Sorting Souls with fMRI

In the March issue of Scientific American, brain-imaging expert John Gabrieli says that we can now use functional magnetic-resonance-imaging (fMRI) technology to predict whether depressed patients will benefit from certain therapies, whether smokers will be able to quit, and whether criminals will land back in jail soon.  But he leaves unanswered some questions he raises—namely, if we find that we can reliably obtain this kind of information, what should we do with it?

First, a brief explanation of what fMRI does.  Using basically the same giant-liquid-helium-cooled-magnet MRI technology that hospitals use, fMRI detects changes in blood flow in the brain as certain regions become more active while the patient is thinking about or viewing different things.  For example, my niece is now a psychology postdoc in Omaha, Nebraska, doing research on troubled adolescents by putting them in an fMRI machine and having them play specially designed video games, and watching what goes on in their brains as they play.  According to Gabrieli, who is at MIT and presumably knows what he's talking about, fMRI studies have been able to discriminate between depressed patients who will benefit from cognitive behavior therapy, and those who won't.  He is somewhat short on statistics of exactly how accurate the predictions are, and admits that the technology has a way to go before it's as reliable as, say, a pregnancy test kit. 

But just for the sake of argument, suppose tomorrow we had a 95%-accurate technology that was cheap enough to be widely used (neither of which describes fMRI yet), and could tell us ahead of time the likelihood that a convicted criminal would be back in jail in five years.  What could we do with the information?

Given that one purpose of imprisonment is to protect the public, you could argue that those criminals who are very likely to commit more crimes should not be let out on the streets, at least until their fMRI scans improve.  And those whose fMRI scans showed that they were at very little risk of committing more crimes might have their sentences curtailed, or maybe we should just release them right away. 

Say you are a member of a parole board, trying to decide which prisoners should be granted parole.  Wouldn't you be glad to have fMRI data on the prisoners that was shown scientifically to be pretty accurate, and wouldn't you feel more confident in your decisions if you based them partly or even mostly on the fMRI predictions?  I think I would.

But what does this look like from the prisoner's point of view?  Suppose you led a life of crime and didn't change your ways until you landed in jail, when you came to yourself and turned over a new leaf.  (It happens.)  You present your sterling behavior record since then to the parole board, but then they make you stick your head in a machine, and the machine says your anterior cingulate cortex is just as unreformed as ever, and the board denies your request for parole.  Wouldn't you feel unfairly treated?  I think I would.

What's going on here is a conflict between two anthropologies, or models of what a human being is.  The psychologists who use fMRI studies to predict behavior emphasize that people are physical structures that work in certain ways.  And they have found strong correlations between certain brain activities and subsequent behavior.  They say, "People with this kind of fMRI profile tend to do that," and they have statistics to back up their claims.  While they admit there are such things as ethical considerations, they spend most of their time thinking of their subjects as elaborate machines, and trying to figure out how the machine works based on what they can see it doing in an fMRI scan.  If you asked Dr. Gabrieli if he believes in free will, he might laugh, or say yes or no, but he would probably regard the question as irrelevant to what he's doing.

The question of free will is crucial to a different model of the human being, the one that claims people have rational souls.  From William James on, the discipline of psychology has tended to dispense with the concept of the soul, but that doesn't change the fact that each of us has one.  I once knew a man who was a former drug user.  Then he became a Christian, settled down, started his own small business, married, and was leading a stable upstanding life the last time I heard of him.  I don't know this for a fact, but I suspect his anterior cingulate cortex would send an fMRI machine off the charts.  Nevertheless, by what psychologists might call strength of will, and by what believers would call the grace of God, he overcame his almost irrepressible desires to do bad things and developed new good habits. 

We once thought it was reasonable to discriminate against people simply because of the color of their skin.  Black people couldn't intermarry with white people, couldn't hold certain jobs, and were (and sometimes still are, regrettably) automatically considered to be the most likely suspects in any criminal investigation.  We now know this kind of discrimination is wrong.

