iMedicine: The Influence of Social Media on Medicine

Kent Bottles

Posted 4/25/12 on Kent Bottles’ Private Views

iMedicine:  The Influence of Social Media on Medicine was the topic of the day-long 27th Annual Physician Student Awareness Day (SPAD) held on April 24, 2012 on the campus of New York Medical College in Valhalla, New York.  The entire conference was run by medical students from the Class of 2015.

Karl Adler, MD, CEO, welcomed the 200 attendees by recalling his own medical school education in the 1960s. Dr. Adler relied on textbooks, mimeographed handouts, and lecture notes to master both the art and science of medicine.  In his day, students were taught to rely on the history, the physical examination, laboratory tests, radiology studies, and the EKG; his teachers stressed that the history and physical obtained in a face-to-face encounter between the physician and the patient were the keys to successfully caring for the patient.

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Human Understanding, Randomness, Free Will, and Delusion – Part V

Kent Bottles

Posted 3/17/12 on Kent Bottles Private Views

I am just as tired of this five-part blog post as you are. That is assuming anyone has bothered to read all five parts (one of my twitter followers nicely tweeted that he liked my posts, but enough already with this particular post that seems to be going on forever). I am happy to announce that this is the final installment. I am unhappy to announce that the seventeen really smart people whose writings I have read for Parts I through IV really have not been able to answer my simple question, “What is going on in the world of Kent Bottles.” The seventeen experts who have accompanied me on this journey so far are: Tom and Ray Magliozzi, Nikoli Tesla, Misha Angrist, Ricki Lewis, Jackie Fenn, Mike Gazzaniga, Kurt Godel, Edmund Gettier, John Barrow, Karl Popper, Francis Crick, Raymond Tallis, Terrence Dean, Benjamin Libet, Tim Crane, and Robert Laughlin.

In Part V of our exploration, we have to deal with one more really smart person and one really dumb person.

The really smart person, whose views I do not always agree with, is Donald Rumsfeld, the youngest and oldest person in the history of the United States to hold the position of Secretary of Defense. Rumsfeld is famous for many things, but I want to focus on his classification of knowledge: known knowns (things we know to be true), known unknowns (things we know we don’t know), and unknown unknowns (things we are unaware that we don’t know).(http://www.youtube.com/watch?v=GiPe1OiKQuk)

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Human Understanding, Randomness, Free Will, and Delusion Part IV

Kent Bottles

Posted 3/16/12 on Kent Bottles Private Views

In many ways this long and meandering four-part blog post is entirely Michael S. Gazzaniga’s and Benjamin Libet’s fault. We have already met Gazzaniga and his left-brain interpreter theory that resulted from studying split-brain patients who underwent surgery to treat epilepsy. Gazzaniga has explored what these studies mean in several books, all of which are written in a way that the layperson can understand. David Wolman has recently published in Nature a nice overview article that would be a good place to start for someone just starting to grapple with their brain’s inherent need to explain things, even when the brain does not have a clue as to what is really going on (http://www.nature.com/news/the-split-brain-a-tale-of-two-halves-1.10213)

As shocking as my brain’s need to confabulate to make sense of a world that increasingly makes no sense is the work of Benjamin Libet of UCSF who stimulated the brain of an awake patient undergoing surgery; he discovered a time lapse between stimulating the cortex that represents the hand and when the patient signaled they were conscious of sensation in the hand. In more recent studies, John-Dylan Haynes showed that the outcomes of an inclination can be encoded in brain activity up to 10 seconds before the patient is conscious of it. Chung Siong Soon also expanded Libet’s work when he showed that regions in the cortex associated with voluntary movement lit up on fMRI scans five seconds before the subject was aware of making a choice. Song concluded that a network of control areas in the brain “begins to prepare an upcoming decision long before it enters awareness.” This phenomenon has been labeled Bereitschaftspotential, which I cannot pronounce, or readiness potential, which is easier for me to say. Gazzaniga summarizes the staggering implications of these experiments:

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Human Understanding, Randomness, Free Will, and Delusion: Part III

Kent Bottles

Posted 3/12/12 on Kent Bottles Private View

In this exercise I am trying to understand what is going on in my world. Car Talk with the Magliozzi brothers is popular with 4 million listeners because they attempt to fix real world problems that callers have with their cars.Genomics, proteomics, and gene therapy have captured the attention of the public and science journalists because they attempt, so far with limited success, to move us from diagnose and treat to predict and prevent which should help us lead longer and more satisfying lives. In Part I and Part II, we saw that even experts like Ray and Tom Magliozzi sometimes are stumped and that science does not always deliver what I desperately need and want: a clear and truthful understanding of what is going on in my world.

Neuroscience and evolutionary psychology are fascinating subjects to read and claim to provide a framework to give me what I want. The natural sciences claim to give an explanation for everything in my world, including me as a human being. However, the explanation the scientists offer clashes with my understanding that I am a conscious person who has a coherent and unified self that is capable of exercising free will. I am a little worried that my left-brain interpreter is making up this story, but that is how I feel.

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Human Understanding, Randomness, Free Will, and Delusion Part II

Kent Bottles

Posted 3/10/12 on Kent Bottles Private Views

In Part I we explored how human beings jump to conclusions when they think they understand reality. This usually occurs when the explanation makes sense, and all of us tend to generate reasons why things are the way they are. It makes sense that understanding our genome would allow us to predict what diseases we are predisposed to developing and to try to do something to avoid getting the disease. Predict and prevent make sense. It makes sense that gene therapy should work because it is so logical and understandable. If you replace the defective gene with the correct gene you should cure the disease.

Why do we humans assume we have the capacity to understand reality?

“This what our brain does all day long. It takes input from other areas of our brain and from the environment and synthesizes it into a story.”

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Human Understanding, Randomness, Free Will, and Delusion Part I

Kent Bottles

Posted 3/10/12 on Kent Bottles Private Views

Just because something makes sense does not mean it explains reality. And yet we are always trying to make sense of a world that scientists increasingly believe is totally random. And if the world is totally random, why do I think I have free will?

I usually do not listen to Car Talk, but I did happen to be driving in Gladwynne when Sally of North Salem, New York proclaimed, “I stumped the Car Talk guys.” Their immediate response is important. One brother said, “No, we do not have any experience with it. We haven’t given you an answer, but we will.” The other brother chimed in, “It doesn’t mean we don’t have an answer.”

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Topol & Agus on the Future of Medicine

Kent Bottles

Posted 2/10/12 on Kent Bottles Private Views

Speaker after speaker at the January 26, 2012 Care Innovations Summit in Washington, DC concluded that increasing the quality and decreasing the per-capita cost of health care is the dominant political, social, and economic issue of our time. More than one expert called for a “jailbreak.” Before January 26, “jailbreak” for me meant either an obscure English reality television show or an expression applied to overriding the software limitations deliberately placed on computer systems for security or administrative reasons. The speakers in DC seemed to be calling for a jailbreak out of the prison of the status quo of the American health care delivery system and into an era of digital medicine and understanding the ill patient as a complex emergent system that does not need to be fully understood to be cared for.

Two new books make the case that American medicine is at an inflection point and about to undergo “its biggest shakeup in history.” Eric Topol, MD in The Creative Destruction of Medicine:How the Digital Revolution Will Create Better Health Care (New York: Basic Books, 2012) is no fan of the traditional approach which he labels as “conservative to the point of being properly characterized as sclerotic, even ossified.” David B. Agus, MD in The End of Illness (New York: Free Press, 2011) applies systems biology to his field of oncology and concludes: “Cancer is not something the body has or gets; it’s something the body does.”

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