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We are products of complexity,
but our evolution has focused our
understanding on the situation of hunter gatherers on the
African savanna.
As humanity has become more powerful we can significantly impact
the systems we depend on. But we struggle to comprehend
them. So this web frame
explores significant real world complex
adaptive systems (CAS):
- Assumptions of randomness & equilibrium allowed the
wealthy & powerful to expand the size and leverage of
stock markets, by placing at risk the insurance and
retirement savings of the working class. The
assumptions are wrong but remain entrenched.
- The US nation was built
from two divergent political
views of: Jefferson and Hamilton. It also
reflects the development
of competing ancient ideas of Epicurus and
Cyril. But the collapse of Bretton Woods forced Wall
Street into a position of power, while the middle and
working class were abandoned by the elites. Housing
financed with cash from oil and derivative transactions
helped hide the shift.
- Most US health care is still
operating the way cars built in the 1940s did.
Geisinger is an example of better solution. But
transforming the whole network is a challenge. And
public health investment has proved far more
beneficial.
- Helping our children learn to be
effective adults is part of our humanity, but we have
created a robust but deeply flawed education system.
Better alternatives have emerged.
- Spoken language, reading and writing emerged allowing our
good ideas to
become a second genetic material.
- The emergence
of the global economy in the 1600s and its subsequent
development;
It explains how the examples relate to each other, why we all
have trouble effectively comprehending these systems and
explains how our inexperience with CAS can lead to catastrophe. It
outlines the items we see as key to the system and why.
Example systems frame |
Dietrich Dorner argues complex adaptive systems (CAS) are hard to understand and
manage. He provides examples of how this feature of these
systems can have disastrous consequences for their human
managers. Dorner suggests this is due to CAS properties
psychological impact on our otherwise successful mental
strategic toolkit. To prepare to more effectively manage
CAS, Dorner recommends use of:
- Effective iterative planning and
- Practice with complex scenario simulations; tools which he
reviews.
Complexity catastrophes |
E. O. Wilson reviews the effect of man on the natural world to
date and explains how the two systems can coexist most
effectively.
Adaptive ecology |
Barton Gellman details the strategies used by Vice President
Cheney to align the global system with his economics, defense, and
energy goals.
US vds alignment |
Kevin Kruse argues that from 1930 onwards the corporate elite
and the Republican party have developed and relentlessly
executed strategies to undermine Franklin Roosevelt and the New Deal. Their
successful strategy used the credibility of conservative
religious leaders to:
- Demonstrate religious issues
with the New Deal.
- Integrate the corporate
elite and evangelicals.
- Use the power of corporate
advertising and Hollywood to reeducate the American
people to view the US as historically religious and
the New Deal and liberalism as anti-religious
socialism.
- Focus the message through evangelicals including Vereide and Graham.
- Centralize the strategy through President Eisenhower.
- Add religious elements to
mainstream American symbols: money, pledge;
- Push for prayer in
public school
- Push Congress to promote prayer
- Make elections more
about religious positions.
Following our summary of his arguments RSS frames them from the
perspective of complex adaptive system (CAS) theory.
Strategy is the art of the possible. But it also depends
on persistence.
Inventing Christian America |
Charles Ferguson argues that the US power structure has become
highly corrupt.
Ferguson identifies key events which contributed to the
transformation:
- Junk bonds,
- Derivative
deregulation,
- CMOs,
ABS and analyst fraud,
- Financial network deregulation,
- Financial network consolidation,
- Short term incentives
Subsequently the George W. Bush administration used the
situation to build
a global bubble, which Wall Street
leveraged. The bursting of the
bubble: managed
by the Bush Administration and Bernanke Federal Reserve;
was advantageous to some.
Ferguson concludes that the restructured and deregulated
financial services industry is damaging to
the American economy. And it is supported by powerful, incentive aligned academics.
He sees the result being a rigged system.
Ferguson offers his proposals
for change and offers hope that a charismatic young FDR will appear.
Following our summary of his arguments, RSS comments on them framed by
complex adaptive system (CAS)
theory. Once the constraints are removed from CAS
amplifiers, it becomes advantageous to leverage the increased flows. And it is often
relatively damaging not to participate. Corruption and parasitism can become
entrenched.
Financial WMD |
Matt Taibbi describes the phenotypic
alignment of the American justice system. The result
he explains relentlessly grinds the poor and undocumented into
resources to be constrained, consumed and ejected. Even as
it supports and aligns the financial infrastructure into a
potent weapon capable of targeting any company or nation to
extract profits and leave the victim deflated.
Taibbi uses five scenarios to provide a broad picture of the:
activities, crimes, policing, prosecutions, court processes,
prisons and deportation network. The scenarios are:
Undocumented people's neighborhoods, Poor neighborhoods, Welfare
recipients, Credit card debtors and Financial institutions.
Following our summary of his arguments, RSS comments on them framed by
complex adaptive system (CAS) theory. The alignment of the
justice system reflects a set of long term strategies and
responses to a powerful global arms race that the US leadership intends to
win.
Aligned justice |
Jonathan Powell describes how the government of, the former UK Prime Minister, Tony Blair,
actually operated. Powell was Blair's only chief of
staff.
Mechanics of power |
H. A. Hayek compares and contrasts collectivism and
libertarianism.
Libertarianism |
John Doerr argues that company leaders and their
organizations, hugely benefit from Andy Grove's OKRs.
He promotes strategies
that help OKR success: Focus,
Align, Track, Stretch; replaces yearly performance
reviews, and provides illustrative success
stories.
Doerr stresses Dov Seidman's
view that employees are adaptive and will
respond to what they see being measured. He asserts culturally supported OKRs/CFR processes will be transformative.
Following our summary of his arguments, RSS comments on them
framed by complex adaptive system (CAS) theory. Doerr's architecture
is tailored for the startups KPCB
invests in. It is a subset of the general case of schematic plans, genetic operators and Shewhart cycles that drive all
CAS. Doerr's approach limits support of learning and deemphasizes the
association to planning.
Startup PDCA |
David Bodanis illustrates how disruptive effects can take
hold. While the French revolution had many driving forces
including famine and
oppression the emergence of a new philosophical vision ensured
that thoughtful leaders
were constrained and conflicted in their responses to the
crisis.
Voltaire's disruptive network |
An epistatic meme suppressed for a thousand years reemerges
during the enlightenment.
It was a poem
encapsulating the ideas of Epicurus rediscovered by a
humanist book hunter.
Greenblatt describes the process of suppression and
reemergence. He argues that the rediscovery was the
foundation of the modern world.
Complex adaptive system (CAS) models of the memetic mechanisms
are discussed.
Constraining happiness |
Isaacson uses the historic development of the global cloud of
web services to explore Ada
Lovelace's ideas about thinking
machines and poetic
science. He highlights the value of computer
augmented human creativity and the need for liberal arts to
fulfill the process.
Complex adaptive system (CAS) models of agent networks and
collaboration are discussed.
Arts technology & intelligence |
Haikonen juxtaposes the philosophy and psychology of
consciousness with engineering practice to refine the debate on
the hard problem of consciousness. During the journey he
describes the architecture of a robot that highlights the
potential and challenges of associative neural
networks.
Complex adaptive system (CAS) theory is then used to illustrate the
additional requirements and constraints of self-assembling
evolved conscious animals. It will be seen that
Haikonen's neural
architecture, Smiley's Copycat
architecture and molecular biology's intracellular
architecture leverage the same associative properties.
Associatively integrated robots |
Good ideas are successful because they build upon prior
developments that have been successfully implemented.
Johnson demonstrates that they are phenotypic expressions of
memetic plans subject to the laws of complex adaptive systems (CAS).
Developing ideas |
A government sanctioned monopoly
supported the construction of a superorganism
American Telephone and
Telegraph
(AT&T). Within this Bell Labs was at the center of
three networks:
- The evolving global scientific
network.
- The Bell telephone network. And
- The military
industrial network deploying 'fire and missile
control' systems.
Bell Labs strategically leveraged each network to create an innovation
engine.
They monitored the opportunities to leverage the developing
ideas, reorganizing to replace incumbent
opposition and enable the creation and growth of new
ideas.
Once the monopoly was
dismantled, AT&T disrupted.
Complex adaptive system (CAS) models of the innovation mechanisms are
discussed.
Strategic innovation |
Roger Cohen's New York Times opinion about the implications of
BREXIT is summarized. His ideas are then framed by complex
adaptive system (CAS) theory and
reviewed.
BREXIT |
Scott Galloway argues that Apple, Amazon, Facebook and Google
are monopolists that
trade workers for technology. Monopolies that he argues
should be broken up to ensure the return of a middle
class.
Following our summary of his arguments, RSS comments on these arguments
assuming they relate to a complex adaptive system (CAS).
While Scott's issue is highly significant his analysis conflicts
with relevant CAS history and theory.
Monopoly job killers |
The IPO of Netscape is
defined as the key emergent event of
the New Economy by Michael Mandel. Following the summary
of Mandel's key points the complex adaptive system (CAS) aspects are highlighted.
New economy |
Ed Conway argues that Bretton Woods produced a unique set of
rules and infrastructure for supporting the global economy. It was
enabled by the experience of Keynes
and White during and after the First World War, their dislike of the Gold Standard,
the necessity of improving
the situation between the wars and the opportunity created
by the catastrophe of the Second
World War.
He describes how it was planned
and developed. How it
emerged from the summit.
And he shows how the opportunity inevitably allowed the US to replace the UK at the center of the global economy.
Like all plans there are
mistakes and Conway takes us through them and how the US recovered the situation as
best it could.
And then Conway describes the period after
Bretton Woods collapsed. He explains what followed
and also compares the relative performance of the various
periods before during and after Bretton Woods.
Following our summary of his arguments RSS comments from the
perspective of Complex Adaptive System (CAS)
theory. Conway's book illustrates the rule making and
infrastructure that together build an evolved amplifier.
He shows the strategies at play of agents that were for and
against the development
and deployment of the system. And The Summit provides a
key piece of the history of our global economic CAS.
Bretton woods |
A key agent in the 1990 - 2008
housing expansion Countrywide is linked into the residential
mortgage value delivery system (VDS)
by Paul Muolo and Mathew Padilla. But they show the VDS
was full of amplifiers and control points. With no one
incented to apply the brakes the bubble grew and burst.
Following the summary of Muolo and Padilla's key points the
complex adaptive system (CAS)
aspects are highlighted.
Housing amplifiers |
Satyajit Das uses an Indonesian company's derivative trades to
introduce us to the workings of the international derivatives
system. Das describes the components of the value delivery
system and the key
transactions. He demonstrates how the system
interacted with emerging economies
expanding them, extracting profits and then moving on as the
induced bubbles burst. Following Das's key points the
complex adaptive system (CAS)
aspects are highlighted.
Derivative systems |
Johnson & Kwak argue that expanding the national debt
provides a hedge against unforeseen future problems, as long as
creditors are willing to continue lending. They illustrate
different approaches to managing the debt within the US over its history and of the
eighteenth century administrations of England and France.
The US embodies two different political and economic systems which
approach the national debt differently:
- Taxes to support a sinking
fund to ensure credit to leverage fiscal power in:
Wars, Pandemics, Trade disputes, Hurricanes, Social
programs; Starting with Hamilton,
Lincoln & Chase,
Wilson, FDR;
- Low taxes, limited infrastructure, with risk assumed by
individuals: Advocated by President's Jefferson & Madison,
Reagan,
George W. Bush (Gingrich);
Johnson & Kwak develop a model of what the US
government does. They argue that the conflicting
sinking fund and low tax approaches leaves the nation 'stuck in
the middle' with a future problem.
And they offer their list of 'first principles' to help
assess the best approach for moving from 2012 into the
future.
They conclude the question is still political. They hope
it can be resolved with an awareness of their detailed
explanations. They ask who is willing to
push all the coming risk onto individuals.
Following our summary of their arguments RSS frames them from the
perspective of complex adaptive system (CAS) theory.
Historically developing within the global cotton value delivery
system, key CAS features are highlighted.
National debt |
Robert Gordon argues that the inventions of the second
industrial revolution were the foundation for
American economic growth. Gordon shows how flows of people
into difficult rural America built a population base
which then took the opportunity to move on to urban settings: Houses, Food in supermarkets,
Clothes in
department stores;
that supported increasing productivity and standard of living.
The deployment of nationwide networks: Rail, Road, Utilities;
terminating in the urban housing and work places allowing the workers to
leverage time saving goods and services, which helped grow
the economy.
Gordon describes the concomitant transformation of:
- Communications
and advertising
- Credit
and finance
- Public
health and the health
care network
- Health insurance
- Education
- Social
and welfare services
Counter intuitively the constraints
introduced before and in the Great Depression and the demands of World War 2
provide the amplifiers that drive the inventions deeply and
fully into every aspect of the economy between 1940 and 1970
creating the exceptional growth and standard of living of post
war America.
Subsequently the
rate of growth was limited until the shift of women
into the workplace and the full networking of
voice and data supported the Internet and World Wide Web
completed the third industrial revolution, but the effects were
muted by the narrow reach of the technologies.
The development of Big Data, Robots,
and Artificial Intelligence may support additional growth,
but Gordon is unconvinced because of the collapse of
the middle class.
Following our summary of Gordon's book RSS frames his arguments from
the perspective of complex adaptive system (CAS) theory.
American growth |
Carl Menger argues that the market induced the emergence of
money based on the attractive features of precious metals.
He compares the potential for government edicts to create money
but sees them as lacking.
Following our summary of his arguments RSS frames his arguments from
the perspective of complex adaptive system (CAS) theory.
With two hundred years of additional knowledge we conclude that
precious metals are not as attractive as Menger asserts.
Government backed promissory notes are analogous to:
- Other evolved CAS forms of ubiquitous high energy
transaction intermediates and
- Schematic strategies that are proving optimal in
supporting survival and replication in the currently
accessible niches.
Emergence of money |
Eric Beinhocker sets out to answer a question Adam Smith
developed in the Wealth of Nations: what is wealth? To do
this he replaces traditional
economic theory, which is based on the assumption that an
economy is a system in
equilibrium, with complexity
economics in which the economy is modeled as a complex
adaptive system (CAS).
He introduces Sugerscape
to illustrate an economic CAS model in action. And then he
explains the major features of a CAS economy: Dynamics,
Agents, Networks, Emergence, and
Evolution.
Building on complexity economics Beinhocker reviews how evolution applies to
the economy to build wealth. He explains how design spaces
map strategies to instances of physical and
social
technologies. And he identifies the interactors and
selection mechanism of economic
evolution.
This allows Beinhocker to develop a new definition
of wealth.
In the rest of the book Beinhocker looks at the consequences of
adopting complexity economics for business and society: Strategy, Organization, Finance,
& Politics
& Policy.
Following our summary of his arguments, RSS explores his conclusions
and aligns Beinhocker's model of CAS with the CAS theory and evidence we
leverage.
Economic complexity |
Sven Beckert describes the historic transformation of the
growing, spinning, weaving, manufacture of cotton goods and
their trade over time. He describes the rise of a first global
commodity, its dependence on increasing: military power, returns for
the control points in the value delivery system(VDS), availability of land
and labor to work it including slaves.
He explains how cotton offered the opportunity for
industrialization further amplifying the productive capacity of
the VDS and the power of the control points. This VDS was quickly
copied. The increased capacity of the industrialized
cotton complex adaptive system (CAS) required more labor to
operate the machines. Beckert describes the innovative introduction of wages
and the ways found to
mobilize industrial labor.
Beckert describes the characteristics of the industrial cotton
CAS which made it flexible enough to become globally interconnected.
Slavery made the production system so cost effective that all
prior structures collapsed as they interconnected. So when
the US civil war
blocked access to the major production nodes in the
American Deep South the CAS began adapting.
Beckert describes the global
reconstruction that occurred and the resulting destruction of the traditional ways
of life in the global countryside. This colonial expansion
further enriched and empowered the 'western' nation
states. Beckert explains how other countries responded
by copying the colonial strategies and creating the
opportunities for future armed conflict among the original
colonialists and the new upstarts.
Completing the adaptive
shifts, Beckert describes the advocates for industrialization in
the colonized global south and how over time they joined
the global cotton CAS disrupting the early western manufacturing
nodes and creating the current global CAS
dominated by merchants like Wal-Mart
pulling goods through a network of clothing manufacturers,
spinning and weaving factories, and growers competing with each
other on cost.
Following our summary of Beckert's book, RSS comments from the
perspective of CAS theory. The transformation of
disconnected peasant farmers,
pastoral warriors and their lands into a supply chain for a
highly profitable industrial CAS required the development over
time: of military force, global transportation and communication
networks, perception and representation control networks, capital stores and flows,
models, rules, standards and markets; along with the support at
key points of: barriers, disruption, and infrastructure and
evolved amplifiers. The emergent
system demonstrates the powerful constraining influence of
extended phenotypic alignment.
