The Most Durable Human Species Ever

The Most Durable Human Species Ever

In recent years our DNA sequencing techniques and abilities have become dramatically better. We are able to get DNA from ancient sources in a way that we previously had not been able to, and we are then able to sequence that DNA more accurately are carefully than ever before. What this has started to reveal is a greater diversity of ancient human species, a greater spread of various human species, and more diversity and intermixing of human species than we had previously thought. A lot of this research is cutting edge and evolving daily, but for the last decade this research has been shifting how we view ancient humans, which in turn shifts the way we view ourselves.
In Sapiens, published in 2011, Yuval Noah Harari writes, “the more eastern regions of Asia were populated by Homo erectus, ‘Upright Man’, who survived there for close to 2 million years, making it the most durable human species ever.” It is somewhat strange to think that one species of human existed for 2 million years, or close to that figure, and eventually was outcompeted by a different species of human. Homo sapiens, our modern human species, eventually outcompeted all the other species of humans, including those which existed for hundreds of thousands to millions of years before our species evolved and began to spread.
Since Harari’s book was published we have learned more about species he briefly mentions such as Homo denisova and how widely those species managed to spread across the Earth. Additionally, research during the COVID-19 Pandemic suggested that some individuals may have genetic mutations stemming from the genome of Homo neanderthalensis, which changed their immune response to the disease. To me, research on ancient humans through DNA is a powerful and humbling reminder that my life and experiences are not unique just to me and this moment. It reminds me that human evolution has been a long and complicated process, with many Homo Sapiens and other human species that could think, talk, and experience the world in similar ways coming before me. Harari also stresses that Homo Sapiens may not be the final version of humans to evolve and dominate the planet, or last the longest on the planet. He continues, “this record [the estimated 2 million years that Homo erectus survived] is unlikely to be broken even by our own species. It is doubtful whether Homo sapiens will still be around a thousand years from now, so 2 million years is really out of our league.”
Mary Roach on Reincarnation in India

Mary Roach on Reincarnation in India

In the book Spook, Mary Roach writes, “People don’t seem to approach life with the same terrified, risk-aversive tenacity that we do. I’m beginning to understand why, religious doctrine aside, the concept of reincarnation might be so popular here. Rural India seems like a place where life is taken away too easily – accidents, childhood diseases, poverty, murder. If you’ll be back for another go, why get too worked up about the leaving?” Roach is joking of course, but this quote comes at the end of a lengthy description of dangers and risks that she experienced in India that we would find appalling in the United States. Her travels to India brought her face to face with cyclists moving through heavy traffic and breathing diesel smog. She was afraid of large trucks overflowing with potatoes and cauliflower that threatened to spill over onto the vehicle she was riding in. And she was also afraid for the lives of more than one woman riding precariously on the back of a fast moving Vespa.
While the quote is funny, it does get at some interesting ways of thinking about life, death, and how we go about our days. I’m not sure how much of our differences in risk tolerance in the United States versus India comes down to beliefs in reincarnation, but I can see how ideas of reincarnation would be comforting in a dangerous society. I don’t know if reincarnation would be enough to create a moral hazard scenario where people were intentionally negligent about safety because they expected to come back in another life, but I’m sure there is some impact that could be studied.
The quote from Roach also seems to suggest that Americans value our lives differently than individuals in India. She highlights how risk averse Americans tend to be, referring to how much we go out of our way to ensure everything we interact with is safe, and how we try to limit risk in everything from roller coasters to strollers. I think that what is likely going on is a difference in culture that stretches back years and is fraught with technological limitations and differences in population density. I am currently listening to an audiobook with an author who interviewed friends from her childhood in rural Ohio in the 1960’s and 70’s. Her dad was a doctor, and she notes how many individuals, including children, died in accidents involving farming equipment. Today we have adopted technology within everything we do, allowing us to make the world safer. Risk stands out more than in the 1960’s and 70’s when we didn’t have the technology to make everything as safe as we can now. Perhaps the difference that Roach noted, that she jokingly attributed to belief in reincarnation, is simply due to limitations in technology and a need to earn money.
Flown By Technology - Mary Roach - Packing for Mars

