Hooking-Up, Physical Forces, Optimism and Dark Energy: Imagery, Hope, and Health. Kim Solez, M.D. Banff New Media Institute Presentation, "Smart, Sexy, Healthy" Think Tank, Sept 7, 2001 Smart: What makes us smart? Howard Gardner (1) has described eight different types of intelligence: linguistic intelligence, logical-mathematical intelligence, musical intelligence, spatial intelligence, bodily-kinesthetic intelligence, interpersonal intelligence, intrapersonal intelligence, and naturalistic intelligence. Daniel Goleman (2) added emotional intelligence. We have postulated a tenth form of intelligence: digital intelligence (3) - particularly useful in the computer age. Think of smart cards - metallicized plastic containing all the key data about us in digital form. There are now more than 1 billion smart cards in use worldwide (4). In North America computer networks are so fast and inexpensive that even the smallest purchase is now electronically verified by the card-issuing bank, so smart cards have not caught on (5). The Internet: How smart does the Internet make us? There are about 500 million people on the Internet (6). Does this seem like a large number? It is only one third of the number which had been predicted in 1995 (7) and only 8% of the current world population of 6.2 billion (8). So if the Internet does make us smart, only a small fraction of the world's population is actually benefiting. Today in North America there is tremendous overcapacity in Internet connectivity. In the past two years overly optimistic dot.com companies have laid 100 million miles of presently unused long-haul fiber optic lines for Internet projects which never materialized (9). This glut of high bandwidth connection lines will likely eventually be used. A century ago a similar glut existed in unused railroad capacity, and then telegraph, and telephone. In technology supply precedes demand. Surprisingly, the predicted cell-phone-based wireless “next phase” of Internet connectivity appears not to be catching on. Instead the wireless standard that is seeing increasing use as a way of connecting laptops in airports and Starbucks coffee houses etc. is the 802.11b protocol used in Apple's flying saucer-like “AirPort” which is 15 times faster connecting via radio waves (10)! Ultimately infrared light will surpass radio waves as a means of local wireless connection. Holograms, long a 3D novelty on the fringes that never lived up to its sci fi image, are finally coming of age as the best way to provide local room-based connectivity via infrared light (11). Sexy: A new survey published July 26th of this year finds that "hanging out" and "hooking-up" have replaced traditional dating (12). Forty percent of surveyed college women said they had had hook-ups. Global human connectedness. Since the time when human beings could first communicate and make eye contact there has always been this need to connect, to express mutual attraction. So "hooking-up" - once a mundane term used to refer to wiring activities of one sort or another - now refers to the most basic and essential of human interactions. Healthy: Coequal with the physician's responsibility to cure and prevent illness is the responsibility to provide hope and comfort. Statistics may be viewed differently by the patient and physician. A patient with a 5% chance of survival would like to hang onto the hope represented by that 1 in 20 chance. An essential part of the art of medicine, providing hope and comfort requires global human connectedness, imagery, insight, and optimism. There may be an optimism deficit in medicine, and in human society in general, which it is the physician's duty to combat. These issues in medicine are so important, and yet so seemingly abstract, that there is a need to consider them first in areas far removed from medicine, and then come back again. Physical Forces: The concept of mutual attraction between bodies is one of the basic elements in physics. Gravity is the most common example of this attractive force. Einstein had originally postulated an opposite repelling force and evidence in favor of this "negative gravity" or "dark energy" has recently been found (13). There is an analogy between these two physical forces and the forces of optimism, hope, and comfort on the one hand and pessimism, despair, and mean-spiritedness on the other. Mean-spiritedness is probably a constant but almost never perceived as such. Perception of mean-spiritedness is influenced by connectedness in two ways: Friendship and global human connectedness are likely to convince one that mean-spiritedness is decreasing, that the world is becoming a better place. Impersonal connectedness without warmth - a man sitting alone watching the television news for hours - is likely to convince one that the world is an increasingly crowded place with intense competition for resources and power, and that even those parts of the world once thought idyllic are filled with unkind people and have a multitude of insoluble problems, and that mean-spiritedness is