Globalization from cotton |
The structure and problems of the US
health care network is described in terms of complex adaptive
system (CAS) theory.
The network:
- Is deeply embedded in the US nation state. It reflects the
conflict between two
opposing visions for the US: high tax with safety net
or low tax without. The emergence
of a parasitic elite supported by tax policy, further
constrains the choices available to improve the efficiency
and effectiveness of the network.
- The US is optimized to sell its citizens dangerous
levels of: salt,
sugar, cigarettes,
guns, light, cell phones, opioids,
costly education, global travel,
antibacterials, formula, foods including
endocrine disrupters;
- Accepting the US controlled global supply chain's
offered goods & services results in: debt, chronic stress,
amplified consumption and toxic excess, leading to obesity, addiction, driving instead of
walking, microbiome
collapse;
- Globalization connects disparate environments in a network. At the edges,
humans are drastically altering the biosphere. That
is reducing the proximate natural environment's
connectedness, and leaving its end-nodes disconnected and
far less diverse. This disconnects predators from
their prey, often resulting in local booms and busts that
transform the local parasite
network and their reservoir and amplifier
hosts. The situation is setup so that man is
introduced to spillover
from the local parasites' hosts. Occasionally, but
increasingly, the spillover results in humanity becoming
broadly infected. The evolved
specialization of the immune system
to the proximate environment during development
becomes undermined as the environment transforms.
- Is incented to focus on localized competition generating
massive & costly duplication of services within
physician based health care operations instead of proven
public health strategies. This process drives
increasing research & treatment complexity and promotes hope
for each new technological breakthrough.
- Is amplified by the legislatively structured separation
and indirection of service development,
provision, reimbursement and payment.
- Is impacted by the different political strategies for
managing the increasing
cost of health care for the demographic bulge of retirees.
- Is presented with acute
and chronic
problems to respond to. As currently setup the network
is tuned to handle acute problems. The interactions
with patients tend to be transactional.
- Includes a legislated health insurance infrastructure
which is:
- Costly and inefficient
- Structured around yearly
contracts which undermine long-term health goals and
strategies.
- Is supported by increasingly regulated HCIT
which offers to improve data sharing and quality but has
entrenched commercial EHR
products deep within the hospital systems.
- Is maintained, and kept in
alignment, by massive network
effects across the:
- Hospital platform
based
sub-networks connecting to
- Physician networks
- Health insurance networks - amplified by ACA
narrow network legislation
- Hospital clinical supply and food
production networks
- Medical school and academic research network and NIH
- Global
transportation network
- Public health networks
- Health care IT supply
network
Health care |
Deaton describes the wellbeing
of people around the world today. He explains the powerful benefit of public
health strategies and the effect of growth in
material wellbeing but also the corrosive effects of
aid.
Following our summary of Deaton's arguments RSS comments from the
perspective of complex adaptive system (CAS)
theory. The situation he describes is complex including
powerful amplifiers, alignment and incentives that overlap
broadly with other RSS summaries of adaptations of: The
biosphere, Politics, Economics,
Philosophy and Health care.
Improving wellbeing |
Donald Barlett and James Steele write about their investigations
of the major problems afflicting US
health care as of 2006.
Problems of US health care |
Glenn Steele & David Feinberg review the development of the
modern Geisinger healthcare business after its near collapse
following the abandoned merger with Penn State AMC. After an overview of the
business, they describe how a calamity
unfolding around them supported building a vision of a
better US health care network. And they explain:
- How they planned
out the transformation,
- Leveraging an effective
governance structure,
- Using a strategy
to gain buy in,
- Enabling
reengineering at the clinician patient
interface.
- Implementing the reengineering for acute, chronic
& hot
spot care; to help the patients and help the
physicians.
- Geisinger's leverage of biologics.
- Reengineering healing with ProvenExperience.
- Where Geisinger is headed next.
Following our summary of their arguments RSS comments on them. We
frame their ideas with complex adaptive system (CAS)
theory.
E2E insured quality care |
Robert Pearl explains the perspectives of a health care leader
and son who know that the current health care network interacts
with human behavior to induce a poorly performing system that
caused his father's death. But he is confident that these
problem perceptions can be changed. Once that occurs he
asserts the network will become more integrated, coordinated,
collaborative, better led, and empathetic to their
patients. The supporting technology infrastructure will be
made highly interoperable. All that will reduce medical
errors and make care more cost effective.
Following our summary of his arguments RSS comments on them. We
frame his ideas with complex adaptive system (CAS) theory
including synergistic examples of these systems in
operation. The health care network is built out of
emergent human agents. All agents must model the signals
they perceive to represent and respond to them. Pinker
explains how this occurs. Sapolsky explains why fear and
hierarchy are so significant. He includes details of Josh
Green's research on morality and death. Charles Ferguson
highlights the pernicious nature of financial incentives.
Bad medical models |
US healthcare is ripe for
disruption. Christensen, Grossman and Hwang argue that
technologies are emerging which will support low cost business
models that will undermine the current network. Applying
complex adaptive system (CAS)
theory to these arguments suggests that the current power hierarchy can effectively resist
these progressive forces.
Disrupting health care |
Atul Gawande writes about the opportunity for a thirty per cent
improvement in quality in medicine by organizing
to deploy as agent based teams using shared schematic
plans and distributed signalling or as he puts it the use of checklists.
With vivid examples from a variety of situations including construction, air crew support and global health care Gawande illustrates
the effects of
complexity and how to organize to cope with it.
Following the short review RSS
additionally relates Gawande's arguments to its models of
complex adaptive systems (CAS) positioning his discussion within
the network of US health care,
contrasting our view of complexity, comparing the forces shaping
his various examples and reviewing facets of complex
failures.
Complexity checklists |
Friedman and Martin leverage the lifelong data collected on
1,528 bright individuals selected by Dr. Lewis Terman
starting in 1921, to understand what aspects of the subjects'
lives significantly affected their longevity. Looking
broadly across each subject's: Personality,
Education, Parental impacts,
Energy
levels, Partnering,
Careers, Religion,
Social networks,
Gender, Impact from war and
trauma; Friedman and Martin are able to develop a set of model pathways,
which each individual could be seen to select and travel
along. Some paths led to the traveler having a long
life. Others were problematic. The models imply that
the US approach to health and
wellness should focus
more on supporting
the development and selection of beneficial pathways.
Following our summary of their arguments RSS comments from the
perspective of CAS theory. The pathways are most
applicable to bright individuals with the resources and support
necessary to make and leverage choices they make. Striving
to enter and follow a beneficial pathway seems sensible but may
be impossible for individuals trapped in a collapsing network,
starved of resources.
Promoting longevity |
Agent death |
Sonia Shah reviews the millennia old (500,000 years) malarial arms race between Humanity, Anopheles
mosquitoes and Plasmodium. 250 - 500 million people are
infected each year with malaria and one million die.
Malaria |
Peter Medawar writes about key historic events in the evolution
of medical science.
Medical science events |
Using John Holland's theory of adaptation in complex
systems Baldwin and Clark propose an evolutionary theory of
design. They show how this can limit the interdependencies
that generate complexity
within systems. They do this through a focus on
modularity.
Modular designed systems |
Lou Gerstner describes the challenges he faced and the
strategies he used to successfully restructure the computer
company IBM.
Compartmented systems |
Grady Booch advocates an object oriented approach to computer
software design.
Object based systems |
Bertrand Meyer develops arguments, principles and strategies for
creating modular software. He concludes that abstract data
types and inheritence make object orientation a superior
methodology for software construction. Complex adaptive
system (CAS) theory suggests agents provide an alternative strategy
to the use of objects.
Software construction |
Tools and the businesses that produce them have evolved
dramatically. W Brian Arthur shows how this occurred.
Tools |
Matt Ridley demonstrates the creative effect of man on the
World. He highlights:
- A list of
preconditions resulting in
- Additional niche
capture & more free time
- Building a network
to interconnect memes processes & tools which
- Enabling inter-generational
transfers
- Innovations
that help reduce environmental stress even as they leverage fossil
fuels
Memetic trading networks |
E O. Wilson argues that campfire gatherings on the savanna supported
the emergence of human creativity. This resulted in man
building cultures and
later exploring them, and their creator, through the humanities. Wilson
identifies the transformative events, but he notes many of these
are presently ignored by the humanities. So he calls for a
change of approach.
He:
- Explores creativity:
how it emerged from the benefits of becoming an omnivore hunter-gatherer,
enabled by language & its catalysis of invention, through stories told in the
evening around the campfire. He notes the power of
fine art, but suggests music provides the most revealing
signature of aesthetic
surprise.
- Looks at the current limitations of the
humanities, as they have suffered through years of neglect.
- Reviews the evolutionary processes of heredity and
culture:
- Ultimate causes viewed
through art, & music
- The bedrock of:
- Ape senses and emotions,
- Creative arts, language, dance, song typically studied
by humanities,
&
- Exponential change in science and
technology.
- How the breakthrough from
our primate past occurred, powered by eating meat,
supporting: a bigger brain, expanded memory &
language.
- Accelerating changes now driven by genetic cultural coevolution.
- The impact on human nature.
- Considers our emotional attachment to the natural world: hunting, gardens; we are
destroying.
- Reviews our love of metaphor, archetypes,
exploration, irony, and
considers the potential for a third enlightenment,
supported by cooperative
action of humanities and science
Following our summary of his arguments RSS frames these from the
perspective of complex adaptive system (CAS) theory:
- The humanities are seen to be a functionalist framework
for representing the cultural CAS while
- Wilson's desire
to integrate the humanities and science gains support from
viewing the endeavor as a network of layered CAS.
Evening campfire rituals |
Brynjolfsson and McAfee explore the effects of Moore's law on the
economy. They argue it has generated exponential
growth. This has been due to innovation.
It has created a huge bounty of
additional wealth.
But the wealth is spread unevenly across
society. They look at the short and long term implications of
the innovation bounty and spread
and the possible future of
technology.
Following our summary of their arguments RSS comments from the
perspective of CAS theory.
Brilliant technologies |
Salman Khan argues that the evolved global education system is
inefficient and organized around constraining and corralling
students into accepting dubious ratings that lead to mundane
roles. He highlights a radical and already proven
alternative which offers effective self-paced deep learning
processes supported by technology and freed up attention of
teams of teachers. Building on his personal experience of
helping overcome the unjustified failing grade of a relative,
Khan:
- Iteratively learns how to teach: Starting with Nadia, Leveraging
short videos focused on content,
Converging on mastery,
With the help of
neuroscience, and filling
in dependent gaps; resulting in a different approach
to the mainstream method.
- Assesses the broken US education system: Set in its ways, Designed for the 1800s,
Inducing holes that
are hidden by tests, Tests
which ignore creativity.
The resulting teaching process is so inefficient it needs to
be supplemented with homework.
Instead teachers were encouraging their pupils to use his tools at home so
they could mentor them while they attended school, an
inversion that significantly improves the economics.
- Enters the real world: Builds a scalable service,
Working with a
real classroom, Trying stealth
learning, At Khan Academy full time, In the curriculum at
Los Altos, Supporting life-long
learning.
- Develops The One World Schoolhouse: Back to the future with
a one
room school, a robust
teaching team, and creativity enabled;
so with some catalysis
even the poorest can
become educated and earn credentials
for current jobs.
- Wishes he could also correct: Summer holidays, Transcript based
assessments, College
education;
- Concludes it is now possible to provide the infrastructure
for creativity to
emerge and to support risk taking.
Following our summary of his arguments RSS frames them from the
perspective of complex adaptive system (CAS) theory. Disruption is a powerful force for
change but if its force is used to support the current teachers
to adopt new processes can it overcome the extended phenotypic alignment and evolutionary amplifiers sustaining the
current educational network?
Education versus guilds |
Amy Chua and Jed Rubenfeld's New York Times opinion based on The
Triple Package is summarized. Their ideas are then framed
by CAS theory and reviewed.
What drives success |
Peter Turchin describes how major pre-industrial empires
developed due to effects of geographic boundaries constraining
the empires and their neighbors' interactions. Turchin
shows how the asymmetries of breeding rates and resource growth
rates results in dynamic cycles within cycles. After the
summary of Turchin's book complex adaptive system (CAS) theory
is used to augment Turchins findings.
Warrior groups |
Through the operation of three different food chains Michael
Pollan explores their relative merits. The application of
complex adaptive system (CAS)
theory highlights the value of evolutionary
testing of the food chain.
Natural systems |
E. O. Wilson & Bert Holldobler illustrate how bundled cooperative strategies can
take hold. Various social insects have developed
strategies which have allowed them to capture the most valuable
available niches. Like humans they invest in
specialization and cooperate to subdue larger, well equipped
competitors.
Insect superorganisms |
Computational
theory of the mind and evolutionary
psychology provide Steven Pinker with a framework on which
to develop his psychological arguments about the mind and its
relationship to the brain. Humans captured a cognitive niche by
natural selection 'building out'
specialized aspects of their bodies and brains resulting in a system of mental organs
we call the mind.
He garnishes and defends the framework with findings from
psychology regarding: The visual
system - an example of natural
selections solutions to the sensory challenges
of inverse
modeling of our
environment; Intensions - where
he highlights the challenges of hunter-gatherers -
making sense of the objects
they perceive and predicting what they imply and natural
selections powerful solutions; Emotions - which Pinker argues are
essential to human prioritizing and decision making; Relationships - natural selection's
strategies for coping with the most dangerous competitors, other
people. He helps us understand marriage, friendships and war.
These conclusions allow him to understand the development and
maintenance of higher callings: Art, Music, Literature, Humor,
Religion, & Philosophy; and develop a position on the meaning of life.
Complex adaptive system (CAS) modeling allows RSS to frame Pinker's arguments
within humanity's current situation, induced by powerful evolved
amplifiers: Globalization,
Cliodynamics, The green revolution
and resource
bottlenecks; melding his powerful predictions of the
drivers of human behavior with system wide constraints.
The implications are discussed.
Computationally adapted mind |
The stages of development of the human female, including how her brain changes and the
impacts of this on her 'reality' across a full life span:
conception, infantile
puberty, girlhood,
juvenile pause, adolescence, dating years, motherhood, post-menopause; are
described. Brizendine notes the significant difference in
how emotions are processed
by women compared to men.
Complex adaptive system (CAS) theory associates the stages with
the evolutionary under-pinning, psychological implications and
behavioral CAS.
Evolved female brain |
The complexity of behavior is explored through Sapolsky
developing scenarios of our best and worst behaviors across time
spans, and scientific subjects including: anthropology,
psychology, neuroscience, sociology. The rich network of adaptive flows he
outlines provides insights and highlight challenges for
scientific research on behavior.
Complex adaptive system (CAS) theory builds on Sapolsky's
details highlighting the strategies that evolution has captured
to successfully enter niches we now occupy.
CAS behavior |
Carlo Rovelli resolves the paradox of time.
Rovelli initially explains that low level physics does not
include time:
- A present that is common throughout the universe does not exist
- Events are only partially ordered. The present is
localized
- The difference between past and future is not foundational.
It occurs because of state that through our blurring appears
particular to us
- Time passes at different speeds dependent on where we are and how fast we travel
- Time's rhythms are due to
the gravitational field
- Our quantized physics shows neither
space nor time, just processes transforming physical
variables.
- Fundamentally there is no time. The basic equations
evolve together with events, not things
Then he
explains how in a physical world without time its perception can
emerge:
- Our familiar time emerges
- Our interaction with the world is partial, blurred,
quantum indeterminate
- The ignorance determines the existence of thermal time
and entropy that quantifies our uncertainty
- Directionality of time is real
but perspectival. The entropy of the world in
relation to us increases with our thermal time. The
growth of entropy distinguishes past from future: resulting in
traces and memories
- Each human is a
unified being because: we reflect the world, we
formed an image of a unified entity by
interacting with our kind, and because of the perspective
of memory
- The variable time: is one
of the variables of the gravitational field.
With our scale we don't
register quantum fluctuations, making space-time
appear determined. At our speed we don't perceive
differences in time of different clocks, so we experience
a single time: universal, uniform, ordered; which is
helpful to our decisions
Emergence of time |
Consciousness has confounded philosophers and scientists for
centuries. Now it is finally being characterized
scientifically. That required a transformation of
approach.
Realizing that consciousness was ill-defined neuroscientist
Stanislas Dehaene and others characterized and focused on conscious access.
In the book he outlines the limitations of previous
psychological dogma. Instead his use of subjective
assessments opened the
window to contrast totally unconscious
brain activity with those
including consciousness.
He describes the research methods. He explains the
contribution of new sensors and probes that allowed the
psychological findings to be correlated, and causally related to
specific neural activity.
He describes the theory of the brain he uses, the 'global neuronal
workspace' to position all the experimental details into a
whole.
