Lifeboat Foundation

My sociology of knowledge students read Yuval Harari’s bestselling first book, Sapiens, to think about the right frame of reference for understanding the overall trajectory of the human condition. Homo Deus follows the example of Sapiens, using contemporary events to launch into what nowadays is called ‘big history’ but has been also called ‘deep history’ and ‘long history’. Whatever you call it, the orientation sees the human condition as subject to multiple overlapping rhythms of change which generate the sorts of ‘events’ that are the stuff of history lessons. But Harari’s history is nothing like the version you half remember from school.

In school historical events were explained in terms more or less recognizable to the agents involved. In contrast, Harari reaches for accounts that scientifically update the idea of ‘perennial philosophy’. Aldous Huxley popularized this phrase in his quest to seek common patterns of thought in the great world religions which could be leveraged as a global ethic in the aftermath of the Second World War. Harari similarly leverages bits of genetics, ecology, neuroscience and cognitive science to advance a broadly evolutionary narrative. But unlike Darwin’s version, Harari’s points towards the incipient apotheosis of our species; hence, the book’s title.

This invariably means that events are treated as symptoms if not omens of the shape of things to come. Harari’s central thesis is that whereas in the past we cowered in the face of impersonal natural forces beyond our control, nowadays our biggest enemy is the one that faces us in the mirror, which may or may not be able within our control. Thus, the sort of deity into which we are evolving is one whose superhuman powers may well result in self-destruction. Harari’s attitude towards this prospect is one of slightly awestruck bemusement.

Here Harari equivocates where his predecessors dared to distinguish. Writing with the bracing clarity afforded by the Existentialist horizons of the Cold War, cybernetics founder Norbert Wiener declared that humanity’s survival depends on knowing whether what we don’t know is actually trying to hurt us. If so, then any apparent advance in knowledge will always be illusory. As for Harari, he does not seem to see humanity in some never-ending diabolical chess match against an implacable foe, as in The Seventh Seal. Instead he takes refuge in the so-called law of unintended consequences. So while the shape of our ignorance does indeed shift as our knowledge advances, it does so in ways that keep Harari at a comfortable distance from passing judgement on our long term prognosis.

Continue reading “Steve Fuller's Review of Homo Deus: A Brief History of Tomorrow by Yuval Noah Harari” »

Transhumanists will know that the science fiction author Zoltan Istvan has unilaterally leveraged the movement into a political party contesting the 2016 US presidential election. To be sure, many transhumanists have contested Istvan’s own legitimacy, but there is no denying that he has generated enormous publicity for many key transhumanist ideas. Interestingly, his lead idea is that the state should do everything possible to uphold people’s right to live forever. Of course, he means to live forever in a healthy state, fit of mind and body. Istvan cleverly couches this policy as simply an extension of what voters already expect from medical research and welfare provision. And while he may be correct, the policy is fraught with hazards – especially if, as many transhumanists believe, we are on the verge of revealing the secrets to biological immortality.

In June, Istvan and I debated this matter at Brain Bar Budapest. Let me say, for the record, that I think that we are sufficiently close to this prospect that it is not too early to discuss its political and economic implications.

Two months before my encounter with Istvan, I was on a panel at the Edinburgh Science Festival with the great theorist of radical life extension Aubrey de Grey, where he declared that people who live indefinitely will seem like renovated vintage cars. Whatever else, he is suggesting that they would be frozen in time. He may actually be right about this. But is such a state desirable, given that throughout history radical change has been facilitated generational change? Specifically, two simple facts make the young open to doing things differently: The young have no memory of past practices working to anyone else’s benefit, and they have not had the time to invest in those practices to reap their benefits. Whatever good is to be found in the past is hearsay, as far as the young are concerned, which they are being asked to trust as they enter a world that they know is bound to change.

Questions have been already raised about whether tomorrow’s Methuselahs will wish to procreate at all, given the time available to them to realize dreams that in the past would have been transferred to their offspring. After all, as human life expectancy has increased 50% over the past century, the birth rate has correspondingly dropped. One can only imagine what will happen once ageing can be arrested, if not outright reversed!

Continue reading “Beware the Rise of Gerontocracy: Some Hard Lessons for Transhumanism, Not Least from Brexit” »

Human civilization has always been a virtual reality. At the onset of culture, which was propagated through the proto-media of cave painting, the talking drum, music, fetish art making, oral tradition and the like, Homo sapiens began a march into cultural virtual realities, a march that would span the entirety of the human enterprise. We don’t often think of cultures as virtual realities, but there is no more apt descriptor for our widely diverse sociological organizations and interpretations than the metaphor of the “virtual reality.” Indeed, the virtual reality metaphor encompasses the complete human project.