very much on the rise. In writing about mean-spiritedness as it relates to the Internet and health, the "truth" is somewhat individual, changeable with time, and seemingly regional. Increasing mean-spiritedness is "newsworthy" (increases ratings) and is fashionable to discuss, whereas decreasing mean-spiritedness is not. Nevertheless, in setting out to discuss health impact of the postulated burgeoning mean-spiritedness in society, we talked to a number of people who felt that the trend was in the other direction - toward kindness, compassion, sharing, and openness. In the end this negative/positive tension itself became worth writing about. Is this perception of mean-spiritedness individual? Perhaps it is expected that a Frenchman celebrating his birthday with his girlfriend or a cancer survivor viewing great mountain scenery would see human interactions as positive, but we also encountered "just ordinary folks" who shared these views. Is perception of mean-spiritedness regional? We have encountered strong belief in the goodness of human beings in the wide-open spaces of Edmonton and Banff, Canada, where no cockroaches survive the winter and the region benefits from the high price of oil. On the other hand we encountered strong belief in the increasing mean-spiritedness of human beings in crowded Philadelphia and New York, where the rapidly reproducing cockroaches are in their 340 millionth year (14,15) and high energy prices are a major problem. There is strong evidence for regional differences in the medical consequences of mean-spiritedness: Inappropriate and futile treatments carried out because of fear of litigation, antibiotic resistance due to treatment of viral illness as bacterial at the insistence of patients or relatives, patients in painful no-win medical situations being kept alive by technology against their will - these are all more common in regions where there is perceived to be increasing mean-spiritedness. Is mean-spiritedness ever adaptive? US businessmen visiting the "kinder, gentler" nation of Canada have sometimes expressed the fear that if they stayed here for a time they would lose the competitive "edge" necessary for survival where they came from. The 1997 movie "The Edge" starring Anthony Hopkins ironically set in the Canadian North (16) paints a picture of the struggle for survival in a hard, cold, beautiful but desolate world filled with jealousy, mistrust, blood, and homicidal men and bears. But even in that world you did not have to be mean to survive, just resolute and constantly thinking. There is a contrasting view of the world. The 2000 book "It's Getting Better All the Time: 100 Greatest Trends of the Last 100 Years" by Stephen Moore and Julian L. Simon (17) points out that we're eating far better food and spending far less money for it than a century ago. More of our neighbors are becoming millionaires. Human beings just keep getting stronger and stronger-as witnessed by the constant shattering of athletic records. And on and on, the book details the positive trends of the past that the authors believe will lead to a glorious future. No reason for mean-spiritedness there! Anger and mean-spiritedness as entertainment can be found in the increasingly popular hip-hop rap music of Eminem, Dr. Dre, and Xzibit,. This cannot be taken too simplistically as evidence of a general societal trend. First, these artists have considerable diversity in their work, some of which has subtlety, poignancy, and insight. The first quote from a rap artist has just appeared in the medical literature (18) ("In these streets, you're only as good as your last transaction." - Xzibit "Restless - Your Walk On" Loud Records, 2000). Second, young people of Generation X and Y (can you imagine Z?) enjoy the release of rap music partly because it puts them in touch with the feelings of people whose lives are more desperate and "on the edge" than their own. So they listen to the music for pleasure, not to live the words. Similarly Napster has come about not because young people are all mean-spirited thieves who do not respect intellectual property, but because technology has made peer to peer computing possible and the drive to share music is very strong. Napster is the first example of diversified peer to peer computing that will eventually become mainstream in society evolving in parallel an economic system to fairly compensate artists. The Internet itself has been said to contribute to feelings of isolation and mean-spiritedness. The widely quoted 1998 study by Kraut et al. (19) involved giving computers and Internet connection to people who would not have spontaneously chosen them at a time when most of their peers were not using the Internet. Today the Internet has become mainstream so that a person who spends time on line is more likely to be in contact with family and colleagues, not less. Email discussion groups for patients and their families are highly important adjuncts to the healthcare system (20). Ultimately real life exists in three dimensions. Computer