He reviews how both theory and practice support diagnosis and
treatment of real world mental illnesses.
The implications of Dehaene's findings for subsequent
consciousness research are outlined.
Complex adaptive system (CAS) models of the brain's development and
operation introduce constraints which are discussed.
Conscious access |
Reading and writing present a conundrum. The reader's
brain contains neural networks tuned to reading. With
imaging a written word can be followed as it progresses from the
retina through a functional chain that asks: Are these letters?
What do they look like? Are they a word? What does it sound
like? How is it pronounced? What does it mean? Dehaene
explains the importance of
education in tuning the brain's networks for reading as
well as good strategies for teaching reading and countering dyslexia. But
he notes the reading
networks developed far too recently to have directly evolved.
And Dehaene asks why humans are unique in developing
reading and culture.
He explains the cultural
engineering that shaped writing to human vision and the exaptations and neuronal structures that
enable and constrain reading and culture.
Dehaene's arguments show how cellular, whole animal and cultural
complex adaptive system (CAS) are
related. We review his explanations in CAS terms and use
his insights to link cultural CAS that emerged based on reading
and writing with other levels of CAS from which they emerge.
Evolved reading |
Read Montague explores how brains make decisions. In
particular he explains how:
- Evolution can create indirect abstract models, such as the dopamine system, that
allow
- Life changing real-time
decisions to be made, and how
- Schematic structures provide
encodings of computable control
structures which operate through and on incomputable,
schematically encoded, physically active structures and
operationally associated production
functions.
Receptor indirection |
Daniel Goleman and Richard Davidson describe a scientific
investigation of meditation's
impact on the brain. They introduce
the book by describing their experiences with meditation,
science and the research establishment, their friendship, how
meditation is now used in two distinct ways: deep - leading to altered
traits & wide - that can reach the multitudes; which
the book reviews as it critiques the claims and research used to
back them up.
Goleman and Davidson describe meeting as Harvard psychology
graduate students, interested in consciousness, and how minds
work. They rebel against the behavioral orthodoxy, visit Asia and discover the Eastern
tradition of exploring and altering the mind.
Goleman had travelled to Sri Lanka to understand an Asian model
of the mind, which he presented to the undergraduates at
Harvard. Goleman and Davidson developed it into a shared vision of
consciousness. It took over twenty years for
scientific theory and experimental data to catch up and align
with this model. Much of the prior
experimental data had to be abandoned.
They introduce meditation's
impact on the amygdala
responding to pain and stress.
They look at the changes in:
- Stress
- Compassion
- Attention
- Self-awareness; and the
potential for use of mediation
in psychiatry.
And they warn of the occurrence of dark
nights.
They detail how scientists were able to study the brains of Tibetan meditation masters,
starting with Mingyur Rinpoche,
and detect meditation altering
traits.
Finally they discuss the potential
benefits of meditation and strategies to distribute it
broadly to a busy America.
Meditating neurons |
Tara Brach was worried from
a young age that there was something terribly wrong with
her: she like many others felt unworthy. She responded
by developing Radical
Acceptance. Brach then explains the steps in
applying it: pause,
greet what happens next with unconditional
friendliness; allowing us to:
- Initially attend to the sensations
of our body,
- Accept the
wanting self and discover its source of boundless
love.
- Welcome
fear with a widening
attention, accept the pain of death and become
free.
- Use adversity as a gateway to limitless compassion for ourselves
and others.
- Focus on
our basic goodness to counter Western culture turning anger, at being betrayed,
towards ourselves. Extend observing this goodness in
everyone. This enables the use of loving-kindness.
- Leverage
friendships to understand more about our shared nature
and strengthen Radical Acceptance.
- Realize our Buddha nature.
Complex adaptive system (CAS) theory describes the emergence of
the dualistic self and the tree of life linked by the genetic
code and machinery. It provides an analog of the Buddhist
presence.
Compassionate CAS |
The influence of childhood on behavior is significant.
Enneagrams define personality
types: Reformer, Helper, Achiever,
Individualist, Investigator, Loyalist, Enthusiast,
Challenger and Peacemaker; based on the impact of
childhood driven wounds.
The Enneagram becomes
a tool to enable interested people to transform from the
emotionally wounded base, hidden within
the armor of the type, to the liberated underlying essence.
Childhood leaves each of us with some environmentally specific Basic Fear. In response each
of us adopts an induced Basic Desire
of the type. But as we develop the inner observer, it will
support presence and
undermine the identification
that supports the armor of the type.
The Enneagram reveals three sets of relations about our type
armor:
- Triadic self
revealing: Instinctive,
feeling, thinking; childhood needs
that became significant wounds
- Social style
groupings: Assertive, compliant, withdrawn; strategies for
managing inner conflict
- Coping styles: Positive outlook, competency, reactive; strategies for
defending childhood wounds
Riso and Hudson augment the Enneagram with instinctual
distortions reflected in the interests of the variants.
The Enneagram also offers tools for understanding a person's level of development:
unhealthy, average, healthy,
liberation; including their
current center of gravity,
steriotypical social role,
wake-up call, leaden rule, red
flag, and direction
of integration and disintegration.
Complex adaptive system (CAS) theory associates the models
presented by the Enneagram with evolved behaviors and structures
in the mind: feelings, emotions, social behaviors, ideas; driven
by genetic and cultural evolution and the constraints of family
and social life. Emergent evolved amplifers can be
constrained by Riso and Hudson's awareness strategies.
Enneagram strategies |
Antonio Damasio argues
that ancient
& fundamental homeostatic processes,
built into
behaviors and updated by evolution
have resulted in the emergence
of nervous systems and feelings. These
feelings, representing the state of the viscera, and represented with general
systems supporting enteric
operation, are later ubiquitously
integrated into the 'images'
built by the minds of higher animals
including humans.
Damasio highlights the separate
development of the body frame in the building of
minds.
Damasio explains that this integration of feelings by minds
supports the development of subjectivity and consciousness. His chain of
emergence suggests the 'order of things.' He stresses the
end-to-end
integration of the organism which undermines dualism. And he reviews Chalmers
hard problem of consciousness.
Damasio reviews the emergence of cultures
and sees feelings, integrated with reason, as the judges of the
cultural creative process, linking culture to
homeostasis. He sees cultures as supporting the
development of tools
to improve our lives. But the results of the
creative process have added
stresses to our lives.
Following our summary of his arguments RSS frames his arguments from
the perspective of complex adaptive system (CAS) theory.
Each of the [super]organisms
discussed is a CAS reflecting the theory of such systems:
- Damasio's proposals about homeostasis routed signalling, aligns
well with CAS theory.
- Damasio's ideas on cultural stresses are elaborated by CAS
examples.
Emergence of feelings |
Robert Coram highlights the noble life of John Boyd. John
spent a lot of time alone
during his childhood.
He: excelled at swimming and was a lifeguard, enlisted in the
Army Air Corp while at school which rejected him for pilot
training, was part of the Japan occupation force where he swam;
so the US paid for him to attend University
of Iowa, where he: joined the Air Force Officers' training
corps, was accepted to be an Air Force pilot, and got engaged to
Mary Bruce.
Boyd trained at Nellis AFB to become a
combat ready pilot in
the Korean War.
While the US Air Force focused on
Strategic bombing, Boyd loved
dogfights. His exceptional tactical ability was
rewarded with becoming an instructor. Boyd created new
ways to think about dogfighting and beat all-comers
by using them in the F-100.
He was noticed and enabled by Spradling. As he trained, and defeated the top
pilots from around the US and allied base network, his
reputation spread. But he needed to get
nearer to the hot spring in Georgia, and when his move to
Tyndall AFB was blocked he used the AFIT to train in engineering at
Georgia tech. While preparing to move he documented his FWS training
and mentored Ronald Catton.
While there he first realized the
link between energy
and maneuverability.
At Eglin, in partnership with Tom Christie,
he developed tools to model the link. They developed
comparisons of US and Soviet aircraft which showed the US
aircraft performing poorly. Eventually General Sweeney
was briefed on
the theory and issues with the F-105, F-4, and F-111.
Sent to the Pentagon
to help save the F-X budget, Boyd joined forces with Pierre Sprey to
pressure procurement into designing and
building tactically exceptional aircraft: a CAS tank killer and a
lightweight maneuverable
fighter. The navy aligned with
Senators of states with navy bases, prepared to sink the
F-X and force the F-14 on
the Air Force. Boyd saved
the plane from the Navy and the budget from Congress, ensuring
the Air Force executive and its career focused hierarchy had the
freedom to compromise
on a budget expanding over-stuffed F-X (F-15). Boyd requested to
retire, in disgust.
Amid mounting hostility from the organizational hierarchy Boyd
and Sprey secretly
developed specifications for building prototype lightweight
fighters with General Dynamics: YF-16;
and Northrop: YF-17; and enabled by Everest Riccioni.
David Packard
announced a budget of $200 million for the services to spend on
prototypes. Pierre Sprey's friend Lyle Cameron picked a
short takeoff and landing transport aircraft and Boyd's lightweight fighter to
prototype.
Boyd was transferred to Thailand
as Vice Commander of Task
Force Alpha, inspector general and equal opportunity
training officer; roles in which he excelled. And he
started working on his analysis of creativity: Destruction
and Creation. But on completion of the tour Boyd was
apparently abandoned and sent to run
a dead end office at the Pentagon.
The power hierarchy moved to protect the F-15, but: Boyd,
Christie, Schlesinger,
and the Air Force chief of staff; kept the
lightweight fighter budgeted and aligned with Boyd's
requirements in a covert campaign. The Air Force
threw a phalanx of developers at the F-16, distorting Boyd's
concept. He accepted he had lost the fight and retired
from the Air Force.
Shifting to scholarship Boyd reflects on how rigidity must be destroyed to enable
creative new assemblies. He uses the idea to explain
the operational success of the YF16 and F-86 fighters, and then
highlights how the pilot can take advantage of their
infrastructure advantage with rapid decision making he
explains with the O-O-D-A Loop.
Boyd encouraged Chuck Spinney
to expose the systemic cost overruns
of the military procurement process. The military
hierarchy moved to undermine the
Spinney Report and understand the
nature of the reformers. Boyd acted as a progressive
mentor to Michael
Wyly, who taught the
Marine Corps about maneuver
warfare, and Jim Burton.
Finally, after the military hierarchy appears to have
beaten him, Boyd's ideas are tested during
the First Gulf War.
Following our summary of his main points, RSS frames the details from the
perspective of complex adaptive system (CAS) theory. Boyd was Darwinesque, placing the art of
air-to-air combat within a CAS framework.
Air warrior |
Alfred Nemeczek reveals the chaotic, stressful life of Vincent
van Gogh in Arles.
Nemeczek shows that Vincent was driven
to create, and successfully
invented new methods of representing feeling in paintings, and
especially portraits. Vincent
worked hard to allow artists like him-self
to innovate. But
Vincent failed in this goal, collapsing into psychosis.
Nemeczek also provides a brief history of
Vincent's life.
Following our summary of his main points, RSS frames the details from the
perspective of complex adaptive system (CAS) theory.
Vincent creates |
Reginald Dwight, better known as Elton John, writes a hilarious
memoir, full of anecdotal and sometimes morbid humor and gossip, which describes his
immediate family, upbringing, development as a singer
songwriter, stardom and its support for his problems, collapse
and eventual recovery.
Elton stresses the serendipitous nature
of his emergence as a musician. He describes
the contributions of his parents, Stanley & Sheila, mother's
sister, and her mother Ivy;
who formed his early
childhood proximate environment which prepared
him for a job in entertainment: he
developed his performance in the club circuits, setup a
commercial partnership with Bernie Taupin to write songs;
entering a network based around Dick James Music.
And he almost got married.
DJM focused Elton and Bernie's initial song writing
while they studied the songs they admired and Elton did session
work, tightening his performance skills and paying for the
food. A first album supported touring and the formation of
a band. A second one sent them to the US where Elton became an
overnight sensation. And during this period of time
Elton's testosterone
level ramped. Life changed
dramatically.
Stardom provided many rewards but there
were still life's problems to deal with. Elton was
befriended by his idol, John Lennon; he achieved new heights of
success but, sensitive to any hint of failure and fraud, suicidally disassociated.
His career crested, he struggled with loneliness and drugs, and
foresaw a fearful vision of his future, as fame caged him idly
in hotels between concerts. His hair abandoned him.
But he was saved by the challenge of
transforming the collapsed Watford football club. He
retired from touring which allowed him the time to reconstruct his life.
Empowered by success, supported by the removal of constraints,
Elton dominates - limiting feedback, doing whatever he
hopes will bring him happiness:
trying new options, expanding the range and increasing the
quantity of mind altering substances; eventually hitting John Reid and marrying
Renata.
He allows his drug use to enter the recording studio. Problems stress him. He is
frightened by a cancer
scare, AIDS, inspired by
Ryan White, angered by the
Sun, and saddened at
breaking Renata's heart. But he was there for Ryan White's
final days. And his lover Hugh Williams confronted Elton
about his string of addictions.
Elton finally agreed he had a problem.
He went to rehab, stopped hating himself,
gave up his current addictions, accepted the influence of a
higher force, and began admiring the everyday world and other
people.
It seemed the higher force was
supporting Elton's progress: he wrote the music for the
Lion King, met David Furnish who accepted Elton warts and all;
they both enjoyed a friendship with Gianni Versace; until Gianni
was murdered. Princess Diana
died soon after, and Elton performed at the funeral.
He toured with Billy Joel and aimed to do the same with Tina
Turner. While his new records sold well he found
himself in debt and terminated the management relationship
with John Reid
Enterprises.
Elton and Bernie improved their
situations: Elton started writing film scores, he helped
turn the film Billy Elliot into a musical, Bernie lobbied Elton
to improve the way they were making records, Elton and David
entered into a civil partnership, and Elton made a record with
his seminal influence: Leon
Russell.
Elton and David became parents of
two boys: Zachary and Elijah; using their sperm a surrogate
mother and network in California. They quietly get married
when the UK allows.
Elton's mum remains
difficult and cruel to him, but he is sad when she dies, and many
at the funeral recall her fun side with him. Being parents
increases the long-term
stresses on their lives, forcing them to adjust, so they can be there for their boys.
But Elton needs to go out with a bang!
And everyone helps.
Following our summary of his main points, RSS frames the details
of the creative process from the perspective of complex
adaptive system (CAS) theory.
My song |
Richard Feynman
outlines a series of amusing vignettes, as he reviews his life story.
Richard's personality
encouraged him to patiently
seek out fun: performing Shewhart cycles
with electricity, in his childhood laboratory, and aligning theory, and
practice through building and fixing radios.
Leonardo's life inspired him to try
innovation, which he
concluded was hard. He played
with the emotion
in communications, a skill
which he used later at
Caltech. And he made a game of avoiding following
orders at MIT. Working during
the holidays revealed the benefit of joining theory and
practice.
Feynman enrolled as a graduate
student at Princeton, where the successful
approach to science was just like his.
His approach was based on
patience and fun: he used his home lab and other tools for
qualitative exploration. Overtime he added experimental
techniques. He would test
the assertions in articles with amusing investigations;
with his mind aligned by
feelings of joy. Everyone at Princeton heard he would want to be hypnotized.
He was driven to compare the challenges of complex subjects being
taught at Princeton to his current pick. In his summer
recess he explored biology.
Gathering problems in challenging areas of science, and then picking one to solve, supported his
creativity. And his practical
orientation and situation when growing up in Far Rockaway,
supported his desire for choices
and adolescent dislike for purely intellectual and cultural
pursuits. Being mostly self-taught, he
developed different approaches to problems than the
standard strategies provided by mass education.
Richard saw his skill set as very different to that exhibited by his father. But are they very
different?
While Richard was at Princeton, America became concerned about
the implications of the European war. After a friend
enlisted he decided to dedicate his
summer holiday to helping the war effort. Feynman got involved in the
Manhattan Project, and went to Los Alamos where he
experienced constraints, applied by: the military, the
physics of the project, him on Niels
Bohr; but was
freed from them by Von
Neumann. The records & reports of the project
were kept in filing cabinets. Richard explored the weaknesses of
the locks and safes deployed to secure these
secrets. Just after the war he was called up by the draft
board for a medical but was rejected for being mentally
unfit.
After the war, Richard was asked to become a professor at Cornell.
He initially struggled in this role: Too young to match
expectations, stressed by the demands of his new job and his
recent experiences; until he adopted an approach that focused on
fun. He enjoyed knowing
about numbers: using, learning about them and the tools to
use them, and competing with others; to calculate, interpolate
and approximate a value the fastest.
Traveling to Buffalo in a light plane once a week to give a
physics lecture before flying back the next morning wasn't much
fun for Richard. So he used
the stipend to visit a bar after each lecture to meet
beautiful women. Richard liked bars and nightclubs, spending a summer in Albuquerque
frequenting one, and later
ones in Las Vegas, as he explored how to get the girls he
drank with to sleep with him.