Virtual Reality researchers, Jim Blascovich and Jeremy Bailenson, write in their book Infinite Reality; “[Cave art] is likely the first animation technology”, where it provided an early means of what they refer to as “virtual travel”. You are in the cave, but the media in that cave, the dynamic-drawn, fire-illuminated art, represents the plains and animals outside—a completely different environment, one facing entirely the opposite direction, beyond the mouth of the cave. When surrounded by cave art, alive with movement from flickering torches, you are at once inside the cave itself whilst the media experience surrounding you encourages you to indulge in fantasy, and to mentally simulate an entirely different environment. Blascovich and Bailenson suggest that in terms of the evolution of media technology, this was the very first immersive VR. Both the room and helmet-sized VRs used in the present day are but a sophistication of this original form of media VR tech.

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I learn useful life lessons from each patient I meet. Some are positive messages, reminding me of the importance of maintaining balance between family, work, and leisure activities, but more frequently I witness examples of the remarkable resilience of the human spirit when facing the reality and risks of a major surgical procedure and a diagnosis of cancer. Rarely, patients and their family members utter remorseful or simply sad remarks when they are faced with a grim prognosis and the emotions associated with an onrushing date with mortality. These comments invariably involve an inventory of regrets in life, including, “I should have spent more time with my kids,” “I wish I had told my father (or mother, brother, sister, child, or some other person) that I loved them before they died,” and “I have spent my entire life working, I never took time for anything else.” I wince when I hear these openly expressed remonstrations, I recognize that I am hearing painful and heartfelt truths. Not a week goes by that I am not reminded that I do not one day want to look back at my life with a long list of regrets, should have dones, and what ifs.

I was blessed to meet a great teacher in the guise of a patient early in my academic career. He came to my clinic in my first year after completing a Fellowship in Surgical Oncology, my first year as an Assistant Professor of Surgery. My patient was a 69 year-old Baptist Minister from a small town in Mississippi. He was referred to me by his medical oncologist who called me and said, “I don’t think there is anything you can do for him, but he needs to hear that from you because he doesn’t believe me.” This tall, imposing man had colon cancer that had metastasized (spread) to his liver. The malignant tumor in his colon was removed the year before I met him, and he had received chemotherapy to treat several large tumors found in his liver. The chemotherapy had not worked and the tumors grew. At the point I met him, the medical oncologist told him he would live no more than 6 months, and because he was an avid fisherman when not preaching or helping others in his community , the doctor suggested that he go out and enjoy his remaining time by getting in as much fishing as possible. I learned two invaluable lessons from this patient and his family. First, never deny or dismiss hope from a patient or their family, even when from a medical perspective the situation seems hopeless and the patient is incurable. Second, quoting the minister directly, “Some doctors think of themselves as gods with a small ‘g’, but not one of you is God”.

Continue reading “The Importance of Hope” »

One of the things I love most about being a Surgical Oncologist is that I see my patients for years after I have treated them. However, my clinic days are inevitably like the opening scenes from the old Wide World of Sports television program that aired on Saturday afternoons on ABC. I remember watching this show on weekends as a child and teenager. The “thrill of victory”, with images of athletes crossing the finish line in first place, equates to those patients who receive good news during their clinic visit. I tell them I am confident I can perform an operation to remove their cancer; or I confirm that their blood tests and scans show that tumors have not recurred after surgery, chemotherapy, and other treatments; or we pass some major chronologic milestone without evidence of cancer rearing its ugly head again (many patients still believe the 5 year anniversary of being cancer-free equates with being “cured”, if only that were always true). In contrast, the “agony of defeat”, forever seared in my memory in the opening scenes of Wide World of Sports with the ski jumper falling off the end of the jump and bouncing hard off the slope, represents the distress and depression felt by patients and their family members when I deliver bad news.

I would never make it as a professional poker player because I can’t bluff when I’m holding a bad hand or keep from grinning when I have a good one. My patients can tell from my face when I walk into the clinic room what the news is going to be. When all of the blood tests and scans reveal no evidence of cancer recurrence, I walk in smiling and immediately tell all gathered in the room that everything looks great and I see no evidence of any cancer. The remainder of the visit becomes a combination of medical checkup and social enterprise. I inquire about the well-being of their children, grandchildren, parents, other friends and relatives I have met, their pets, their gardening, their recent travels, and sundry snippets of their ongoing lives. Patients frequently bring pictures of children and grandchildren, or travel photos of places they have been since their last visit with me. Often I’m asked for medical advice on conditions totally unrelated to their cancers as they get farther and farther away from that diagnosis. My patients also know about tidbits from my life. They ask about the status of soccer teams that I coached, how my son or daughter were doing in college (both graduated and onto successful careers, thank you), and whether I have progressed from owning a Ferrari lanyard to hold and display my medical badge (I’m a fan of Ferrari F1 racing) to actually owning a Ferrari automobile (I do not).