Flown By Technology

In Packing for Mars, Mary Roach wrote the following about the Mercury Capsules that took America’s first astronauts to space, “the astronaut doesn’t fly the capsule; the capsule flies the astronaut.” Roach explained that this was evident from two test flights that took chimps to space and returned them to Earth. If a monkey could fly to space, then we could question whether the astronauts were really necessary, a slight tarnish on the otherwise impressive feat of being the first Americans in space. The question raised during the Mercury Capsules is still with us, and as technology in all areas of life automates, it is more common than ever. Do we need to drive our cars, or can our cars drive us? Do we need to go grocery shopping, or can the fridge order food for us? Do we need to work, or can machines work for us?
In our lives we all like control. We may not be piloting space ships, but still like to feel as though we are in control of the machines and destinies of our lives. We don’t generally like to believe our destiny is a pre-set course, and we don’t want to feel as though our machines are in control of us. Some of us may be fully ready for the world of self-driving cars, autonomous kitchen gadgets, and artificial intelligences that can end the world of work as we know it, but for many of us, each step toward automation is terrifying. Many of us fear what we lose, what control goes away, when we hand over more of our lives to machines and computers.
I think that for many of us, these fears are a little late. Our retirement savings may already be dependent on algorithms that direct computers to trade stocks at super high speed. We already depend on sanitary systems that are incredibly complex and virtually impossible for any single person to comprehend. Sometimes a single human error or ship run aground in a canal can disrupt global systems driven by humans, machines, and algorithms. The reality is that we really don’t have the control we always like to believe that we have. We are not flying the ships of our own lives to the extent we like to believe, quite often the machines, systems, and institutions on which we depend are really flying our lives. Fully automated or not, there isn’t actually that much that we have direct control over.
As we move forward into an uncertain and confusing world, many of us will have an impulse to push back against technology, innovation, and automation. We won’t want to accept that we are as dependent on machines, algorithms, and artificial intelligence as we are and increasingly will be. We will hold back progress and development, but we will only temporarily delay the inevitability. Humans won’t be needed for many things, and while that will be scary, it may open new doors for human potential that we can’t imagine now. We should recognize that humans have never truly had control over their own lives and destinies. We have always in one way or another been flown by forces bigger than ourselves.
Technological Uncertainty & Fear

Technological Uncertainty & Fear

New technologies scare people. When a new technology comes along, we react to the uncertainties of what the technology will mean. We predict worst case scenarios, fear that some sort of physiological change that we cannot control may take place, and we worry that the new technology could destroy some part of social life. We can look back at many of these technological changes and laugh at the worries and concerns of people at the time, but the truth is that we see this occur over and over in response to technological change and we are guilty, or capable of being guilty, of the same fear.
Technological fear is tied to uncertainty. Thinking about putting computer chips directly into our brains to interface directly with the internet or some type of computer hardware and software is a good example of such a fear today. What will happen if our brains can be hacked? What will happen to media, information, and social connections if we all have chips in our brain. Will we still be human (whatever that means) if we merge our brains with silicon chips?
I am currently reading about the industrial revolution in the 1800’s and early 1900’s and while people were not afraid of computer chips in their brains, they were afraid of new technology and what it would do to people and society. In a previous book I read, Packing for Mars, Mary Roach explains that this same fear and uncertainty took place when people thought about space travel and zero gravity. Space travel required immense speeds and we didn’t know if the body and mind could handle such speeds. On top of that, no one knew what would happen in zero gravity to the human body. Would normal body functions still work without Earth’s gravitational pull?
Regarding our technological uncertainty and fear, specifically with ever increasing transportation speeds, Roach writes, “over the course of history, the same sort of anxiety has appeared every time a newer, faster form of transport has come along.” Scientists feared that trains would be too fast for people, that airplanes would be too foreign from any experience the body was evolved to handle, and that all kinds of other technologies and forms of transport would zoom and shake the body into jelly. When we are uncertain about a new technology fear can take over, and we worry about a range of impacts that could occur. Humans have been doing this since at least the industrial revolution, and with robots, computer chip implants, and other changes on the horizon, we are not likely to stop any time soon.
Humans to Rocket Scientists