Richard reflects on various times when he made government
officials obey their parts of contracts: patent fees, limits on red tape;
Richard became frustrated with his life at Cornell, seeing more
things that interested him on the sunny west coast at Caltech. Both
institutions, and Chicago, offered him incentives to help his decision making,
but Richard began to find reevaluating the alternatives a waste
of time and he saw risks in
a really high salary, deciding he would move to Caltech
and stay there.
Richard is invited to attend a scientific symposium in
Japan. Each of the US attendees is asked to learn a little
Japanese. Richard takes lessons, persists, can converse
effectively, but stops when he
finds the cultural parts of the language conflict with his
individualism.
Richard was unhappy with his achievements in physics. He
felt: slower than his peers, not keeping up or understanding the
latest details, fearful that
he could not cope; as the community
worked to understand the laws of beta decay. But
Martin Block pushed him to question the troubling parity
premise. Encouraged by Oppenheimer the community focused
on parity and failures were discovered in a cascade of
reports. Richard attended a meeting where Lee & Yang
discussed a failure and a theory to explain it. Richard
felt terrified and could not understand what they said.
His sister pushed him to change his attitude: act like a student
having fun, read every
line and equation of their paper; he would understand it.
And he did, as well as developing additional insights about what
was happening and what still seemed conflicted. He
reported his ideas back to the community. After Richard
returned from Brazil he reviewed the confusion of facts with
Caltech's experimental physicists who made him aware of
Gell-mann abandoning another former premise of Beta decay.
Feynman realized his ideas were consistent: fully and simply
describing the details of beta decay. He had identified
the workings of a fundamental law. Years later he was awarded the Nobel
prize for physics. He was conflicted about the prize
and attending the ceremony, but eventually enjoyed the trip,
where he discussed cultural achievement with the Japanese
ambassador.
Richard was interested in the operation of the brain, modeling
it on a digital computer. He explored hallucinations and the reality of
experiences.
Richard lobbies for integrity
in science.
In aspects of his life that weren't focused directly on science,
Richard was quirky. He would tease those who asked for his
help: pushing bargains to their logical conclusion; insisting on everyone keeping to
their part of the agreement. And he paid no attention to the
logistical details of planning. He loved percussion,
playing: drums, bongos, baskets, tables, Frigideira; and became quite a success. He
eventually discovered art could be
fun, and tried to express his joy at the underlying
mathematical beauty of the physical world. He had a great
art teacher. But he discovered although he could
eventually draw well he did not understand art.
Many of the artists he met were fakers, and even the powerful,
who were interested in integrating art and science, did not
understand either subject. He found the situation was
similar in other complex adaptive systems: philosophy, religion and
economics; which he dabbled in for a while but found the
strategies of other people practicing the study of such subjects
made him angry and
disturbed, so he avoided participating in them. It seemed
ironic that he was eventually asked to help in bringing
culture to the physicists!
He discusses issues in teaching creative physics in Brazil. He gets
involved in the California public school text
book selection process which he concluded was totally
broken, but also reveals how his father
provided him with a vision of how our world works,
inspiring his interest in experimentation and physical
theory.
Following our summary of his main points, RSS reviews how his personality, family and cultural history supported
his creative development from the perspective of complex
adaptive system (CAS) theory.
Richard draws |
Desmond & Moore paint a picture of Charles Darwin's life,
expanded from his own highlights:
- His naughty
childhood,
- Wasted
schooldays,
- Apprenticeship with Grant,
- His extramural
activities at Cambridge, walks with Henslow,
life with FitzRoy on the
Beagle,
- His growing
love for science,
- London: geology, journal and Lyell.
- Moving from
Gower Street to Down and writing Origin and other
books.
- He reviewed his position on
religion: the long
dispute with Emma, his
slow collapse of belief
- damnation for unbelievers like his father and brother, inward conviction
being evolved and unreliable, regretting he had ignored his father's
advice; while describing Emma's side of the
argument. He felt happy with his decision to dedicate
his life to science. He closed by asserting after Self &
Cross-fertilization his strength will be
exhausted.
Following our summary of their main points, RSS frames the details from the
perspective of complex adaptive system (CAS) theory. Darwin placed
evolution within a CAS framework, and built a network of supporters whose
complementary skills helped drive the innovation.
Darwin emerges |
Richard Dawkin's explores how nature has created implementations
of designs, without any need for planning or design, through the
accumulation of small advantageous changes.
Accumulating small changes |
Russ Abbott explores the impact on science of epiphenomena and
the emergence of agents.
Autonomous emergence |
Terrence Deacon explores how constraints on dynamic flows can
induce emergent phenomena
which can do real work. He shows how these phenomena are
sustained. The mechanism enables
the development of Darwinian competition.
Constraint based phenomena |
|
|
Agent death
Summary
Gawande uses his personal experience, analytic skills and lots
of stories of innovators to demonstrate better ways of coping
with aging and death. He introduces the lack of focus on
aging and death in traditional medicine. And goes on to
show how technology has amplified
this stress point. He illustrates the traditional possibility of the
independent self, living fully while aging with the
support of the extended family. Central
planning responded to the technological and societal changes
with poorly designed infrastructure and funding. But
Gawande then contrasts the power of
bottom up innovations created by experts responding to
their own family situations and belief
systems.
Gawande then explores in depth the challenges
that unfold currently as we age and become infirm.
He notes that the world is following the US is the United States of America. path. As such it will
have to understand the dilemma of
integrating medical treatment and hospice
strategies. He notes that all parties
involved need courage to cope.
He proposes medicine must aim to assure
well being. At that point all doctors will practice
palliative care.
Complex adaptive system (CAS) models of agency, death,
evolution, cooperation and adaptations in evolutionary biology is a trait that increased the number of surviving offspring in an organism's ancestral lineage. Holland argues: complex adaptive systems (CAS) adapt due to the influence of schematic strings on agents. Evolution indicates fitness when an organism survives and reproduces. For his genetic algorithm, Holland separated the adaptive process into credit assignment and rule discovery. He assigned a strength to each of the rules (alternate hypothesis) used by his artificial agents, by credit assignment - each accepted message being paid for by the recipient, increasing the sender agent's rule's strength (implicit modeling) and reducing the recipient's. When an agent achieved an explicit goal they obtained a final reward. Rule discovery used the genetic algorithm to select strong rule schemas from a pair of agents to be included in the next generation, with crossing over and mutation applied, and the resulting schematic strategies used to replace weaker schemas. The crossing over genetic operator is unlikely to break up a short schematic sequence that provides a building block retained because of its 'fitness'; In Deacon's conception of evolution, an adaptation is the realization of a set of constraints on candidate mechanisms, and so long as these constraints are maintained, other features are arbitrary.
to new technologies are discussed.
Being Mortal
In Atul Gawande's book
'Being Mortal' he uses true stories to illustrate the various
ways in which the old, frail and dying are cared for by the
evolving societies in which they live. As a practicing
surgeon he notes that his medical training ignored: how death
unfolds, how people experience the end of their lives, how it
affects them; the subject seemed beside the point when the goal
was to save lives.
It has been typical to treat a dying person as if they just need
the right treatment and they will become fully functional
again.
Gawande's initial simplistic view was that he should treat all
his patients with honesty and kindness which would result in his
providing compassionate indicates an emotional state where resonance with someone else's distress leads one to help them. The Dalai Lama stresses we must feel compassion for ourselves and others. Tara Brach sees compassion as our capacity to relate in a tender and sympathetic way to what we perceive. Meditation focused on feeling love for the suffering, strengthens compassion by activating the neuron networks for parental love for a child: ACC, insula, striatum, PAG, orbitofrontal cortex; and inducing a reduction in areas responsible for negative emotions.
care. But some of his surgical patients were forced to
confront the realities of decline and mortality. It struck
Gawande that he was unprepared to help them. Patients with
incurable, terminal disease given the choice of either comfort
care or treatments often selected the treatments which were
inherently dangerous with difficult or improbable recovery
paths. Its hard for anyone involved to discuss the reality
of such situations. It is far easier to hide in the
details rather than focus on the limits of treatments and true
implications of the terminal condition.
Gawande explains that modern scientific capabilities have turned
the process of aging and dying into medical experiences.
But health care is not designed to cope with old age and in
trying it removes the responsibility and experience from the
rest of society. Death is normal but its concrete reality
is divergent from medicine as curing. Doctors strive to be
competent. They aim to be knowledgeable and technically
skilled. Those goals are misaligned with accepting
death. For the dying such system problems are
experienced as callousness and inhumanity and can result in
extraordinary suffering.
The independent self
Indian tradition supports the old as the center of the extended
family. The family ensure their [grand]parents can be as
independent as possible. Gawande notes that this system
scaled in the past because very few people previously lived into
old age. In the west a number of changes undermined this
framework of support:
- The development of the nuclear family required that one
child remained at home to care for their parents.
- Living into old age has become more common.
- Increased longevity means that parents compete for
resources, such as the family home, with their offspring
resulting in tensions between the generations.
The global system now encourages individual agency tearing down
the extended family strategy.
Increasing wealth is schematically useful information and its equivalent, schematically useful energy, to paraphrase Beinhocker. It is useful because an agent has schematic strategies that can utilize the information or energy to extend or leverage control of the cognitive niche. and
property rights has enabled 'retirement'. Parents were
able to collateralize their resources and live off of some of
the capital is the sum total nonhuman assets that can be owned and exchanged on some market according to Piketty. Capital includes: real property, financial capital and professional capital. It is not immutable instead depending on the state of the society within which it exists. It can be owned by governments (public capital) and private individuals (private capital). . And
women now have fewer children so their offspring become adults
sooner increasing the possibility of retiring. Separation
provided both parents
and offspring with increased individual freedom.
This western trend of individual agency is now happening in
China, Japan and Korea.
The US is the United States of America. Robert Gordon argues that the inventions of the second
industrial revolution were the foundation for
American economic growth. Gordon shows how flows of people
into difficult rural America built a population base
which then took the opportunity to move on to urban settings: Houses, Food in supermarkets,
Clothes in
department stores;
that supported increasing productivity and standard of living.
The deployment of nationwide networks: Rail, Road, Utilities;
terminating in the urban housing and work places allowing the workers to
leverage time saving goods and services, which helped grow
the economy.
Gordon describes the concomitant transformation of:
- Communications
and advertising
- Credit
and finance
- Public
health and the health
care network
- Health insurance
- Education
- Social
and welfare services
Counter intuitively the constraints
introduced before and in the Great Depression and the demands of World War 2
provide the amplifiers that drive the inventions deeply and
fully into every aspect of the economy between 1940 and 1970
creating the exceptional growth and standard of living of post
war America.
Subsequently the
rate of growth was limited until the shift of women
into the workplace and the full networking of
voice and data supported the Internet and World Wide Web
completed the third industrial revolution, but the effects were
muted by the narrow reach of the technologies.
The development of Big Data, Robots,
and Artificial Intelligence may support additional growth,
but Gordon is unconvinced because of the collapse of
the middle class.
Following our summary of Gordon's book RSS frames his arguments from
the perspective of complex adaptive system (CAS) theory.
market
economy developed
retirement communities designed to venerate the independent
self.
But Gawande notes the ideal of independence ignores the reality
of aging, serious illness and infirmity.
Things fall apart
Gawande discusses how modern medicine has altered the impact of
aging. For all but recent history death was ever
present. But now medical and public health is the proactive planning, coordination and execution of strategies to improve and safeguard the wellbeing of the public. Its global situation is discussed in The Great Escape by Deaton. Public health in the US is coordinated by the PHS federally but is mainly executed at the state and local levels. Public health includes: - Awareness campaigns about health threatening activities including: Smoking, Over-eating, Alcohol consumption, Contamination with poisons: lead; Joint damage from over-exercise;
- Research, monitoring and control of: disease agents, reservoir and amplifier hosts, spillover and other processes, and vectors; by agencies including the CDC.
- Monitoring of the public's health by institutes including the NIH. This includes screening for cancer & heart disease.
- Development, deployment and maintenance of infrastructure including: sewers, water plants and pipes.
- Development, deployment and maintenance of vaccination strategies.
- Development, deployment and maintenance of fluoridation.
- Development, deployment and maintenance of family planning services.
- Regulation and constraint of foods, drugs and devices by agencies including the FDA.
improvements have pushed out the likelihood of immediate
death. Today medicine has cut the mortality of heart attack is an AMI. It can induce cardiac arrest. Blocking the formation of clots with platelet aggregation inhibitors, can help with treating and avoiding AMI. Risk factors include: taking NSAID pain killers (May 2017). There is uncertainty about why AMI occur. Alternative hypotheses include: - Plaques started to gather in the coronary arteries and grew until no blood flow was possible. If this is true it makes sense to preventatively treat the buildup with angioplasty.
- Plaques form anywhere in the body due to atherosclerosis and then break up and get lodged in the coronary artery and start to clot. If this is true it makes sense to preventatively limit the buildup of plaques with drugs like statins or PCSK9 inhibitors.
s,
respiratory illness, stroke is when brain cells are deprived of oxygen and begin to die. 750,000 patients a year suffer strokes in the US. 85% of those strokes are caused by clots. There are two structural types: Ischemic and hemorrhagic. Thrombectomy has been found to be a highly effective treatment for some stroke situations (Jan 2018).
etc. And even incurable diseases such as cancer is the out-of-control growth of cells, which have stopped obeying their cooperative schematic planning and signalling infrastructure. It results from compounded: oncogene, tumor suppressor, DNA caretaker; mutations in the DNA. In 2010 one third of Americans are likely to die of cancer. Cell division rates did not predict likelihood of cancer. Viral infections are associated. Radiation and carcinogen exposure are associated. Lifestyle impacts the likelihood of cancer occurring: Drinking alcohol to excess, lack of exercise, Obesity, Smoking, More sun than your evolved melanin protection level; all significantly increase the risk of cancer occurring (Jul 2016). can be treated to
extend life, until a major organ is undermined. So old age
now reflects the accumulated crumbling of one's bodies
systems. And medicine is often disinterested in this
unless there is something for it to cure.
Aging encourages damage of the body parts:
- Teeth get difficult to clean because the decay is not felt
as easily, and the aged person struggles to use the tooth
brush and floss.
- Teeth and bones soften as calcium ions leach from them and
flow into the soft tissues where they make the rest of the
body harden.
- The hardening of arteries forces the heart to pump
harder.
- Lose bone and muscle mass.
- Brain shrinks (initially the frontal lobes of the cerebral cortex is at the front of the brain. It includes the: prefrontal cortex, motor cortex. Sapolsky asserts it makes you do the harder thing when it's the right thing to do. The frontal cortex supports working memory to sustain focus on a task. It also coordinates the strategic actions necessary to achieve success. It provides impulse control, regulation of emotion, and willpower. The prefrontal cortex maintains focus by deprioritizing currently irrelevant streams of information. The frontal cortex tracks rules. Over a lifetime, that builds into a costly activity. Once it tires, responses become less prosocial. But practice shifts operation of tasks to the cerebellum. The frontal cortex signals the tegmentum and accumbens with the conclusions of its expectancy/discrepancy calculations. The frontal lobe provides executive function, considering bits of information, assessing patterns and then prioritizing the strategies. The frontal lobe is the most recent part of the brain to evolve and involves a disproportionate percentage of primate-unique genes in its development and operation. It does not complete development until the mid-20s. It includes spindle neurons. It is easily damaged. Sapolsky (Nauta) notes that its ventromedial prefrontal cortex is a quasi-member of the limbic system.
and
hippocampus is a part of the medial temporal lobe of the brain involved in the temporary storage or coding of long-term episodic memory. It includes the dentate gyrus. Memory formation in the cells of the hippocampus uses the MAP kinase signalling network which is impacted by sleep deprivation. The hippocampus dependent memory system is directly affected by cholinergic changes throughout the wake-sleep cycle. Increased acetylcholine during REM sleep promotes information attained during wakefulness to be stored in the hippocampus by suppressing previous excitatory connections while facilitating encoding without interference from previously stored information. During slow-wave sleep low levels of acetylcholine cause the release of the suppression and allow for spontaneous recovery of hippocampal neurons resulting in memory consolidation. It was initially associated with memory formation by McGill University's Dr. Brenda Milner, via studies of 'HM' Henry Molaison, whose medial temporal lobes had been surgically destroyed leaving him unable to create new explicit memories. The size of neurons' dendritic trees expands and contracts over a female rat's ovulatory cycle, with the peak in size and cognitive skills at the estrogen high point. Adult neurogenesis occurs in the hippocampus (3% of neurons are replaced each month) where the new neurons integrate into preexisting circuits. It is enhanced by learning, exercise, estrogen, antidepressants, environmental enrichment, and brain injury and inhibited by various stressors explains Sapolsky. Prolonged stress makes the hippocampus atrophy. He notes the new neurons are essential for integrating new information into preexisting schemas -- learning that two things you thought were the same are actually different. Specific cells within the hippocampus and its gateway, the entorhinal cortex, are compromised by Alzheimer's disease. It directly signals area 25. ).