But if fMRI machines, or their cheaper successors, ever attain the accuracy that Dr. Gabrieli hopes for, we will face a choice just as momentous as that faced by the nation when Dr. Martin Luther King challenged the nation with his dream in 1963.  Will we decide to sort people into rigid categories based on physical characteristics?  Or will we treat each human being as fully human, each fully deserving the right and opportunity to change and make better decisions regardless of what an imperfect scientific study says?  Those are the kinds of questions that we need to face before we inadvertently create a nightmarish regime in which your rights depend on the physical characteristics of your brain, just as much as they depended on the color of your skin in 1950.

Sources:  John Gabrieli's article "A Look Within" appeared on pp. 54-59 of the March 2019 edition of Scientific American.

Can Dating Apps Save Marriage?

On Valentine's Day last week, the Washington Post carried an article by their technology reporter Drew Harwell that looked into the dating and marriage situation in Silicon Valley—the area around and south of San Francisco where so many high-tech companies have clustered.  What he found was not good.  Despite the proliferation of dating apps with kooky names like Zoosk, Coffee Meets Bagel, and OkCupid, he talked to many single young people who are jaded about the whole idea of relationships between the sexes and the questionable usefulness of dating apps for forming them.

One problem the area has is the demographic preponderance of men.  Some zip codes around Palo Alto and vicinity have 40% more single men than single women.  To forestall a stampede of women out west to catch the next potential Bill Gates or Mark Zuckerberg (an old-fashioned idea to start with), the reporter cited a common saying among single women who already live in Silicon Valley:  "The odds are good, but the goods are odd."

With six or seven sixteen-hour days considered by many companies to be a standard workweek, it's understandable that young singles out there scarcely have time to sleep and take baths, much less develop a relationship with a potential life partner that could endure beyond the first date.  Unlike eating and sleeping, the sexual aspect of life is optional on an individual basis for the human creature, though universal neglect of this matter would lead to the demise of the species. 

Perhaps what we are seeing is a kind of specialization not unlike what happens among social insects such as bees and ants.  Reproduction is limited to the queen and a few necessary drones, while the vast majority are, well, worker bees to whom sex (and marriage in the case of people) is not a live option, so to speak.  I doubt, however, that Google and Apple would improve their chances of hiring the best and the brightest if they added a requirement of sworn celibacy to their employment requirements.

To those of a religious persuasion who see the norm for most people to be marriage and children, Silicon Valley is an anomaly where devotion to one's job trumps almost everything else.  But the idea of life as a giant winner-take-most competition seems to make sense to a lot of young people, and may explain the popularity of grim fiction such as The Hunger Games.  And it's understandable that the competitive feel would taint even such activities as seeking a mate, with women, especially, setting their standards for a suitable match impossibly high.  But requiring your next date to have the physique of a Superman and the bank statement of a billionaire is a good way to go a long time between dates.

And men don't always approach the problem realistically either.  Back in the 1980s, I knew a single man who most women would have considered highly eligible.  He eventually met a woman whom he fell in love with, but a few weeks before their wedding he expressed doubts to me:  "What if once I get married, somebody else comes along who's really the right one?"  I told him he couldn't be sure that wouldn't happen, but it didn't matter either.  He evidently figured out that marriage is a commitment more serious than any job, or career, or (for some) even life itself.  I am glad to report that they are still married, some thirty years later, so if he ever ran across another woman who might have ranked higher on an online dating score than his present spouse, he must have just kept going.

That couple met long before dating apps were invented, but this is not to say they can't be helpful.  A relative of ours, a widower whose wife died about four years ago, is now plannning his marriage to a woman he met through an online dating service on the first try.  They are from similar employment backgrounds and are both in their 50s, so it's not the young never-married situation that the Silicon Valley folks are typically in.  But it can work, certainly, under the right conditions. 

