A rchive Date
[ 08-05-2003 ]
Category
[ Science ]
sub-Categoy
[ Epidemiology ]
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[http://listserv.templeton.org/scripts/wa.exe?A2=ind99&L=metaviews&D=1&O=D&F=&S=&P=18383
Review of Pollack's
The Missing Moment: How the Unconscious Shapes Modern Science.
Robert Pollack. Houghton Mifflin, Boston, 1999. ISBN
From: "Dr. N.S.Lehrman" <nslehrmanmd@earthlink.net>
N.S. Lehrman, M.D., former Clinical Director, Kingsboro Psychiatric Center, Brooklyn, of
0-395-70985-7
Contents
Introduction
1. Sensation
2. Consciousness
3. Memory and the Unconscious
4. The Fear of Invasion
5. The Fear of Insurrection
6. The Fear of Death
Conclusion
- Appendix: An Agenda for a More Humane Science
- Notes
- Further Reading
This book is a stunningly successful effort by a distinguished biologist to use new molecular biology and old Talmudic wisdom to evaluate important current public health and biomedical science practices.
Its author, Columbia University professor Robert Pollack, is founding Director of its new Center for the Study of Science and Religion and former Dean of its College. The book, despite its puzzling title, demonstrates "the difference between scientific knowledge and scientific wisdom" (p.1) by pointing out fundamental errors in public health and biomedical science practises today - the latter being "at war with its own stated purposes" (p. 79).
Recognizing the difference between knowledge and wisdom can help correct the blind, near-idolatrous science-worship sometimes found in discussions of the science-religion relationship.
The book's first half lucidly describes how the immune and central nervous systems develop and function. The second half demonstrates some fundamental errors in our approaches to infection, cancer, and aging and dying. The conclusion discusses the implications of these errors, and an appendix offers a detailed "agenda for a more humane science."
Sensation and subjective consciousness, whose neurological underpinnings the book discusses in glorious detail, are based on "a set of changes in neural networks." (p. 42) Mental function depends on "evanescent networks of brain cell clusters linked by the coincidence of their firing," (p. 43) all regulated by biological clocks. And although inborn circuitry is important, it is individual experience which determines whether or not needed brain circuits - the basis of psychological functioning - are actually established.
Pollack points out the immense number of cells and connections, and the rapid changes, involved in brain activity, to refute the claims of "artificial intelligence" supporters about future synthetic minds. Since "no two brains are the same, and no brain ever has the same circuit twice," it is "unlikely that consciousness will ever be successfully modeled by a hardware-driven technology, no matter how small, fast or complicated." (p. 46)
The same conclusion was reached by John Horgan's fine new book, "The Undiscovered Mind."
Pollack also affirms the widely-denied importance of emotionality as driver of both thinking and behavior by noting the "richly emotional context in which science actually takes place." (p. 58). And after examining the genic evolution of the human body, the result of gradual but massive modifications of earlier biological structures, he points out (p. 21) "how natural selection differs from conscious design."
Infection and "the fear of invasion"
Pollack's yardstick for measuring current approaches to infection and cancer is our immune system's mode of dealing with harmful agents: when infectious microbes invade, the system domesticates rather than eradicating them, so it can remain primed against future invasions. This is, of course, the basis of immunization.
Today, however, the prime focus of infectious disease research is the search for ever-new drugs to eradicate these invading agents. New, mutated, drug-resistant organisms are the inevitable result.
"Redoubled efforts to develop and distribute new vaccines, the world-wide reporting of outbreaks of infectious diseases and the wide dissemination of what we already know about epidemiology and preventive medicine" (p. 100) are, to Pollack, appropriate goals for infectious disease research.
"The three tools of public health that can keep microbial efforts at bay - an enhanced immune response, clean drinking water and insect control - were developed to high degrees of sophistication more than a century ago, and were very successful," he points out.
"Yet at the first victory of antibiotics, all three were set aside and forgotten as research strategies. As the great strategy of killing infectious agents and their vectors continues to breed its own failures, we need to recover the memory of these earlier successes." (p. 102)
Pollack is particularly shocked at how, "in 1986, just as tuberculosis was beginning to surface in AIDS patients, the United States government's Centers for Disease Control and Prevention - the CDC - ceased to require hospitals to report cases of INH-resistant tuberculosis. The timing could not have been worse. With this decision, INH-resistant tuberculosis was given the time and chance it needed to send forth variants that would be resistant to other drugs as well." (p. 95)
Millions of deaths occur each year from focusing almost exclusively on drugs and neglecting other methods of dealing with infections.