Humans to Rocket Scientists

Mary Roach opens her book Packing for Mars with the following:
“To the rocket scientists, you are a problem. You are the most irritating piece of machinery he or she will ever have to deal with. You and your fluctuating metabolism, your puny memory, your frame that comes in a million different configurations. You are unpredictable. You’re inconstant. You take weeks to fix.”
Packing for Mars is all about the science of space that doesn’t get talked about. The news covers rocket launches, successful missions, journey’s to asteroids, and space vehicles on other planets or beyond the solar system entirely. Popular culture celebrates astronauts, sometimes asks about the food they eat, but rarely addresses the end products of that food. Roach dives into the particulars, asking the difficult and sometimes gross questions that someone has had to ask in order for human beings to become a spacefaring civilization. As the quote above shows, the most difficult aspect of this journey into space, at least for the engineers, has been figuring out how the challenges of navigating space when you take people along for the journey.
Humans, and living creatures in general, are amazing. We are incredibly adaptable to almost any situation we find ourselves within. Space is no different. We can live in a tiny hunk of metal floating without the effects of gravity thanks to our incredible adaptability skills. However, that adaptation and the effects of our environment on our living bodies has created incredible challenges for engineers who need to keep people (and mice and plants) alive. Throughout the book Roach shows not just how adaptable humans are, but how challenging it is to keep a living being alive in a reasonable way in space, and all the miraculous, and sometimes gross, innovations that have been developed along the way.
We Bet on Technology

We Bet On Technology

I am currently reading Steven Pinker’s book Enlightenment Now and he makes a good case for being optimistic about human progress. In an age when it is popular to write about human failures, whether it is wealthy but unhappy athletes wrecking their cars, the perilous state of democracy, or impending climate doom, the responsible message always see ms to be warning about how bad things are. But Pinker argues that things are not that bad and that they are getting better. Pinker’s writing directly contradicts some earlier reading that I have done, including the writing of Gerd Gigerenzer who argues that we unwisely bet on technology to save us when we should be focused on improving statistical thinking and living with risk rather than hoping for a savior technology.
In Risk Savvy, Gigerenzer writes about the importance of statistical thinking and how we need it in order to successfully navigate an increasingly complex world. He argues that betting on technology will in some ways be a waste of money, and while I think he is correct in many ways, I think that some parts of his message are wrong. He argues that instead of betting on technology, we need to develop improved statistical understandings of risk to help us better adapt to our world and make smarter decisions with how we use and prioritize resources and attention. He writes, “In the twenty-first century Western world, we can expect to live longer than ever, meaning that cancer will become more prevalent as well. We deal with cancer like we deal with other crises: We bet on technology. … As we have seen … early detection of cancer is also of very limited benefit: It saves none or few lives while harming many.”
Gigerenzer is correct to state that to this point broad cancer screening has been of questionable use. We identify a lot of cancers that people would likely live with and that are unlikely to cause serious metastatic or life threatening disease. Treating cancers that won’t become problematic during the natural course of an individual’s life causes a lot of pain and suffering for no discernable benefit, but does this mean we shouldn’t bet on technology? I would argue that it does not, and that we can see the current mistakes we make with cancer screening and early detection as lessons to help us get to a better technological cancer detection and treatment landscape. Much of our resources directed toward cancer may be misplaced right now, but wise people like Gigerenzer can help the technology be redirected to where it can be the most beneficial. We can learn from poor decisions around treatment and diagnosis, call out the actors who profit from misinformation, uncertainty, and fear, and build a new regime that harnesses technological progress in the most efficient and effective ways. As Pinker would argue, we bet on technology because it offers real promises of an improved world. It won’t be an immediate success, and it will have red herrings and loose ends, but incrementalism is a good way to move forward, even if it is slow and feels like it is inadequate to meet the challenges we really face.
Ultimately, we should bet on technology and pursue progress to eliminate more suffering, improve knowledge and understanding, and better diagnose, treat, and understand cancer. Arguing that we haven’t done a good job so far, and that current technology and uses of technology haven’t had the life saving impact we wish they had is not a reason to abandon the pursuit. Improving our statistical thinking is critical, but betting on technology and improving statistical thinking go hand in hand and need to be developed together without prioritizing one over the other.

