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Dr Kathy Miller discusses beneficial changes that have resulted from the COVID-19 pandemic and implications for the future of medicine.
Medscape Oncology

Dewey Library - JC328.6.T54 2018

Dewey Library - JC423.R48 2018

Garnaut, Ross, 1946- author

The company also announced the Swift Student Challenge, an opportunity for student developers to showcase their coding skills by creating their own Swift playground

Lowering low-density lipoprotein cholesterol (LDL-C) levels remains a mainstay of cardiovascular disease prevention, but gaps in treatment remain, even in persons with hypercholesterolemia and greatly elevated LDL-C levels. Although well-described gene variants in the apolipoprotein B (APOB), low-density lipoprotein receptor (LDLR), and proprotein convertase subtilisin/kexin type 9 (PCSK9) genes explain small but important fractions of monogenic hypercholesterolemia, recent attention has turned to prognostication of cardiovascular disease using polygenic risk scores (PRS) that incorporate common genetic variants derived from large-scale genome-wide association studies of lipid subfractions. Earlier PRS considered only variants with genome-wide significance, and newer studies have focused on methods that better capture the variance conferred by millions of variants, suggesting an ability to identify risk equivalent to monogenic mutations. There remains a gap in evidence from prospective observational studies or treatment trials regarding the appropriate placement of PRS in risk assessment and lipid treatment decisions relative to information on rare monogenic gene variants, particularly in multiethnic populations.

Davis, John K., author

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The following is an interesting extract from Straw Dogs by John Gray (pp. 109–116) discussing some of the differences between Western and Taoist philosophical traditions.

The fetish of choice

For us, nothing is more important than to live as we choose. This is not because we value freedom more than people did in earlier times. It is because we have identified the good life with the chosen life.

For the pre-Socratic Greeks, the fact that our lives are framed by limits was what makes us human. Being born a mortal, in a given place and time, strong or weak, swift or slow, brave or cowardly, beautiful or ugly, suffering tragedy or being spared it – these features of our lives are given to us, they cannot be chosen. If the Greeks could have imagined a life without them, they could not have recognised it as that of a human being.

The ancient Greeks were right. The ideal of the chosen life does not square with how we live. We are not authors of our lives; we are not even part-authors of the events that mark us most deeply. Nearly everything that is most important in our lives is unchosen. The time and place we are born, our parents, the first language we speak – these are chance, not choice. It is the casual drift of things that shapes our most fateful relationships. The life of each of us is a chapter of accidents.

Personal autonomy is the work of our imagination, not the way we live. Yet we have been thrown into a time in which everything is provisional. New technologies alter our lives daily. The traditions of the past cannot be retrieved. At the same time we have little idea of what the future will bring. We are forced to live as if we were free.

The cult of choice reflects the fact that we must improvise our lives. That we cannot do otherwise is a mark of our unfreedom. Choice has become a fetish; but the mark of a fetish is that it is unchosen.

Animal virtues

The dominant Western view…teaches that humans are unlike other animals, which simply respond to the situations in which they find themselves. We can scrutinise our motives and impulses; we can know why we act as we do. By becoming ever more self-aware, we can approach a point at which our actions are the results of our choices. When we are fully conscious, everything we do will be done for reasons we can know. At that point, we will be authors of our lives.

This may seem fantastical, and so it is. Yet it is what we are taught by Socrates, Aristotle and Plato, Descartes, Spinoza and Marx. For all of them, consciousness is our very essence, and the good life means living as a fully conscious individual.

…

Western thought is fixated on the gap between what is and what ought to be. But in everyday life we do not scan our options beforehand, then enact the one that is best. We simply deal with whatever is at hand. …Different people follow different customs; but in acting without intention, we are not simply following habit. Intentionless acts occur in all sorts of situations, including those we have never come across before.