This is often seen as multi-tasking capabilities peaking in
mid-life. Once brain has shrunk the skull becomes less
protective since the brain rattles about inside.
Gawande outlines some alternative theories about why we age:
- Genetically organized shutdown.
- Gawande
notes that until recently we died on average before 30 so he
doubts that aging is normal. So he sees wear and tear
as likely culprits. He cites Leonid Gavrilov who
claims that all complex systems fail randomly and gradually
because they leverage redundancy. But over
Carlo Rovelli resolves the paradox of time.
Rovelli initially explains that low level physics does not
include time:
- A present that is common throughout the universe does not exist
- Events are only partially ordered. The present is
localized
- The difference between past and future is not foundational.
It occurs because of state that through our blurring appears
particular to us
- Time passes at different speeds dependent on where we are and how fast we travel
- Time's rhythms are due to
the gravitational field
- Our quantized physics shows neither
space nor time, just processes transforming physical
variables.
- Fundamentally there is no time. The basic equations
evolve together with events, not things
Then he
explains how in a physical world without time its perception can
emerge:
- Our familiar time emerges
- Our interaction with the world is partial, blurred,
quantum indeterminate
- The ignorance determines the existence of thermal time
and entropy that quantifies our uncertainty
- Directionality of time is real
but perspectival. The entropy of the world in
relation to us increases with our thermal time. The
growth of entropy distinguishes past from future: resulting in
traces and memories
- Each human is a
unified being because: we reflect the world, we
formed an image of a unified entity by
interacting with our kind, and because of the perspective
of memory
- The variable time: is one
of the variables of the gravitational field.
With our scale we don't
register quantum fluctuations, making space-time
appear determined. At our speed we don't perceive
differences in time of different clocks, so we experience
a single time: universal, uniform, ordered; which is
helpful to our decisions
time the backup systems fail too
resulting in frailty and eventual collapse. Felix
Silverstone a senior geriatrician at Parker
Jewish Institute NY agrees. He does not see a
single common cellular mechanism. Instead we just fall
apart.
Increased life
expectancy is a measure of the average life time of a new born baby. Without public health assistance many children die in the first five years of life significantly lowering the life expectancy of the whole group. There are representational and data capture problems with the model: - Not knowing the risk of dying in the newborn's future, demographers use the risks present at that time to predict impacts in the future of the person. No adjustment can be made for increased wellbeing.
- Saving the lives of children has a far larger effect on increasing life expectancy than extending the lives of the elderly
- Impacts that occur in a particular year, such as a epidemic or pandemic, are treated as permanent effects for that years life expectancy even though they may be handled by public health strategies and hence be transients. For life expectancy calculations in subsequent years the impact is ignored.
- Programs that reduced the impacts of infectious diseases, such as antibiotics and vaccine deployment, have reduced the variability of life expectancy following their introduction.
- Vital registration systems gather accurate data for life expectancy. But most countries do not have the infrastructure and instead estimates are generated from demographic and health surveys.
has altered society's demographics. But
societies have not responded:
- People are still retiring at 65 creating a huge
overhead.
- The number of geriatricians is falling. It is not
well reimbursed by Medicare is a social insurance program that guarantees access to health insurance for Americans aged 65 and over, and younger people with disabilities and end stage renal disease or ALS. Medicare is currently missing a cap on out-of-pocket costs and direct prescription drug coverage. It includes:
- Benefits
- Part A: Hospital inpatient insurance. As of Dec 2013 Medicare pays for home care in only limited circumstances, such as when a person needs temporary nursing care after a hospitalization. Part A covers 20 days of inpatient rehabilitation at a SNF after discharge from inpatient care at a hospital.
- Part B: Medical insurance for non-hospital services including: doctor visits, tests, injectable drugs, ambulances, physical therapy;
- Part C: Medicare Advantage
- Part D: indirect prescription drug coverage The MMA prohibits Medicare from directly negotiating drug prices.
- Eligibility
- All persons 65 years of age or older who are legal residents for at least 5 years. If they or a spouse have paid Medicare taxes for 10 years the Medicare part A payments are waived. Medicare is legislated to become the primary health plan.
- Persons under 65 with disabilities who receive SSDI.
- Persons with specific medical conditions:
- Have end stage renal disease or need a kidney transplant.
- They have ALS.
- Some beneficiaries are dual eligible.
- Part A requires the person has been admitted as an inpatient at a hospital. This is constrained by a rule that they stay for three days after admission.
- Sign-up
- Part A has automatic sign-up if the person is drawing social security. Otherwise the person must sign-up for Part A and Part B.
- Should sign-up for Part B during the Initial Enrollment Period, of seven months centered around 65th birthday, online or at a social security office. But if still covered by spouse's insurance or not yet retired then may only join during the 3 month general enrollment period (January to March) each year, with coverage initiated the following July. Incremental yearly 10% penalties apply for not signing up at 65. These penalties apply to all subsequent premiums.
- Premiums
- Part A premium
- Part B insurance premium
- Part C & D premiums are set by the commercial insurer.
and so medical schools are turning out highly remunerated
oncologists, orthopedic surgeons, urologists is a surgical and medical specialty which deals with diseases of the male and female urinary tract and the male reproductive organs. etc.
Also there are few tools to support doing geriatrics well
and the complex diseases encountered are hard to
handle. But that is a pity. Patients supported
by a geriatrics team had 25% less likelihood of becoming
disabled, were half as likely to develop depression is a debilitating episodic state of extreme sadness, typically beginning in late teens or early twenties. This is accompanied by a lack of energy and emotion, which is facilitated by genetic predisposition - for example genes coding for relatively low serotonin levels, estrogen sensitive CREB-1 gene which increases women's incidence of depression at puberty; and an accumulation of traumatic events. There is a significant risk of suicide: depression is involved in 50% of the 43,000 suicides in the US, and 15% of people with depression commit suicide. Depression is the primary cause of disability with about 20 million Americans impacted by depression at any time. There is evidence of shifts in the sleep/wake cycle in affected individuals (Dec 2015). The affected person will experience a pathological sense of loss of control, prolonged sadness with feelings of hopelessness, helplessness & worthlessness, irritability, sleep disturbances, loss of appetite, and inability to experience pleasure. Michael Pollan concludes depression is fear of the past. It affects 12% of men and 20% of women. It appears to be associated with androgen deprivation therapy treatment for prostate cancer (Apr 2016). Chronic stress depletes the nucleus accumbens of dopamine, biasing humans towards depression. Depression easily leads to following unhealthy pathways: drinking, overeating; which increase the risk of heart disease. It has been associated with an aging related B12 deficiency (Sep 2016). During depression, stress mediates inhibition of dopamine signalling. Both depression and stress activate the adrenal glands' release of cortisol, which will, over the long term, impact the PFC. There is an association between depression and additional brain regions: Enlarged & more active amygdala, Hippocampal dendrite and spine number reductions & in longer bouts hippocampal volume reductions and memory problems, Dorsal raphe nucleus linked to loneliness, Defective functioning of the hypothalamus undermining appetite and sex drive, Abnormalities of the ACC. Mayberg notes ACC area 25: serotonin transporters are particularly active in depressed people and lower the serotonin in area 25 impacting the emotion circuit it hubs, inducing bodily sensations that patients can't place or consciously do anything about; and right anterior insula: which normally generates emotions from internal feelings instead feel dead inside; are critical in depression. Childhood adversity can increase depression risk by linking recollections of uncontrollable situations to overgeneralizations that life will always be terrible and uncontrollable. Sufferers of mild autism often develop depression. Treatments include: CBT which works well for cases with below average activity of the right anterior insula (mild and moderate depression), UMHS depression management, deep-brain stimulation of the anterior insula to slow firing of area 25. Drug treatments are required for cases with above average activity of the right anterior insula. As of 2010 drug treatments: SSRIs (Prozac), MAO, monoamine reuptake inhibitors; take weeks to facilitate a response & many patients do not respond to the first drug applied, often prolonging the agony. By 2018, Kandel notes, Ketamine is being tested as a short term treatment, as it acts much faster, reversing the effect of cortisol in stimulating glutamate signalling, and because it reverses the atrophy induced by chronic stress. Genomic predictions of which treatment will be effective have not been possible because: Not all clinical depressions are the same, a standard definition of drug response is difficult; and were
40% less likely to require home help. They obtained
these results by:
Gawande took
the Carlo Rovelli resolves the paradox of time.
Rovelli initially explains that low level physics does not
include time:
- A present that is common throughout the universe does not exist
- Events are only partially ordered. The present is
localized
- The difference between past and future is not foundational.
It occurs because of state that through our blurring appears
particular to us
- Time passes at different speeds dependent on where we are and how fast we travel
- Time's rhythms are due to
the gravitational field
- Our quantized physics shows neither
space nor time, just processes transforming physical
variables.
- Fundamentally there is no time. The basic equations
evolve together with events, not things
Then he
explains how in a physical world without time its perception can
emerge:
- Our familiar time emerges
- Our interaction with the world is partial, blurred,
quantum indeterminate
- The ignorance determines the existence of thermal time
and entropy that quantifies our uncertainty
- Directionality of time is real
but perspectival. The entropy of the world in
relation to us increases with our thermal time. The
growth of entropy distinguishes past from future: resulting in
traces and memories
- Each human is a
unified being because: we reflect the world, we
formed an image of a unified entity by
interacting with our kind, and because of the perspective
of memory
- The variable time: is one
of the variables of the gravitational field.
With our scale we don't
register quantum fluctuations, making space-time
appear determined. At our speed we don't perceive
differences in time of different clocks, so we experience
a single time: universal, uniform, ordered; which is
helpful to our decisions
time to observe a geriatrician
at work. They use specialized skills:
- Check feet since if they are in poor condition it signals
that the person is not able to care for them.
- Check agility of the patient in getting onto the exam
table. Loss of agility typically correlates with
increased falling. Falling is the key danger:
- 40% of falls drive the person into a nursing home.
- 20% never walk again.
- The risk factors are poor balance, muscle weakness and
more than four medicines. There is a 10% chance of
falling without one of these factors. With all three
its 100%.
- Medicines may include a diuretic. As people age
these become problematic causing dehydration leading to
dizziness. Geriatricians can hugely reduce the
risks by thoughtfully adjusting the medicines to be age
appropriate.
- Old people tend to eat too few calories. This
contributes to muscle weakness.
- They aim to help their patients to:
- Gain as much freedom from the ravages of disease as
possible.
- Retain enough function for active engagement in the
world. This is an unusual goal for most
doctors.
Gawande noted that deterioration has complex implications.
For example lordosis of the spine which occurs commonly with age
tips the head forward. This means that when sufferers eat
they are more likely to choke on food particles and cough them
into the lungs where the aspirated particles can result in pneumonia is an inflamed lung. It can be caused by infection with viruses or bacteria, drugs and autoimmune diseases. HAP, including VAP can be very troubling. !
Dependence
The care experienced by the elderly can be exasperating.
All too often the elderly are treated like patients not
persons. And their care worker does not have enough Carlo Rovelli resolves the paradox of time.
Rovelli initially explains that low level physics does not
include time:
- A present that is common throughout the universe does not exist
- Events are only partially ordered. The present is
localized
- The difference between past and future is not foundational.
It occurs because of state that through our blurring appears
particular to us
- Time passes at different speeds dependent on where we are and how fast we travel
- Time's rhythms are due to
the gravitational field
- Our quantized physics shows neither
space nor time, just processes transforming physical
variables.
- Fundamentally there is no time. The basic equations
evolve together with events, not things
Then he
explains how in a physical world without time its perception can
emerge:
- Our familiar time emerges
- Our interaction with the world is partial, blurred,
quantum indeterminate
- The ignorance determines the existence of thermal time
and entropy that quantifies our uncertainty
- Directionality of time is real
but perspectival. The entropy of the world in
relation to us increases with our thermal time. The
growth of entropy distinguishes past from future: resulting in
traces and memories
- Each human is a
unified being because: we reflect the world, we
formed an image of a unified entity by
interacting with our kind, and because of the perspective
of memory
- The variable time: is one
of the variables of the gravitational field.
With our scale we don't
register quantum fluctuations, making space-time
appear determined. At our speed we don't perceive
differences in time of different clocks, so we experience
a single time: universal, uniform, ordered; which is
helpful to our decisions
time to understand the needs of the
person in their care. Self-help and partner based care
leave more control over life. They have to give up their
homes. The institutions focus is on safety and require
their residents give up:
- Household possessions
- Transport independence
- Personalized and interesting meals
- Own control of activities. Many institutions
organize group activities which are not valued by the
residents.
Gawande reviewed the historic development of hospitals
and nursing homes. Western Europe and the US is the United States of America. replaced poor houses with
care homes. It was assumed that the old needed medical
care within a nursing home to ensure they were safe. Post
1945 the emergence
of modern drugs encouraged the US congress to sponsor the
building of hospitals. The Hill-Burton Free and Reduced-Cost Health Care act of 1946 gave health facilities including: Hospitals: General, Long-term care, Mental; Nursing homes, Outpatient facilities, Public health centers; grants and loans for construction and modernization. It specified administration through the HRSA. It was amended by Congress in 1954 to cover development of nursing homes. act (1946)
allocated huge government funds to building hospitals.
That resulted in the construction of 9000 new hospitals.
There emerged a new option: 'cure me'.
It was hoped that the poor house system would be made redundant
with the advent of Social
Security in 1935 is the social securities act of 1935 was part of the second New Deal. It attempted to limit risks of old age, poverty and unemployment. It is funded through payroll taxes via FICA and SECA into the social security trust funds. Title IV of the original SSA created what became the AFDC. The Social Security Administration controls the OASI and DI trust funds. The funds are administered by the trustees. The SSA was amended in 1965 to include: - Title V is Maternal and child health services.
- Title XVIII is Medicare.
. But it became obvious that there
were many people who were too weak, frail, senile, and broken to
care for themselves. In the 1950s hospitals were used to
house these people. Congress allocated Hill-Burton funds
in 1954 for extended recovery facilities -- the modern nursing
homes. With many states having substandard facilities
funded with federal money it was felt necessary to allow the
substandard nursing homes to remain funded with the 1965
inclusion of 'substantial compliance'. Access to this flow
of funds encouraged an explosion in the number of nursing
homes. There were 13,000 by 1970.
Assistance
Nuclear families caring for parents introduce huge stresses is a multi-faceted condition reflecting high cortisol levels. Dr. Robert Sapolsky's studies of baboons indicate that stress helps build readiness for fight or flight. As these actions occur the levels of cortisol return to the baseline rate. A stressor is anything that disrupts the regular homeostatic balance. The stress response is the array of neural and endocrine changes that occur to respond effectively to the crisis and reestablish homeostasis. - The short term response to the stressor
- activates the amygdala which: Stimulates the brain stem resulting in inhibition of the parasympathetic nervous system and activation of the sympathetic nervous system with the hormones epinephrine and norepinephrine deployed around the body, Activates the PVN which generates a cascade resulting in glucocorticoid secretion to: get energy to the muscles with increased blood pressure for a powerful response. The brain's acuity and cognition are stimulated. The immune system is stimulated with beta-endorphin and repair activities curtail. In order for the body to destroy bacteria in wounds, pro-inflammatory cytokines increase blood flow to the area. The induced inflammation signals the brain to activate the insula and through it the ACC. But when the stressor is
- long term: loneliness, debt; and no action is necessary, or possible, long term damage ensues. Damage from such stress may only occur in specific situations: Nuclear families coping with parents moving in. Sustained stress provides an evolved amplifier of a position of dominance and status. It is a strategy in female aggression used to limit reproductive competition. Sustained stress:
- Stops the frontal cortex from ensuring we do the harder thing, instead substituting amplification of the individual's propensity for risk-taking and impairing risk assessment!
- Activates the integration between the thalamus and amygdala.
- Acts differently on the amygdala in comparison to the frontal cortex and hippocampus: Stress strengthens the integration between the Amygdala and the hippocampus, making the hippocampus fearful.
- BLA & BNST respond with increased BDNF levels and expanded dendrites persistently increasing anxiety and fear conditioning.
- Makes it easier to learn a fear association and to consolidate it into long-term memory. Sustained stress makes it harder to unlearn fear by making the prefrontal cortex inhibit the BLA from learning to break the fear association and weakening the prefrontal cortex's hold over the amygdala. And glucocorticoids decrease activation of the medial prefrontal cortex during processing of emotional faces. Accuracy of assessing emotions from faces suffers. A terrified rat generating lots of glucocorticoids will cause dendrites in the hippocampus to atrophy but when it generates the same amount from excitement of running on a wheel the dendrites expand. The activation of the amygdala seems to determine how the hippocampus responds.
