Remembering Ned Freed (1959-2022)

The Internet lost a hero this week. Ned Freed and I were in our early thirties when we met. I was a researcher in Pittsburgh, passionate about extending email to include pictures, sounds, and rich text in any language. Ned was a young entrepreneur in California, passionate about improving interoperation between independently designed email-like systems. We were the closest of collaborators during the early 1990's, when we led the design of the Multipurpose Internet Mail Extensions (MIME) -- three years of intense partnership that turned out to be the career highlight that both of us would be best remembered for.

MIME is now used trillions of times daily, in virtually every web page and email message, and we've both long since recognized that it would feature prominently in our obituaries. But it isn't what I think of when I remember Ned. MIME was the product of our collaboration, but it was the collaboration itself that I most treasure.

It's my observation that a remarkable number of innovations seem to originate in the well-timed creative dynamic of a pair of fortuitously compatible people in a collaboration that can be far more intimate than, say, merely producing a baby. UNIX came from the pairing of Thompson and Richie, Apple from Jobs and Wozniak, Microsoft from Gates and Allen, Google from Page and Brin. Cerf and Kahn gave us TCP/IP, while Parker and Stone gave us South Park and The Book of Mormon. Fate -- in the form of Einar Stefferud (universally known as Stef), one of the less remembered heroes of the early Internet -- brought Ned and me together at the moment when something like MIME was desperately needed.

I think that such creative partnerships usually involve people with very different but complementary personalities and skills, focused on a common task. Ned and I were nearly the exact opposite -- temperamentally fairly similar, but initially focused on very different tasks. I wanted to make email richer, while he wanted to make it more robust and interoperable. A third constituency lacked email expertise and was laser-focused on freeing email from its English-only heritage. When Stef realized that these three goals were highly complementary and might be achieved together, he introduced me to Ned and suggested we get involved with the IETF (Internet Engineering Task Force) and try to change the world.

We did, but in retrospect that's not nearly as remarkable to me as the fact that we did it without a single argument. Perhaps in part because we came into the MIME work with different motivations and expertise, we had no built-in disagreements. I've had other very successful collaborations, but there was always something to disagree about, sometimes leading to the kind of blowout fights that make you wonder how a couple can manage to stay together. With Ned and me, however, it was all harmony. I know we weren't always right -- I frequently point to one or two aspects of MIME that embarrass me to this day -- but we were even unified in our mistakes.

Or at least, I'm about 99% sure we were that perfectly harmonized. It's hard for me to be absolutely positive, however, because Ned was such a master of reasonableness and amiability. While I would occasionally get overexcited and argumentative, Ned could stay calm and sunny in the face of the most egregious wrong-headedness and ignorance, though he could be frank and even scathing about it in private. There were surely people who worked well with Ned, liked him very much, and never had a clue that he thought they were idiots, so gentle was he in debating and correcting them. He could completely separate their opinions from their identities, and he seemed to like nearly everyone, which meant that nearly everyone liked him. I would not put it past Ned to have disagreed with me so gently that he actually won arguments I never knew we were having.

MIME was our first involvement with Internet standards work, the first RFC either of us had our names on. The MIME work was a career-making breakthrough for both of us, but we went different ways afterwards.  I went off in a number of directions, founding several startups and then helping lead innovation and standards work at IBM and Mimecast. Ned was astonishingly stable and even-keeled, never once changing employers; the company he founded before I met him was acquired by Sun, which was acquired by Oracle, where he remained to the end. His stability, patience, and clarity were a perfect match for standards work, and he never stopped working with the IETF, ending up as the author of over 50 RFC's (far more than my 16, and in fact more than 99.95% of RFC authors), and one of the best known and most respected figures in the Internet standards community.

You only had to meet Ned once to understand why he was so good at this. He was wicked smart, of course, but there are plenty of smart people who flame out in the process of trying to build consensus. But Ned always had a warm smile. His humor could be quite biting in private, but never malicious, and in larger meetings he carried himself in such a way that it was almost impossible not to like him.

I knew Ned for just over half his life, but never without health problems. When I met him, at just barely over 30, he was already deep in his lifelong struggle with ulcerative colitis. He talked openly about his health issues when asked, but I never once heard him complain. In his later years his health led him to stop traveling to IETF meetings, but he remained an active and soothing presence who proved over and over, to a still-skeptical world even within the IETF community, how modern technology can allow people with the right communication skills to be first-class participants from thousands of miles away. He worked so effectively through his illness for so long that I almost stopped worrying about him, as if I expected him to live forever.

