Is your wisdom consumed in confidence?

How do we know what we know? It’s a question I used to think was obvious: if we cannot investigate the answer ourselves, we turn to others –somebody will know. Even the polymaths of old relied on other people for the groundwork on which they built. Nobody can know everything -knowledge is a jigsaw puzzle, the integral pieces of which make little sense on their own. We have to know what fits, and where.

But how do we know who to trust? How do we know who knows? If the foundation on which we construct is badly planned -or worse, wrong– the building will not last. Think of Ptolemy and his epicycles that became hopelessly complicated in a vain attempt to explain celestial movements and maintain earth as the center of the universe.

And it’s not as if Scientists are always reliable anyway. Consider the disappointment of Fleischmann-Pons’ claims that they had produced ‘cold fusion’ -a nuclear reaction occurring at room temperature? More ominous by far, however, was Andrew Wakefield’s fraudulent 1998 paper in the prestigious British medical journal The Lancet that claimed that the MMR vaccine (measles, mumps, rubella) caused autism. The paper was retracted by the journal in 2004, but by then, the damage had been done.

My point is that if we are not careful about the source -the reputation- of our information we may be led astray. It’s an almost trite observation, perhaps, but in this era of ‘Fake News’, one best kept in mind. I was again reminded of the importance of this in an essay by Gloria Origgi, an Italian philosopher, and a tenured senior researcher at CNRS (the French National Centre for Scientific Research) in Paris. She was writing in Aeon: https://aeon.co/ideas/say-goodbye-to-the-information-age-its-all-about-reputation-now

As she observes, ‘[T]he greater the amount of information that circulates, the more we rely on so-called reputational devices to evaluate it. What makes this paradoxical is that the vastly increased access to information and knowledge we have today does not empower us or make us more cognitively autonomous. Rather, it renders us more dependent on other people’s judgments and evaluations of the information with which we are faced … we are moving towards the ‘reputation age’, in which information will have value only if it is already filtered, evaluated and commented upon by others … reputation has become a central pillar of collective intelligence today. It is the gatekeeper to knowledge, and the keys to the gate are held by others. The way in which the authority of knowledge is now constructed makes us reliant on what are the inevitably biased judgments of other people, most of whom we do not know … In the best-case scenario, you trust the reputation of scientific research and believe that peer-review is a reasonable way of sifting out ‘truths’ from false hypotheses and complete ‘bullshit’ about nature. In the average-case scenario, you trust newspapers, magazines or TV channels that endorse a political view which supports scientific research to summarise its findings for you. In this latter case, you are twice-removed from the sources: you trust other people’s trust in reputable science.’

So how do we ever know whether we are building on sand or rock? Let’s face it, few of us are competent to judge the raw data of a scientific study, let alone repeat the experiment to verify the results. And how many of us would be inclined to repeat it even if we could? No, some things we simply have to take on trust.

Even so, Origgi offers us another option: ‘What a mature citizen of the digital age should be competent at is not spotting and confirming the veracity of the news. Rather, she should be competent at reconstructing the reputational path of the piece of information in question, evaluating the intentions of those who circulated it, and figuring out the agendas of those authorities that leant it credibility.’ As the Nobel laureate Friedrich Hayek, an Austrian economist and political philosopher wrote, ‘civilisation rests on the fact that we all benefit from knowledge which we do not possess.’

I’m trying to learn from Origgi, though. I’m trying to pick my filters carefully. Figure out their agendas. Sometimes you can even do that by listening.

I was sitting in my favourite dark corner of Starbucks the other day when two women sat down at the table next to me. I’m not sure they even noticed my ears in the shadows because they seemed to be in the middle of a conversation about technology as they each held their phones in front of them like crucifixes warding off the devil.

“I got a new running app, Fran,” said a tall thin woman with short curly dark hair and attired in expensive looking running gear.

“Which app you using, Dor?” her friend responded, equally attired and reaching for Dor’s phone.

“It’s a new one,” Dor said, holding it out of Fran’s reach. “Supposed to be the best at approximating calorie expenditure. Takes account of your weight, leg length, and then adds in changes in altitude on the run, as well as the time taken.” She looked at it again. “Even asks for a picture so you can post.”

Fran smiled benevolently. “Your IP address and Email, too?”

“Huh?”