- Depletes the nucleus accumbens of dopamine biasing rats toward social subordination and biasing humans toward depression.
- Disrupts working memory by amplifying norepinephrine signalling in the prefrontal cortex and amygdala to prefrontal cortex signalling until they become destructive. It also desynchronizes activation in different frontal lobe regions impacting shifting of attention.
- Increases the risk of autoimmune disease (Jan 2017)
- During depression, stress inhibits dopamine signalling.
- Strategies for stress reduction include: Mindfulness.
:
- Parent and child trade roles
- Parent no longer master of his house
- Parent moves away from old friends and communities
In this situation:
- Parents often adapt to the situation by befriending
visitors
- Caregiver (daughter) has little help but a demanding role
and becomes more constrained:
- Coping with falls
- Woken by parents nightmares
- Having to upgrade infrastructure
- Handling prostrate issues
- Having to provide different menus for parent and family
- Managing the trips to specialists
- Finds job impacted
With nursing homes typically rejected by the parent, assisted living is an alternative to parents joining their children's nuclear family or entering a SNF, or Greenhouse Nursinghome. Atul Gawande's Being Mortal describes the situation. Federal Medicaid does not directly cover assisted living. State Medicaid adds coverage through a federal waiver. Congressional legislation covering assisted living is limited. Assisted living providers are represented by the National Center for Assisted Living.
facilities offered an attractive way out. The concept
originated by Karen Brown Wilson in Oregon in the 1980s as an
alternative to nursing homes. They had the goal of
providing a life of freedom and autonomy, no matter what
physical limits, for their residents.
Karen's mother was a stroke is when brain cells are deprived of oxygen and begin to die. 750,000 patients a year suffer strokes in the US. 85% of those strokes are caused by clots. There are two structural types: Ischemic and hemorrhagic. Thrombectomy has been found to be a highly effective treatment for some stroke situations (Jan 2018).
victim who hated traditional nursing homes. The problem is
they were designed to control.
The vision was of an alternative small place with a little
kitchen and bathroom. A place where she could keep her
cat, and her unfinished projects, coffee pot, cigarettes;
Where she could lock the door, control her heat and have her
furniture. It was a vision of a person in control again
rather than a patient.
Karen designed and built such a facility with her husband.
Retirement community developers disliked her proposal.
Once built Oregon would not license the facility she named Park
Place. But explains Gawande by 1983 she had overcome all
the hurdles. And Park Place was a sellout. It
offered a life of freedom but added help with food, personal
care, medications, and provided an onsite nurse and urgent care
button. Called 'assisted living' it was attacked for
failing to protect the elderly. But in 1988 results showed
satisfaction with lives was higher and health had been sustained
while the costs were 20% lower.
Gawande explains that while fit young people are keen to attain
aspirational goals as life is threatened goals and priorities
adapt. They narrow in from achievement and building
networks. Any assisted living facility must provide
everyday comforts and companionship. By doing this Park
Place was very successful.
By 1990 Karen's company Assisted
Living Concepts was a Wall Street success. But by
2003 Nursing homes had used marketing to relabel themselves as
assisted living. By this time only 11% of "assisted
living" facilities provided the capabilities that Karen had
designed. Wilson comments that it is not surprising:
- It is difficult to do.
- Caregivers have to think and act differently. They
have to be less efficient and more attentive.
- Children of the elderly are interested in their parents'
safety.
- Parents allow their children to make the choices.
A better life
Gawande similarly describes how a driven visionary Bill
Thomas transformed a nursing home. He became the medical
director of Chase
Memorial nursing home which was looking after 80 severely
disabled residents. Half were physically disabled.
Four out of five had Alzheimer's is a dementia which correlates with deposition of amyloid plaques in the neurons. As of 2015 there are 5 million Alzheimer's patients in the USA. It was originally defined as starting in middle age which is rare, so it was a rare dementia. But in 1980s it was redefined as any dementia without another known cause. Early indications include mood and behavioral changes (MBI) and declarative memory and thinking problems (MCI). Specific cells within the hippocampal circuitry and its gateway, the entorhinal cortex, are damaged. The amygdala, cerebelum and other areas supporting implicit memory are not impacted during the early stages of the disease. Grid cell destruction results in a sense of being lost. The default mode network is disrupted. Variants include: late-onset sporadic; with risk factors - ApoE4 for late onset Alzheimer's, presenilin, androgen deprivation therapy (Dec 2015), type 2 diabetes. There are multiple theories of the mechanism of Alzheimer's during aging: Allen Roses argues that it is due to gene alleles that limit the capacity of mitochondria to support neuron operation, Neurons of sporadic Alzheimer's sufferers show greater APP gene diversity due to somatic recombination; It may be initiated by: stress induced HHV-6a, HHV7 herpes activation (Jun 2018) and or an increasingly leaky blood-brain barrier; and a subsequent innate immune response to the infections (May 2016). The Alzheimer's pathway follows: - Plaques form. These are seen in fMRIs 10 to 15 years prior to detecting memory and thinking changes. APP deployed in the cell membrane is cut into three parts. The external part becomes amyloid-beta peptide which aggregates into Amyloid plaques, external to the neurons, if too much is generated or it is not removed fast enough.
- Solanezumab aimed to inhibit plaque formation but clinical trials failed (Nov 2016).
- Encouraging the garbage collection of amyloid and tau with gamma rhythms stimulation retards Alzheimer's in mice studies (Mar 2019)
- BACE inhibitors block an enzyme needed to form amyloid.
- Mutation driven misfolded Tau proteins can form tangles within the cytoplasm of neurons. The Tau tangles kill nerve cells. LMTX is a drug treatment targeted at these tangles.
- The brain becomes inflamed resulting in the killing of many more nerve cells. The hippocampus disintegrates and the brain loses critical functions and memory loss becomes noticeable.
.
He was immediately concerned about the despair evident in all
the residents. Eventually he concluded it was caused by
'lack of life'. He noted boredom, loneliness is an aversive signal like thirst, hunger or pain. It has been associated with the dorsal raphe nucleus (Sep 2016). Loneliness affects several important bodily functions through overstimulation of the stress response. Chronic loneliness is associated with increased cortisol levels, hypertension and impaired production of white blood cells undermining the immune system. and
helplessness. He proposed adding:
- Plants - vegetable garden and plants.
- Animals - Dogs, cats and 100 birds.
- Children.
Again it was against all the government regulations. But
the results undermined the constraints:
- Residents began to wake up and come to life
- People who were considered incapable of speech started
speaking.
- People who had been completely withdrawn and
non-ambulatory started walking the dogs.
- Residents named the birds.
- The number of prescriptions per resident halved.
Psychotropic drug need fell more. Deaths fell by
15%
Thomas formed the Eden
Alternative. This is a not-for-profit to teach Eden
principles. He founded Pioneer network which developed the
Green House Greenhouse nursing homes offer personal service and private rooms. This reduces the opportunities for cross infections reducing cost of errors. - Most nursing homes are designed like hospitals. They are designed around the nursing station. They are institutions and aim to limit risk and serve the patient's childrens' interest in the safety of their parents. But they actually undermine will to live.
- Greenhouses are smaller and designed around the kitchen. They allow knives. Patients keep their own shoes - even though they may increase the likelihood of falling. Patients bring in their own furniture. Greenhouse nursing home developers had to educate the regulators and health officials about the goal of improved purpose of life rather than patients being destroyed by 'safety' (really boredom, loneliness and helplessness).
.
It is funded by the Robert
Wood Johnson foundation. The Green House looks like
a nursing home to the government but feels like a home to
residents. 150 Green Houses have been developed in 25
states.
Gawande describes one The
Leonard Florence Center for Living:
- It has all single rooms - a typical issue for residents of
regular nursing homes.
- Caregivers are given control of their schedule. They
are encouraged to be focused on just a few residents and to
do the cooking, cleaning, helping and friending.
Gawande concludes that typical medicine is mismatched to owning
the care of the aged. Medicine's focus is narrow -- on
repair of health. Death is related to greater things by
transcendence. The probability of death induces a need to
feel meaningful and worthwhile. This is often achieved by
seeking a cause beyond you. Gawande explains how Peter
Sanborn Place's determined and informed manager had used
trained staff and smart goals to support the infirm, without it
ever becoming a nursing home or assisted living is an alternative to parents joining their children's nuclear family or entering a SNF, or Greenhouse Nursinghome. Atul Gawande's Being Mortal describes the situation. Federal Medicaid does not directly cover assisted living. State Medicaid adds coverage through a federal waiver. Congressional legislation covering assisted living is limited. Assisted living providers are represented by the National Center for Assisted Living.
facility. Again Peter Sanborn Place had to battle the
medical system:
Gawande describes a further success story: Newbridge
on the Charles which he introduces as a new model of
nursing home architecture. It supports the full continuum of care is a Post-Acute Care provider. A three-day hospital admission and discharge are prerequisite requirements to receiving Medicare PAC services. Acute care hospitals become portals to the PAC business. Referrals are key. PAC includes different types of facility focused on different severity of illness (high to low): - Long term care Hospital (LTCH),
- Inpatient rehabilitation facility (IRF),
- Skilled nursing facility (SNF),
- Home health agency (HHA) - most acute care hospitals and EMR providers have strategies for integration with home based care,
- Outpatient rehabilitation. SNF and HHA represent 80% of discharges and expenditures. Assisted living is not part of federal Medicaid, but states often include it through a waiver.
offering independent living, assisted living and skilled
nursing. Its building is constructed as pods -- Rooms
around a central dining room, kitchen and activity room.
The pods are family size inducing a sense of safety, increasing
socialization and friendship and reducing anxiety is manifested in the amygdala mediating inhibition of dopamine rewards. Anxiety disorders are now seen as a related cluster, including PTSD, panic attacks, and phobias. Major anxiety, is typically episodic, correlated with increased activity in the amygdala, results in elevated glucocorticoids and reduces hippocampal dendrite & spine density. Some estrogen receptor variants are associated with anxiety in women. Women are four times more likely to suffer from anxiety. Louann Brizendine concludes this helps prepare mothers, so they are ready to protect their children. Michael Pollan concludes anxiety is fear of the future. Sufferers of mild autism often develop anxiety disorders. Treatments for anxiety differ. 50 to 70% of people with generalized anxiety respond to drugs increasing serotonin concentrations, where there is relief from symptoms: worry, guilt; linked to depression, which are treated with SSRIs (Prozac). Cognitive anxiety (extreme for worries and anxious thoughts) is also helped by yoga. But many fear-related disorders respond better to psychotherapy: psychoanalysis, and intensive CBT. Tara Brach notes that genuine freedom from fear is enabled by taking refuge. and depression is a debilitating episodic state of extreme sadness, typically beginning in late teens or early twenties. This is accompanied by a lack of energy and emotion, which is facilitated by genetic predisposition - for example genes coding for relatively low serotonin levels, estrogen sensitive CREB-1 gene which increases women's incidence of depression at puberty; and an accumulation of traumatic events. There is a significant risk of suicide: depression is involved in 50% of the 43,000 suicides in the US, and 15% of people with depression commit suicide. Depression is the primary cause of disability with about 20 million Americans impacted by depression at any time. There is evidence of shifts in the sleep/wake cycle in affected individuals (Dec 2015). The affected person will experience a pathological sense of loss of control, prolonged sadness with feelings of hopelessness, helplessness & worthlessness, irritability, sleep disturbances, loss of appetite, and inability to experience pleasure. Michael Pollan concludes depression is fear of the past. It affects 12% of men and 20% of women. It appears to be associated with androgen deprivation therapy treatment for prostate cancer (Apr 2016). Chronic stress depletes the nucleus accumbens of dopamine, biasing humans towards depression. Depression easily leads to following unhealthy pathways: drinking, overeating; which increase the risk of heart disease. It has been associated with an aging related B12 deficiency (Sep 2016). During depression, stress mediates inhibition of dopamine signalling. Both depression and stress activate the adrenal glands' release of cortisol, which will, over the long term, impact the PFC. There is an association between depression and additional brain regions: Enlarged & more active amygdala, Hippocampal dendrite and spine number reductions & in longer bouts hippocampal volume reductions and memory problems, Dorsal raphe nucleus linked to loneliness, Defective functioning of the hypothalamus undermining appetite and sex drive, Abnormalities of the ACC. Mayberg notes ACC area 25: serotonin transporters are particularly active in depressed people and lower the serotonin in area 25 impacting the emotion circuit it hubs, inducing bodily sensations that patients can't place or consciously do anything about; and right anterior insula: which normally generates emotions from internal feelings instead feel dead inside; are critical in depression. Childhood adversity can increase depression risk by linking recollections of uncontrollable situations to overgeneralizations that life will always be terrible and uncontrollable. Sufferers of mild autism often develop depression. Treatments include: CBT which works well for cases with below average activity of the right anterior insula (mild and moderate depression), UMHS depression management, deep-brain stimulation of the anterior insula to slow firing of area 25. Drug treatments are required for cases with above average activity of the right anterior insula. As of 2010 drug treatments: SSRIs (Prozac), MAO, monoamine reuptake inhibitors; take weeks to facilitate a response & many patients do not respond to the first drug applied, often prolonging the agony. By 2018, Kandel notes, Ketamine is being tested as a short term treatment, as it acts much faster, reversing the effect of cortisol in stimulating glutamate signalling, and because it reverses the atrophy induced by chronic stress. Genomic predictions of which treatment will be effective have not been possible because: Not all clinical depressions are the same, a standard definition of drug response is difficult;.
Newbridge leverages children's participation to inspire
life.
Letting go
Gawande comments that reviewing the needs of the elderly
introduces a question for medicine. When should doctors
try to fix and when should they not?
25% of all medicine spending is for the 5% of patients who are
in their final year of life, and most of it is spent on care
that is of apparently little benefit.
Gawande illustrates the issue with a typical cancer is the out-of-control growth of cells, which have stopped obeying their cooperative schematic planning and signalling infrastructure. It results from compounded: oncogene, tumor suppressor, DNA caretaker; mutations in the DNA. In 2010 one third of Americans are likely to die of cancer. Cell division rates did not predict likelihood of cancer. Viral infections are associated. Radiation and carcinogen exposure are associated. Lifestyle impacts the likelihood of cancer occurring: Drinking alcohol to excess, lack of exercise, Obesity, Smoking, More sun than your evolved melanin protection level; all significantly increase the risk of cancer occurring (Jul 2016). cost curve.
- Year 1 $28,000 for diagnostics, surgery, radiation and chemotherapy is the treatment of cancers by highly cytotoxic chemicals: Paclitaxel, Platinum, 6-mercaptopurine; assuming that cancer cells are unusually active and will be differentially poisoned. It has been successful in offering treatments when no other course was available, but non-specificity means that healthy cells also get poisoned resulting in side effects which increase with age: Permanent nerve damage, heart failure (4-5%) and leukemia (0.5-1%).
.
- Year 2 .. n -1 $2000 a year
- Year n $94,000 for metastatic breast cancer is a variety of different cancerous conditions of the breast tissue. World wide it is the leading type of cancer in women and is 100 times more common in women than men. 260,000 new cases of breast cancer will occur in the US in 2018 causing 41,000 deaths. The varieties include: Hormone sensitive tumors that test negative for her2 (the most common type affecting three quarters of breast cancers in the US, BRCA1/2 positive, ductal carcinomas including DCIS, lobular carcinomas including LCIS. Receptor presence on the cancer cells is used as a classification: Her2+/-, estrogen (ER)+/-, progesterone (PR)+/-. Metastasis classes the cancer as stage 4. Genetic risk factors include: BRCA, p53, PTEN, STK11, CHEK2, ATM, GATA3, BRIP1 and PALB2. Treatments include: Tamoxifen, Raloxifene; where worrying racial disparities have been found (Dec 2013). International studies indicate early stage breast cancer typed by a genomic test: Oncotype DX, MammaPrint; can be treated without chemotherapy (Aug 2016, Jun 2018).
He explains that the cost curve does not have to look this
way. A 2008 study by the National Coping with Cancer
project compared terminally ill cancer patients put on a
mechanical ventilator, given defibrillation, or admitted when
near death to an ICU is intensive care unit. It is now being realized that the procedures and environment of the ICU is highly stressful for the patients. In particular sedation with benzodiazepines is suspected to enhance the risk of inducing PTSD. Intubation and catheterization are also traumatic. Sometimes seperated into MICU and SICU. eICU skill centralization may bring down costs. have a
worse quality of life for their final week than those who do not
get intervention. The intervention fails to achieve the
patients typical goals:
- Avoid suffering
- Strengthening relationships with family and friends
- Being mentally aware
- Not being a burden on others
- Achieving a sense that their life is complete
Gawande notes that swift catastrophic illness is now the
exception. Instead one can expect a long struggle with:
- Advanced cancer
- Dementia is a classification of memory impairment, constrained feelings and enfeebled or extinct intellect. The most common form for people under 60 is FTD. Dementia has multiple causes including: vascular disease (inducing VCI) including strokes, head trauma, syphilis and mercury poisoning for treating syphilis, alcoholism, B12 deficiency (Sep 2016), privation, Androgen deprivation therapy (Oct 2016), stress, Parkinson's disease, Alzheimer's disease, and prion infections such as CJD and kuru. The condition is typically chronic and treatment long term (Laguna Honda ward) and is predicted by Stanley Prusiner to become a major burden on the health system. It may be possible to constrain the development some forms of dementia by: physical activity, hypertension management, and ongoing cognitive training. Dementia appears to develop faster in women than men.
