Driving Blind

On the opacity of human health.

Biological systems, as I’ve attempted to emphasise, are massively complex entities/processes. To give you a sense of just how complex, consider one of the central problems of biology: protein folding. Proteins make us up; they make us work, right. They are, at some level of things, what we are as organisms: huge, intricate towers of proteins. The protein folding problem is the problem of figuring out how proteins, you guessed it, fold. For implicit in the folding dynamics of proteins is their structural/functional dynamics. And since form follows function, and vice versa, gaining insight into one provides, or so we hope, insight into the other. Despite impressive recent advances, the protein folding remains precisely thus: a problem. We really don’t have any reliable/efficient means of figuring out how individual proteins do their thing. Now consider, by comparison, just how challenging the ‘organism problem’ is; that is, the problem of understanding how organisms do their thing, how they work. If we can scarcely wrap our heads around how individual proteins are folding, it stands to reason that wrapping our heads around how billions of proteins coordinate to produce all the things we know and love about life will be considerably more challenging.

Irrespective of the level of understanding/description — i.e. atoms, proteins, tissues, organ systems, electrical networks — that ultimately proves most fruitful, in terms of enabling us to control the dynamics of life, the first step is to get our hands on the data, the info. Before we can ascertain the dynamical, emergent laws by which life does its thing, we must first develop a high-resolution picture of what’s actually happening inside life, over relevant spatiotemporal frames. For before we can figure out how to intervene when something goes wrong, we must first figure what actually goes wrong when something indeed goes wrong. What we require is a rich model — a literal motion picture — of how the going wrong actually happens — that is, unfolds — over time.

To bring this down to earth, consider how we presently manage our own biological systems, our beings. For the most part, we rely on how we’re feeling to ascertain how things are going on the inside. Every now and then we get a medical check-up either just because, or, every now and then something goes to shit and we’re ostensibly compelled to. Only in such cases, for the most part, do we actually get our hands on some objective info re what’s happening, biologically speaking. We might, for instance, get our blood done or our heart listened to. If something’s up, the doc’ll then try to diagnose us, based on the model that he/she develops around such data, and then, based on this diagnosis, put us onto some kind of treatment — pharmaceutical, lifestyle or otherwise. That’s how we do — and more or less how we’ve always done — medicine in a nutshell. Now what this state of affairs amounts to, in practice, is akin to driving blind; driving that is, without any relevant gauges as to what one’s vehicle is doing at any given moment. It’s only when our engines breakdown that we care to get a sense of how the tires are doing.

To be clear, it’s not that how we’re feeling is an irrelevant measure of how we’re doing on the inside. On the contrary, the quality of our subjective experience is perhaps the single-most reliable — and high-fidelity — indicator of our overall health, especially when one has deliberately developed their powers of introspection. It’s just that, no matter how subtle our capacity for self-reflection becomes — no matter how in-tune with ourselves we are, experientially — introspection will always be a highly limited window onto our interior happenings. One could be the most accomplished yogi, for all Reality cares, and yet remain hopelessly ignorant to the fact of a cancer metastasising within their pancreas — for example. This is just to say that evolution has equipped us with a wide variety of cool traits, which has rendered us relatively fit for survival within a very particular configuration space. It has not rendered us omniscient.

Now this is where science and technology comes to the party. While we cannot, through the independent powers of our own minds, come to know all there is to know about what’s happening re the mechanics of our own meatsuits — how all our proteins are folding etc. — we can augment these powers with technology. We can, for instance, get our blood work done, our pulse and HRV read, our genomes sequenced, EEGs and MRIs and all the rest of it. We can thus, through the use of technology, ascertain what our minds cannot. The present problem, however, is not that we don’t ever use technology to determine what’s happening inside us, rather it’s that we rarely do. Moreover, when we do, we utilise only a very limited set of technologies. Thus what we get is a very blurry picture of only the briefest moment in time. We then make critical decisions based on this extremely low-resolution image, often, invariably, to our great detriment. Sometimes, admittedly and remarkably, we fluke it — we get things right. Now while this is great, that we sometimes manage to sort ourselves out, the downside is it tends to instil a false sense of confidence — it makes us think we actually know what we’re doing, when in reality that’s all too rarely the case.

