The Doctor Will See You Now

by Cory Franklin

  If you’ve ever driven in a strange city or isolated area, you may be familiar with overdependence on technology. GPS is an invaluable tool that usually directs you reliably to your destination. But occasionally GPS will not tell you about detours and road construction or what the shortest route is. It may misidentify your destination and take you miles out of your way. So the value and reliability of GPS are enhanced by having a traditional paper map, the ability to read the map, and directions from local residents.

  Societal progress results when each new generation acquires more information and greater knowledge and then constructs new tools to solve problems. But in the process, things are lost. So while knowledge increases in our modern society, fewer people know how to bake a cake from scratch, build a campfire, or read a map. Of course those skills no longer have much use, and if you really want to bake a cake, you can always google it. But the computer also creates a loss of knowledge, and the loss has been especially dramatic in skills acquired in childhood, such as cursive writing and spelling.

  Another skill that is threatened is computational ability. Give a third grader a calculator to solve a list of math problems, and even with poor math skills, he or she will likely obtain the right answer for most problems. But the child will get some wrong, a few by a large margin. And without a math background, the child won’t realize how bad their errors are: 12 x 10 is not 1,200. This matters and eventually becomes a more serious problem than just a generation that can’t make change for a twenty-dollar purchase.

  Medicine was confronted with a similar issue of technology versus experience in the 1980s. When CT scans were introduced, the technology facilitated making diagnoses that formerly required long hospital stays, dangerous procedures, or surgery. Today physicians routinely—sometimes too routinely—order CT scans as part of their immediate diagnostic plan. This approach often results in an immediate diagnosis, albeit at a cost: new doctors fail to learn important skills, including how to take a history and examine a patient. If the CT scan does not, or cannot, provide the answer, the physicians are stymied. They are at a loss as to how to proceed.

  The story of the CT scan provides a historical lesson about technology versus experience. When the first CT scans displayed images of the brain, some doctors predicted the technology would make neurologists obsolete. Others argued the opposite—the CT scan would never match an experienced neurologist doing a detailed history and physical. Ultimately, neither prediction proved true. CT scans revolutionized medicine and made all doctors better diagnosticians. The test did not make neurologists obsolete; good neurologists who knew how to interpret the test became even more valuable. What the introduction of the CT scan demonstrated was that experience plus technology is superior to either one alone. Today the challenge to the navy presented by GPS is similar to the one that medicine faced. Today’s GPS is amazingly accurate, but guidance by the stars remains a necessary complementary technology. Capt. Timothy Tisch of the United States Merchant Marine Academy told the Telegraph, “Knowledge of celestial navigation in the GPS era provides a solid backup form of navigation in the event GPS becomes unreliable for whatever reason. It is also a good professional practice to use one navigational system to verify the accuracy of another.”

  This is a reminder that technology is invaluable for navigation, medical diagnosis, and teaching children math and verbal skills. However, and this is essential, without human experience GPS, CT scans, and tablet computers will never be sufficient to guarantee our future.

  60

  VOLKSWAGEN:

  PRIMUM NON NOCERE

  * * *

  Primum non nocere (First, do no harm)

  —A HIPPOCRATIC DICTUM

  COMPUTER SOFTWARE NOW governs virtually every aspect of our lives, from cars to kitchen appliances; the human element has been removed from most machinery we use daily. But computer software can deceive us, and this was the disturbing message from the 2015 Volkswagen scandal, where the German carmaker fitted millions of cars with software that could outsmart emission-control testing. This demonstrates the need for a code of ethics, a Hippocratic oath, for our computer engineers and the software they create.

  As part of an international campaign to market “clean” diesel vehicles, Volkswagen sold eleven million cars worldwide, nearly a half million in the United States, that were supposedly clean. They were not. The cars were equipped with “defeat devices,” software that monitored variables including speed, engine features, and steering-wheel position, thus detecting when the car was undergoing emission testing.

  During testing, the car immediately switched into a diminished power/performance mode that cut engine emissions sufficiently to pass the test. When the testing was completed, the car reverted to its normal driving mode, where pollutants far exceeded permissible levels. Once the deceptive software was developed and installed in cars, the scheme could be carried out without human involvement. By the same measure, it was virtually impossible for anyone unaware to uncover the deception (it was discovered serendipitously by professional engineers who were initially surprised by their findings).

  The fallout from the scandal cost Volkswagen hundreds of millions of dollars, but the health costs to the public are incalculable. The nitrogen oxide pollutants released from the tainted vehicles aggravate the symptoms of people with asthma, bronchitis, emphysema, or heart disease. Some people will certainly die prematurely, even if the victims can never be directly linked to Volkswagen’s subterfuge.

  This scandal should begin a vigorous debate about the values that software developers incorporate in their software, not just in the automotive industry but in every industry. At present the public has little appreciation of the importance of software ethics. (What exactly does the familiar Google motto “Don’t be evil” really mean?) Moreover, like law and medicine, the debate about software ethics appears to be a topic of discussion more in universities than in the real world.

