Cells are fast and crowded places (2011)
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Look at any other system that produces aggregate emergent behavior out the behavior of smaller parts. For example, here's Conway's Game of Life implemented using... Conway's Game of Life: https://www.youtube.com/watch?v=xP5-iIeKXE8 It takes many many steps of the inner game of life to produce a single iteration of the outer simulation.
In general, with emergent behavior, it takes a lot of inner steps to produce a single meaningful step in the outer system. So it makes sense that our cells are much faster than we intuititively think of as "fast". Because our intuition about speed is itself the product an emergent system. We are that larger Game of Life there, so it looks incredibly fast to watch the inner one according to our own time scale.
Turns out collision detection is real fast in real life!
So opposed to that there would need to be some kind of ordering, signaling, queuing, synchronization, etc.
Thanks to osmosis building block things are always pretty close when they are needed, and products are always getting spread out evenly too. (And there is a transport network in each cell that helps with those that need some help spreading.)
Of course there are certain things that work based on a kind of synchronization, like the waiting for all actin fibers and the two copies of each chromosome during cell division (probably the metaphase) to be in place so they can start pulling apart the cell nucleus (anaphase), and then the daughter cells can separate. Of course this also depends on signals (cyclins). The G1 cyclin slowly accumulates, and unless it's inhibited (by eg. signals get produced when "lack of nutrients" state happens around the cell) it'll start a cascade to ultimately split the cell in two.
Similarly there are certain genes that are environmental gradient dependent, usually these work when a stem cell differentiates into something specific. And the stem cell stuff is active because some parts of the DNA is conveniently exposed, certain signaling pathways are active - so the cell reacts to the gradient. And after differentiation those things get put away, locked down, coiled up, broken down, absorbed, etc.
Okay, so how could a cell skip all those iterations? It needs to know what to do and when, that's environment dependent (locally signaled by other cells, and sometimes signals arrive from far via special stuff in the blood, eg. hormones). Something like that could be probably implemented in cells. Eg. "simply" enumerating all the functions of a cell and making every process inside it depend on outer signals, and maybe leave the simple accumulators.
And when any process is about to start the cell would need to know if it has enough resources to go through with it. This would basically need yet another signaling and computational system. Or, sure, it might just start things and ... fail to finish it in time, but then it needs to disassemble whatever is half-finished. And basically that's already what happens. All the time. And if something is "really needed" it'll be finished fast. (Because signals inhibit things that slow things down, and also maybe slow down the cleanup crew too.)
the intricate network of transcription factors operate as a security system to unlock key processes in DNA regulation in eukaryotes. security must be maintain because the system is under constant attack from other information systems (viruses)
You might want to look into the mechanics of heavy metal poisoning.
There is no type safety, and there's no type checking. Everything attempts to interact with everything it encounters. Those interactions usually fail.
So while these molecules offering themselves up "automatically" works, it only works at very short ranges and it's a stochastic range. At 1nm they meet 100k times per second. At 1cm once per 6 hours. At 3cm once per month.
So there is in fact a lot of bookkeeping, keeping things tethered where they need to be and dragging things around to be done inside the cell where everything magically happens. People in this thread aren't correct that it's not necessary to do that. You don't need to get positions exactly right, as in you don't have to get the amino acids in every ribosome, but you DO have to get them "more or less" where they need to be. If for example if the amino acid concentrations near ribosomes ever get low, that's the end of you in about 2h (there's a fungus that causes that).
The molecules really do move randomly, not magically, and it's just that they go so fast and are so numerous and collide so often that even random chance puts the right molecules in the right place many times per second. This article was a revelation when I first read it and I'm quite disappointed that this was never explained properly in my entire school life.
I'm thinking of the atari pong ball where you can ricochet the ball between the top of the court and bricks repeatedly; is there some locality in the cell which takes advantage of positioning to increase likelihood of collision?
Cells are very subdivided, and the ease with which macromolecules traverse these spaces varies greatly. There are organelles and the nucleus that require only let certain proteins in and and out and at certain rates.