- Parkinson's
disease corresponds to the breakdown of certain interneurons in the brain. It is not fully understood why this occurs. Dopamine system neuron breakdown generates the classical symptoms of tremors and rigidity. In some instances an uncommon LRRK2 gene mutation confers a high risk of Parkinson's disease. In rare cases Italian and Greek families are impacted in their early forties and fifties resulting from a single letter mutation in alpha-synuclein which alters the alpha-synuclein protein causing degeneration in the substantia nigra, after a build up of Lewy bodies in the neurons. But poisoning from MPTP has also been shown to destroy dopamine system neurons. DeLong showed that MPTP poisoning results in overactivity in the subthalamic nucleus. People who have an appendectomy in their 20s are at lower risk of developing Parkinson's disease. The Alpha-synuclein protein is known to build up in the appendix in association with changes in the gut microbiome. This buildup may support the 'flow' of alpha-synuclein from the gut along neurons that route to the brain. Paraquat has also been linked to Parkinson's disease. Parkinson's disease does not directly kill many sufferers. But it impacts swallowing which encourages development of pneumonia through inhaling or aspirating food. And it undermines balance which can increase the possibility of falls. Dememtia can also develop. Treatment with deep-brain stimulation, after surgical implantation of electrodes in the subthalamic nucleus removes the symptoms of Parkinson's disease in some patients.
- Progressive organ failure: heart > lungs/kidneys provides multiple vital functions. It: Produces renin which supports negative feedback, Removes excess organic molecules from the blood, Regulates electrolytes in the blood, Maintains pH homeostasis, Regulates fluid balance, Regulates blood pressure, monitors blood oxygen concentration and signals erythropoiesis with EPO, Reabsorbs water, glucose (SGLT2) and amino acids. Kidney function is monitored with the GFR. Kidneys can fail acutely or chronically. Kidneys are affected by a variety of cancers including: advanced kidney cancer, von Hippel Landau; some of which are induced by PFAS. Multiple myeloma, type 2 diabetes, TB and drug treatments for MDR TB place a strain on the kidneys and can induce failure. > liver is an emergent cellular system providing metabolic: Dietary compound metabolism and signalling: After gorging on sugar-rich foods the liver releases FGF21 hormone to dampen further eating activity; Detoxification, Regulation of glucose through glycogen storage (asprosin signalling from white adipose tissue); clotting, immune, exocrine and endocrine functions. It is supplied with oxygen-rich blood via the hepatic artery and blood rich in semi-processed foodstuffs from the intestines & spleen via the hepatic portal vein. It is constructed from: Hepatocytes which swim in the blood to process it, BECs, Stromal cells, Hepatic stellate cells, Kupffer cells, and blood vessels. The embryonic endoderm cells invade the mesoderm to form the liver bud. Subsequently the liver bud vascularizes and is colonized by hematopoietic cells. The liver operates on a daily cycle (Aug 2018) allowing it time to recover from the stress of processing toxic substances. In a healthy adult liver cells do not divide significantly. But in a damaged liver, the liver cells shift back to a neonatal state to re-enter the cell cycle and rebuild the liver. There are over 100 disorders of the liver. Obesity and diabetes are associated with increased prevalence of these liver disorders worldwide.
.
- Old age
He continues that death is certain but the timing isn't.
We all struggle with how and when to accept that the battle is
lost. And technology can now sustain the body past the
point of awareness and coherence.
In comparison hospice has the key goal of helping people with a fatal illness to have the fullest possible life right now. There are major hospice chains focused on providing palliative care. has
the key goal of helping people with a fatal illness to have the
fullest possible life right now. But it too has to fight
against the momentum of medical treatment.
A visiting hospice nurse has a set of key questions:
- Are you in pain emerged as a mental experience, Damasio asserts, constructed by the mind using mapping structures and events provided by nervous systems. But feeling pain is supported by older biological functions that support homeostasis. These capabilities reflect the organism's underlying emotive processes that respond to wounds: antibacterial and analgesic chemical deployment, flinching and evading actions; that occur in organisms without nervous systems. Later in evolution, after organisms with nervous systems were able to map non-neural events, the components of this complex response were 'imageable'. Today, a wound induced by an internal disease is reported by old, unmyelinated C nerve fibers. A wound created by an external cut is signalled by evolutionarily recent myelinated fibers that result in a sharp well-localized report, that initially flows to the dorsal root ganglia, then to the spinal cord, where the signals are mixed within the dorsal and ventral horns, and then are transmitted to the brain stem nuclei, thalamus and cerebral cortex. The pain of a cut is located, but it is also felt through an emotive response that stops us in our tracks. Pain amplifies the aggression response of people by interoceptive signalling of brain regions providing social emotions including the PAG projecting to the amygdala; making aggressive people more so and less aggressive people less so. Fear of pain is a significant contributor to female anxiety. Pain is the main reason people visit the ED in the US. Pain is mediated by the thalamus and nucleus accumbens, unless undermined by sleep deprivation.
?
- How is your appetite, thirst, sleeping?
- Any trouble with confusion, anxiety is manifested in the amygdala mediating inhibition of dopamine rewards. Anxiety disorders are now seen as a related cluster, including PTSD, panic attacks, and phobias. Major anxiety, is typically episodic, correlated with increased activity in the amygdala, results in elevated glucocorticoids and reduces hippocampal dendrite & spine density. Some estrogen receptor variants are associated with anxiety in women. Women are four times more likely to suffer from anxiety. Louann Brizendine concludes this helps prepare mothers, so they are ready to protect their children. Michael Pollan concludes anxiety is fear of the future. Sufferers of mild autism often develop anxiety disorders. Treatments for anxiety differ. 50 to 70% of people with generalized anxiety respond to drugs increasing serotonin concentrations, where there is relief from symptoms: worry, guilt; linked to depression, which are treated with SSRIs (Prozac). Cognitive anxiety (extreme for worries and anxious thoughts) is also helped by yoga. But many fear-related disorders respond better to psychotherapy: psychoanalysis, and intensive CBT. Tara Brach notes that genuine freedom from fear is enabled by taking refuge.
or
restlessness?
- Chest pain or heart palpitations?
- Trouble with constipation, urination or walking?
- Checks if taking medicines
75% of people enter hospice with a terminal illness but not
accepting that they are dying. Typically feel that doctors
have abandoned them. A hospice nurse has about 5 seconds
to get a new patient to like is an emotion which initiates and maintains an altruistic partnership. It is a willingness to offer someone a favor. It is directed to those who appear likely to return the favor.
and trust and distrust are evolved responses to sham emotions. During a friendship where no sham emotions have been detected trust will build up. them. They
have a powerful offer: "I am a hospice nurse and here's what I
have to offer to make your life better and I know we don't have
a lot of Carlo Rovelli resolves the paradox of time.
Rovelli initially explains that low level physics does not
include time:
- A present that is common throughout the universe does not exist
- Events are only partially ordered. The present is
localized
- The difference between past and future is not foundational.
It occurs because of state that through our blurring appears
particular to us
- Time passes at different speeds dependent on where we are and how fast we travel
- Time's rhythms are due to
the gravitational field
- Our quantized physics shows neither
space nor time, just processes transforming physical
variables.
- Fundamentally there is no time. The basic equations
evolve together with events, not things
Then he
explains how in a physical world without time its perception can
emerge:
- Our familiar time emerges
- Our interaction with the world is partial, blurred,
quantum indeterminate
- The ignorance determines the existence of thermal time
and entropy that quantifies our uncertainty
- Directionality of time is real
but perspectival. The entropy of the world in
relation to us increases with our thermal time. The
growth of entropy distinguishes past from future: resulting in
traces and memories
- Each human is a
unified being because: we reflect the world, we
formed an image of a unified entity by
interacting with our kind, and because of the perspective
of memory
- The variable time: is one
of the variables of the gravitational field.
With our scale we don't
register quantum fluctuations, making space-time
appear determined. At our speed we don't perceive
differences in time of different clocks, so we experience
a single time: universal, uniform, ordered; which is
helpful to our decisions
time to waste."
The nurse must evaluate the patient's family for its ability to
support the care. They will provide a comfort pack and a
help line for how to use it. The pack includes:
- Morphine for pain
- Ativan for anxiety
- Compazine for nausea
- Haldol for delirium
- Tylenol
for fever
- Atropine for death rattle
But it is not easy for the elderly, their care givers or doctors
to decide on the right approach. There are new
experimental therapies. S. J. Gould was told he had a
terminal cancer but he lived due to the long tail of
possibility. These possibilities offer hope in
treatment.
And the strategy of withholding treatment because it is costly
and has no statistical validity was undermined when Healthnet
took this approach in 1991 and their patient died. The
family was awarded $89 million by a jury.
Aetna
in 2004 found that offering hospice in addition to, rather than
as an alternative to treatment, resulted in less visits to the ER is emergency department. Pain is the main reason (75%) patients go to an E.D. It has traditionally been part of an acute care hospital but recently is being deployed standalone as a catchment funnel to the owning hospital. The EMTALA legislation requires E.D. treatment to stabilize every person seeking treatment by most hospitals. Unreimbursed care is supported from federal government funds. E. D. profitability has been helped by hospitals contracting with 3rd party companies who are able to improve margins through surprise billing. The standalone E.D. competes with the positioning and brand power of lower cost urgent care clinics. Commercial nature of care requires walk-ins to register to gain access to care. With the focus on treatment of pain, E.D.s are a major distributor of opioids (5% of opioid prescriptions) and a major starting point of addiction in patients but are cutting back (Jun 2016). , ICU is intensive care unit. It is now being realized that the procedures and environment of the ICU is highly stressful for the patients. In particular sedation with benzodiazepines is suspected to enhance the risk of inducing PTSD. Intubation and catheterization are also traumatic. Sometimes seperated into MICU and SICU. eICU skill centralization may bring down costs. and costs fell 25%.
The key need in either strategy is to help people negotiate
overwhelming anxiety. Gawande notes it has to be a
process. You must sit down and take time and the doctor
must mostly listen. The aim is to find out what is
important to them in the circumstances. Then can provide
information and advice on the best chance of achieving their desires.
Their circumstances will depend on what they understand their
prognosis to be. As such they will have concerns about
what lies ahead. It is important to understand what
tradeoffs they are willing to make. How do they want to
spend their time? Who do they want to make decisions for
them if they become incapacitated?
Hard conversations
The world is now following the US is the United States of America.
trend of deploying hospitals.
The US is adopting hospice has the key goal of helping people with a fatal illness to have the fullest possible life right now. There are major hospice chains focused on providing palliative care. :
45% of deaths by 2010 will be hospice supported. But
Gawande warns there is no process to link the hospital and
hospice approaches. With his father developing a terminal
cancer is the out-of-control growth of cells, which have stopped obeying their cooperative schematic planning and signalling infrastructure. It results from compounded: oncogene, tumor suppressor, DNA caretaker; mutations in the DNA. In 2010 one third of Americans are likely to die of cancer. Cell division rates did not predict likelihood of cancer. Viral infections are associated. Radiation and carcinogen exposure are associated. Lifestyle impacts the likelihood of cancer occurring: Drinking alcohol to excess, lack of exercise, Obesity, Smoking, More sun than your evolved melanin protection level; all significantly increase the risk of cancer occurring (Jul 2016). Gawande experienced
the problem at first hand.
He describes three approaches taken by the hospital doctors:
- 'Dr. knows best' enforces a treatment plan that moves the
patient to the ICU is intensive care unit. It is now being realized that the procedures and environment of the ICU is highly stressful for the patients. In particular sedation with benzodiazepines is suspected to enhance the risk of inducing PTSD. Intubation and catheterization are also traumatic. Sometimes seperated into MICU and SICU. eICU skill centralization may bring down costs.
.
- 'Dr. informative' who presents details of treatments and
their statistical effects. This approach leaves the
patient anxious and bewildered but also heading towards the
ICU.
- 'Dr. complexity' who:
- Asks questions to identify the patients goals and fears
- Takes
Carlo Rovelli resolves the paradox of time.
Rovelli initially explains that low level physics does not
include time:
- A present that is common throughout the universe does not exist
- Events are only partially ordered. The present is
localized
- The difference between past and future is not foundational.
It occurs because of state that through our blurring appears
particular to us
- Time passes at different speeds dependent on where we are and how fast we travel
- Time's rhythms are due to
the gravitational field
- Our quantized physics shows neither
space nor time, just processes transforming physical
variables.
- Fundamentally there is no time. The basic equations
evolve together with events, not things
Then he
explains how in a physical world without time its perception can
emerge:
- Our familiar time emerges
- Our interaction with the world is partial, blurred,
quantum indeterminate
- The ignorance determines the existence of thermal time
and entropy that quantifies our uncertainty
- Directionality of time is real
but perspectival. The entropy of the world in
relation to us increases with our thermal time. The
growth of entropy distinguishes past from future: resulting in
traces and memories
- Each human is a
unified being because: we reflect the world, we
formed an image of a unified entity by
interacting with our kind, and because of the perspective
of memory
- The variable time: is one
of the variables of the gravitational field.
With our scale we don't
register quantum fluctuations, making space-time
appear determined. At our speed we don't perceive
differences in time of different clocks, so we experience
a single time: universal, uniform, ordered; which is
helpful to our decisions
time to slowly adjust
as the patient adapts.
- Aligns strategic options with the goals and fears
identified earlier.
- Agrees a plan with the patient. Gawande stresses
this is not just a set of options which would result in
inducing panic. Instead treatments are described
with benefits of success and risks and impacts. And
alternative palliative aims to relieve and prevent the suffering (symptoms, pain and stress of serious illness) of patients what ever their prognosis. /hospice
options are evaluated. The situation must cope with
adaption. At each point Gawande stresses it is
important to ask the patient:
- What goals are important?
- What tradeoffs are they willing to make?
Still Gawande concedes there is a difficult decision that must
be faced. Should we focus on our vision and legacy or
making our present the best experience possible. We are
not built to make this decision effectively. Gawande
describes the remembering self and the experiencing self from
Daniel Kahneman's research and book Thinking
Fast and Slow. This is what evolution has provided
us with to make decisions over a long life of repeating
experiences. But these patients probably only have the
here and now! When time is limited they both seem
important.
Courage
Gawande identifies two kinds of courage required to cope with
aging and sickness:
- To confront reality of our mortality -- the courage to
seek out the truth of what is to be feared and what is to be
hoped
- To act on the truth we find
But the wise choice is frequently unclear. Should one care
most about hopes or fears? The perspective of Carlo Rovelli resolves the paradox of time.
Rovelli initially explains that low level physics does not
include time:
- A present that is common throughout the universe does not exist
- Events are only partially ordered. The present is
localized
- The difference between past and future is not foundational.
It occurs because of state that through our blurring appears
particular to us
- Time passes at different speeds dependent on where we are and how fast we travel
- Time's rhythms are due to
the gravitational field
- Our quantized physics shows neither
space nor time, just processes transforming physical
variables.
- Fundamentally there is no time. The basic equations
evolve together with events, not things
Then he
explains how in a physical world without time its perception can
emerge:
- Our familiar time emerges
- Our interaction with the world is partial, blurred,
quantum indeterminate
- The ignorance determines the existence of thermal time
and entropy that quantifies our uncertainty
- Directionality of time is real
but perspectival. The entropy of the world in
relation to us increases with our thermal time. The
growth of entropy distinguishes past from future: resulting in
traces and memories
- Each human is a
unified being because: we reflect the world, we
formed an image of a unified entity by
interacting with our kind, and because of the perspective
of memory
- The variable time: is one
of the variables of the gravitational field.
With our scale we don't
register quantum fluctuations, making space-time
appear determined. At our speed we don't perceive
differences in time of different clocks, so we experience
a single time: universal, uniform, ordered; which is
helpful to our decisions
time also affects how our goals and
fears are evaluated.
Gawande reflects that assisted suicide has multiple problems
seen in this light. It:
- Should not be allowed for healthy people who are likely to
reevaluate their situation in the future.