The people you hear the most about aren't generally, in my experience, the people who most deserve it. A lot of the most important and constructive work is quiet and behind the scenes. Ned never, to my knowledge, sought to aggrandize himself. Even for the work we did together, I ended up being the one who people know as the "father of the email attachment." But I could never have realized my vision of richer, more powerful email alone. Ned's deep expertise and focus on detail kept me from going down more than a few rabbit holes that could have sunk the whole MIME project, while his disposition probably made the difference between a gradually emerging consensus and a pitched battle of entrenched ideas.

Meeting, collaborating with, and becoming friends with Ned Freed was one of the highlights of my career, and I will miss him for all the time I have left. Although I'm not a believer, I'd like to picture him in heaven right now, smoothing out communication problems between the cherubim and the seraphim, devising protocols for synchronizing the tuning of everyone's harps, and perhaps gently trying to convince God to loosen up and decentralize the universe a little more. If anyone can do it, Ned would be the man. Rest in peace, old friend.

Grieving and Singing Joyfully at Passover

 Note:  Although it's not essential, I highly recommend that you play this music by Elaine Hagenberg(*) in the background while you read this essay.  I will be quoting heavily from the underlying poem, by William Wordsworth(*), and discussing the music, which I've been singing with my chorus.  

 

Like most Jewish holidays, Passover is a celebration of the human spirit in the face of loss and tragedy.  (They say most Jewish holidays can be summarized in ten words:  "They tried to kill us all.  They failed.  Let's eat.")    Jews are told to remember times of happiness even when things are worst, and to remember times of sadness when we are happiest; a Jewish bridegroom traditionally breaks a glass at his wedding, to commemorate the destruction of the Temple in Jerusalem 2000 years ago.

"There was a time when meadow, grove, and stream,

The earth, and every common sight,

To me did seem

Apparelled in celestial light,

The glory and the freshness of a dream."

Such melancholy subtleties don't generally sink in with children, of course.  I remember the Passovers of my childhood as times of special foods and family gatherings, mostly happy but with the occasional blowout argument.  I heard the tales of how our ancestors were liberated from slavery 3000 years ago, but didn't think much about the suffering that preceded the liberation.  Getting together with the family, telling stories, eating traditional foods, and singing holiday songs -- it's hard for a child to see this as anything but joyous.

Me and my father, when I still listened to him.

It was only when my father passed away on the eve of Passover in 2006 that the holiday developed a shade of sorrow for me.  Jews traditionally remember departed loved ones annually on the anniversary of their death, known as the Yahrtzeit.  Since 2006, my father's Yahrtzeit has taken place at the Passover Seder -- the meal and ceremony that begin the holiday -- and this adds just the right tinge of sadness for a Jewish celebration.  The Seder chronicles the suffering and struggles of ancestors who died 3000 years ago, and is full of commentary from ancestors who died one to two thousand years ago.  Taking a moment to mourn a parent who died a few years ago -- the kind of sadness that we grow up expecting to face some day -- fits the holiday perfectly, and didn't really change the tone for me substantially.

Then, in 2020, as the pandemic shut down the planet, my beautiful oldest daughter, Shana, suddenly dropped dead a few hours before the Seder.

Shana Nova Borenstein, 1982-2020

Losing a child, at any age, is nothing like losing a parent at the end of a long life.  It tears at the foundation of everything you have lived for.

"It is not now as it hath been of yore;

Turn wheresoe'er I may,

By night or day.

The things which I have seen I now can see no more."

The year that followed was the worst of my life.  In addition to losing Shana suddenly, we lost my daughter Lea's husband, Mike, slowly to brain cancer, while my wife and I cared for our three young, soon to be fatherless granddaughters.  The year included Mike's fourth and fifth brain surgeries, four minor surgeries for Lea herself, a miscarriage for my youngest daughter, and heart surgery for me, to implant a defibrillator.  Along the way, my wife was suffering terrible back pain but postponing surgery to care for the rest of us.  It was, in short, a dreadful year, and at Passover in 2021, just 3 months after Mike's death, Shana's Yahrtzeit felt like another blow, the reopening of a still raw wound, and not at all like the first step towards healing.

Why with such earnest pains dost thou provoke

The years to bring the inevitable yoke,

Thus blindly with thy blessedness at strife?

