Tuesday, February 26, 2008

The power of social networking: medicine with meaning

Shredding a paper tiger

Carl Sagan once noted that pursuing the truth no matter where it took you is far more enriching and fulfilling than believing in fantasies and made up realities. No matter how harsh, if you acknowledge your limitations- your humanity- nothing trumps the search for truth.


This is a premise for many who chase down and expose false and deceptive lines of reasoning in human society in an unending search for those gems that shine true. This is why complementary and alternative medicine (CAM) sometimes sticks out like a sore thumb. It pretends to dress itself in a robe of legitimacy and reality claiming actual therapeutic abilities for many of the maladies of society. Yet most of its most basic tenets disintegrate like sand between your fingers if you stop to examine them closely.


Because CAM is so replete with falsehoods peeling away at the facade is an important exercise because it sheds light on what not to do as a client or doctor. In this way much of CAM can be seen for what it is; a non-falsifiable belief system. The doctors’ stethoscope gets replaced with a sorcerer’s wand, and the lab coat with a priests robe.


Critical thinking can also help clarify many problems and pitfalls of the relationship and bond between modern medicine and society. Though there are plenty of issues on the table here, a crucial point to remember is something Carl Sagan alluded to. We need to acknowledge our humanity as it is. In other words, no matter how close to the truth we might get, we are necessarily driven to live with some form of "human" meaning (i.e.; awe, spirituality, inspiration).


But what is it that breathes life and meaning into our everyday lives? This core question has been an insufferable bane to philosophers and the opium of the masses for innumerable religions. It’s likely it has no one real answer.

We have made tremendous inroads -in spite of our limitations- towards a better understanding of reality. At the same time though, certain human qualities such as esthetics, art, and “value” still belong to a hazy area within the spectrum of human society. Somewhere in this realm CAM has created its own meaning with powers it doesn’t have as it stakes claim to things it doesn’t own – namely human “bonds”.


Human qualities (i.e.; fear, anger, happiness, love) form an integral part of the human condition and who we are. Though they may be as hard to pin down as an electron orbit, they contribute to how humanity relates to the world as well as how one individual relates to another. What has all this discussion got to do with social networking?


The importance of interconnections

Richard Dawkins in “An Ancestors Tale” noted that -to some degree- evolution rhymes, patterns repeat themselves. From the gene to the cell and beyond, there is a thread of constant interplay occurring that allows for differing levels of connection. This can be observed throughout the interdependent ecological scheme of life on this planet.


Zoologically speaking, one of its most elaborate versions seems to come in the form of multicellular animals. Here the tightness of interaction (along with the need for a nervous system) seems to have produced a unique form of interconnection. This is a pattern that can be loosely followed from cells that make up organisms to organisms that make up larger groups, herds, to even human societies.


It seems that this repeating phenomenon of networking gives rise to many of the emergent qualities resulting from interconnectedness in humans. For example, phenomena such as consciousness, art and “morality” may be some of the hard to quantify byproducts of networking that are tied to clearer evolutionary mechanisms (i.e.; kin selection, altruism). That these qualities are hard to pin down doesn’t make them less important- especially when we try to understand what it is to be “human”.


The implications for gaining insight into the fuzzy realm of human interactions can have huge payoffs in medicine. For instance, much of what may be attributed to the placebo actually has to do with some of the spin off effects of social networking. This person to person interaction can have a significant influence on the quality of the human experience in medical interactions which can -in turn- positively impact health.


Much of the force and claimed power of CAM actually stems from these networking effects and not at all from the CAM method itself. If doctors better understand how these interactions occur and who they affect, perhaps many CAM modalities would atrophy and be thrown into histories trash bin- at least as medical therapies.


The always interesting Edge web site has a video of Dr Nicholas Christakis Professor of Medical Sociology at Harvard and Attending Physician at Mt. Auburn Hospital in Cambridge, Mass., discussing the remarkable properties of social networks, how they obey certain deep biological-like rules and the amazing capacity they have to spread many qualities including altruism, happiness, and even loneliness. These qualities seem to propagate in a way similar to “biological contagions” yet they are social aspects of human interactions.


This research takes the potential for social networks in medicine to new levels. According to his web site This work takes seriously the contention that because people are inter-connected, their health is inter-connected. This work explores two aspects of social networks: the process by which they form ("connection") and the way they operate to influence behavior ("contagion"). Related work examines the health benefits of marriage and the consequences of spousal illness and widowhood. Other ongoing investigations consider the effects of neighborhoods on people's health, the biodemographic determinants of longevity, and the genetic bases for human behaviors. His past work has examined the accuracy and role of prognosis in medicine and ways of improving end-of-life care.


Unlike the false magical claims of CAMs “humanity”, this research is based on solid research and science. If these properties are better understood, they could expand our ability to positively impact social networks. We inherently know that illness can indirectly impact others in addition to the ill individual -but we don’t know all the details and potentially miss out on an opportunity to effectively help a broader circle of affected people.


For example, Christakis evaluated how the illness of a spouse affected the healthy partner in the marriage and found that it is possible to identify individuals at greater risk for emotional stress and diseases of their own (mental health and substance abuse). This could allow for specific interventions depending on the circumstance that relieves the caregiver and minimizes the propagation of the negative social effects of what was originally a real organic medical disease in somebody else. This might seem like common sense, but studying its effects brings home the importance that medicine take social networks very seriously.


Part of what we understand as a “good bedside manner” has roots in being aware of these issues. By expanding our body of knowledge, it may be possible to formalize clear and effective approaches to the client/doctor relationship and teach aspiring students solid techniques that seam the “human condition” more intimately into the tapestry of medical practice. That way, these important social interactions would be less prone to false hopes and empty promises common in CAM while softening some of the “sharp edges” of modern medicine.


Christakis describes his research as follows “it is critical when you think of networks to think about their dynamics. A lot of times, people fail to understand networks because they focus on the statistics. They think about topology; they think about the architecture of the network. They think about how people are connected, which is of course incredibly important and not easy to understand either. While on the one hand the topology can be understood or seen as fixed or existing, on the other hand this topology is itself mutable and changing and intriguing, and the origin of this topology and its change is itself a difficult thing.


But here is something else: Once you have recognized that there is a topology, the next thing you must understand is that there can be a contagion as well — a kind of process of flow through the network. Things move through it, and this has a different set of scientific underpinnings altogether. Understanding how things flow through the network is a different challenge from understanding how networks form or evolve. It is the difference between the formation and the operation of the network, or the difference between its structure and its function. Or, if you see the network as a kind of super-organism, it is the difference between the anatomy and the physiology of the super-organism, of the network. You need to understand both. And they both interconnect and affect each other, just as in our bodies our anatomy and our physiology are interrelated.”


The implications of his work are somewhat reminiscent of the social “meme” concept that Dawkins originated and Blackmore is trying to legitimize. Whether these particular ideas reflect reality remains to be seen. The social networking scheme of Dr Christakis work though does appear promising. The potential benefits to understanding how social systems network and function in medicine can positively impact health on a broader more human scale (without CAM help). This is a good thing.


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