There are also kinds of tar-pits that keep certain proteins around for longer.
Stress granules and vesicles also gobble-up macromolecules into these fun party bags that burst in certain contexts.
Sometimes you even have complexes of macromolecules like ribosomes whose entire job is to intercept other macromolecules so that they might interact (there is a subtle difference between enzymes/catalysis here if I understand correctly)
Sure, in the sense that the cell isn't actually a single homogeneous compartment the way it's often portrayed.
There are numerous organelles, most (all?) separated by lipid bilayer membranes. (https://en.wikipedia.org/wiki/Lipid_bilayer) There are various transporters (ie protein machines) embedded in the different membranes that move specific things from one side to the other. There are also complex transport systems that move packets of things from one organelle to another. (https://www.nature.com/scitable/topicpage/endoplasmic-reticu...)
The end result is that the contents and chemical conditions of compartments are quite different from one another. As a concrete example, this is actually one of the ways that viruses know when to "wake up" and start doing things. (https://www.uniprot.org/keywords/KW-1170)
> Some kind of repelling force on a large molecule that would keep similarly charged molecules at arms length.
It's more that proteins get "sorted" into the appropriate locations where they aren't reactive with anything except their intended targets. If they react with things they aren't supposed to then (over generalizing to an absurd degree for illustrative purposes) everything stops working, that organism dies, evolution continues, and one way or another eventually we're back at that protein only reacting with the things it's supposed to react with.
Moreover, this is just what we know, but there must be so much more we don't know. It's astounding to think just how much more might be hiding in these very complex systems.
The evolution of eukaryotes, which comprise all the plants and animals you see on David Attenborough's Life on Earth show, didn't occur until the Earth had developed an oxygen rich atmosphere.
What's amazing about eukaryotic cells is that they formed from colonies of prokaryotic cells, in a process called endosymbiosis.
There's a reason why the mitochondria in eukaryotic cells look like little bacteria like organisms. They actually were once separate prokaryotic organisms. Same for chloroplasts in plant cells.
How Two Microbes Changed History
I was pretty surprised at the amount of biology we don't know (I'm writing software to help geneticists, a recent development for me). We know a lot, but its astounding how complex these biological systems are.
It is kinda amazing we're alive.
To get an idea about what life processes are like, you need to read endocrinologists like Robert Sapolski or Robert Lustig.
A lot of processes only work because there are so many moving parts each pushing only a little of the way, so that when something is wrong it doesn't all collapse.
You can do this in a lot of fields, but you're right, Bio is one where it's very easy to do.
I'm always struck by the 'pathways' side of mol-bio. It's not easy, but many grad students can come up with experiments that will lead to discoveries of new signaling pathways inside a cell. I'm sure someone has done a census of the number of pathways in their particular cell, but for all cells? It must be a gigantic number of proteins that interact.
And I'd hedge that we're no where even close to knowing how they all interact
https://youtu.be/YyIQKBzIuBY?t=1384
He actually mentions the book that is the source for the first illustration in the article. He also often talks about the speed of molecules and how it's counter-intuitive to the commonplace idea of cell operation.
Cell biology was an inspiration for original OOP (which wasn't much like Java/C++ at all).
When reading about Covid stuff and immunity, I often think how these mechanism could be imitated in engineering. I definitely believe there are some general principles that we could benefit from without trying to "simulate" biology.
Edit: Sorry, same author/illustrator, but different book.
https://www.youtube.com/watch?v=QjJaFG63Hlo
Some of them never got fully translated to reality at Xerox because of various reasons (e.g. memory limitation of hardware at the time). This is worth a read:
http://alumni.media.mit.edu/~mt/thesis/mt-thesis-Contents.ht...
https://www.sciencemag.org/news/2019/04/meet-scientist-paint...