Medical Progress

What does medical progress look like? To many, medical progress looks like new machines, artificial intelligence to read your medical reports and x-rays, or new pharmaceutical medications to solve all your ailments with a simple pill. However, much of medical progress might be improved communication, better management and operating procedures, and better understandings of statistics and risk. In the book Risk Savvy, Gerd Gigerenzer suggests that there is a huge opportunity for improving physician understanding of risk, improved communication around statistics, and better processes related to risk that would help spur real medical progress.

 

He writes, “Medical progress has become associated with better technologies, not with better doctors who understand these technologies.” Gigerenzer argues that there is currently an “unbelievable failure of medical schools to provide efficient training in risk literacy.” Much of the focus of medical schools and physician education is on memorizing facts about specific disease states, treatments, and how a healthy body should look. What is not focused on, in Gigerenzer’s 2014 argument, is how physicians understand the statistical results from empirical studies, how physicians interpret risk given a specific biological marker, and how physicians can communicate risk to patients in a way that adequately inform their healthcare decisions.

 

Our health is complex. We all have different genes, different family histories, different exposures to environmental hazards, and different lifestyles. These factors interact in many complex ways, and our health is often a downstream consequence of many fixed factors (like genetics) and many social determinants of health (like whether we have a safe park that we can walk, or whether we grew up in a house infested with mold). Understanding how all these factors interact and shape our current health is not easy.

 

Adding new technology to the mix can help us improve our treatments, our diagnoses, and our lifestyle or environment. However, simply layering new technology onto existing complexity is not enough to really improve our health. Medical progress requires better ways to use and understand the technology that we introduce, otherwise we are adding layers to the existing complexity. If physicians cannot understand, cannot communicate, and cannot help people make reasonable decisions based on technology and the data that feeds into it, then we won’t see the medical progress we all hope for. It is important that physicians be able to understand the complexity, the risk, and the statistics involved so that patients can learn how to actually improve their behaviors and lifestyles and so that societies can address social determinants of health to better everyone’s lives.
Healthcare Stagnation

Healthcare Stagnation

We are facing a disastrous healthcare stagnation in the United States. Our hospitals are getting older, Medical providers are aging with too few young providers to replace them, and the quality of care that many of us experience is not getting much better. Despite this, the cost of healthcare has been soaring. Healthcare expenditures, including the costs of our deductibles, co-pays, and what our insurance pays out, has been going up at a rate reliably above inflation.

 

In The Opioid Crisis Wake-Up Call, Dave Chase writes the following about our healthcare stagnation, “Unlike virtually every other item in our economy, where the value proposition improves every year, the norm in health care for decades has been to pay more and get less. Also, unlike nearly every other industry, healthcare hasn’t had a productivity gain in 20 years.”

 

Productivity is how much we produce per unit of time spent on production. A factory that makes 5,000 widgets per hour is more productive than a factory that makes 1,000 widgets per hour. Automation and new technologies have helped factories and offices become more productive, but our healthcare stagnation is evidence that we are not seeing the same gains in healthcare. Technology has improved, but not in areas that seem to produce more healthy patients given the same amount of time and effort from our medical providers. We have some new technologies, but somehow those technologies have not translated into a healthcare system that supports the same number of people with fewer resources.

 

Chase continues, “In other words, for the last two decades, there has been a redistribution tax from the working and middle class and highly efficient industries to the least productive industry in America.” 

 

As your job has become more efficient and more productive, your healthcare costs have risen. Chase equates this healthcare stagnation price increase to a tax. Factories that can work with fewer employees, software engineers, and other employees form highly productive sectors are paying more in healthcare for services that haven’t kept the same pace as the industries of the patients they treat. This is the cost of healthcare stagnation that chase wants to push back against by demanding better systems and structures from healthcare providers, insurance companies, and benefits brokers. Chase believes we can find a way to improve our healthcare system and help people live healthier lives for less cost, if employers are willing to make real investments in their employees healthcare, and are willing to hold their brokers and insurance providers accountable for the value their products provide.
Medical Technologies

The Problem with Healthcare Technology

In my last post I wrote about hidden costs of the healthcare system in America. I wrote about tax breaks for employers who offer health benefits, and I wrote about third party insurance preventing the healthcare system from working like a pure market. This post introduces one consequence of the hidden costs of our system and the ways in which our system fails to act like a market: the high cost of medical technologies.

