Immanent Domain

My SciFi Reality in Search of a Narrative Form

This appeals to my inner 12 year old boy: both mouse and human DNA are used in the most effective treatment for my arthritis. Remicade, a medication I will resume being treated with in four days, is an antibody that binds to Tumor Necrosis Factor Alpha (TNF-α). 

The active part of the antibody comes from mice, but they put human DNA in other parts of it to keep the human immune system from going apeshit about murine DNA. It is a “chimeric monoclonal antibody.” (You may be familiar with chimeric DNA from “CSI” or “House, M.D.”) 

Remicade is the only thing that has really worked for my condition, and has fewer side effects (at least in the extreme doses I'd need) than pharmaceuticals or herbs. But this “biologic” treatment interests me because I think it disrupts the narratives many of us carry around in our heads about medication. 

In a future post I’ll be musing about the chimeric DNA in Remicade. We have just tons of narratives, most of them scary, about that. (Frankenstein, or the Modern Prometheus, for instance, is a black hole that pulls all kinds of things like this into its gravity well and across an event horizon where thought--among other things--is crushed.) 

One thing that interests me about Remicade is that its aim is so specific: it inhibits a single precursor of the inflammatory process. This makes it different in kind from most herbal or pharmaceutical approaches. The way I think of it is that Remicade fixes a few pebbles before there is an avalanche, while most other anti-inflammatories try to stop, or at least moderate, an avalanche in process. 

And make no mistake, for me it is an avalanche. If my condition were completely untreated, I’d have trouble moving at all, including moving my ribs and my jaw. I’d be open to less expensive and intensive treatments if they were half as effective. (For instance, I’m keeping my eye on studies about anti-inflamatory agents that hookworms secrete.) 

That’s plenty for one post. My main point: biologics strike me as different in kind from most pharmaceuticals and herbal treatments, and I don’t think we yet have good narratives for being treated with a designer antibody instead of a chemical or a plant. Lots of knee-jerk, off-the-shelf narratives developed in different times; plenty of things to reinforce existing beliefs. But nothing, that for my experience, helps me explore new beliefs for a new kind of thing, a biologic treatment.

The Public Abattoir

"Handing one's work to society is just like driving living animals into a slaughterhouse. The work no longer belongs to me: it has become the property of all the people who have touched it. It is now concrete and filthy."

--Contemporary Chinese Artist Xu Bing

Accountable Or Only Accounting?

My new litmus test for medical advice is this: who gets sued if the advice is wrong? This is another way of asking "Who is accountable?" Is a person or company confident enough about their claims that they'll face dire consequences if those claims are false? Is the wording on the bottle such that the claims are strong and clear enough to invite a lawsuit if they turn out to be unfounded? Will that person dispensing sage advice in the supplement aisle be willing to put it in writing and sign it?

Could they lose their license? Could they be barred from making future claims about their service or product? Could they lose their livelihood altogether? If they are making claims about healing, should the consequences for making mistakes or unsubstantiated claims be any less dire?

If an unlicensed practitioner or alternative supplement company is wrong, do they only lose a little business, or could they lose considerably more? If they only might lose my business, but not lose their business altogether, that's not accountability: it's only accounting.

We are an over-litigious society, especially with doctors. But at least they can be sued for malpractice. Likewise with big pharma: they make obscene profits, the FDA may let through some drugs it shouldn't, and patents on new medicines last too long. But at least pharmaceutical companies don't pretend that they are not businesses. At least if their products cause harm, they are sued (sometimes successfully) for a fair chunk of change.

With medical issues, I know what's on the line for me: my health and well-being. So when a person or company makes a claim about healing, I'm inclined to ask myself: "what's on the line for them?" If it's their reputation, that's not enough. To be harsh, when it comes to health advice, reputation is only about a local market and word of mouth: in other words, recommendations and sales.

Much alternative medicine resembles the laissez-faire approach of the 19th century health market. Especially in that there are often no lasting or punitive consequences if the advice is wrong, or the product is ineffective or even harmful. It's strictly a matter of letting the buyer beware. I'll beware alright; I have the most at stake and the most to lose.

The Hurt Spigot

Tumbling down the chasm between ending one insurance plan and waiting for my new insurance information to be official, I've had the opportunity to experience just how quickly my body can change. Though unwelcome, it's been instructive.