For instance, there's a video of simulated viral icosahedral capsid assembly, where the panels are tethered together to maintain proximity, so you get to see realistic assembly and disassembly and reassembly, temporary misfits and irreversible fails, and just a whole lot of flailing and slamming around until something clicks. It's ok for showing 10 nm scale object violence, but I've never seen anything good for 1 nm or 100 nm scale violence. And for concentration enhancement, I've only ever seen nice slides in research talks.
Given how pervasive related misconceptions are, it'd be interesting to have a page to point to where the best available misconception antigens are slowly accumulated.
An event like a "protein folding" can take milliseconds, in a tube [1]. While atomic/biophysical/biochemical simulations have time-steps of femto-seconds.
[1] https://www.youtube.com/watch?v=gFcp2Xpd29I
From https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3890418/
"Traditional MD [Molecular Dynamics (protein folding)] simulations are limited in length by timestep limits. Studies by our group and others have shown that traditional MD is limited to timesteps of about 2 fs due to high-frequency resonance frequencies.1–3 Many biologically relevant motions occur on the microsecond to millisecond range, which is 9 to 12 orders of magnitude greater than the timesteps possible with traditional MD. Further, each step requires a costly force calculation (O(N) to O(N2)). As such, simulating medium-size proteins often requires months of computer time on a large distributed cluster such as Folding@home4,5 to simulate milliseconds of dynamics, while simulating a large protein (e.g. the β-2 Adrenergic Receptor) on biologically-relevant time scales (milliseconds through hours) using a standard desktop computer would take years. Thus, it is not feasible to simulate timescales of biological interest without substantial advances in MD methods."
12 orders of magnitude of difference in time is akin to the difference between causal events happening once per millisecond and those happening once per century. How do you show a movie capturing the nuance of someone's blink reflex, along with their birth life and death...
Indeed, teaching of scale pervasively fails. Physical, temporal, and other. But it's also taught very very badly. Thus it seems an open question how well it might be taught, and to whom.
Might we teach it better? This[1] (mine) illustrates one speculative approach to teaching size down to atoms, for a young and outreach audience. And here's[2] an old attempt at helping develop a feel for torque, down to picoNewton-nanometers. Many years back I started on a temporal zoomer - don't know if it would have worked, but I've not seen anything similar since. I recall some work on teaching deep time in intro geology as being rather nice.
Interactives with physically realistic molecular motion are vanishingly rare, and I've never seen a one with temporal zoom. So I suggest we're not even trying yet to explore whether we can teach this well.
Those last two "Inner Life ..." videos are regrettably even more misleading than the original. Motion in the original was aphysical, but at least it was simple. Those two retain that aphysicality, and add aphysical jiggle, further obscuring how badly you're being misled.
Creating educational content to support an excellent understanding of science is ghastly hard. So much so, that I suggest we're not even really trying yet. Which would mean how hard it will be to teach, once such content exists, is necessarily an open question. I wish I knew of folks exploring it.
[1] first section of http://www.clarifyscience.info/part/Atoms (page loads slowly - was meeting prep, not intended to be public) [2] http://www.clarifyscience.info/part/ZoomB?v=A&p=CK6Ji&m=torq...
I personally think having even a modest intuition for how to map physical knowledge to its appropriate 'scale' (time/space, from plank to universe) is one of the most straightforward ways to be "smart". And a great way to get to know the limits of our knowledge.
I still haven't seen a video that matches my intuition. Which is unfortunate. I want to build a version of your scaler there, but for VR that you can slide up and down along at least time/scale axes - and maybe additional ones too.
> for VR
An unfinished lockdown project was a RL version of that hands-apart-to-zoom cartoon, with an atomic-bonding interactive, with realistic electron density, as content. Educational XR might eventually be so much fun.
> maybe additional ones too
Maybe Ashby diagrams in XR?! Someday.
I'd love an "measure explorer" - a densely fleshed out space of order-of-magnitude overviews. Length; velocity; accel; jerk; length/dollar; length/dollar^2; length/mass; etc, etc.