But a more fundamental problem results when someone expects an online service to transform one's whole life by means of bringing the ideal mate into it.  Some people, such as my friend from the 1980s and our relative, want to make a lifetime commitment.  The traditional Anglican wedding vows read in part, ". . . be faithful to [him or her] as long as you both shall live. . . ."  But many young people today have seen so many such commitments broken by people their parents' age that, while they may think a lifelong marriage is an appealing ideal to use in a romance novel, the chances of it working out in real life are so small that they don't even seriously consider it when they search for someone for a romantic involvement with.

The problem with this attitude is that it dooms whatever relationships they do form to temporary alliances, with both partners keeping one eye on the exit and looking for signs that things aren't working out, so as to leave before they are seriously hurt.  But guess what—even the briefest of encounters can leave lasting wounds, and often does.

As with many other forms of technology, dating apps can be helpful or harmful depending on the intentions with which they are used.  As many happily married couples who met through such an app can attest, they can play a role in increasing the net sum of human happiness.  Or, as many in Silicon Valley have found, they can hold out the illusion of hope for a happily-ever-after which runs aground when it encounters the unfavorable demographics of the region and the short-term mentality engendered by the competitive world of high-tech engineering. 

Especially for women, the problem of how to have both a rewarding career in engineering and how to have a satisfying and enduring marriage can be a hard one these days.  It's not easy for men either.  Dating apps may be part of the answer, but clearly, this is one problem that technology alone can't solve.

Sources:  The article "Why Silicon Valley singles are giving up on the algorithms of love" appeared on Feb. 14, 2018 in the online version of the Washington Post at https://www.washingtonpost.com/business/economy/why-silicon-valley-singles-are-giving-up-on-the-algorithms-of-love/2018/02/14/6cbd74ee-1041-11e8-8ea1-c1d91fcec3fe_story.html.  I also referred to statistics on marriage presented at https://www.thespruce.com/estimated-median-age-marriage-2303878.  The Anglican Book of Common Prayer quotation is from http://justus.anglican.org/resources/bcp/marriage.pdf.  And I thank my wife of 39 years for pointing out the Post article to me. 

The Latest Amtrak Crash: A Deadly Combination

Many accidents in complex systems happen when two or more failures align like tumbler pins in a lock, opening the way to tragedy.  That is apparently what happened around 2:45 AM on Sunday, Feb. 4, outside the central South Carolina town of Cayce.  Here's what led up to the crash.

For the last several years, U. S. railroads have been under the federal gun to complete installation of Positive Train Control (PTC), a complicated system involving GPS receivers on trains, transponders along the tracks, and coordinated data links that will automatically slow down trains that are going too fast and stop those heading toward disaster.  Lack of PTC has been cited in every recent fatal train wreck, and so at the time of this crash, installers were working on the South Carolina section of track in question to put in the necessary PTC equipment.  The only trouble was, as part of the process they had to shut down the safety block signals—the red-yellow-green lights beside the track that inform the engineer as to whether the track ahead is clear. 

Railroads have a way of dealing with the absence of block signals, which is to dispatch trains by means of documents called "track warrants."  Obviously, there has to be a special procedure for this, with good communications by radio to the dispatcher, because running through an area with no signals is a little like flying an airplane blind.  It can take more than a mile to stop an average train, so by the time the engineer sees an obstruction on the track it's usually too late to do anything more than set the brakes, blow the horn, and hope.

At this writing, it is unclear whether the track-warrant procedure was followed correctly.  But what is clear is that earlier in the evening, after a railroad employee set a switch to allow a freight train to pull off to a siding out of the main line that the Amtrak train was going to use later, the switch was locked in place,  still set to the siding.  In other words, any train coming down the main line in the same direction was going to head straight onto the siding, toward the sidelined freight.

Normally, this switch setting would cause the signals on the main line to change to yellow or red.  But due to the work going on to install PTC, the signals were inoperative.  So all that stood between the southbound Amtrak train that was coming along about 2:45 AM and disaster was good communications among the person who set the switch, the train dispatcher (many miles away in a CSX control center, CSX being the freight railroad that owns the track which Amtrak uses), and the Amtrak crew.