- Presents a valuable option for the terminally ill who are
suffering. But Gawande notes in societies where it has
been deployed it tends to undermine the development of hospice has the key goal of helping people with a fatal illness to have the fullest possible life right now. There are major hospice chains focused on providing palliative care.
type strategies
that could reduce the suffering and allow the patient to
achieve more of their immediate goals.
When palliative care aims to relieve and prevent the suffering (symptoms, pain and stress of serious illness) of patients what ever their prognosis.
works the patient's goals extend. This extension enables
the development of a rewarding 'dying role'.
Epilogue
Gawande argues being mortal is about the struggle of coping with
the constraints of our biology. Medical science can push
against the limits. But there is harm induced when we fail
to acknowledge the limits.
Gawande suggests the job of medicine has been
misunderstood. It is easy to assume that it is to ensure
health and survival. Really it is to assure wellbeing indicates the state of an organism is within homeostatic balance. It is described by Angus Deaton as all the things that are good for a person: - Material wellbeing includes income and wealth and its measures: GDP, personal income and consumption. It can be traded for goods and services which recapture time. Material wellbeing depends on investments in:
- Infrastructure
- Physical
- Property rights, contracts and dispute resolution
- People and their education
- Capturing of basic knowledge via science.
- Engineering to turn science into goods and services and then continuously improve them.
- Physical and psychological wellbeing are represented by health and happiness; and education and the ability to participate in civil society through democracy and the rule of law. University of Wisconsin's Ryff focuses on Aristotle's flourishing. Life expectancy as a measure of population health, highly weights reductions in child mortality.
. Then all
doctors will practice palliative
care aims to relieve and prevent the suffering (symptoms, pain and stress of serious illness) of patients what ever their prognosis. .
Complex adaptive system This page introduces the complex adaptive system (CAS) theory
frame. The theory provides an organizing framework that is
used by 'life.' It can be used to evaluate and rank models
that claim to describe our perceived reality. It catalogs
the laws and strategies which underpin the operation of systems
that are based on the interaction of emergent
agents. It highlights the
constraints that shape CAS and so predicts their form. A
proposal that does not conform is wrong.
John Holland's framework for representing complexity is
outlined. Links to other key aspects of CAS theory
discussed at the site are presented.
(CAS) theory
supports reasoning about agency, death, evolution, cooperation
and adaptations in evolutionary biology is a trait that increased the number of surviving offspring in an organism's ancestral lineage. Holland argues: complex adaptive systems (CAS) adapt due to the influence of schematic strings on agents. Evolution indicates fitness when an organism survives and reproduces. For his genetic algorithm, Holland separated the adaptive process into credit assignment and rule discovery. He assigned a strength to each of the rules (alternate hypothesis) used by his artificial agents, by credit assignment - each accepted message being paid for by the recipient, increasing the sender agent's rule's strength (implicit modeling) and reducing the recipient's. When an agent achieved an explicit goal they obtained a final reward. Rule discovery used the genetic algorithm to select strong rule schemas from a pair of agents to be included in the next generation, with crossing over and mutation applied, and the resulting schematic strategies used to replace weaker schemas. The crossing over genetic operator is unlikely to break up a short schematic sequence that provides a building block retained because of its 'fitness'; In Deacon's conception of evolution, an adaptation is the realization of a set of constraints on candidate mechanisms, and so long as these constraints are maintained, other features are arbitrary. to new
technologies.
Death is typically an architected aspect of a CAS Plans are interpreted and implemented by agents. This page
discusses the properties of agents in a complex adaptive system
(CAS).
It then presents examples of agents in different CAS. The
examples include a computer program where modeling and actions
are performed by software agents. These software agents
are aggregates.
The participation of agents in flows is introduced and some
implications of this are outlined.
agent. Indeed when such aspects
fail as in many metastatic cancers is the out-of-control growth of cells, which have stopped obeying their cooperative schematic planning and signalling infrastructure. It results from compounded: oncogene, tumor suppressor, DNA caretaker; mutations in the DNA. In 2010 one third of Americans are likely to die of cancer. Cell division rates did not predict likelihood of cancer. Viral infections are associated. Radiation and carcinogen exposure are associated. Lifestyle impacts the likelihood of cancer occurring: Drinking alcohol to excess, lack of exercise, Obesity, Smoking, More sun than your evolved melanin protection level; all significantly increase the risk of cancer occurring (Jul 2016).
the planning and cooperation typical of CAS as well as the
system itself collapses. For multi-cellular agents and superorganisms is a wealthy autonomous entity needing and controlling the richest niches in the proximate environment, that emerges from the bundled cooperation of schematically aligned agents. The term is based on the social insect model, used by: ants, termites, and bees; and identified by Holldobler & E.O. Wilson. These genetically identical insect superorganisms cooperatively limit their reproduction to align with the resources available in the niche. Wilson asserts these insects all developed nests to which they returned to raise their offspring, and when the nest sites were of limited capacity some family members responded by focusing on defending the nest and foraging while their mother became an egg laying queen, enabled by "a single genetic change which silenced the brain's program for dispersal and prevents the mother and her offspring from dispersing to create new nests," Wilson explains. He adds climate control of the nest and disease resistance, just like the human immune system, demand individually focused diversity. So the queen's genome consists of low variety alleles for the extended phenotypic 'robot' worker caste agents and their organization - queen and workers competing as one, with other colonies and individual insects - and other parts which are high where the genome includes significant diversity. For humans it is an evolved cultural strategy used when the environment is supportive, but it is dependent on our imperfect cognitive assessment of kinship as well as group selection driven emotions: other-condemning, other-praising, other-suffering and self-conscious; and group oriented pressures to conform and remain: religions. And the adjacent possible must be recreated and modeled culturally through the emergence of processes such as democracy. It depends on inter-agent signalling. In both insects and humans it allows specialization, and encourages operations and flows that are tightly controlled, limiting waste, leveraging parallel activity, supporting coherence. Superorganisms reflect cliodynamic flows. A superorganism has a development and operational phase. As additional agents are coopted into the superorganism they align, participate in supply and demand activities and so contribute to the evolutionary amplification. Damasio notes that prokaryotes, in rich environments, can similarly operate in a symbiotic fashion expressing cultural behaviors. death
also provides a key support for In this page we summarize the arms race between hosts
and their parasites.
The deadly nature and adaptive
pressure of the relationship is introduced. How the
slowly reproducing hosts cope is
described. Cultural
hosts and parasites are discussed.
sexual
reproduction's competitive response to parasites.
And it appears important in moving the parents out of the way
and thus allowing the offspring access to the resources they
will need to survive and reproduce.
From the perspective of the system once the agent has
replicated, its Plans emerge in complex adaptive
systems (CAS) to provide the
instructions that agents use to
perform actions. The component architecture and structure
of the plans is reviewed.
schematic plan is
perpetuated. The agent need only persist while it is
providing material support to the developing offspring.
But as Gawande notes the structure of the family has been
transformed from the large
extended to the small nuclear. There are significant
unintended consequences. One appears to be the limited
opportunity for cross infection from one familial infant to
another. Key participants of the human microbiome, the trillions of bacteria and viruses that live inside higher animals' guts, on their skin etc. These bacteria and viruses seem to play a role in: immune responses, digesting food, making nutrients, controlling mental health and maintaining a healthy weight. The signals from the gut microbiota are relayed by major nerve fibers: vagus; to the central nervous system. The symbiotic relationship must be actively managed. Human armpits include glands which provide food favoring certain symbionts who build a defensive shield above the skin. In the human gut: Barriers are setup: Mucus secretions form a physical constraint and provide sites for bacteriophages to anchor and attack pathogenic bacteria; Symbiont tailored nourishment: Plant-heavy food creates opportunities for fibre specialists like Bacteroides thetaiotaomicron; is provided, Selective binding sites are provided, Poisons are deployed against the unwelcome, and Temperature, acidity and oxygenation are managed. High throughput sequencing allows the characterization of bacterial populations inside guts. Beginning at birth, as they pass down the birth canal infants are supplied with a microbiome from their mothers. If they are borne via cesarean they never receive some of the key bacteria: Bifidobaterium infantis which is also dependent on oligosaccharides in breast milk; from their mothers. A variety of diseases may be caused by changes in the microbiome: - Eczema can be related to changes in the skin microbiome.
- Obesity can be induced by changes to the gut microbiome.
- Chronic inflammation
- Allergies
- Type 1 diabetes
: Bifidobacterium
infantis is a key symbiont in the human infant microbiome. It is selected for by breast milk's array of oligosaccharides. This structures the microbiome and helps bootstrap the immune system. Its growth limits the opportunities for pathogenic bacteria to occupy the infant lower intestine. But its transmission to further generations may depend on large families where the children typically cross infect. It appears to be collapsing in western societies with small nuclear families and a focus on cleanliness. , Helicobacter
pylori is a gram-negative bacteria, found in the stomach microbiome. Having been identified as the causative agent of stomach ulcers and stomach cancer it has been a focus of eradication campaigns. However, it has been subsequently realized that it limits acid reflux and esophageal cancer, and may be a necessary component of the infant microbiome. ; are collapsing as their transmission chains have
failed.
Gawande suggests that aging is an unusual event for humans and
that complex
systems are redundant and fail randomly and gradually in
fragile ways. The high death rates of infants and
old people distort average death rates. Most adults in
previous ages did not die at 30. A lot of infants died
lowering the average. For CAS agents tailored and
customized through the execution of genetic plans which
specified their emergence by aggregation of cooperating lower
level agents' randomness can only be part of the picture.
Whenever agent death is valuable from the systems perspective it
can surely be invoked. Such mechanisms exist. Janet
Mann describes in The
Adapted Mind when economically is the study of trade between humans. Traditional Economics is based on an equilibrium model of the economic system. Traditional Economics includes: microeconomics, and macroeconomics. Marx developed an alternative static approach. Limitations of the equilibrium model have resulted in the development of: Keynes's dynamic General Theory of Employment Interest & Money, and Complexity Economics. Since trading depends on human behavior, economics has developed behavioral models including: behavioral economics.
stressed is a multi-faceted condition reflecting high cortisol levels. Dr. Robert Sapolsky's studies of baboons indicate that stress helps build readiness for fight or flight. As these actions occur the levels of cortisol return to the baseline rate. A stressor is anything that disrupts the regular homeostatic balance. The stress response is the array of neural and endocrine changes that occur to respond effectively to the crisis and reestablish homeostasis. - The short term response to the stressor
- activates the amygdala which: Stimulates the brain stem resulting in inhibition of the parasympathetic nervous system and activation of the sympathetic nervous system with the hormones epinephrine and norepinephrine deployed around the body, Activates the PVN which generates a cascade resulting in glucocorticoid secretion to: get energy to the muscles with increased blood pressure for a powerful response. The brain's acuity and cognition are stimulated. The immune system is stimulated with beta-endorphin and repair activities curtail. In order for the body to destroy bacteria in wounds, pro-inflammatory cytokines increase blood flow to the area. The induced inflammation signals the brain to activate the insula and through it the ACC. But when the stressor is
- long term: loneliness, debt; and no action is necessary, or possible, long term damage ensues. Damage from such stress may only occur in specific situations: Nuclear families coping with parents moving in. Sustained stress provides an evolved amplifier of a position of dominance and status. It is a strategy in female aggression used to limit reproductive competition. Sustained stress:
- Stops the frontal cortex from ensuring we do the harder thing, instead substituting amplification of the individual's propensity for risk-taking and impairing risk assessment!
- Activates the integration between the thalamus and amygdala.
- Acts differently on the amygdala in comparison to the frontal cortex and hippocampus: Stress strengthens the integration between the Amygdala and the hippocampus, making the hippocampus fearful.
- BLA & BNST respond with increased BDNF levels and expanded dendrites persistently increasing anxiety and fear conditioning.
- Makes it easier to learn a fear association and to consolidate it into long-term memory. Sustained stress makes it harder to unlearn fear by making the prefrontal cortex inhibit the BLA from learning to break the fear association and weakening the prefrontal cortex's hold over the amygdala. And glucocorticoids decrease activation of the medial prefrontal cortex during processing of emotional faces. Accuracy of assessing emotions from faces suffers. A terrified rat generating lots of glucocorticoids will cause dendrites in the hippocampus to atrophy but when it generates the same amount from excitement of running on a wheel the dendrites expand. The activation of the amygdala seems to determine how the hippocampus responds.
- Depletes the nucleus accumbens of dopamine biasing rats toward social subordination and biasing humans toward depression.
- Disrupts working memory by amplifying norepinephrine signalling in the prefrontal cortex and amygdala to prefrontal cortex signalling until they become destructive. It also desynchronizes activation in different frontal lobe regions impacting shifting of attention.
- Increases the risk of autoimmune disease (Jan 2017)
- During depression, stress inhibits dopamine signalling.
- Strategies for stress reduction include: Mindfulness.
mothers find they
have too little food to feed their whole family they may opt for
'infanticide' of one or more of the children. And Medawar
and Williams's mutations potentially set an upper limit on life
span in the scenario Gawande outlines for humans (Dec
2016)
At each This page discusses the mechanisms and effects of emergence
underpinning any complex adaptive system (CAS). Physical forces and
constraints follow the rules of complexity. They generate
phenomena and support the indirect emergence of epiphenomena.
Flows of epiphenomena interact in events which support the
emergence of equilibrium and autonomous
entities. Autonomous entities enable evolution
to operate broadening the adjacent possible.
Key research is reviewed.
emergent level the agents
must be able to The agents in complex adaptive
systems (CAS) must model their
environment to respond effectively to it. Evolution's
schematic operators and Samuel
modeling together support the indirect recording of past
successes and their strategic use by the current agent to learn
how to succeed in the proximate environment.
model their
proximate environment. For multi-cellular animals this
requires the Consciousness has confounded philosophers and scientists for
centuries. Now it is finally being characterized
scientifically. That required a transformation of
approach.
Realizing that consciousness was ill-defined neuroscientist
Stanislas Dehaene and others characterized and focused on conscious access.
In the book he outlines the limitations of previous
psychological dogma. Instead his use of subjective
assessments opened the
window to contrast totally unconscious
brain activity with those
including consciousness.
He describes the research methods. He explains the
contribution of new sensors and probes that allowed the
psychological findings to be correlated, and causally related to
specific neural activity.
He describes the theory of the brain he uses, the 'global neuronal
workspace' to position all the experimental details into a
whole.
He reviews how both theory and practice support diagnosis and
treatment of real world mental illnesses.
The implications of Dehaene's findings for subsequent
consciousness research are outlined.
Complex adaptive system (CAS) models of the brain's development and
operation introduce constraints which are discussed.
development of neuronal
infrastructure and adaptive learning. With these
constraints it is not surprising that our ability to represent
our historic experiences uses short cuts. Our remembering
self maintains just the notable event and the end event.
Given the previous comments on death the remembering self seems
satisfactory from This page reviews the implications of selection, variation and
heredity in a complex adaptive system (CAS).
The mechanism and its emergence are
discussed.
evolution's
perspective.
Gawande provides powerful demonstrations of the issues of H. A. Hayek compares and contrasts collectivism and
libertarianism.
central
planning. His contrasting illustrations of local
agents (Karen Brown Wilson, Bill Thomas) developing adaptive in evolutionary biology is a trait that increased the number of surviving offspring in an organism's ancestral lineage. Holland argues: complex adaptive systems (CAS) adapt due to the influence of schematic strings on agents. Evolution indicates fitness when an organism survives and reproduces. For his genetic algorithm, Holland separated the adaptive process into credit assignment and rule discovery. He assigned a strength to each of the rules (alternate hypothesis) used by his artificial agents, by credit assignment - each accepted message being paid for by the recipient, increasing the sender agent's rule's strength (implicit modeling) and reducing the recipient's. When an agent achieved an explicit goal they obtained a final reward. Rule discovery used the genetic algorithm to select strong rule schemas from a pair of agents to be included in the next generation, with crossing over and mutation applied, and the resulting schematic strategies used to replace weaker schemas. The crossing over genetic operator is unlikely to break up a short schematic sequence that provides a building block retained because of its 'fitness'; In Deacon's conception of evolution, an adaptation is the realization of a set of constraints on candidate mechanisms, and so long as these constraints are maintained, other features are arbitrary. strategies
which proved valuable and grew by replication are clearly
superior approaches.
The crumbling
of one's bodily systems is Aubrey de Grey's focus as
discussed in our In his talk 'The Science of Ending Aging' Aubrey de Grey argues
we should invest more in maintenance of our bodies. In
this page we summarize his video comments and then use complex
adaptive system (CAS) theory to
review his arguments. Focusing the lens of CAS theory and
mechanisms of emergence on the system we highlight the pros and
cons of ending aging.
summary of the science
of ending aging.
Being Mortal provides a sophisticated and visionary description
of the challenge of aging in our high technology society and how
we should organize to cope with it. I hope my health care
providers have read and thought about Atul Gawande's important
points.
.
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