Tag Archives: information

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Do We Really Understand?

Okay, call me a cynic, or maybe even a curmudgeon, but I sometimes wonder just how much we understand about Information –and by extension, it’s relationship to Knowledge.

Information can be construed as the answer to a question or, seen from a different perspective, as that which has the potential to resolve uncertainty. Numbers, for example, are not information unless they pertain to something. And when we think of information in the form of data, it doesn’t necessarily require someone to receive it, but can stand alone, unwatched and unprocessed until summoned. Knowledge on the other hand can be thought of as the reception, collation, and subsequent processing of that data –requested, in other words. Whether that which stands in isolation, unprocessed and unused constitutes Knowledge is an interesting, but tricky issue –likely of the same ilk as ‘If a tree falls in the woods with no one around to hear it, does it still make a noise?’ that we all puzzled over in Philosophy 101 in University. Because data –information- has the potential to answer a question, does that automatically qualify it as knowledge even if there is no question? Even if it might not resolve any uncertainty?

I raise these issues not to transition into a discussion of information theory, but to ask how much we are furthered by information about issues that are incompletely understood –known?- even by experts in the field. I’m referring, of course, to our own DNA.

Scientists are accumulating more and more data about genes and their codes and loci on specific chromosomes. They are beginning to link particular code changes in these genes to specific conditions, and the process is just beginning. Progress seems to increase logarithmically. The promise of this information is enormous in terms of diagnosis and perhaps eventually, treatment. http://www.bbc.com/news/health-35282764

I do wonder, however, whether it is valuable or premature to offer personalized genotypes as a commercial venture to anyone who asks for them. Clearly, there are situations when the information would be helpful when questions are asked of it: risks of a genetically-carried disease, hereditary lineage, or even paternity, as examples. But do we really know more about ourselves because some company has mapped our chromosomes? Without a question being posed to which the genetic sequences are the answer, is what is received useful, or pap? At this stage of our investigation of the genetic code, is an undirected map of base-pairs on a chromosome anything other than simply that: a small scale map of largely unnamed streets of a mysterious city that happens to have the label of the requester on it? A hieroglyph?

Undoubtedly, as the data accumulate, this mapping will progress to the stage where it becomes an essential guide to a city we wish –or need- to explore. And perhaps the store of information acquired will allow retrospective analysis of things whose importance we have yet to understand. Answer questions we don’t yet have –or at least can’t yet formulate in a way that could be solved.

In the meantime, however, I worry about that very personal and private information being made available against our wishes and perhaps to our detriment. Insurance companies, for example, employers –or maybe even an untrammeled government worried about threats of terrorism or contagion may request, or perhaps legislate that the genetic information be provided –especially if it has already been obtained. Unfortunately, at least at the time of this writing, there is no protection in Canada against discrimination based on genetics. There is, however, some legislation under review (Bill S-201) that addresses this. https://openparliament.ca/bills/41-2/S-201/ One hopes that its adoption will be soon, but it is a concern that certainly needs resolution before widespread adoption of personalized DNA should be considered. Once Pandora’s box has been opened, it might be too late, so we must think long and hard about what we decide.

Well considered safeguards are essential in advance -both for governments as well as for industry that may be tempted to oversell the potential. I stand with Hamlet in this: one may smile, and smile, and be a villain.

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Gynicles

I’m not sure why I’m so much against what are now politely referred to as listicles. Maybe they’re too much like sound-bites and too little like enjoyable prose; maybe it’s because if I gloss over the word quickly, it always looks like testicles…

I have nothing against lists –pithy reminders of what I need to buy at the grocery store, or as memory aides if I have to do some task in a particular order- but I object to having information sufficiently divorced from its source that it seems already chewed and partially digested –a dictionary substituting one word for another with little or no background. As nourishing as junk food.

It seems to me that information, to be reliable, must have depth. Context. Credentials. And to be believable, it needs substantiation –evidence to support its content, and proof that it wasn’t just made up to fill the final position on the list.

I’m sure that lists have been around since writing began –before maybe- but they were seldom confused with substantive writing. A possible exception might be Homer’s detailed catalogue of ships in the Iliad… but my attention was drawn to this by reading it in a listicle: https://timeline.com/stories/list-of-listlces-hammurabi-luther-homer -so I’m not contending that they are completely without value. And yet, if I were to want to pursue it further –lecture about it, for example- this ‘facticle’ would only deserve a Powerpoint asterix as a reminder to elaborate further on the topic and prove my contention that Homer did indeed say that, and that he meant it as literature (or not…). On its own and unexplained, it could qualify as a rumour, a joke, or even a mistake.

