bonus. A dentist once tried to reassure me that not everybody has them and, in an attempt to impress me that she had recently graduated with honors from dental school, that it is probably related to the functioning of a gene called PAX9. This only depressed me further, however, and immediately suggested to me that either I didn’t get the gene, or that mine was malfunctioning. She tried a different tack (attempting, no doubt, to distract me from what she was doing in my mouth). Third molars (she had to explain that she was using dental-speak for ‘wisdom teeth’ when I started to salivate excessively) were probably how our ancestors dealt with plants they were eating. They were grinders. But I was lucky, she continued, probing deeper into my gum, because we changed our diets and evolved smaller jaws. So nowadays there’s no room for the extra teeth. They are vestigial and have to be pulled out, in other words. My persisting skepticism must have been obvious, however, and I could see her mask change shape. Given the drill in her hand and the impatience in her eyes, I pretended to be convinced and dropped the subject. I still worry, though.

Embryology, like its eponymous subjects, has evolved over the years. It has become more interesting and certainly accumulated more frills. DNA and ever-advancing technology have dragged it into social media and otherwise polite conversation -our ancestry titillates us like never before. I mean I could probably even stay awake in the classes nowadays. But all the same, the skill I developed for napping unawares shouldn’t be dismissed as vestigial; it is still useful. I look upon it as an exaptation of my neck muscles and inner ear, an evolutionary strategy for surviving some of the appurtenances that continue to bedevil us in the modern age: there are still concerts I would rather not attend. And as for meetings…