Outside the Western tradition, the Taoists of ancient China saw no gap between is and ought. Right action was whatever comes from a clear view of the situation. They did not follow moralists – in their day, Confucians – in wanting to fetter human beings with rules or principles. For Taoists, the good life is only the natural life lived skillfully. It has no particular purpose. It has nothing to do with the will, and it does not consist in trying to realise any ideal. Everything we do can be done more or less well; but if we act well it is not because we translate our intentions into deeds. It is because we deal skillfully with whatever needs to be done. The good life means living according to our natures and circumstances. There is nothing that says that it is bound to be the same for everybody, or that it must conform with ‘morality’.

In Taoist thought, the good life comes spontaneously; but spontaneity is far from simply acting on the impulses that occur to us. In Western traditions such as Romanticism, spontaneity is linked with subjectively. In Taoism it means acting dispassionately, on the basis of an objective view of the situation at hand. The common man cannot see things objectively, because his mind is clouded by anxiety about achieving his goals. Seeing clearly means not projecting our goals into the world; acting spontaneously means acting according to the needs of the situation. Western moralists will ask what is the purpose of such action, but for Taoists the good life has no purpose. It is like swimming in a whirlpool, responding to the currents as they come and go. ‘I enter with the inflow, and emerge with the outflow, follow the Way of the water, and do not impose my selfishness upon it. This is how I stay afloat in it,’ says the Chuang-Tzu.

In this view, ethics is simply a practical skill, like fishing or swimming. The core of ethics is not choice or conscious awareness, but the knack of knowing what to do. It is a skill that comes with practice and an empty mind. A.C. Graham explains:

The Taoist relaxes the body, calms the mind, loosens the grip of categories made habitual by naming, frees the current of thought for more fluid differentiations and assimilations, and instead of pondering choices lets the problems solve themselves as inclination spontaneously finds its own direction. …He does not have to make decisions based on standards of good and bad because, granted only that enlightenment is better than ignorance, it is self-evident that among spontaneous inclinations the one prevailing in the greatest clarity of mind, other things being equal, will be best, the one in accord with the Way.

Few humans beings have the knack of living well. Observing this, the Taoists looked to other animals as their guides to the good life. Animals in the wild know how to live, they do not need to think or choose. It is only when they are fettered by humans that they cease to live naturally.

As the Chuang-Tzu puts it, horses, when they live wild, eat grass and drink water; when they are content, they entwine their necks and rub each other. When angry, they turn their backs on each other and kick out. This is what horses know. But if harnessed together and lined up under constraints, they know how to look sideways and to arch their necks, to career around and try to spit out the bit and rid themselves of the reins.

For people in thrall to ‘morality’ , the good life means perpetual striving. For Taoists it means living effortlessly, according to our natures. The freest human being is not the one who acts on reasons he has chosen for himself, but one who never has to choose. Rather than agonising over alternatives, he responds effortlessly to situations as they arise. He lives not as he chooses but as he must. Such a human has the perfect freedom of a wild animal – or a machine. As the Lieh-Tzu says: ‘The highest man at rest is as though dead, in movement is like a machine. He knows neither why he is at rest nor why he is not, why he is in movement nor why he is not.’

The idea that freedom means becoming like a wild animal or machine is offensive to Western religious and humanist prejudices, but it is consistent with the most advanced scientific knowledge. A.C. Graham explains:

Taoism coincides with the scientific worldview at just those points where the latter most disturbs westerners rooted in the Christian tradition – the littleness of man in a vast universe; the inhuman Tao which all things follow, without purpose and indifferent to human needs; the transience of life, the impossibility of knowing what comes after death; unending change in which the possibility of progress is not even conceived; the relativity of values; a fatalism very close to determinism; even a suggestion that the human organism operates like a machine.

Autonomy means acting on reasons I have chosen; but the lesson of cognitive science is that there is no self to do the choosing. We are far more like machines and wild animals than we imagine. But we cannot attain the amoral selflessness of wild animals, or the choiceless automatism of machines. Perhaps we can learn to live more lightly, less burdened by morality. We cannot return to a purely spontaneous existence.

Read, Nicholas A. C

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