Years ago I prototyped an interactive where oom diagrams were tied with other content. So as you slide mass, you get different animals, and as metabolic rate scales with animal mass, you get heart beat. Life expectancy, etc. Heart to Hz, keyboard, and sound ripples spreading in space. Or explore equations: select ideal hand crank for torque, with a meter arm, a bacteria for mass, and a second later, hey, relativistic E. coli. :)
I've found the bottleneck on creating such to be finding usable media. Hopefully google will eventually do semantic scene indexing of youtube videos, and of images. If anti-trust doesn't break them. And sci-hub still exists. Finding "a bit of video with an X doing Y" is still prohibitively hard. And licensed for reuse? Perhaps structure the effort to survive being sued for aggressive use of Fair Use, or some country's similar exception, because copyright is a nightmare.
Bionumbers is a fun site: "membrane potential" https://bionumbers.hms.harvard.edu/search.aspx?trm=membrane+...
[1] https://bionumbers.hms.harvard.edu/bionumber.aspx?id=106433&... [2] https://bionumbers.hms.harvard.edu/bionumber.aspx?id=110762&...
The process is inefficient in that it takes a long time for it to get to a workable solution, but the solutions are usually incredibly efficient.
One way I like to think of evolution is how long it takes to get from one state to another. So it took hundreds of millions of years for the first "life" to evolve-- perhaps close to a billion. This includes RNA, DNA, ATP, etc. Then it took about a billion-ish years to go from prokaryotic to eukaryotic life. Then about another billion-ish years to get multicellular eukaryotic life. Then it only took about a quarter billion years to have dinosaurs. It only took about 10-20 million years to go from the ancestors of all apes to having chimps, gorillas, and people. (!!!) And when you have people directing evolution, like with dogs or crops, you can make things happen very "quickly".
As if what applies to us individuals, with our thoughts and actions, also applies to these subsystems of a cell, in a different form.
What could be their motivation to build humans, to assemble brains that can reflect, eyes that can see, senses built to enable interaction with this world?
Where do these instructions come from?
These things don't want anything. It's just the way things work.
If you manage to form an organism that survives better than other organisms, there will be more of you (and your cells). There is no "want" and "like" in evolution, just "works" and "replication".
depends how optimistic/pessimistic you are. I find it far more likely that humans will eventually hit some local maximum in a trough too deep to ever escape.
Yet I may be no more than a replicating machine whose purpose it is to build these new machines which may likely replace us one day, maybe keep us in a zoo, or as pets, if we get lucky.
I can't imagine what motivates these molecules to behave, to group the way they do; why the existing energies get channeled to make them move that way, since there is no need for the energy to do anything at all.
Something motivates me, and I see no reason why there isn't motivation in these molecules; what they do is already complex enough to be considered as something which may have a special purpose.
We do have consciousness. There is this something in me which sees and tastes, which experiences life. It's hard to believe that this is something material. To me it feels as if complex enough structures of molecules allow something to plug into this universe, to absorb its information and to feed something into it, like instructions which allow this "me" to interact with it.
The same could well be applicable to bacteria or to the most rudimentary lifeforms. Because a bacteria forms part of my body doesn't mean that it can't have its own consciousness; the same may be valid for all this stuff that (maybe) "lives" inside my cells. Lucky me, that I get to stand on its shoulders in order to perceive this universe the way I can and interact with it.
"Works" and "replication" isn't wrong, but removing the "wants" and "likes" from this equation doesn't feel right.
You might want and like things; perhaps (perhaps) cells and bacteria might want and like things, but evolution certainly does not.
So which instantiations/states of the electromagnetic field experience feelings and desires? Are they held in the energy potential or in the energy transfer, or both? Is it enough to have a sufficiently complex feedback loop simulating/predicting itself?
The answer is likely to be both sort of simple but also profound. Eventually we'll have an a-ha moment studying electrocardiographs or FMRI or individual neural networks and be able to replicate experience in other electromagnetic substrates, and knowing precisely what we are, in a sense, will be pretty neat.