David Leonhardt in the New York Times, attempted to defend the listicle as a more efficient way to convey information –referring to a listicle by Aaron Carroll titled simple rules for healthy eating As Leonhardt put it, ‘…it was a better, more useful piece than it would have been as a 1,000-word essay or news article.’ http://www.nytimes.com/2015/04/25/upshot/in-defense-of-the-listicle.html?_r=0&abt=0002&abg=1

Perhaps, but listicles can also be excuses for lazy, slovenly researched journalism. Unfortunately, the ones my patients have been quoting to me, or bringing in on their tablets for me to read, do little to bolster my confidence in what is out there.

The one I remember the best, perhaps, was from the Huffington Post: http://www.huffingtonpost.ca/2015/02/02/university-of-vagina-lessons_n_6591506.html and delivered to me from Lucy like a bible…

Lucy was an occasional patient of mine who seemed prone to recurrent vaginal problems of one sort or another. Forty-five years old, or so, she was entering the time of her life when her hormones were beginning to misbehave and she seemed to blame it all on her vagina. It hurt one time; it itched on another; sometimes too small, the next too large, I was always on tenterhooks with each of her visits as to what else could go wrong. On the most recent visit, however, she informed me that it even bothered her husband… It was almost like a poorly trained, but as yet unnamed, pet.

I saw her in the waiting room clutching an electronic tablet –not reading it, merely clutching it, readying it for me to see. I took a surreptitious deep breath before I crossed the room to greet her. She usually relied on Google or Wikipedia for her diagnosis and presented it to me as a fait accompli. Incontrovertible evidence to support the fact that others, too, suffered from similar problems but only received adequate diagnoses and helpful remedies after multiple visits to multiple doctors led them to experiment with alternative strategies: alternative healers using esoteric knowledge of plants and energy fields.

When she finally made it into my office after fiddling with the tablet while walking down the corridor and bumping into things on the way, she looked at me with a satisfied but condescending expression on her face. And before I could even ask her how she was, “I found an article online that was very helpful,” she said, unable to contain her enthusiasm for the discovery any longer. She held the tablet to her breast so I couldn’t spoil her surprise. “Superficially, it seems quite humourous, but the insights in it are…” she launched her eyes at the ceiling for a moment as she rummaged around for the best word to describe it. “Well, they’re profound!”

I could almost see the italicization; I could certainly hear the exclamation mark. She was preparing me for something, I could tell. I steeled myself for some testimonial from a vaginal victim who had finally discovered a cure somewhere unexpected.

“Now I want you to read this carefully, doctor,” she said as she loosened the tablet from her abdomen where it had taken up residence after sliding from her bosom. “Read between the lines…” She knifed me with her eyes and left them there, pinning me to my seat, for emphasis. She was taking no chances.

The first thing that grabbed me was the picture of the perineum as the gateway to a university building and I have to admit I chuckled. Softly, though. Respectfully. The problem came when I was expected to appreciate some of the wisdom. I really couldn’t decide what she felt was profound and valuable information. I have to admit that a louder and unmistakeably improprietous laugh escaped at the ‘sword holder’ part at the end.

She immediately snatched the tablet back from me and nestled it safely on her lap. She did not appreciate my levity and seeming inability to extract the kernels of wisdom however cleverly disguised. In fact, her look was one I remember from my teacher in grade school whenever I made one of those rude noises with a hand in my axilla. I was about to be expelled as a healer if I didn’t think of something to assuage the insult.

“It’s a very…” -I, too, had to hunt for a word- “..clever article, isn’t it?” I said with due humility at my gaff. “Which point did you find the most valuable, Lucy?” I certainly wasn’t going to commit myself.