I am told by patients, family members, and members of my patient care team that I am quite solemn when I walk in a clinic room to deliver bad news. No “light-hearted” chatter or discussion of recent family events or outings occurs. The nervous, hopeful smiles on the faces of the patient and the family members in the room quickly fade as I describe what I am seeing on their blood tests and the scans I have reviewed. Friedrich Nietzsche, the pejorative poster boy of pessimism, is credited with the aphorism, “Hope is the worst of evils, for it prolongs the torments of man.” Thankfully, he was not involved in the care of patients with cancer or other chronic illnesses. A particular patient comes to mind when I remember the importance of dealing with both the highs and the lows of talking with cancer patients.

The patient in question was the wife of an Emeritus Professor of Engineering at a prestigious American university. The Professor knew a thing or two about scientific investigation, statistics, and assessments of probability. Mrs. Professor had a large, grapefruit-sized malignant vascular tumor in the center of her liver called an epithelioid hemangioendothelioma. Quite a mouthful of a name for a rare malignant tumor of the liver. Her tumor was in an unfortunate location in the center of the liver and was wrapped around two of the three veins that drain all of the blood out of the liver into a large blood vessel called the inferior vena cava. The tumor was abutting a portion of the third vein. As a hepatobiliary surgical oncologist, I know I must preserve at least one of these veins to allow blood that flows into the liver to flow back out properly. She had seen surgeons at several other hospitals in the United States and was told that the tumor was inoperable and untreatable. If she was lucky, she might live a year, these doctors told my patient and her husband. The Professor contacted me, and I examined Mrs. Professor and evaluated her prior scans, and then obtained some additional high resolution scans to better understand the appearance of her tumor. I realized that her particular tumor had a very thick fibrous capsule surrounding it. I explained to the patient and her husband that it may be possible to remove the tumor, but that it would be challenging. This lady who had been sullen, withdrawn, and tearful every time I had met with them previously suddenly looked up and said, “If there’s any chance, I’m willing to take it!” I preceded the next week to perform an operation that removed the entire left lobe and a portion of the right lobe of her liver and I was able to gently dissect the tumor capsule free from the third hepatic vein. The operation was successful and the patient recovered well over the next several weeks.

Continue reading “Good News Bad News” »

I learn useful life lessons from each patient I meet. Some are positive messages, reminding me of the importance of maintaining balance between family, work, and leisure activities, but more frequently I witness examples of the remarkable resilience of the human spirit when facing the reality and risks of a major surgical procedure and a diagnosis of cancer. Rarely, patients and their family members utter remorseful or simply sad remarks when they are faced with a grim prognosis and the emotions associated with an onrushing date with mortality. These comments invariably involve an inventory of regrets in life, including, “I should have spent more time with my kids,” “I wish I had told my father (or mother, brother, sister, child, or some other person) that I loved them before they died,” and “I have spent my entire life working, I never took time for anything else.” I wince when I hear these openly expressed remonstrations, I recognize that I am hearing painful and heartfelt truths. Not a week goes by that I am not reminded that I do not one day want to look back at my life with a long list of regrets, should have dones, and what ifs.

I was blessed to meet a great teacher in the guise of a patient early in my academic career. He came to my clinic in my first year after completing a Fellowship in Surgical Oncology, my first year as an Assistant Professor of Surgery. My patient was a 69 year-old Baptist Minister from a small town in Mississippi. He was referred to me by his medical oncologist who called me and said, “I don’t think there is anything you can do for him, but he needs to hear that from you because he doesn’t believe me.” This tall, imposing man had colon cancer that had metastasized (spread) to his liver. The malignant tumor in his colon was removed the year before I met him, and he had received chemotherapy to treat several large tumors found in his liver. The chemotherapy had not worked and the tumors grew. At the point I met him, the medical oncologist told him he would live no more than 6 months, and because he was an avid fisherman when not preaching or helping others in his community , the doctor suggested that he go out and enjoy his remaining time by getting in as much fishing as possible. I learned two invaluable lessons from this patient and his family. First, never deny or dismiss hope from a patient or their family, even when from a medical perspective the situation seems hopeless and the patient is incurable. Second, quoting the minister directly, “Some doctors think of themselves as gods with a small ‘g’, but not one of you is God”.

