A Few Thoughts to Make Up for Lost Time

I obviously haven’t written in awhile- although I’m not sure if that matters much, since I may be the only functioning reader of this journal at the moment. However, that’s neither here nor there. I originally had larger plans for this site, but like all new adventures, the novelty tends to wear off as my goals beforehand seemed rather grandiose for this project. I suppose it’d be more advantageous to keep myself restricted to simplicity; that is, focus on one topic instead of spattering all my current, instantaneous thoughts on the page in no particular order.

I, therefore, will waste no time in going against my own prescriptions and offer two things to consider, and hopefully, at some point in the future I’ll have a chance to explicate each in less abstract terms, and more detail.

The First: I’ve been keeping up with the New York Times as they have been following the current evolutionary strides being made in the field of genetics. The newest prediction to hit the pages is the thought that starting in 2019, a mere decade away, all children born will be genetically mapped so that a regiment of preventative medicine can be put into the works for the course of their lifetime. Obviously, there are a slew of ethical considerations to take on, but I’d like to address one; how will this shape one’s view of the human? What will it mean to be human?

Oddly enough, in most of their articles, you only find a mention of “ethical considerations”, without any expansion on them whatsoever. I find that to be a bit scary, as it seems indicative that the general public are either fine with, or, more importantly, don’t necessarily realize that going forth with these possible practices (genetic mapping and such) seem to intrinsically reduce the human to a sack of self propagating cells that, at some point in the future, will undergo some sort of defect in their machinery, and it is the future of medicine to intervene any such defect before it becomes a true problem.

Don’t get me wrong, I am for genetic research, as part of me is a scientist, however my philosophical conscience has been feverishly trying to locate the real problem with this. Thus far, I’ve only really described the problem that is the basis of the movie Gattica – but what of this implicit, unstated reduction of the human? I wish to avoid the commonplace conversation, so I’ll move to the possible practice to be instituted in 2019.

Conservatives and those of religious beliefs hold that life begins at conception (give or take), and that every life is worth saving, as each is human. However, immediate genetic mapping poses two more criteria that I can see, that may negate the conception-human life relationship.

The first is the classical criteria where one can look at a newborn’s genetic map and place him/her amongst a hierarchy of the rest of the newborns based on physiological data, and more importantly, genetic predisposition to disease where one can not only associate a certain probability in the eventual development of certain diseases, but the certainty that such a disease will develop. I find two inherent complications with this- (1) what is to stop someone from placing a cutoff point as to what level of health is considered “socially acceptable” or, in some sort of construed utilitarian argument, “whether the life of the baby will contribute to the common good of the family”, and, if the argument is made rather elegantly, “whether the child, when grown, would find his/her own life worth living” (which would correlate somewhat with the conscious decision to commit suicide, or fill out a DNR card). Another way to say this is what would be the new definition of disease? Currently, we have children, who, over the course of their lifetimes, like all of us develop disease. However, akin to the concept of Original Sin, over time, do genetically mapped children now bear the burden, the label, of being born “diseased” children without ever having developed a single symptom? I fear that our view of the human may be severely impacted by an inherent change in the way we may view disease. (2) The privacy of this information would be compromised. In all practicality, money can buy you almost anything in this life, as sad as that is, everything material in this world has a price, including the dignity of most people. This genetic information would be an investment for pharmaceutical companies – children may become the new retirement plan for drug executives. Search out the few newborns with daunting probabilities for the development of some debilitating genetic disease, and you have the freedom to map out the “preventative” treatment plan for the rest of their lives.

The second, is perhaps, a bit more of a fallout affect of the first. If we are to start raising our children according to a lifelong treatment plan designed from genetic probabilities, what happens to natural evolution? The human body has an amazing ability to adapt and evolve. The drawback, it takes time. With genetically based preventative medicine, we do not speed up the process, but bypass it. Thus, have we lost a pivotal physiological component to the human? Minute to minute adaptation to one’s environment is a function of the frontal lobe of the brain, a sophisticated area of integration driven by real-time practice. The long term effects of such integration allows each successive generation to evolve in complexity, thus discovering new parts of their reality, interacting with their environment on a level higher than the generation previous. This latter part is not so much physiological, but more abstract, a higher level of human consciousness – though I fear we may soon compromise this ability and its growth, for, is it not that higher level of consciousness that serves as the basis for our most fundamental social, educational, religions, political (the list goes on) institutions?

