I have a cold.  It is a very common cold.  Nothing special.  Just enough to make me want to sleep at 2 in the afternoon.  We can land humans on the moon and yet we can’t cure the common cold.

Coincidentally, yesterday’s RadioLab podcast was indirectly about the common cold.  The podcast was about complexity and the limits of human understanding.  When we have complex systems, with many parts that interact and affect each other in complex ways, it is difficult for humans to make sense of the chaos.  Despite its commonness, the common cold is one of these complex systems.  The way that the cold virus interacts with the genes and proteins and other parts of the human body is extraordinarily complex.  The human brain cannot make sense of such a large number of interactions.  We have a limited capacity for understanding these kinds of interactions.

And so, according to RadioLab, we build robots.  My sense is that these are artificial intelligence tools which map the interactions and attempt to create mathematical equations to model those interactions.  And we have been successful in creating the equations that model those interactions.  The problem is that we don’t understand the equations.  We recognize that the equations are correct in the sense that they can predict the future.  That is, given new data, they can predict the consequences on other variables in the system.  These kinds of tests are common in neural networks, an artificial intelligence technique that attempts, in a limited sense, to model the human brain.  One of the ways that we test whether a neural network has been created correctly is to measure its ability to generalize, to predict the results of new data.  The problem with neural networks is that they can’t tell us WHY they predict what they predict.  Instead, they create mysterious, almost mystical equations to predict the consequences of new data, to predict the future.  But we can’t understand these equations.  We know that the equations tell us that when one variable goes up another variable goes down by some fractional amount.  But we don’t understand why.  We cannot make sense of the equations.  And so researchers are pushing our tools to explain themselves.  To tell us why one variable goes up when another goes down or vice versa.  Interesting.

And still, I have a cold.  I know how this virus manifests itself in my body.  But no one yet understands why.   Or how to cure it.

My grandmother will turn 92 this April.  If you do the math, you will see that she was born in 1918, a year in which hundreds of thousands of Americans were killed by an influenza epidemic.   In October, 1918,  in the midst of World War I, 195,000 Americans died of the flu, making it the deadliest month in American history.  The flu killed the most robust of people who contracted it.  Soldiers were among the hardest hit, both in Europe and in the United States. I figure that I’m lucky to have ever been born, given that my grandmother was six months old, with little immune defenses against one of the deadliest influenza epidemics in modern history, in this deadliest month.  A bunch of coincidences have brought this flu epidemic to my mind in recent days.

As I have written about in earlier blog posts, I recently bought a Kindle.  One of my favorite authors is Dennis Lehane (a Boston author who wrote Mystic River, among other great novels) and so the first work of fiction that I’ve been reading on my Kindle is The Given Day, Lehane’s novel set in 1918.  It focuses on labor and race issues set against the deadliness of the flu epidemic of that year.  I haven’t finished the novel yet, but so far, it has been informative and enjoyable. 

As I have also written about in earlier blog posts, I decided to get the flu vaccine this year.  The swine flu was predicted to have been the deadliest since 1918 although it has turned out not to be.  The reasons for its relative mildness are not yet known but perhaps one thing is that we now understand how the flu is spread.  And of course, we do have vaccines that are quite effective.

The other night, PBS showed a documentary about the 1918 influenza epidemic.  The documentary details the devastation of the flu as well as the doctors who fought against.  They developed a vaccine which didn’t work because they were focused on bacteria and the flu is viral.  Little was known about viruses in 1918.  Luckily, according to the documentary, “As mysteriously as it had come, the terror began to slip away.”  It had virtually disappeared in Boston by early November.  Armistace Day (Nov 11) brought end to war in Europe and the worst of the epidemic was passing.  It appears that the flu ran out of “fuel”–people who were susceptible.  Survivors developed immunity.  550,000 Americans had died in the 10 months of the epidemic.  At least 30 million people around the world had died.  Nearly every human being on Earth was infected with the virus and therefore developed immunity.  And that probably explains why the swine flu of 2009, although not as deadly as predicted, didn’t hit elderly people very hard.  They had developed immunity from previous exposures.

An interesting side note to this story is that I had lunch with my grandmother today.  She lives in an elderly housing building in Goffstown, NH, where she, and my father, and I, all grew up.  This was the building that she had gone to high school in, and my father had gone to junior high in, and I had gone to 5th and 6th grade in.  When it was no longer needed as a school, it was renovated into apartments for the elderly.  She noted today that she graduated from high school in 1935 (at the age of 17 since she had skipped a grade when she was the only student in her grade in her one room school house).  This is the 75th anniversary of her high school graduation, a high school that was located in the building in which she now lives.  I asked if her class was going to have a reunion.  She said probably not, since she is one of only two of the sixteen she graduated with who are still alive.  And the other woman, who is nearly two years older than my grandmother, is not in very good health.  So no, they will probably not get together to celebrate their graduation from high school 75 years ago.