When I first walked into the examining room, this man was slouched on the examining table in the perfunctory blue and white, open-backed, always unflattering hospital gown. He made eye contact with me briefly, then looked down to the floor. In that momentary meeting of our eyes, I saw no sparkle, no life, no hope in his eyes. He responded to my initial questions with a monotonic and quiet voice. Several times I had to ask him to repeat an answer because his response was so muted. Mid-way through our first visit, the patient’s wife told me he had been very depressed by his diagnosis of untreatable metastatic colon cancer. She reported, despite his occasional side-long warning glances requesting her silence, that while he was eating well, he was spending most of his time sitting in a chair or laying in bed, and that the active, gregarious man with the quick wit and booming voice she had married was gone.

Continue reading “The Importance of Hope” »

As recently as 50 years ago, psychiatry lacked a scientific foundation, the medical community considered mental illness a disorder of the mind, and mental patients were literally written off as “sick in the head.” A fortunate turn in progress has yielded today’s modern imaging devices, which allow neuroscientists and psychiatrists to examine the brain of an individual suffering from a mental disorder and provide the best treatment options. In a recent interview, Columbia University Psychiatry Chair Dr. Jeffrey Lieberman stated that new research into understanding the mind is growing at an accelerated pace.

(iStock)

Lieberman noted that, just as Galileo couldn’t prove heliocentrism until he had a telescope, psychiatry lacked the technological sophistication, tools, and instruments necessary to get an understanding of the brain until the 1950s. It wasn’t until the advent of psychopharmacology and neuroimaging, he said, that researchers could look inside the so-called black box that is the brain.

“(It began with) the CAT scan, magnetic resonance imaging (MRI) systems, positron emission tomography (PET scans) and then molecular genetics. Most recently, the burgeoning discipline of neuroscience and all of the methods within, beginning with molecular biology and progressing to optogenetics, this capacity has given researchers the ability to deconstruct the brain, understand its integral components, its mechanisms of action and how they underpin mental function and behavior,” Lieberman said. “The momentum that has built is almost like Moore’s law with computer chips, (and) you see this increasing power occurring with exponential sort of growth.”

Continue reading “How Technology Changes the Way We Diagnose and Treat Mental Illness” »

Can an emotional component to artificial intelligence be a benefit?

Robots with passion! Emotional artificial intelligence! These concepts have been in books and movies lately. A recent example of this is the movie Ex Machina. Now, I’m not an AI expert, and cannot speak to the technological challenges of developing an intelligent machine, let alone an emotional one. I do however, know a bit about problem solving, and that does relate to both intelligence and emotions. It is this emotional component of problem solving that leads me to speculate on the potential implications to humanity if powerful AI’s were to have human emotions.

Why the question about emotions? In a roundabout way, it has to do with how we observe and judge intelligence. The popular way to measure intelligence in a computer is the Turing test. If it can fool a person through conversation, into thinking that the computer is a person, then it has human level intelligence. But we know that the Turing test by itself is insufficient to be a true intelligence test. Sounding human during dialog is not the primary method we use to gauge intelligence in other people or in other species. Problem solving seems to be a reliable test of intelligence either through IQ tests that involve problem solving, or through direct real world problem solving.

As an example of problem solving, we judge how intelligent a rat is by how fast it can navigate a maze to get to food. Let’s look at this in regards to the first few steps in problem solving.

Continue reading “Robotic EQ” »

What follows is my position piece for London’s FutureFest 2013, the website for which no longer exists.

Medicine is a very ancient practice. In fact, it is so ancient that it may have become obsolete. Medicine aims to restore the mind and body to their natural state relative to an individual’s stage in the life cycle. The idea has been to live as well as possible but also die well when the time came. The sense of what is ‘natural’ was tied to statistically normal ways of living in particular cultures. Past conceptions of health dictated future medical practice. In this respect, medical practitioners may have been wise but they certainly were not progressive.

However, this began to change in the mid-19th century when the great medical experimenter, Claude Bernard, began to champion the idea that medicine should be about the indefinite delaying, if not outright overcoming, of death. Bernard saw organisms as perpetual motion machines in an endless struggle to bring order to an environment that always threatens to consume them. That ‘order’ consists in sustaining the conditions needed to maintain an organism’s indefinite existence. Toward this end, Bernard enthusiastically used animals as living laboratories for testing his various hypotheses.

Historians identify Bernard’s sensibility with the advent of ‘modern medicine’, an increasingly high-tech and aspirational enterprise, dedicated to extending the full panoply of human capacities indefinitely. On this view, scientific training trumps practitioner experience, radically invasive and reconstructive procedures become the norm, and death on a physician’s watch is taken to be the ultimate failure. Humanity 2.0 takes this way of thinking to the next level, which involves the abolition of medicine itself. But what exactly would that mean – and what would replace it?

Continue reading “The Abolition of Medicine as a Goal for Humanity 2.0” »