 

In The Opioid Crisis Wake-Up Call, Dave Chase writes, “We ended up focusing on a certain type of high-technology, acute medical care – which we financially reward far more than lower-level preventive and chronic care – without regard for the quality of the outcomes or value of the care.”

 

When I took a healthcare policy and administration class along with a healthcare economics class for my graduate studies, I was surprised to see a critique of advancing medical technologies as part of the problem of American healthcare costs. I live in Reno, under the sphere of influence of the Bay Area, where technological solutions to global problems are hailed as the cure-all, deus ex machina that we need for a peaceful and prosperous world. I always thought that better medical technology saved lives, made us healthier, and ultimately reduced cost by being more efficient and precise than older technologies.

 

As it turns out, new medical technologies are incredibly expensive, and often times the benefits that patients receive are only marginally better than what existing technology offers. In some instances those marginal improvements make the difference between life and death, but in many instances, the new technologies might only add a few months of life to a terminal diagnosis, a few additional months lived in pain and fear. In other instances, the new technologies might add a little more comfort or certainty in a patient’s procedure or diagnosis, but it is fair to question whether its really necessary and worth the additional cost.

 

The quote from Chase reveals that when we are shielded from the costs of care, and when we remove market aspects from the healthcare system, we adopte a mindset that healthcare equals expensive interventions with high cost technology. I had clearly bought into this narrative prior to my graduate studies. The alternative that Chase highlights in his book, which we have underdeveloped in the United States, is to move upstream, and take care of people at a preventative level before they are sick and before they need expensive technological interventions. Developing systems, structures, and norms for healthy lifestyles will do more to reduce costs than the development of new magical cures and technological fixes. Our priorities and the focus of our system is flawed, and a as a result we focus on high cost interventions within a system no one is happy with. Rather than develop a system that actually supports healthy living, we have fished around for quick, high-cost technological solutions to our health woes.
Technology & Pain

Questioning Our Confidence in Technological Solutions

Sam Quinones interviewed Alex Cahan, a pain medicine specialist in New York, for his book Dreamland. He is quoted in the book talking about the approach that most people have toward pain and alleviating their pain. Many people want an immediate solution that comes from technology and allows them to continue living their life as they always have.

 

Quinones writes, “Cahana saw stuff [Author Note: unproven medical treatments, more surgeries, more pills, etc…] as the problem. Our reverence for technology blinded us to more holistic solutions.” The holistic approach is not one of mystic arts or managing ones energy, but is an approach focused on how we live and what health habits we have. Smoking, minimal exercise, and living with stress that we can’t regulate are all parts of our life that can make the physical pain that we experience much worse, or can lead to worsening health and pain developing from other real medical conditions. An approach to pain medicine that doesn’t consider our actual lifestyle cannot help address the root of our pain.

 

Quinones continues with a quote from Cahana, “We got to the moon, invented the internet. We can do anything. It’s inconceivable to think there are problems that don’t have a technological solution. To go from I can do anything to I deserve everything is very quick.” 

 

Cahan’s argument is that our technological innovations and the stories we tell about our scientific progress blinds us from the reality of the human body. We are not machines, we are not our own technological innovations, even if we like to believe that we can all be Iron Man. The reality is that we have to think about how we live, about the things we do, and about what could be changed, adapted, or included in our lives to help us be more healthy and experience less pain. We don’t have to believe in a mystical energy around our bodies. We don’t have to turn to medical treatments that are not proven to be safe or effective. But we do have to think about what is important in our lives, what values we hold, and how we can make changes that help us align with  those values in a healthy and reasonable way. Once we have seen where we can make changes in our actual lives and what habits can help us improve our health and reduce our pain, it is up to us to live accordingly, not up to technology to instantly solve our problems.