generated 3D art will one day play an important role in medical imaging and education. One of the best examples of use of 3D graphics today is the WWW site of the artist Frogdot (21). There is a fascinating series of images containing red rope (22) which the artist does not explain but solicits theories on. Although none of the other 53 theories advanced on the WWW site involve the Internet, it is obvious to us that the Red Rope is a very effective combined symbol of the Internet and the great interconnectedness of human beings. Images show it traversing the world through steaming deserts, across the frozen Artic, undersea passing over the open hatch of the sunken Kursk and interacting with humans in a variety of situations finally culminating in the latest image in which it is seen to be stabilizing a giant boulder balanced over the artist's house on sticks (23)! The Red Rope is as varied as real life but ultimately comes off as a positive optimistic connecting force. Not a mean-spirited rope! Perhaps ultimately there is no universal truth about mean-spiritedness, only a universal hope that it will decline and be replaced by positive human qualities. So in the end this is a "good news" story, and that probably means it will never make it to CNN or the New York Times. But that's O.K. because if there are kernels of universal truth here we can rely on the great interconnectedness of human beings/RedRope/Internet to get the word out! And what are the implications for Medicine? We have been using 3D art on the cyberMedicine WWW site to stimulate thinking about technology and the near future of medicine. Increasingly, 3D imaging will be used in medical specialties, for instance, telesurgery, to increase the accuracy of tumor resections. In time, the notion of optimism, as conveyed in imagery such as 3D red rope, will come to embody the cyberMedicine message of inter-relatedness -- one global medical community with many new medical teams of doctors and patients. This trend ensures that empathy and hope are on the ascent. References: 1. Gardner H, Frames of Mind: The Theory of Multiple Intelligences (Basic Books, 1983) http://www.education-world.com/a_curr/curr054.shtml 2. Goleman D: Emotional Intelligence : Why It Can Matter More Than IQ for Character, Health and Lifelong Achievement 352 pages (October 1995) Bantam Books 3. Solez K and Katz SM: Digital Intelligence (submitted, August, 2001) 4. http://www.smartcardcentral.com/ 5. Hansell S: Credit card chips with little to do. New York Times, Section: National Desk, August 12, 2001. http://www.nytimes.com/2001/08/12/business/12CARD.html 6. http://www.nua.ie/surveys/how_many_online/ 7. http://www.anamorph.com/docs/stats/stats.html 8. http://www.census.gov/cgi-bin/ipc/popclockw 9. Akst D: In technology, supply precedes demand, On the Contrary, New York Times ; Sept. 2, 2001 http://www.nytimes.com/2001/09/02/business/02CONT.html 10. Grossman WM: Wireless Wonder: A dark-horse standard could win the broadband race. Scientific American August 2001 p. 14 http://www.sciam.com/2001/0801issue/0801scicit4.html 11. Gallagher DH: Beaming Data Holds Promise, With Limits, for Networking New York Times - What's Next August 23, 2001 http://www.nytimes.com/2001/08/23/technology/23NEXT.html 12. http://www.cnn.com/2001/US/07/26/sex.survey/index.html 13. http://www.nytimes.com/2001/04/03/science/03STAR.html 14. The Compleat Cockroach : A Comprehensive Guide to the Most Despised (And Least Understood) Creature on Earth by David George Gordon http://www.amazon.com/exec/obidos/ASIN/0898158532/ref=sim_books/107-4954010-8020535 15. The Cockroach Papers : A Compendium of History and Lore by Richard Schweid http://www.amazon.com/exec/obidos/ASIN/1568581378/ocratchinesepage/103-3066887-9281420 16. The Edge, a movie directed by Lee Tamahori, Twentieth Century Fox Pictures, 1997. http://www.foxmovies.com/theedge/origin.html 17. It's Getting Better All the Time: 100 Greatest Trends of the Last 100 Years, by Stephen Moore and Julian L. Simon. Cato Institute. 2000. 294 pages. 18. AJ Matas and K Solez, From first principles - Tubulitis in protocol biopsies and learning from history, American Journal of Transplantation 1:4-5, 2001. http://www.blackwell-synergy.com/Journals/toc.asp?issueid=5255 19. Kraut R, Patterson M, Lundmark V, Kiesler S, Mukopadhyay T, Scherlis W. Internet paradox. A social technology that reduces social involvement and psychological well-being? Am Psychol 1998 Sep;53(9):1017-31. Human Computer Interaction Institute, Carnegie Mellon University, Pittsburgh, PA 15217, USA. robert.kraut@cmu.edu http://www.apa.org/journals/amp.html 20. Johnson KB, Ravert RD, Everton A. Hopkins Teen Central: Assessment of an Internet-based support system for children with cystic fibrosis. Pediatrics 2001 Feb;107(2):E24 http://www.pediatrics.org/cgi/content/full/107/2/e24 21. http://phazedance.critical-depth.net/ 22. http://www.froggod.f2s.com/ 23. http://www.3dcommune.com/3d/galview.mv?Bryce+oYfHa84VI+0988998085
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