Life goes on and on and on.  And I’m struck by the arbitrariness, the luck, of it all.

I just finished reading My Lobotomy by Howard Dully and Charles Fleming.  Howard Dully received a transorbital lobotomy (also known as an “ice-pick lobotomy”) when he was 12 years old.  The doctor who performed the lobotomy was the king of transorbital lobotomies, Walter Freeman.  The book chronicles Dully’s life as well as his search, more than 40 years after the lobotomy, for answers as to why this surgery was performed on him.  It’s a harrowing story, especially because by almost all accounts, Dully was a normal kid.  The problem in his life seems to have been his step-mother who for some reason just didn’t like him and was probably afraid of him because he was a big kid.

Antonio Egas Moniz was the pioneer of the lobotomy and in fact, received the Nobel Prize in Medicine in 1949 for his work in this area.  By the late 1950’s, with the introduction of drugs that worked far better than lobotomies, the procedure fell out of favor in the mainstream medical community.   In fact, some have characterized the lobotomy as the biggest mistake ever made by mainstream medicine.  My favorite quote about the lobotomy comes from Norbert Weiner who is the father of cybernetics.  He said on page 148 of his book Cybernetics, “…prefrontal lobotomy …has recently been having a certain vogue, probably not unconnected with the fact that it makes the custodial care of many patients easier. Let me remark in passing that killing them makes their custodial care still easier.”

Reading My Lobotomy is an eye-opening experience.  Throughout the entire book, I wondered where the authorities were.  Surely there were adminstrators at the hospitals where Freeman worked who realized that his methods for diagnosing patients as having major psychoses were problematic.  Why did they let him continue to practice for so long?  What about all those doctors that Dully’s step-mother took him to who said he was a fine, normal kid?  Why did none of them recognize that she was going to continue in her pursuit until she found the diagnosis she was looking for?  The problem, of course, is that at the time, a lobotomy could be prescribed for conditions as mundane as “youthful defiance” or even just “moodiness.”  There is no doubt that Howard Dully was a defiant youth.  Reading the book, I get a portrait of him as a really smart kid who was bored in school and who probably had attention deficit disorder as well as an incredible amount of stress as a result of being an abused child.  But the kind of trouble he got into was normal kid stuff and probably could have been dealt with by someone paying a little bit of attention to him and maybe challenging him a little more in school. 

The other question that kept popping into my head was whether things are better now.  Could this sort of thing happen today?  Obviously, there are not a lot of lobotomies performed today but kids are put onto serious psychotropic medicines all the time.  What kind of safeguards do we have in place to protect kids (or adults for that matter)?  Do we require multiple physicians to look at a kid before he or she is diagnosed as schizophrenic or bipolar or whatever?  My guess is that we don’t.  Although it seems like the effects of taking drugs for these conditions would not be permanent in the same ways that having a lobotomy would be permanent, some of the stigmatization that Dully describes would be present and very damaging simply with a diagnosis of schizophrenia or some other serious mental disorder.

One of the most moving parts of the book is the afterword to the paperback edition of the book.  Dully is contacted by two brain researchers to have a detailed MRI taken of his brain to determine the kind of damage that was done by the ice picks.  The researchers suspected they would find little damage because Dully seemed so normal, too normal for someone who has had a lobotomy.  What they found was brain damage that was so significant that if it had been done to an adult, that person would be a vegetable.  But because Dully had the surgery when he was 12, his brain was still maleable.  It adapted to the damage so that after 40+ years, he was a normally functioning adult.  Dully then says that he had always felt burdened by the lobotomy, like something really bad had been done to him as a child.  After the MRI, he realized that he actually was quite lucky that he had the lobotomy at such an early age.  If it had been done even five years later, he probably would never have left the institutions he grew up in.  He would never have had a life with a wife and kids and a job.  So he now sees his life as lucky.  It’s an inspirational shift in perspective, I think, and I’m not sure how many of us would be able to make that shift. 

From a technology standpoint, this story reminds me that we have developed lots of tools that we can use in a variety of situations.  But having the tools doesn’t mean that we should actually use the tools.  And when we do use the tools, we need to put into place significant checks and balances to avoid abuses of power and to protect the powerless as much as we can.  I don’t think we’ve really learned these lessons yet.

By the way, National Public Radio did a 22-minute documentary about Howard Dully back in 2005.  Here’s that story–I strongly encourage you to listen to it by clicking on “Listen Now” in the upper left corner of the page.