A few weeks ago I had a corticosteroid shot that made me feel almost normal. I hadn't realized just how much background pain I'd been carrying around until it was gone. But unlike Remicade, the highly effective medicine I will soon be on again, the effects of the steroid shot wore off quickly and dramatically. As if someone had suddenly reopened what I'm calling "the hurt spigot."

The first time I went off Remicade, it was as if I were a frog and pain was the slowly raising water temperature. It took months. This time I went from dancing to crippled in a matter of a couple of days: like some arthritic version of "Flowers for Algernon," only with my body slipping away instead of my mind. Not almost crippled or as if I was crippled. Nope, just plain crippled. Especially when I first woke up, it would be all I could do to cross the room, even with a cane. It was as if someone had taken the happy jumping frog and tossed him straight into the fire.

One of the discouraging things about my form of psoriatic arthritis is that it attacks the tendons as well as the joints. So things like yoga that I'd usually do to promote flexibility, relaxation, and range of motion were of limited effect. When you have an injury, there is a discrete trauma, followed by a period in which you need to stretch the muscles and tendons to retain your range of motion, rebuild strength, and so on. Only in this case, it was as if my tendons were being injured continuously. And to add insult, injured by my own body.

Yesterday I had another steroid shot to turn back the hurt spigot, but I find myself rethinking some ideas about pain. Like many of my non-medical peers, I tend to think about health in metaphors that go back to Galen: balance, harmony, the intake of foods and other substances, the excretion of by-products, homeostasis, and in some cases, homeopathy. I think one reason these notions have had so much longevity is because they fit well with how we experience our own bodies. They give one a sense of control: "I can change how I'm doing by changing what I ingest." Similarly, yoga or t'ai chi are about nothing if not about a deep sense of balance, literally and figuratively.

None of these notions and practices had any traction against the hurt spigot. In the past I've often fallen back on descriptions of the body that I know are not literally true, but that I find are very helpful on the level of practice and visualization. Ancient Daoists, for instance, believed that air flowed down the spine to be distributed throughout the body. Thinking of breathing this way helps me breathe more deeply.

But the hurt spigot has me thinking about tropes that might be more physically accurate and culturally recent. Could I learn to feel those just as deeply? I've been thinking a lot lately about non-linear dynamics and self-organizing properties. (In recent writing in the US, this was often referred to as "chaos theory," though some of my favorite French philosophers were thinking about it fifty years ago--thanks to some of the key early texts being in French.) 

My nerves are part of an electro-chemical system composed of simple parts that give rise to complex behaviors. So surely there's some medical research out there (that even I could follow) relating these facts to positive feedback loops, turbulence, and other things that disrupt smooth functioning. That would be step one: find the medical research. Step two would be to think about metaphorical descriptions of this research that make sense on a intuitive, experiential level. Step three would be to look for practices, some of which might be very old practices, that fit well with this new research and metaphors derived from that research. 

I hope someone has already done or is doing this kind of cultural work: translating research into metaphors and those into practices. Very soon Remicade should completely close the hurt spigot, but I don't want to simply forget the experience of it at nearly full blast. Instead, I want to learn from it, to use the experience as an opportunity to rethink some of my guiding assumptions.

No Boasting Goliath

Tinkerbell is dead. Despite all the clapping, things went off script and she crashed against the Bulldog's backboard as they went down by two points.

Either team deserved the win, but I'm impatient with the ubiquitous David vs Goliath metaphor. A team from a school that graduates 97% of its athletes is no Goliath. A team where so few players duck out for NBA careers is no Goliath. A team where the coach has such complimentary things to say about his opponents and their college and genuinely means it is a rarity.

Duke plays smart because it has to. Coach K is a brilliant tactician because he has to be. Duke gets good talent, but many of the very best players choose less demanding schools. But the one thing I consistently feel good about when Duke wins is that I know those players have futures apart from basketball. Their best years aren't behind them the minute they get that championship ring.

NCAA players make ungodly sums of money for their schools without seeing a dime for themselves. Very few of those players go on to the NBA. If you're rooting for a team without bothering to find out things like their graduate rate, you're hardly a populist. The real underdogs in the NCAA are players who bring money into their schools, and then are cut loose without a degree, or a degree in name only. One of the reasons I would have felt good about a Butler win is that the school graduates most of their athletes, something Coach K praised.