  This must change, and that’s why what happened at Volkswagen is so important. Issues of safety, privacy, and confidentiality have to become essential professional concerns. The Volkswagen case should become a case study in every company that depends on software, as well as in the academic community.

  Ethics for software engineers—what the public expects from the profession and what the profession expects from itself—will not replace the law but can complement it. Software engineers are less likely to cut corners if they know their behavior will earn the opprobrium of colleagues and engender public suspicion. Ignorance of the importance of software ethics is surely one more step in the descent into a more mistrustful society.

  In a sense, the person who first brought the issue of software ethics to public attention was the brilliant scientist and science fiction author Isaac Asimov. In a 1942 magazine article, he developed the Three Laws of Robotics, a primitive code of behavior for robots, one applicable to today’s software as well:

  First Law: A robot may not injure a human being, or through inaction, allow a human being to come to harm.

  Second Law: A robot must obey the orders given by human beings, except where such orders would conflict with the First Law.

  Third Law: A robot must protect its own existence, as long as such protection does not conflict with the First or Second Law. (Asimov subsequently developed a Fourth Law that superseded the first three laws: A robot may not harm humanity, or, by inaction, allow humanity to come to harm. Volkswagen egregiously violated this law.)

  When it came to malevolence, Asimov was hardly naive. He understood that the world was entering a new era of man and machine, one that would reveal uncharted territory of human behavior (so brazenly demonstrated by Volkswagen).

  Asimov once said of his laws, “Whenever someone asks me if I think my Three Laws of Robotics will actually be used to govern the behavior of robots, once they become versatile and flexible enough to be able to choose among different courses of behavior, my answer is, ‘Yes, the Three Laws are the only way in which rational
human beings can deal with robots—or with anything else.’ But when I say that, I always remember (sadly) that human beings are not always rational.”

  61

  WHAT IS LIFE,

  AND WHO IS CARL WOESE?

  * * *

  An honest man, armed with all the knowledge available to us now, could only state that in some sense, the origin of life appears at the moment to be almost a miracle, so many are the conditions which would have had to have been satisfied to get it going.

  —FRANCIS CRICK

  LIFE IS HARD, as the philosophers love to remind us. Besides being hard, life is also complex, as biology students soon learn when they begin studying how living organisms are classified. So a little-known University of Illinois professor, Carl Woese, merits some recognition in that respect. A giant in the science of biology who revolutionized the field, Woese contributed a glorious chapter to the complexity of life.

  From ancient times until recently in human history, classification of life was simple: upon inspection a living thing was either an animal or a plant. Then in the seventeenth century, Anton van Leeuwenhoek invented the microscope and discovered bacteria invisible to the naked eye. This represented a fundamental problem for biology since these invisible organisms did not fall easily into either category of plant or animal.

  Even as the legendary giants of biology, Charles Darwin and Carl Linnaeus, were refining biologic classification, no one had a clue how to classify bacteria for another two hundred years after the discovery of the microscope. In the nineteenth century, the centuries-old plant/animal paradigm forever changed when microscopic organisms were given their own place on the evolutionary life tree. At that point there were plants, animals, and then bacteria.

  A new era in biology began in the twentieth century with the development of the electron microscope, an exponential development in technology. This new instrument permitted scientists to look at the cell nucleus and other subcellular structures. It became the tool by which biologists were able to refine their classifications of microorganisms.

  Enter Carl Woese, who came of age professionally at the University of Illinois at Urbana-Champaign. While doing research early in his career, he took full advantage of another of the twentieth century’s transformative events in biology—the discovery of DNA, genes, and genetic sequencing.

  As befits great scientists who cross boundaries, Woese adapted these new discoveries to his own work, and the results were groundbreaking. Woese understood that living organisms no longer had to be classified by how they looked, as had been the case for centuries. Life, especially microorganisms, could now be classified by how their cells worked. By studying molecular structures, how cells manufacture proteins, and evaluating genetic sequences, Woese identified Archaea, a completely heretofore-undiscovered form of microbial life. Few scientists can lay claim to such a momentous discovery as a new life form.

  Archaea are structurally and functionally different from common bacteria and represent a completely new branch on the evolutionary tree. They are believed to be the earliest forms of life (the word Archaea is Greek for “ancient”). Archaea were once thought to inhabit only extreme environments such as the Antarctic and suboceanic volcanoes. Now it is clear they are ubiquitous—in every climate and terrain, as well as in the human body.

  It is a historical truism that great scientific discoveries often begin as heresies and rarely go unchallenged. Woese’s description of a new life form was no exception. In the late 1970s, the scientific community did not immediately accept his published research on Archaea. It took two decades before he was vindicated and his discovery became a standard part of every biology textbook. Ironically, one of the signs of recognition he received from other biologists was his receipt of the 1992 Leeuwenhoek Medal, the top honor in microbiology. It is named after the man who, three centuries before, saw the first microbes under the microscope and whose work provided the foundation for Woese’s work.