"Five million babies, for example, died in 1992 of serious childhood diseases like measles, tetanus, diarrhea, whooping cough and polio because they were not properly vaccinated. Currently more than a million American children under the age of three have not received the vaccines that would have immunized them against" these diseases. "Each of these children is a walking time bomb." (p. 103) And while one group of surveyed physicians thought that 90% of their young patients had been vaccinated, only 40% actually had been. Bill Gates gave $75 million since the book appeared to ensure needed immunizations for all American children.
Cancer and "the fear of insurrection"
"Just as every infection is an invasion of the body, every tumor is an insurrection from within," Pollack notes. (p. 106). "A mutation in any of hundreds of different genes may allow a cell to break free of the constraints of differentiation. Thereafter, the genetically altered descendants of that cell will continue to divide, possibly forming a clone of mutant cells, each capable of unlimited further division. When the clone gets big enough to disrupt the architecture of the tissue it displaces and to spread its descendants through the bloodstream to distant parts of the body, we recognize it as a malignant tumor." (p. 107)
Killing cancerous cells while sparing their normal cousins has been the primary approach to cancer for the past fifty years. This "resembles to an uncanny extent the current strategy for dealing with infectious disease by searching for new families of antibiotics." (p.108) The growing tumor throws off a cloud of genetic variants, so that any mutant cells that survive the body's defenses and the medicine's assaults can become the seeds of new resistant tumors. Some cancer victims therefore succumb to the progeny of drug-resistant, radiation-resistant variants of their tumors, just as some people die of secondary infection by antibiotic-resistant microbial variants evoked by the drugs intended to kill them.
Cancers arise by mutation and are therefore preventable. Only a small percentage are the consequence of an inherited condition, and but a few more are the product of infectious agents. (p. 109) 90% or more of new cancers result from avoidable habits and preventable exposure - to tobacco smoke, pesticides in foods, pollutants in the air and water, radiation and drugs, all of which can cause mutations. "Given the will, these can be changed at any time without the need for any further basic research."
Nevertheless, cancer prevention, so much simpler and easier than curing it, is largely ignored in cancer research today. It focuses instead on genes associated with higher cancer risk, on the premise that one day, the information will provide better drugs to kill every last tumor cell - an agenda Pollack sees as "woefully incomplete at best and absurd at worst." "To discover precisely which chemicals will cause cancer when they enter the bloodstream and then - instead of working to remove these chemicals from everyone's food, air and water - to study the genetics of the liver proteins that detoxify them, is to be in a waking dream." (p. 111)
Cancer scientists' dream of total victory after total war has led them to wrap their "research in military metaphors over the decades" - four separate "wars" aimed mostly at killing every last cancer cell.
The first, in the 1930's and 40's, was useful by fighting cancer with information by stressing self-examination and early detection.
Radiation, seen as "a clean new knife that would remove all traces of the disease from a sick person's body," although still useful, lost much of its sheen when radiation-resistant tumor cells appeared in many treated patients.
The third war, against infectious agents - especially viruses - "was going no better in 1975 than the war on Viet Cong insurgents. Neither was going to be won by the forces of the United States government, and Congress was no longer willing to support either.
By 1980, the Special Virus Cancer Program had been partially disbanded." But in that one decade, the budget of the National Cancer Institute grew from $240 million to $1 billion.
Today's "war," the fourth, focuses on the genes specifically mutated in cancers.
But the recent discovery that some of the genetic differences converting a normal cell into a cancerous one could also be inherited thorough the human germ line opened an unexpected, dangerous second front; remarkably high frequencies of specific cancers are found in those rare families in whom such a mutation has been inherited.
But "while avoidable cell mutation is responsible for the vast majority of cancer, and germ-line mutation is responsible for only a few, scientists on this new front imagined all cancers to be problems of family inheritance rather than random misadventures" - predestined rather than preventable.