The third thing that is clear is that the communications broke down.  The last thing the Amtrak engineer saw was the end of the freight train, as his engine barreled off the main line at 56 MPH onto the siding and crashed.  He and the conductor were killed, and about 100 passengers were injured in the resulting Amtrak car derailments, some critically.

Amtrak officials were quick to throw blame to CSX, whose tracks they were using, as it was CSX's responsibility to ensure that any switches their crew used were set back to the proper direction.  Records indicate that the freight-train crew reported that they had set the switch correctly, so it is unclear at this point how the switch ended up in the wrong position anyway. 

While this is only the latest in a string of several fatal Amtrak accidents, each one has apparently had a different set of contributing factors, and accusations that Amtrak's safety culture is at fault are premature, to say the least.

The irony of this particular accident is that it was apparently caused at least partly by the rush to install PTC—a safety feature—which indirectly led to the accident.  It reminds me of the recent Takata air-bag-inflator fiasco, in which millions of cars had to be recalled, and many people were killed by defective inflators that shot shrapnel at them in accidents that would have otherwise merely bent a few fenders.

This is not to say we shouldn't have airbags, or we should call a halt to installing PTC.  And here is where we fall back on a philosophical method which engineers use almost without thinking—utilitarianism, otherwise known as the greatest good for the greatest number.  Utilitarianism is not the only way to decide ethical issues, by any means, but it has its uses.  Clearly, it makes sense to complete PTC installations even if it means shutting down signals temporarily here and there.  But the problem comes when those responsible for safety measures get too focused on the future good they will do, and neglect the present potential harms such installations can cause.  I don't know what went wrong with the track-warrant system in this case, but clearly something did.  And once a decision is made to install a safety feature, it is easy to allow too many temporary compromises in present safety in view of the greater good that the ultimate installation will lead to.

But that temptation has to be resisted.  Takata shouldn't have been as sloppy as they were in making crummy airbag inflators that would turn into bombs down the road a few years.  And everyone involved—train dispatchers, PTC installers, and above all, the freight train crew who apparently left the switch in the wrong position—should have been doing a better job communicating in the absence of the usual track signals. 

Sometimes people who work on safety features get careless because most of the time, the features don't see action.  But they are really like a standing army ready for battle.  When the crisis comes, the safety features rise to the top of the priority list.  Never mind the usual function of the system—transportation, communication, or whatever.  If the user is injured or killed, it would have been better not to have made the product at all.  So although Amtrak's safety culture alone may not be at fault, clearly something went wrong in Cayce that night.  And more work needs to be done to make sure that a complicated system like a railroad runs even more safely with PTC than it does without it.  Just installing PTC won't guarantee that, because PTC itself has the potential to cause trouble.  Let's hope that it doesn't, and that the recent flurry of fatal train mishaps are the last ones before PTC makes train-passenger fatalities as rare as airline-passenger fatalities are today.

Sources:  I referred to a thorough report on the accident carried by NPR on their website on Feb. 5 at https://www.npr.org/2018/02/05/583455540/ntsb-looks-at-disabled-signals-locked-switch-in-latest-deadly-amtrak-crash.

Do Machines Determine Death?

Jahi McMath is legally dead in California, where a routine tonsillectomy on the thirteen-year-old girl went awry on Dec. 9, 2013 and she basically bled to death.  But she is still legally alive in New Jersey.  After refusing to let the California hospital harvest her organs, her family insisted she was still alive and moved her to New Jersey to take advantage of a law that allows them to do so.  Her case, described in a recent New Yorker article, raises serious questions about the role of technology in determining the end of human life. 

New Jersey and New York are the only states which allow families to refuse a diagnosis of brain death if it violates their religious beliefs.  This exception was made to accommodate the beliefs of Orthodox Jews, who believe that breathing indicates life.  Not so long ago, most people and governments would have said the same thing, but then medicine developed the ability to monitor brain function via electroencephalography (the EEG machine), as well as more sophisticated technologies such as MRI scans and automatic ventilator machines. 