  What is the significance of Carl Woese’s discovery of Archaea? It is impossible to know all the implications; however, without question it will affect future generations. Most of Archaea’s functions are still unknown, but they play an important, albeit poorly understood, role in the regulation of gases in the Earth’s atmosphere. In addition they afford a greater understanding of the origin of life on Earth and may provide a clue to whether life exists in outer space.

  Someday some enterprising scientist, perhaps still to be born, will employ the knowledge Carl Woese gave us to investigate that question of extraterrestrial life.

  Whatever happens, Woese’s place is certified as one of the great transitional figures in evolutionary biology. Every scientist’s work is the culmination of the work of the great scientists who came before him and a prologue to the chapters that will be written by those who follow him. So it was hardly an overstatement when one of Woese’s colleagues told the journal New Scientist that Woese has done more for biology than any biologist in history—including Charles Darwin.

  62

  THE NFL MAY BECOME EXTINCT IF WE DO NOT PAY ATTENTION TO YOUTH FOOTBALL

  * * *

  I am delighted to have you play football. I believe in rough, manly sports. But I do not believe in them if they degenerate into the sole end of any one’s existence. I don’t want you to sacrifice standing well in your studies to any over-athleticism; and I need not tell you that character counts for a great deal more than either intellect or body in winning success in life. Athletic proficiency is a mighty good servant, and like so many other good servants, a mighty bad master.

  —THEODORE ROOSEVELT IN THEODORE ROOSEVELT’S LETTERS TO HIS CHILDREN

  THE NATIONAL FOOTBALL LEAGUE (NFL) may be as popular as ever, but when NFL immortals like Troy Aikman and Bo Jackson publicly announce they would never allow their children to play football, the game clearly faces an existential threat. Not since 1905, when President Theodore Roosevelt rescued the game from its brutal, violent origins by demanding the outlaw of the dangerous strategy of players running downfield arms interlocked, the notorious “flying wedge,” has the game’s long-term future been in such peril.

  Like other sports football must confront a litany of long-standing problems, including drug use by players, owners of dubious integrity, exorbitant salaries, franchises disloyal to home cities, uncertain television ratings, criminal behavior outside the lines, recruiting abuses, and labor difficulties.

  But these problems, which come and go, are part and parcel of all professional sports. The existential threat to football, more than any other sport, is from head injuries and the concern of parents and younger players. If football is perceived to be unsafe, the pool of young players necessary to support a competitive NFL will eventually disappear.

  After decades of denial, the NFL has finally admitted a direct connection between head trauma on the field and degenerative brain disease. The past decade has seen the premature retirement of current players, several suicides by retired players, class action lawsuits against the league, and settlement funds created to compensate injured players.

  Meanwhile, youth football has witnessed an almost 10 percent drop in participation in the last eight years. Current research suggests that brain trauma in the young can stunt neurologic development and that earlier participation leads to a greater risk of long-term cognitive impairment. In addition even subconcussive blows can have a lasting negative impact. Understandably, parents across the country are increasingly uneasy about youth football.

  Acknowledging these problem, USA Football, a group that sets standards for amateur football, has developed a plan to make youth football safer called Heads Up Football. Working with doctors and coaches, the group has made modifications in the game that include smaller playing fields, fewer players, and eliminating punts and kickoffs. Because the traditional head-down, one-hand stance places linemen in a vulnerable position, players are now instructed to position themselves in a heads-up crouch. Players are also taught to tackle and block with th
eir heads up as well.

  However, as Vince Lombardi observed, football is not a contact sport but a collision sport. In spite of these changes to the game, kids will still run into each other at full speed and hit one another as hard as they can. Head trauma will be reduced but not eliminated completely; concussions will still occur. But making the sport safer may assuage some parental fears and reduce player attrition.

  As part of the process, USA Football is also promoting seven-on-seven flag football with no tackling, blocking, or full contact, so helmets are unnecessary. The focus is on promoting speed, coordination, and endurance that transfer to the next level. High school teams now regularly compete in seven-on-seven passing competitions that are essentially safe from the standpoint of head injuries.

  There is no blocking and tackling in flag football, which makes it an especially attractive alternative for young players because those are the situations most conducive to head injuries. In truth, in youth football young players learn very little about blocking and tackling, which puts them at risk of serious injury, with no substantive value in terms of experience.

  Most experts acknowledge that high school is the proper time to introduce players to full-contact tackling and blocking football. At the same time, high schools all over the country are putting greater emphasis on safer techniques and fewer full-contact practices. Along these lines, engineers are experimenting with better helmet design to protect the brain.

  When played at the highest level by great athletes, football can be a thrilling and beautiful game. Some of the country’s best athletes gravitate to the sport for that reason. (Bo Jackson, a bona fide all-star in both baseball and football, was quite possibly the best athlete of our generation.) If football does not want to lose its best athletes to other sports, it must make a concerted effort to temper the unnecessary violence at all levels, from youth leagues to the NFL.