Then what will we really know about experience? Is it truly in the electromagnetic field or does it exist in the mathematical relationships that determine the evolution of the fields? That might be a question we never definitely answer from an outside perspective, but is endlessly fascinating to me.
> So which instantiations/states of the electromagnetic field experience feelings and desires?
Personally this is why I think that perhaps qualia is not an emergent phenomenon after all, and must come from outside the system. I.e. I suspect that philosophical zombies are possible
Will we? How can we ever verify that our intervention produces this or that sort of qualia?
(For the record, I'm a fan of theories like IIT [0] that aim to answer questions in the neighborhood of these -- but we should be sober about what is even, in principle, knowable to us. We can verify that intervention X gives behavior Y, but I don't see how we could ever verify that intervention X gives qualitative experience Z (intervening on ourselves aside, which in any case will only tell us about our sort of conscious experience).)
[0]: https://en.wikipedia.org/wiki/Integrated_information_theory
Think back 4 billion years to some of the first lifeforms on earth, colonies of slime mould clinging to a rock in the ocean.
The first behaviour of these organisms was to respond to the movement of the sun overhead. They'd orient themselves to regulate their exposure to the sun's rays, arranging themselves in a horizontal plane on top of the rock when the sun was overhead, and vertically along the side of the rock when the sun was at an angle.
The first "desire" was the want of energy. The first behaviour was to move towards the sun.
The first communication was the signal that was passed through the colony of cells to coordinate the movement of the whole community into a mutually beneficial configuration.
The first conflict was when the colony became large enough and so diversely distributed that a part of the community "decided" it would rather not obey the signal to move and instead would move to its own preferred surface of the rock.
As these organisms get more complex and develop more and more differentiated cells, mechanisms also evolve to prohibit cells from “regressing” to undifferentiated forms, and to tightly control aspects of cell growth. Unlike unicellular organisms, a functioning multicellular organism needs to have all its cells coordinate in order to survive. Human cells for instance contain a regulation mechanism which detects abnormal behaviour and directs the cell to commit suicide (a key protein in this mechanism, p53, is widely studied in cancer research).
So no, your cells don’t get their own “will”. They do what they are genetically fated to do. Those that don’t either die, or wind up as a cancer that chokes the life out of their host.
Sometimes we have to reset our natural intuitions and I'm glad that professor did her job in making me more accurately imagine the interior of the cell.
That would be some hell of IPCs.
If you think we live in the Matrix then all fundamental questions of existence can be asked about the "outer" world instead. It can't be turtles all the way down.
I remember reading (think it was Neil Tyson) that at some point in the future, if the universe continues at its current rate of expansion, we (earth) might arrive at a future state where we cannot detect the cosmic b/g radiation and other markers which confirm certain physical characteristics of the universe. I wonder if the future humans will accept that the humans who came before them really observed this phenomenon and that they can rely on that data :)
https://evolutionspace.wordpress.com/2007/04/17/then-call-it...
Since you've identified what you don't understand, evolution, there is some hope.
Try a basic programming exercise: evolutionary growing 2d or 3d "walkers" on a simulation on a PC, or alternatively running core wars.
It's enlightening to see order, logic and machines arise from total randomness.
I am really glad to see this piece. I've spent more than 19 years getting myself healthier while the world spit in my face and called me crazy. I did so by focusing on trying to understand my genetic disorder at the cellular level.
Most genetic disorder involve a miscoded protein. Your DNA serves as the blue prints for a complex factory called a "cell" and when there is a bug in the code of your DNA, the 3D printer mechanisms translating those instructions into physical reality create something broken.
That something broken is typically a bit of protein that normally gets folded up and used as a tool within the cell. When it is miscoded, it can't do it's job. It's sometimes kind of like a cog missing a tooth.
As the cell gets more chemically deranged from the tools misfiring, you see more misfolded proteins. If either salinity or pH balance are off, those proteins are more likely to misfold.
I think this accounts for what gets called "The normal progression of CF." It's a positive feedback loop -- aka a vicious cycle.