This second consideration (as I mentioned in the beginning I have two) is one I just began thinking about, but I am always open to input, as I have yet to set myself on any specified track on the matter. There is a class that runs the hour before my grad philosophy class (oh, by the way, a little update on my life – I’m taking Aesthetics with Dr. Joseph Margolis where we’re trying to articulate the relationship, if one exists, between the aesthetic and the ethical) called Philosophy of Mind. The goal of this class is to try and justify the “a priori”-esque faculties of the human mind with the hard wiring of neuroanatomy. I always like to think that we’re more than our wiring, but based on the above discussion, the way we’re headed may soon prove me wrong.

If you’ve read this far, congratulations. Your patience is much appreciated. Now its time to see if any of this makes sense to anyone, haha.

Only the Weak

I had to remove this blog. I had originally set out to make an achingly personal point by creating an anonymous person who was the compilation of multiple people I knew and experiences I had. However, I suppose it got out of hand and put in too many specific details which eventually lead to me pushing some buttons I didn’t originally intend to push.

I found myself at an impasse; I felt really strongly about something, an issue that has haunted me all throughout college, however I relieved it unintentionally at the expense of someone else. So what is fair? I keep it bottled up and have it eat at me, or piss someone off? I originally intended to write the blog knowing that none of my immediate friends knew I had one. I wrote it so that I could clear my conscience; put my thoughts into a neutral zone. Psychologists of the Lacanian school call it telling the “Big Other”. For example, when a child, while no one is around, says “I’m taking a cookie from the jar” as he reaches in to grab one is essentially telling The Big Other. He is relieving himself of guilt by stating what he is doing, so that he can complete the action with no harm done. He’s played by the rules. He has has done it with a clear conscience since he has promulgated the action. This concept is what “fine print” is all about.

This was my intention, to put into words something I cared about, and to put those words out there so that I could relieve some of the tension. I was confessing to the Big Other, letting the anonymous ear listen. Its interesting, though, that I did strike a chord with people who did read it. It wasn’t a personal attack, and should not have been taken as one. I was merely holding up a mirror; trying to make a point larger than a personal relationship.

SPSA: 34th Annual CME Conference in Traverse City, Michigan

At the moment I’m in Traverse City, Michigan with the Society of Philippine Surgeons in America attending their 34th annual Continuing Medical Education seminar in surgery, more specifically entitled “Surgical Highlights 2008: Controversies, Problems and Techniques”. I’ve been coming to this annual meeting for two years now, where last I year I was in Norfolk Virginia attending “Surgical Highlights 2007: From Complications to new Technology”.

Rather than droll on about the different surgical lectures (all of which at the moment I have trouble following due to my inferior medical knowledge), I have found a common thread that seems to catch the perview of all the experienced surgeons that attend. It is a simple one; new surgeons that are practicing now have been subject to advanced technology and are therefore losing “old school”, yet critical surgical technique. Case in point, the ability to convert a percutaneous laparoscopic procedure to an open procedure when complications begin to arise.

Take for example a laparoscopic cholecystectomy. The stigma is that opening a laparoscopic procedure is a sign of an unskilled surgeon. However, the opinion and statistical data show that laparoscopic complications (i.e. bile leak) occur after the learning curve; it is the experienced surgeon that becomes a bit too comfortable, thus leading to a problem. Compound that fact with no training in open surgery, and we are left with the statistic that only 0.1% of open choly procedures have a post-op complication, versus the 0.6% complication rate of a lapcholy. How does such a stigma still survive when the “advanced technique” produces 6 times the complication rate of an open procedure?

I guess the point is that yes modern technology helps in tremendous ways. Yet, we lose the art of surgery; the feel for the anatomy is lost to the secondary interaction via cold steel, the surgeon is now working in two dimensions on a tv screen, rather than three. I think the take home message is frugality with technology, and therefore one should not abandon the classic procedures, but cultivate such skills.

Marx talks about this phenomena. He describes man as “an appendage to the machine”. I’d like to think that what I will be doing in the future evades such a benign fate. I think that I am fortunate to have such a glimpse into the minds of the experienced, and I plan on taking their concerns to heart when doing my surgical training. To some, technology is God, but to others, I hope some of us find it scary when surgical procedures are no longer the outcome of a surgeon’s dexterity, but an outcome of the maturity of the technology being utilized. The newest and best thing in the technical world always has a built in expiration date, but refined skill and practice remains constant.

Thoughts?