As stated in one of Zeno’s nine paradoxes, an arrow in flight is “somewhere” and “somewhere in transit”, implying the flow of time as a continuum. Thereafter, approximately a thousand years after Zeno, the theologian Augustine of Hippo attempted to categorize time by writing, “perhaps it would be exact to say: there are three times – a present of things past, a present of things present, a present of things to come.” Even though billions of years have elapsed since the beginning of the universe, we humans are not accustomed to thinking in such timescales. Mapped to the astronomical cycles of seasons and synchronized by the light from the sun, our biological, historical, and cultural time clocks are accustomed to evaluate stretches of time in units of a day or a year. Just as early human hunting and agriculture were influenced by the cyclical changes of the year, today, our personal, social, economic, and political plans are organized by calendar years. In keeping with this convention, in this last post of the year, I will review the elapsed year of essays and readings with a look towards the upcoming year.
I ended last year and began this year writing about a general class of processes that can yield lasting benefits to health and decrease the rate of physiological decline. Stress has developed a negative connotation in our world and chronic stressors do indeed cause physiological harm, but the aphorism ‘the dose that makes the poison‘ hold true. Low to moderate dose stressors interspersed with periods of recovery activate an innate compensatory adaptive response that facilitates innate repair mechanisms and builds resilience. In fact, the purported benefits of fruits and vegetables ascribed to their antioxidant properties might in fact be a hormetic response triggered by pro-oxidant phytochemicals. Thereafter, I wrote an essay on the importance of sleep as the third pillar of health and a related subsequent essay on the role of circadian misalignment and chronotype mismatch as factors in interconnected phenomena such as psychological health and physician burnout.
In the middle of the year, I began with an essay about augmented human intelligence. Augmentation of human intelligence with cultural artifacts is a defining feature of our species and machine learning applications are the most recent version of this history. Machine learning applications in healthcare have the potential to improve medical decision making, positively impact the epidemic of errors, and decrease variation in care processes. Next, I wrote about how human thought is rooted in language and metaphors and how these roots often constrain us from thinking about the range of possibilities. We (individuals, cultures, and civilizations) often conflate the metaphorical “is like” with the homologous “is”, which often puts artificial parameters on the range of adjacent possibles. For example, the pervasiveness and all-purpose use of industrial and commercial applications have impeded healthcare and its delivery. Safety processes in healthcare “are like” safety processes in the airline industry. Moreover, price signals are often used as the sole facilitators of human action when empirically they might not even be the most important factor that drives human action. As a deeply social species, it is the cultural and social norms that drive human behavior at all scales, while the cultures and metaphors of industrialization and commerce often clash with the traditional cultures of healing, care, and compassion that are of the essence in medicine.
The last two essays of the year were devoted to evolutionary concepts of fitness landscapes and functions, and how these concepts can be extended and applied to the optimization of social systems. While the chasm between intention and action is often wide but nonetheless mostly linear, high-level meaningful objectives, intentions, and actions are weakly or non-linearly correlated with outcomes. Therefore, the plurality of ideas, testing those ideas against criteria, retaining the flexibility to adapt not only the ideas but also the criteria when appropriate, are most likely the best tools we possess to building robust social systems.
Moving to the ‘present of things to come,’ in the next year I hope to look at dogma challenging and iconoclastic hypotheses in medicine. My disposition seems to align with Terrance Deacon who stated, “my sympathies naturally tend to be with cranks and doubters and against well-established doctrines. I believe that [the] search for knowledge is often impeded by faulty assumptions and by a limited creative vision for alternatives, as by a lack of necessary tools or critical evidence.” The most interesting things often happen on the fringe. Additionally, I will continue to look to integrate models from evolutionary biology, anthropology, economics, history, and psychology to healthcare. As the legendary investor Charlie Munger stated, “to become wise you’ve got to have models in your head. And you’ve got to array your experience — both vicarious & direct — on this latticework of models.”