These changes were reflected in a 1981 report written by a Presidential commission entitled Defining Death:  Medical, Legal, and Ethical Issues.  Modern ventilator machines can keep the rest of a human body functioning even after the brain is destroyed —for a time, anyway.  But the ability to detect brain function with EEGs, plus the increasing popularity of organ transplants (which stand a better chance of success if the organ is harvested from a donor whose systems are still functioning) led to a redefinition of death as cessation of activity in the whole brain.  Definitions are one thing, but decisions made under stressful actual conditions are another, especially in gray areas such as Jahi's.

In New Jersey, Jahi underwent a tracheotomy and had a feeding tube inserted.  Although she is still dependent on a ventilator, an MRI by a New Jersey brain researcher showed that parts of her cerebrum were intact.  The cerebrum is considered to be the seat of higher mental activity.  And there are videos showing that she can occasionally respond accurately to her mother's request to move certain fingers, as well as heart-rate changes when she hears familiar voices.  Because the legal limits on malpractice damages are capped at $250,000 but only if the victim dies, Jahi's parents are suing the State of California to bring about a trial in which a jury will determine whether Jahi is dead or alive in that state.

I find it fitting that the legal system in at least two states defers to religious beliefs on matters of death, because in doing so the law acknowledges that it doesn't perhaps know everything there is to know about this subject.  In dealing with death, we have to base our actions on some theory of what it involves.  And there are two distinctly different current narratives.

The first version is the secular narrative.  Human life is for purposes we can't discern and came about for reasons we can't figure out.  Human life on the whole is good, but utilitarian considerations of the greatest good for the greatest number tell us that if we use the criterion of brain death rather than more traditional definitions of death, organ transplants can benefit other people more.  And I see this point of view.  My brother-in-law is now doing very well, freed of the drudgery of thrice-weekly dialysis treatments, because he received a kidney transplant from a brain-dead accident victim last August.  And if Kansas hadn't been using the modern definition of brain death on the donor, doctors would not have been able to harvest that kidney.

The second version is the religious narrative, and because I'm most familiar with it, I'll give the Christian version.  God created the heavens, the earth, and all that is in them.  He created humans with the ability to sin, which they unfortunately took advantage of, and death entered the world.  But believers in Jesus Christ have overcome death and will rise with him at the general resurrection.  A person's spirit uses the brain, but brains are not necessary in order for a person to exist.  Angels and God Himself are personal beings, but they are not encumbered by brains.  There are testimonies from dozens, if not hundreds, of people who have had near-death experiences in which they have visited Heaven, and then returned to their bodies, some of whom probably met the criteria for brain death in the interim.  And if surgeons had started harvesting organs before they came back, well, that would have been the end of that.

There are both present and future reasons why Jahi's parents don't want her taken off the machinery that keeps her going.  One is the simple human desire to have your child with you.  We know each other through our bodies, and in a real sense, we are our bodies. To let a loved one's body cease to live and fall victim to decay is a final parting from that body which we have known and loved. 

The second reason is prospective:  the hope that Jahi might recover.  Medical science tells us that this is very unlikely in Jahi's case.  But broadly similar cases have resulted in the eventual recovery of the person involved.  In the magazine article's photo of Jahi on her bed in New Jersey, she is covered with a blanket that reads "I Believe in Miracles—Mark 11:24"  The reference is to the words of Jesus:  "Therefore I say unto you, What things soever ye desire, when ye pray, believe that ye receive them, and ye shall have them." I'm not going to presume to interpret that passage here, but the point is that the Christian virtue of hope sometimes leads people to do things that look ridiculous, wasteful, or even sacreligious to less hopeful people.

I don't know how Jahi's situation will end up.  But that is the point.  Sometimes even the best and most advanced technology won't tell us everything we want to know.  And in such cases, faith may be a better guide than technical expertise.

Sources:  The article by Rachel Aviv, "The Death Debate" appeared on pp. 30-41 of the Feb. 5, 2018 issue of The New Yorker.  I also referred to Wikipedia articles on brain death and Jahi McMath.