It has proved to be a difficult endeavor to pin-down specific human universals. Exceptions appear to be the rule. Nonetheless, although the specifics vary, in broad terms it can safely be claimed that humans are universally social, symbolic, and ritualistic. Humans across time and space have and continue to be bound in webs of relationships… Continue reading Back Scratchers
Category: Health
Windows to the Soul
The development of technologies such as the telescope and microscope were transformational events in human history. They extended human perception to the far and the small, to the big and the near. Thereby upending our understanding of the universe and our place within it. Similarly, radiological imaging has extended our power of perception, not to… Continue reading Windows to the Soul
Fitness Functions
If the “burnt out” attrition of emergency physicians, the shortage of emergency nurses, the unfilled emergency medicine residency positions, the prevalence of errors (here and here), the persistence of misdiagnosis, or the news headlines (here, here, and here) are relevant indicators, then the emergency department (ED) could be considered a failed - or at least… Continue reading Fitness Functions
Drowned in (False) Positives
In most real-world biological ecosystems where stimuli are often riddled with ambiguity, predictions are inherently probabilistic, and resources are time and computation constrained, organisms are forced to navigate the trade-offs between false-positives and false-negatives and the opportunity costs of (in)action. For example, if a feeding animal senses the presence of a possible predator, at the… Continue reading Drowned in (False) Positives
Fluency and Its Illusions
Although we think of information overload as a contemporary phenomenon, throughout evolutionary history organisms have always had to grapple with a world brimming with noisy data. Ever present and life threatening features such as camouflaged prey, lurking predators, strategizing competitors, invasive species, weather changes, and insecure food supply have always been part of the challenges… Continue reading Fluency and Its Illusions
Plastic Brains
To qualify as a licensed London taxi driver, trainees require comprehensive training and testing that typically takes three to four years. Drivers need to commit to memory and learn the mishmashed layout of approximately 25,000 streets, the location of thousands of landmarks, and the quickest way to navigate between any points in the city. In… Continue reading Plastic Brains
(Mis)matched
The 300,000 year old history of our species is one of migrations made possible by our biological and cultural adaptations. From their East African cradle, homo sapiens now occupy every longitude and latitude of the world. As a generalist species with a penchant for story-telling, socializing, teaching, learning, technology, and engineering, we have transformed our… Continue reading (Mis)matched
The Study of Self
Cover: Strangers to Ourselves The philosopher Karl Jaspers introduced the concept of the Axial Age to describe convergent movements in thought that occurred across the Old World from the Greco-Roman to the Indian and Chinese. This period from approximately 8th century to the 3rd century BCE was the documented birth of the study of self.… Continue reading The Study of Self
Language and Its Discontents
Ludwig Wittgenstein wrote, “the limits of my language mean the limits of my world.” Fortunately, human communication carries multiple layers of signals - verbal and non-verbal, conscious and subconscious - with language or consciousness representing summarizations of all those signals. Similarly, the patient-physician interaction also is laden with signals. Even without considering the vagaries of… Continue reading Language and Its Discontents
Worlds Far and Wide, Near and Close
Who we are emerges out of the dynamic interplay of what we are (the person), where we are (the situation), what we say we will do (intentions), and what we do (actions). Medicine has built a model of disease with a focus on the person in a hospital or a clinic and their intentions. In… Continue reading Worlds Far and Wide, Near and Close
The Person and the Situation
It has almost become a truism to attribute the causes of diseases to social determinants of health (SDOH). By one estimate, SDOH account for 60% of premature death in the United States. According to the CDC, SDOH are the conditions in the environments where people are born, live, learn, work, play, worship, and age. While… Continue reading The Person and the Situation
The Wanderer
A core functionality of biological organisms is to track regularities in the environment and utilize those regularities as a substrate for predictions. In general, organisms that can identify markers of risk, danger, and safety and respond appropriately to those markers are better adapted than organisms that lack this functionality. Thus, the largely reflexive fight-flight-freeze responses… Continue reading The Wanderer
Steep Hills
As I discussed in my last essay, social relationships - the types, the numbers, and the nature - constitute a major risk factor for health. It rivals well established medical risk factors such as hypertension, hyperlipidemia, obesity, and physical fitness. In fact, by one estimate nearly 60% of the variation in health outcomes is caused… Continue reading Steep Hills
The Systems Above
The 17th century poet, John Donne, famously wrote, “No man is an island, entire of itself; every man is a piece of the continent, A part of the main.” In reality, even an island is not an island - structurally or functionally. Islands are separated (or connected) - depending on perspective or purpose - to… Continue reading The Systems Above
The systems above, the (epi)genomes below
In medicine, it is often said the exceptions are the rule and atypical presentations of diseases are typical. However, diagnoses are also often preceded by typical symptoms, accompanied by diseases, and succeeded by other symptoms and diseases. There are patterns in these journeys and they often follow consistent trajectories. A heart attack is announced by… Continue reading The systems above, the (epi)genomes below
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