“Privacy, Dor. Privacy.”

Dor stared at her quizzically for a moment. “I just figured they were being thorough, eh? More accurate… Anyway, they know all that other stuff nowadays.”

Fran stared back, and then sighed. “I suppose they do, but I refuse to make it easy for them… Sometimes you’re so naïve, my friend.”

“But…”

Fran shook her head. “I’ve just got a simple running app. And they didn’t ask for my picture.”

Dor blinked -rather provocatively I thought. “The more info, the more accurate the assessment, don’t you think?”

Fran rolled her eyes. “Well, we’ve just run together this morning -let’s see if the calorie count is the same.” She glanced at her screen. “I’ve got 725 cals. And 5K. for distance. How about you?”

“1100… and 4.85 K” Dor smiled. “I like mine better.”

Fran leaned across the table and peeked at the other screen. “Your app looks pretty well the same as mine… Yours play music?” Dor nodded. “And give verbal encouragement?”

“Uhmm, well I don’t turn on all the audio stuff… But I had to pay to download this one so it probably does.” She started tapping and then turned the screen so Fran could see it. “See? It won some sort of award for excellence.”

Fran sat back in her seat, her expression unreadable. “You paid? Mine’s free…” She began a similar tapping frenzy. “Mine won an award, too… Who makes yours?”

Dor started scrolling down her screen and then turned it towards Fran again. “Can’t pronounce it, but here…”

Fran showed her own screen. “It’s the same company, Dor!”

They were both silent for a moment. Then Dor smiled contentedly. “You get what you pay for, I guess, eh?”

I smiled to myself, still hidden in the shadows, and wondered what Origgi would make of the effort of these two mature citizens of the digital age. At least they were trying -and after all, they had pretty well figured out the intentions and agendas of their source…

Advertisements

What the Walrus said.

The media are at it again, beating the data-drums for scraps of hope. It’s not that we don’t all long for reassurance and want to believe in the steady march of Science; it’s more that we can’t shake the suspicion that if we wish hard enough, stuff happens. For some reason I am reminded of the legends of the knightly quests for the Holy Grail where, to mix metaphors, ‘Lord Ronald said nothing; he flung himself from the room, flung himself upon his horse and rode madly off in all directions’ as Stephen Leacock would have it.

A bit of a stretch, perhaps, but a news report that I happened upon, brought it to mind: http://www.bbc.com/news/health-35111443 It was commenting on a large study on screening for ovarian cancer reported in the Lancet that looked at the value of a well-known cancer blood test (Ca125) coupled with ultrasound, and contrasted it with the value of ultrasound alone, or no screening at all. They were trying to ‘establish the effect of early detection on ovarian cancer mortality.’ In all, over 200,000 women were studied over a period of four years. And the results? ‘Their initial statistical analysis of the data showed no benefit to screening. But there was a benefit when they removed the data from any women who may have already started to develop ovarian tumours.’ [Bold letters and italics mine] Umm, I thought the whole idea was to find asymptomatic people who might have tumours…  And, as the news report does acknowledge, ‘…the interpretation is a bit messy and the researchers admit it is “controversial”.’ And yet, the article’s title screams: ‘Ovarian Cancer: Screening may cut deaths by a fifth. Buried in the second to last paragraph, however, is the more important point from Dr. Fiona Reddington, from Cancer Research UK: “While this is an important step in ovarian cancer research, we would not recommend a national screening programme at this point.”

I suppose my somewhat cynical point is that one has to read more than headlines to know the world, and that it is probably unwise to believe everything that is offered by the Media anyway… Then, for some reason, I remembered how I had managed to misread Germaine and her wish to be screened.

I like to see people smiling in the waiting room –it makes me want to choose them as the next patient and forget the scowlers or the eye-predators who attempt to capture me even before I make it past the front desk. Germaine imprisoned me with her eyes the moment I saw her –but more like in a flower than a jail. Her smile grew wider, the closer I approached, and almost exploded when I shook her hand to introduce myself.

But it faded slightly even after she realized she had in fact been chosen as the successor to my last patient, and had firmly ensconced herself in the hard wooden seat across from my desk.

The time has come, the walrus said…”. Those were the first words she uttered as soon as she sat down but when she saw the expression on my face, she managed to produce an embarrassed grin. “I’m an English Lit major…” she added, as if that were the definitive explication of the quote.