More broken proteins leads to worse chemical derangement and worse chemical derangement leads to more broken proteins and we are off and running on a highway to hell.
In cystic fibrosis, the protein that gets miscoded is known as the CFTR -- the cystic fibrosis transmembrane conductance regulator. It serves as a channel in the cell membrane.
You can think of it like a traffic light managing traffic into and out of the cell of certain proteins or an air lock and only certain proteins with the right ID card get to use it.
It causes the body to misprocess salt (NACL -- sodium chloride) and also sodium bicarbonate -- aka baking soda. I think the misprocessing of sodium bicarbonate is a large factor in why people with CF are so prone to being very acid.
I initially thought this my big discovery. It turns out everyone who knows anything about CF knows it causes excess acidity, including patients and doctors. They just don't bother to do a damn thing about it and act like it isn't clinically significant information.
"You are people are dying. We know you are too acid. Meh. Can't be related. Moving on."
Even though if you get ketoacidosis they promptly hospitalize you because you can be dead within three days.
Ketoacidosis is typically rooted in diabetes and people with CF are at high risk of developing a special form of diabetes known as Cystic Fibrosis Related Diabetes (CFRD). But lets not confuse any poor doctors and scientists with the facts. The slow boiling of the tissues of people with CF in acid couldn't possibly be anything like this extremely deadly condition for which they promptly hospitalize you. No. Let's just ignore the acidification of people dying of CF. Can't possibly be clinically significant.
The salt wasting we do has significant implications because as the salt gets sweated out at high rates, it drags other electrolytes with it. Reading up on Altitude Sickness was hugely helpful to my understanding of what was going on with my body and finally gave me a direct connection between the respiratory problems and the gut issues that both occur in CF.
When you are altitude and can't get enough oxygen, you begin peeing more. You do this because the body cannot breath out all of the wastes accumulating in your blood and your body starts shunting those wastes through the kidneys as a backup system.
So your blood chemistry directly connects what is going on in your lungs to what is going on in your gut. These are not "separate and unrelated systems that never interact." It is not "mere coincidence" that people with CF have both gut and respiratory issues.
Of course, a more fundamental issue is that CF significantly impacts all epithelial tissues and all mucus membranes and your lungs and gut both fall in both categories. (Your skin is also epithelial tissue, but not a mucus membrane.)
Anyway, glad to see cell biology getting some attention. This helps explain a lot about what I have accomplished and I am sort of glad I didn't get the memo earlier. Thinking of the cell in relatively simple terms was helpful to me, if only to make me feel less intimidated by the process of trying to get well while the entire world treated me abusively for not liking what was happening to my body and not wanting to quietly and meekly go along with their plans to gruesomely murder me so doctors and scientists could feel like they are smart and know things and former homemakers are clearly all "dumb blondes" or some shit.
Yes, I have baggage. No, I'm not apologizing. The world could have been less awful to me. It chose not to be.
Given this sort of knowledge and understanding, what do you do about your CF then? Is there a way to prevent your body from being so acidic, or to mitigate the effects of it?
I eat very carefully with an eye towards food chemistry. If you have no idea I have CF and I do this, you wouldn't notice that I eat any differently from anyone else.
For example, pizza is a staple part of my diet. But I mostly get takeout pizza from Little Caesar's.
They are the only national franchise that makes their dough fresh in house daily. Everyone else ships it in from elsewhere in frozen form.
They also use corn meal to help make it not stick. This was something I did when I used to make homemade pizza with a pizza stone.
The corn meal is more alkaline than wheat. Most wheat only crusts leave me too acid, but Little Caesar's pizza doesn't because of the addition of a small amount of corn meal to the crust.
I also avoid certain oils. It is well established that people with CF misprocess oils and I got very interested in the chemistry of oils.
They come in three forms: long chain triglycerides, short chain triglycerides and medium chain triglycerides. Medium chain triglycerides also get called MCT oil and it has long been established that MCT oil is medically beneficial for CF and certain other conditions.