She took a slow, unnecessarily noisy breath, and sat up as straight as a ruler on the hard wooden chair. “Well,” she finally deigned to answer, all the time thrashing me with her eyes as if she shouldn’t really give me another chance, “I’m torn between learning the number of orgasms it is capable of –I mean, who would have thought…?” She blinked in a brave attempt to get back to her original line of reasoning. “And the bacteria thing. Maybe that’s where mine goes wrong –it never seems very clean…” She paused for a little self reflection before finally deciding on the most influential point she took from the listicle. “But I suppose if I had to choose…” –she didn’t really. I was just curious- “If I had to choose,” she repeated herself, as if her credibility depended on it. “I think I’d go for the self-cleaning aspect. But I mean if it really is self cleaning like they say, then why are there still bacteria in there, for goodness sakes?” She shook her head and shrugged as if she’d finally discovered what had been wrong with her all these years. “The self-cleaner must break down a lot in others, too, or they wouldn’t have mentioned the bacteria…” She hit me with her eyes again, but this time more softly.

“Anyway, I solved the problem with a nightly vinegar douche .” I smiled, relieved at the news. “But my husband won’t go near me now.” For some reason a tiny trace of a smile raced across her lips and disappeared into her makeup.

I knew there had to be something. “And why’s that, Lucy?”

“Says it hurts.” She shook her head as someone used to the bludgeonings of Chance. “There’s always something, isn’t there..?” she said, accepting her fate with another shrug.

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FHR: Fetal Heart Rap

When I was a child, I was fascinated with noise. Well, perhaps sounds would better describe what interested me. What were they –I mean really? And what happened to them after I heard them? When I was finished listening and if there was nobody else around to use them, what occurred then? Sounds told us stuff –information- and I didn’t think Nature would just throw them away. So were they like the wind and simply moved on after touching my ears, or did the data get stored somewhere? Collected and saved –someplace chock-a-block with noise bouncing off every wall, or stacked neatly in little, labelled piles? Maybe there was a sound library somewhere. And when I discovered echoes, I thought I was getting close: recycled sound. It was like taking a book out of that library.

As I grew older –I was going to say matured, but that never really happens, does it?- the riddle of the information contained in sound only intensified for me. I mean, where is it? I even wrote a novel to explore my fascination with it (Sound Bites) that’s published somewhere Googleable online, but that didn’t quell the itch… I began to wonder if I was haunted by something –an idée fixe.

When we are enchanted by something, does that make it more likely we will find it? Or just more likely that we will look for it..? Seek, and ye shall find. But even more mysteriously, does it find us?

 

FHR. Every obstetrician –every nascent parent- knows what that stands for: Fetal Heart Rate. Along with uterine contractions, it’s what we measure on our monitors in delivery rooms around the world. More importantly, it’s the sound that connects us to that inner intrauterine environment. The hidden world. It’s the baby talking to us, giving us a weather report directly from that moist, warm space where we all once lived.

And it’s not a one-off either. Midwives, doctors -and increasingly, parents- are regularly tapping into it for news. Information. Meaning. It’s a sound fraught with emotion and expectation –the unopened present.

But I recently got to unwrap the present in an unexpected venue, in an unforeseen medium: music.

 

“Would it be okay if my uncle came to one of my appointments?” Cynthia was a tiny little woman from the Caribbean that was seeing me for her first pregnancy. She spoke with a delightful accent and every sentence was embedded in an almost musical rhythm. It was as if she was singing to me… She was certainly one of my favourite patients and I looked forward to her visits.

With the notable exception of her husband –another small person who usually sat quietly at her side with an embarrassed smile on his face- I hadn’t met any of her family. “Of course he can come with you, Cynthia,” I said. “Your aunt, too, if you want…”

She shook her head, and ringlets of rich, shiny hair escaped from her headband like children at recess. “No, my aunt is no longer with us…” She blinked and then a huge smile invaded her face and her eyes twinkled like crumpled foil in the overhead lights. “Uncle Ed raised me pretty well by himself…” She seemed to hesitate for a moment before continuing. “But now he says he’s curious.”

“Curious?” Now I was curious.

She nodded her head, and her hair came out to play again. “About the sound.”

“The sound? I don’t…”

“You know, doctor. The sound!”

My face must have galvanized her husband because he realized he finally had a role to play: the interpreter. “She means the sound you play from the baby each time we come, doctor.”

“The baby’s heart rate?” I tried not to make it sound like a question. More like an acknowledgment of a point made. They both nodded their heads in a sort of random unity, and smiled. The doctor had understood.

“Well, I’ll try to put on a good show for him, then.”

Cynthia glanced at her husband and a surprised expression flitted briefly over her face; she suppressed it as she turned back to look at me. “Do you know my uncle?” she said, this time unable to disguise her curiosity at my seeming prescience.