“The Walrus and the Carpenter -Lewis Carroll, right?” I said, surprised at how quick I’d got it.

I was rewarded with a twinkle from her eyes. “I have come to talk of many things,” she added, and promptly went on to explain. “I want you to check me for everything.” Her face glowed with expectation.

I tried to keep my eyes from rolling, but I’m not sure how successful I was. I then attempted to disguise my reaction further by scrolling through her records on the computer. I had seen her before, but not for a year or two. At that time, she had been referred for a pap smear and a discussion about becoming pregnant. She was now 26 so I assumed she was probably newly pregnant and was coming to me for her first prenatal visit. But the current referral letter said she was not pregnant and hinted at something else –something unspecified. I hate letters like that. I smiled anyway and looked up at her.

“My partner decided to be unfaithful, and said I need to be checked,” she said quite matter-of-factly as soon as she saw she had my attention.

Now we were on more familiar territory for me. I glanced at the screen. “Well, the pap smear your GP did a couple of months ago was normal…”

She looked as if she were about to roll her own eyes. “Well, of course…”

I politely ignored the unexpected reaction. “And you’re not having any symptoms?” Even if she weren’t I would still do the same tests, but it never hurts to ask.

“You mean like with gonorrhoea or syphilis…?” Her eyes narrowed slightly as she considered the ramifications.

I nodded. “Or chlamydia…”

She shook her head vehemently –almost violently, actually. “No, no. That’s not an issue.”

“Well, are you concerned about HIV, or…”
She threw her hands up in a theatrical denial of the very thought. Her mouth managed to roll up this time to complete the rejection. “Doctor!” she almost whined. “It’s not that kind of thing…!” But her sentence trailed off suddenly, leaving me to wonder if there was something she had been hiding from me. Something that she expected me to investigate without actually naming it.

“What would you like me to check then, Germaine?”

She looked down at her lap for a moment, the smile a mere ghost of its former self. She had pasted on another paler version by the time she looked up again. “Can I ask you a question first, doctor?”

“Of course you can…”

“Ahhh, I umm, read somewhere that ovulation drugs can give you cancer… ovarian cancer… Is that true?”

I had to think for a moment. There had been a spate of studies a few years before looking at the risk of ovarian cancer after the use of Clomid (clomiphene is a medication that tricks the pituitary gland into manufacturing FSH and LH which stimulate ovarian egg maturation and subsequent ovulation). The early and smaller studies suggested a slightly increased risk, but later studies either were unable to establish this, or had mixed results. “Well, those early studies were small and somewhat controversial, Germaine, and even with long term use, the risks were still very small…May I ask why you’re worried about this?”

A silent anguish seemed to drift across her face. “Well, what I read was that the longer you take the medication, especially if you don’t become pregnant, the greater the risk.”

“And did someone put you on it, Germaine?” I scanned through my old history but could find nothing to suggest a reason she would be infertile.

She nodded. “My GP did. We’d been trying for pregnancy for almost 6 months with no success.” She glanced at the ceiling for a moment and then out the window behind me. “And I mean the guy has good sperm –it worked before on another woman…”

I stared at her for a moment; I didn’t mean to, but my eyes just seemed to attach to her face. It was a rather odd way to talk about things. I decided to ignore it. “And how long were you on the treatment?”

She thought about it for a moment. “Well about 6 months, I think. But it didn’t work!” She took a deep breath and let it out slowly. “I told Jo -my partner- that I was worried about the risk of the Clomid… Then we both became worried, and that obviously led to the alternate route.”

“The alternate route?”

Germaine stared back at me with a puzzled expression on her face. “Yes,” she said after she’d thought about my reaction. “We both wanted a child and if I couldn’t be the one to carry it, then we’d have to make other arrangements –and it would have to be with someone else.”

Surrogate pregnancy?  I thought that was a little drastic after only 6 months or so of trying and I said so.

She looked surprised. “Oh it’s okay, she didn’t mind.” Then her eyes narrowed and a naughty expression suddenly laid siege to her face. “It was me… I was just a little surprised at the methodology, that’s all…”

By now I was hopelessly lost. Germaine seemed to find my puzzled expression funny and she started to laugh. Then her eyes twinkled again as the truth dawned on her. “I think you should look a little closer at the history you took when you first saw me.”