"The search for genes associated with higher likelihood of developing a tumor has been vested with magically high expectations on the premise that one day it will somehow lead to better treatment." (p.117) But harm has been created in the interim.
Cancer, a preventable disease which can strike anyone, has been reinterpreted as an inherited disease which cannot be escaped if one chose his or her ancestors poorly. Cancer itself has thus been transformed from a threat to us all, and therefore a preventable social problem, into a personal problem, limited to those placed at higher risk by genetic endowment.
The results are pernicious: for some, unnecessary fears; for others false reassurance, which can breed carelessness - denying the importance of self-examination, for example.
Aging and "the fear of death"
Our current ways of dealing with the dying are measured against a humanistic yardstick provided by the Hebrew Talmud: someone beyond medical help and expected to die within three days nevertheless retains his basic human rights and social needs; the quality of his last days may be more important than their mere number.
"Leaving the dying person alone in a cold room with tubes and monitors blocking all human interaction" (p. 148) neither respects the dying person'sdignity nor improves the quality of his final days. Pollack therefore strongly endorses the use of hospices - as well as using enough drugs to stop pain.
Pointing out how "medical scientists treat very old age, dying and death with equally fastidious disdain, as though they were all somehow intrinsically uninteresting," (p. 145) Pollack cites the recommendation by the Hastings Institute's Daniel Callahan that scientists and physicians accept the inevitability of death rather than seeking endlessly to prolong life, shift from doing everything it takes to keep an old person alive to a commitment acknowledging the finiteness of life, and research improving the quality of the final years. (p. 149)
Since aging involves damage to stem cell DNA, research on slowing the aging process by enhancing repair of that DNA might be fruitful - and without denying the inevitability of death. The human organism does have physiological limits, apparently reached in our 80's or 90's, beyond which life probably cannot be prolonged.
Pollack's conclusions
Although "scientific discoveries paint a coherent and clear picture of the living world and of our place in it that is notable for its complete lack of meaning," Pollack seeks meaning for himself, and the future, hoping that "the science of the future will be made by men and women who have found meaning in their lives." "Meaning" to him apparently means the existence of something above oneself to which we are accountable , whether that be God or Moral Law. After reminding us of the often-forgotten dangers of science without morality - the allegedly "scientific bases" of the real-life Soviet and Nazi experiences, and the fictional "Brave New World" and "1984" - he points out the need for moral leadership in science, centered on freedom of thought and an ideal "mind of society."
Greatly increased emphasis on immunizations to prevent infectious diseases, more stress on prevention in the fight against cancer, and cautious efforts to treat it by "a slowly evolving combination of genetic, immunologic, and antibiotic interventions" (pp. 173 -174) are at the heart of his "agenda for a more humane medical science." He warns particularly, however, against the increasingly popular efforts to change human embryos' DNA, thus sacrificing the current generation for the next, because of the unknown, widespread and possibly harmful effects which can result from efforts to change one known aspect of the embryo.
This erudite book's only weakness is in blaming - most visibly in its subtitle - "the unconscious" of scientists rather than conscious human agency for the problems it examines.
Most central nervous system processes occur outside of consciousness (which can perhaps best be defined as the subjectively-aware aspect of making verbalizable choices). This apparently provides the rationale for the book's erroneously equating and lumping together two very different aspects of unconscious mental activity: the initial tenth of a second of our response to stimuli before they register in our consciousness (the "missing moment") and the Freudian "unconscious," which supposedly makes its own complex, difficult decisions, including the "shap[ing of] modern science," outside of consciousness. Indeed, Pollack uses the concept of scientists' unconscious fears - of invasion and insurrection, and especially of death - to link his chapters on infection, cancer and aging.
While scientists' fears may be significant in our mishandling of aging and dying, drug company bottom lines and the self-aggrandizing genome project, for example, are far more responsible for the mishandling of infectious and malignant diseases. Who was responsible for the CDC's decision to stop reporting drug-resistant tuberculosis? And Pollack's claim, from Freud, that the inevitability of death is not merely a major motivator but one of the great discoveries of the past century (along with evolution and how the brain works) seems a bit much.
The book is, however, Pollack's brilliant, courageous, highly successful effort to use his own religious, humanistic wisdom to examine and correct both the dehumanization which exists within important segments of medical practice and biomedical research and the current worship of "science" as infallible.]
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