This is the basis for why coconut oil is popular in some circles: it is high in MCTs. MCT oil has long been prescribed by doctors to people with CF and coconut oil has an even longer history of being medically prescribed for various gut issues, including stomach cancer (though I can no longer find the link supporting that statement, sadly).
I not only favor MCT oils, including butter which is a good source of such, I actively avoid long chain triglycerides because my body fails to break them down and it wreaks havoc and makes me really sick. So I avoid peanut oil, canola oil and some other things.
I am a butter fiend and I tolerate animal fats well, such as bacon (though bacon is high in something that is hard on the lungs and I had to be careful with it when my lungs were in worse shape).
So I pay a lot of attention to food chemistry and I do eat what other people see as "junk food" but one brand of potato chips is perfectly fine because they cook with oils I tolerate well and another makes me dog sick because they use different oils. If you don't know that, you see me eating pizza and potato chips and don't think I'm some kind of super extreme "health food nut" though I am.
I also am very careful about what I touch. Skin is epithelial tissue and people with CF are prone to aquagenic wrinkling -- aka we get extremely pruney in bath water. This is so extreme that they are now using it a cheap initial screening in rural clinics in India.
I've actually already written about the skin stuff so let me give a link rather than repeat myself on too little sleep and yadda:
https://atypicalcysticfibrosis.blogspot.com/2020/01/skin-and...
That even has a link to the PDF about the test they are developing (or have developed) in India for rural clinics.
I spent a long time taking $300/month worth of supplements. I now manage my condition with diet and lifestyle and I am mostly well, having resolved that backlog of malnourishment, chemical derangement, accumulated infections, etc etc. I'm trying to figure out how to solve my financial problems because I remain dirt poor and it sucks and I hates it.
I wanted to be an urban planner and now I am trying to figure out how to provide low cost services to small communities and I have fantasies the world will support my Patreon so I can pay my bills while doing a lot of stuff mostly "for free" for small communities so we can reverse this trend out in the world of everyone going to big cities and mostly hating it because that's where the jobs are and small communities shriveling up and dying. I think it is part of why our world is so dysfunctional.
I promise you will not regret joining.
Years of homelessness atrophied my social skills. I feel like I don't thank my Patrons enough. It's made a huge difference in my life.
I saw this far to closely and personally for a little over two years. I went to a very dark place for some time but ultimately decided that the healthiest attitude for me to take was that doctors are simply overwhelmed with information and overpowered with the risk of career ending litigation. I pray that I never have to go down that road again, but if I do there's going to be an extremely frank conversation up front and the doctors will have a choice if they want to ride shotgun or not.
Historically, doctors in a small community were some of the best educated people there and they knew people pretty well simply because it was small. They also took their little black bag and went to see you where you lived, which gave them enormous amounts of information about your life without saying one word and this informed their assessment of what exactly was wrong and needed to be fixed.
Then modern tech came along and now we go to see them because their office or the hospital is where the big fancy tools are for running diagnostics, as if what ails you is entirely about your body and your body is separate from your life. And they are little more than fancy technicians. They've lost that role of "village wise man" and we fail to see how valuable that was, how critical it was to the practice of good medicine.
I don't know how to fix it, but doctors don't do what they used to do and then we wonder why some things go so very wrong in a world with more "miracles of modern medicine" than ever before.
The diagnostics are amazing. Getting the right diagnosis was a big, huge deal. But then the treatment and attitudes were a huge disappointment and when I began getting healthier, my physician expressed zero interest in how and why that was. He just scheduled me fewer appointments because other patients needed him more than I did.
So when I moved, I didn't bother to find a new doctor. It seemed pointless. And then the internet decided I was some extremist anti-doctor nutcase when in reality it was doctors who basically wanted nothing to do with me.
Honestly I think there are some parallels with what we're seeing in law enforcement as well. In a drive to reduce costs and risks both roles have pulled back from that deep social contact into something just focused on execution (no pun intended ;) and it turns out the relationship that has been lost was incredibly important.