I pulled it up on the screen again and blushed. It’s funny how you can miss things when you’re searching for something else entirely.

“Even our eyes get caught in ruts, doctor,” she said when she saw my face. “It seems a shame, the walrus said, to play them such a trick…”

The poem again! But I finally understood; Jo had decided to have the baby.

“And my risk of cancer?” She was in a better mood now, and didn’t seem as worried.

The night is fine, the walrus said…” It didn’t really fit, I suppose, but the line had probably lain dormant in my head since university and I had to try it out.

She looked at me for a second and then giggled. “We’re really milking it, aren’t we?”

“You mean the butter’s spread too thick -as the walrus said?”

She nodded and then corrected me. “It was the carpenter…”

Recycling the Old

For everything there is a season, and a time for every matter under heaven

Really? It made sense when I was young, I suppose -when all of Time was ahead. When I needed to think there was some order to things. That past and future meant old and new. But as the years slip past, I find myself wondering about disparate things. Opposites. Like what, really, is the difference between new and old? Is it merely a temporal distinction? A nudge along a spectrum? Or a more fundamental change -a conceptual shift? I suspect it can be any of these, of course, but it still begs the question: does any change, any difference qualify? What if there is no change in form at all, but rather a change in function? In Purpose? Would that be new, or merely a rose with another name?

The concept of recycling has been with us from the dawn of time. When materials were scarce or unavailable things were used again, either in their original roles, or repurposed for something else their makers had not anticipated -a new situation, a new need. And so the old rises from its ashes like a Phoenix, but this time in a different play as another, unfamiliar actor.

The tradition of respecting the wisdom of elders and retelling their stories is also an honoured tradition. But as stories do, they alter over time and are often interpreted in new and unexpected ways. The knowledge is not lost, it’s just explained in different words. Understood in a new context. Reconstituted. Society has learned that there is often a benefit that accrues to re-examining the old and looking at it from an altered perspective. So has Science: http://www.bbc.com/news/health-33635575 Bisphosphonates have been around for a while as treatments for osteoporosis, a condition in which there is decreased bone mass. They help to prevent bone loss and so strengthen the bones themselves. It is most frequently used in the post menopausal woman when she no longer produces bone-protective hormones from her ovaries.

Bone is a common site for breast cancer cells to travel to (metastasize) however, and they can lie dormant there for years after the primary tumour has been removed from the breast. And yet, interestingly, those women who were already being treated with the bisphosphonates in the menopause and later developed breast cancer, showed a 28% reduction in cancers developing in their bones. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60908-4/fulltext And because the patents on bisphosphonates have expired in many jurisdictions, the cost of these bisphosphonates is minimal when compared to other ‘new’ treatments on the market.

But there’s more. A medication originally designed for diabetes –glitazone- has been found to decrease the likelihood of developing Parkinson’s disease. http://www.bbc.com/news/health-33608725 Of course this is just a comet in an otherwise cloud-filled night because glitazone is not without its own serious side effects –bladder and heart problems, to name just two- but it is a promise whispered emphatically, albeit quietly, to anyone working in the field. A starting point for future research…

So I suppose we should keep poking about in the ashes. Stirring embers to see if there is a Phoenix hiding somewhere in the cinders, fast asleep and dreaming of another job. We affix labels to things –categorize, then name them for all time. It’s a way of keeping track. Knowing what to expect. The problem, of course, is that things change. Evolve. Mutate. And as Jiddu Krishnamurti, a philosopher, once said of the disadvantage of naming god, it constrains the concept. Limits it. Doesn’t allow for growth and development. I think it is sort of like naming and classifying something when it is only a seed and we are still unaware of its potential. Maybe old is something like that. Where there is life there is always a seed and its age is beside the point. Meaningless.

I’m beginning to see age as a definitional issue, and not in the currently favoured framework of chronological versus biological –or even psychological- age so condescendingly mouthed by those too young to have experienced the ill-disguised discrimination it entails. There is useful wisdom that accretes with years and experience of course. But age is an oven that cooks whatever has been put inside –changes it into something else. Sometimes something entirely new.

I opened with a quote from Ecclesiastes, so let me close with one from the Talmud: ‘For the unlearned, old age is winter; for the learned, it is the season of the harvest.