To be sure, it’s not our fault that we don’t have near-perfect insight into our inner workings at all times. That we only have the most half-baked sense of what’s going on, at any given moment, is merely reflective of where we’re at in the scheme of technological progress. We’re monkeys that have just come down from the trees, after all. Additionally, there are some structural/systemic forces that are impeding the widespread adoption of such a biomedical reality — the pharmaceutical status quo, for instance. However, on the whole, that we haven’t already cooked up such a situation is more a symptom of the technological challenge of the mission at hand than it is the result of any conspiratorial design by the “powers that be”. It is also, however, a symptom of a lack of clear vision, a lack of a unifying sense of how the ideal health care system ought to be. It is hard to build the future, that is, when one can’t see it.

So what is the vision? It is simple: a world wherein we know all there is to be known — all that can be known — about what’s happening within our organism, at all times. A real-time, 4K film of what’s going on always; constantly monitored, system-wide, high-resolution insight into our internal unfolding. Right about this point, there’s bound to be a split amongst readers. Half of you, or thereabouts, find the notion of internal omniscience intoxicating, an example of the computer-human symbiosis ideal made real. The other half, or thereabouts, are likely to find the idea downright scary; perhaps you’re already conjuring some dystopian, Brave New world scenario, a world where we’re paralysed by knowledge, maniacally obsessed with our biological data at the expense of the quality of our lived experience. Neither reaction is correct, but neither reaction is incorrect, either. There is something obviously cool about the idea, the utopian scenario is readily imaginable. There is also something scary about the notion, it does indeed provide scope for shit to go wrong. In the end, both reactions are reasonable given one’s implicit premises, that is, one’s intuitive sense of how things would shake out.

Things would no doubt be kinda shit if were were incessantly flooded with information re our biology and yet none the better for it. Indeed even if we were better for it, being flooded with information would still suck. The idea, of course, would be to devise ways to interface intelligibly with the information/knowledge we acquire, pragmatic and sensible means of taking the ocean of biological data and turning it into actionable behaviours and interventions, without losing our minds. This will surely be a great challenge. It’s one thing to acquire lots of data, veritable mountains of it, another to figure out what it all means and what to do with it. But make no mistake, the data is and will be key. Before we can develop truly remarkable biological technologies, we must have better models of biological systems; models that are not only higher-resolution, spatially, but also much more comprehensive, temporally. We are creatures embedded in what — at the level of our interface, at least — is spacetime. To understand ourselves fully, we will therefore require detailed spatiotemporal maps of ourselves; the better the map, the better the understanding.

The kind of argument I’m making here is not especially novel. On the contrary, the ideas are at the centre of a somewhat prominent cultural development known as the “quantified self movement”. At the centre of this centre is the use of wearable devices, like sensor-laden rings and watches and straps, things that provide insight into one’s heart rate, HRV, blood oxygenation etc. Naturally, within this movement, dorky white tech dudes are highly overrepresented, but that is largely arbitrary and thus shouldn’t be held against it. Moreover, these technologies are highly primitive and of relatively little value. With little exception, they’re toys; good for a bit of fun but little else. Yet neither should this fact be held against the ideas. For while the technology is clunky as hell, and perhaps viscerally repulsive to your own aesthetic sensibility, the underlying philosophy they embody, however, is deep and powerful. They’re on the right track, conceptually. And that’s something.

All other things being equal, a world where we know more is a better world than a world where we know less. Of course what we do with that knowledge is another thing. Knowledge is power and power brings, yes, responsibility, and responsibility can be scary. However, shying away from responsibility is scarcely ever the right way to go, and neither, I contend, is it here. We want, I suggest, a world where we have crystal clear insight into ourselves, a world where we can take said insight and translate it into a better, happier, healthier planet. Now whether such a world comes to pass is on us, of course. For the future is inevitable, but its quality never guaranteed. It is in our hands, always.

@fair