So maybe it was David vs David. What's discouraging is that two programs like these are rarities. If caring what happens to your players after the tournament is elitist,then I'm happy for Duke and Butler to be called elitist. But the only braying Philistines out there are fans who see players as unpaid entertainment, who want Tinkerbell to live, but only till the final buzzer. Then it's out of sight, out of mind: she's alone in a deafening silence.

Pain as Intensive Difference

Soon I will be teaching a segment on thermodynamics, differences between hot and cold, high and low pressure. They occur on a gradient, and they generate motion, as in a steam engine. They have emergent properties like turbulence and thunderstorms. There are not clearcut, easily quantifiable differences, but sudden phase transitions between states, like water turning into ice or steam. Intensive differences are a matter of thresholds and tipping points: of changes that can be described, but not always predicted from causes in a linear way.

As I've been on a threshold myself of sorts when it comes to health insurance (starting a new plan, but waiting for my id number so I can get preauthorization for treatment), I've had the chance to reflect on whether some kinds of pain might be described in these intensive terms. 

Not all pain. Some pain is quite linear: you stub your toe and your toe hurts. But my experience the past week has been more akin to thresholds and tipping points: challenged, then crippled, with no real transition between them. Muscles that are tight, then solid, like parts of them have been replaced with rocks or railroad spikes. 

Yet if this sort of pain and inflammation is akin to turbulence (a neuronal storm if you will) then perhaps its treatment is as well. Remicade, which targets tumor-necrosis-factor-alpha, may inhibit inflammation in a similarly emergent way: stopping the cascade of reactions that eventually cause an avalanche by preventing the initial pebbles from moving.

I remember just where I was standing when ...

So I'm walking across the room when my partner Liz, who is at her computer, gives one of those time-has-stopped gasps. The following possibilities run through my head:

• The president has been shot
• There has been a terrorist attack
• There is an asteroid headed toward Earth

Then she says, with complete glee "our ipads have shipped!"

God I love that woman.

Syllabi & Design

I've been trying to rethink my syllabi this term by focusing on their design (which, understandably enough, has clarified their content).

So for my Junior and Senior level Art History class (which will cover complicated, interrelated issues each session), I tried to come up with a design that uses visual hierarchy to organize complicated information. I also tried to break the units and weeks up into clear visual chunks.

Download ArtH 330 Spr 10 Syllabus 1

This term I'm trying something new with my syllabus for my composition and youth culture class. Instead of packing it with a detailed, day-by-day plan (which I usually end up changing) I just included topics for the week, and any readings or assignments that are due. This gives me a good deal more flexibility (especially since students generate much of the course content). I think it's also easier, for them and for me, to take in the term at a glance.

Download Syllabus USEM 103 3-10

Note to David Foster Wallace

 I found this photocopy of a note I wrote on the outside of a box I sent to David Foster Wallace. There was a copy of Giorgio Agamben's Potentialties inside, for which he wrote back thanking me.

NOTE: This contains a gift, and only a gift, for DFW's edification and amusement. It does not contain a novel written by me (or any novel) or some other sordid attempt at self-promotion disguised as a gift. Nor is it some day-camp-style handicraft of my own manufacture, and although this is supposedly a "manuscript box," it most definitely is NOT a manuscript.

Okay, there is a book in here, but it not by me, or a friend, or even a novel. It does seem like something DFW would enjoy, but not not across on his own (perhaps), and there is a brief (3 paragraph) narration of how I came to think that.

The Assistant Professor's Nightmare

My niece's pre-lecture jitters reminded me of this poem by Ronald Wallace:

The Assistant Professor's Nightmare

I'm giving the Faulkner lecture as usual,

all the pencils nodding their heads

in astonishment: Wallace is brilliant,

Wallace is wise. My sure voice filling

their notebooks up when

back row, aisle three, Kevin McGann,

graduate teaching assistant, begins

to shake his ominous head. A white balloon

drifts out of his mouth, and oozes

to the front of the room: ridiculous,

it says, ridiculous. Suddenly confidence

slips out of my voice, sits down

in the front row, snoring.

My stomach and the room give out,

my small words stumbling on. Soon

all of the pencils are wagging their fingers,

shouting with their black tongues.

Two hundred points rise up at me

as I grow smaller and smaller, my thin

voice humming like a gnat. I look

for a safe way out of this, but

lost in grammatical confusion,

my sentence goes on and on

and I disappear in a flurry of notes,

my fury and my sound crossed out,

the room closed up like a book.