I shrugged politely and smiled. “I don’t think so… Should I?”

They exchanged looks again; secrets crept from eye to eye. “Well…” –her husband started to say something, but Cythia reached out and squeezed his hand.

“It’ll be a surpise… Okay?” she said, the last word asking for my permission.

“Okay. I’ll look forward to meeting him.” I really was looking forward to it.

She was fairly far along in her pregnancy so I saw her again in a couple of weeks. It was, however, just long enough for me to forget the surprise. An office is busy, even chaotic at times. There are many surprises…

Cynthia was already in the examination room when I walked in and I noticed the uncle immediately. A tall, thin man with a patchy white beard, sat comfortably beside her –lounged might describe it more accurately. He looked entirely at ease in his rumpled brown fedora and clean but wrinkled blue suit, and his face lit up and immediately cracked into a thousand crevices when he noticed me and smiled. He stood up and extended his hand. “Thanks for letting me come,” he said, his voice sonorous with a hint of gravel. “Cynthia’s been bragging about you for some time now,” he added, and his eyes locked on me like talons from under the brim of his hat.

He glanced at an expensive looking recording device he’d placed on the table by the sink and his smile widened. “Thought I’d record the baby –if that’s okay with you…” He was asking permission, but his eyes knew my answer and relaxed their grip, caressing my face briefly as they returned to the recorder.

“Of course, of course,” I found myself repeating, strangely nervous that my performance might not be up to the machine –or the uncle’s- standards. Cynthia got onto the table and I proceeded to take her blood pressure and assess the size of the baby in her abdomen with my measuring tape. It was an old tape, the numbers worn thin by the years of use, and for some reason I felt embarrassed with it. Like I should have used the new one I had in another room…

And then came the time to listen to the heart. I positioned the doptone over the region of her abdomen I hoped would give the best sound and turned it on. Nervously again. With stage fright, almost. I got the area right and the sounds pounded out in their usual steady cadence –fast at first (I had disturbed the baby by measuring the abdomen) and then settled down into a steady, industrial rhythm. A horse galloping. One hundred and forty hooves per minute -I almost said that, I was so anxious.

Uncle Ed, for his part was entranced, and his eyes were focussed elsewhere –inside his head, if I had to guess. Then he closed them -closed the private door- and his whole body began to sway in sync with the beating heart. Even his feet began to tap. I almost thought he was going to get up and dance…

Finally he raised his head and opened his eyes, sated. Exhilarated. Then, like an orchestral conductor he nodded for me to stop the sounds as he reached for the machine to turn it off in tandem. The performance was over; I almost expected applause, but except for the delight, bordering on exaltation I could feel around me, that was it.

He shook my hand warmly, gathered up his instrument, and sidled out of the room as relaxed and in control as ever. He left Cynthia beaming and her husband wide-eyed. But she winked at me as she left –a show of silent appreciation of the concert.

The whole episode left me puzzled however. Why had I felt so nervous? It was like I’d been onstage the whole visit. I walked down the short corridor that led to the reception desk and discovered both my secretaries huddled together and whispering loudly. They both looked up in unison when I turned the corner, their eyes sparkling, their expressions, well, rapt I suppose. Another puzzle.

“Interesting chap that uncle, eh?” I said, to break the spell.

“Interesting?” one of them managed to gasp as they saw my entirely benign expression.

I felt naïve, for some reason. “Yeah, he was really into the fetal heart stuff. He even recorded it,” I said, trying not to expose how strangely anxious his taping of it had made me, but I must have said it too loudly.

A patient I didn’t recognize was sitting nearby in the waiting room and she rolled her eyes when she heard me. “Well, I guess so, eh?” she said, and exchanged glances with one of my secretaries. They both laughed.

“Do you even know who that was?” the patient said.

I shook my head slowly. But just then, my colleague, the other doctor in the office, called for the patient, and she disappeared through a door after winking at my secretaries with an enigmatic smile on her face.

“Well,” I said to the now empty waiting room, trying to pretend I wasn’t as curious as I must have looked. “Who was the uncle..?”

Another set of eye-rolls –this time from behind the counter. “Come on,” one of them said when she finally found the strength to close her mouth. “Don’t you ever listen to rap?” She pronounced it like an accusation, but I know she didn’t mean it like that.

I am appreciated in the office –admired, maybe- but not for my musical insight. I am loved for other things… I hope.