Full soon thy Soul shall have her earthly freight,

And custom lie upon thee with a weight,

Heavy as frost, and deep almost as life!

This year is very different.  For starters, my life has been utterly transformed by a medical miracle, leaving me in the best physical and mental health of my entire life, and rather more inclined to embrace comfort, solace, and hope where I can find them.  

The Rainbow comes and goes,

And lovely is the Rose,

The Moon doth with delight

Look round her when the heavens are bare,

Waters on a starry night

Are beautiful and fair

Moreover, my physical and emotional rebirth was followed by a career change that enabled me to return, this spring, after 30 years of far too much travel, to one of my greatest loves, choral singing.  And among the pieces I practiced for my first concert, to take place shortly after Passover, was Hagenberg's musical setting of Wordsworth's poem.  Like most singers, I can enjoy singing almost anything, but particular moments can reward us with a powerful physical thrill not entirely unlike erotic ecstasy.  For me there is such a moment -- at around 2:30 in the YouTube recording -- where we tenors briefly get to carry the melody, and I can think only of Shana:

The sunshine is a glorious birth;

But yet I know, where'er I go,

That there hath passed away a glory from the earth.

The tenors are mostly alone as we conclude this phrase, making any errors excruciatingly obvious.  It's not easy to sing this lovely line with a clear and steady voice through my tears.  But I feel like a bridegroom stomping on a glass, determinedly embracing the possibility of joy without ever forgetting the saddest of times.

There is a part of me that feels guilty to have enjoyed the best year of my life so soon after losing a beloved daughter and son-in-law.  But my world has been suddenly, as in Wordsworth's romantic youth, "apparelled in celestial light," a light that illluminates both the glory of today and the grief at the glory that is gone.

What though the radiance which was once so bright

Be now for ever taken from my sight,

Though nothing can bring back the hour

Of splendour in the grass, of glory in the flower;

We will grieve not, rather find

Strength in what remains behind;

At the Passover Seder, we hear about the sufferings of our ancestors in slavery and the triumph of their liberation.  We argue over words of wisdom from rabbis long gone, reminisce about more recently departed parents and grandparents, and I inevitably tell jokes about my father.   The shadow of my departed daughter will loom over every Seder that remains to me, but I know I will find strength in what remains behind: my wife, daughters, grandchildren, and a much wider loving community of relatives and friends.  It is not hard to find strength amid such gifts, only to muster the discipline to focus on what remains rather than what is lost.

Thanks to the human heart by which we live,

Thanks to its tenderness, its joys, and fears,

To me the meanest flower that blows can give

Thoughts that do often lie too deep for tears.

Until these last two years, I'm not sure I ever had any thoughts "too deep for tears."  The happiness that I have found in the last year is imperfect, but I can sense, in my bones, an inkling of a larger picture, in which the world may in fact make sense in a manner too big and glorious for my tiny brain to understand, but from which my slowly broadening heart can always hope to take comfort.

(*) Words from  William Wordsworth, "Ode: Intimations of Immortality from Recollections of Early Childhood"

Music by Elaine Hagenberg, "There Was a Time"

The Hopeful Solace of Randomness

Just two years ago, I was a seeker, hoping to find some purpose underlying my relatively fortunate life. But after the last two years, the very idea seems absurd. Today, I find hope and comfort in the world's randomness. If God plays dice with the universe, I think we may be in the best of all possible worlds.

My first sixty years were mostly very good. Then in 2019, after collapsing on the street, I learned that I was facing open heart surgery, specifically a septal myectomy, in which the wall of my heart would be shaved down from the inside. I'd known for decades that I had hypertrophic cardiomyopathy (HCM), but until then I had been considered asymptomatic.

A septal myectomy is major surgery, to be followed by months of recovery. My odds overall were pretty good, but I'm a mathematician, and I knew that the odds of my dying were better than any lottery ticket ever printed.

Weirdly, however, I was told that this potentially deadly surgery was not urgent, and that the timing was up to me. My increased risk of sudden cardiac death could be managed with a much smaller surgery to implant a cardiac defibrillator. But without the big surgery, my symptoms would grow steadily worse, while the risks of the surgery would also grow as I aged. At 62, I didn't want to wait until both my quality of life and my chances of recovery were much worse, but I wanted some time to prepare myself. I gave myself a year. I decided to have the big surgery at the end of 2020. I began a slow process of sorting out my finances and affairs, winding down my career, and preparing myself emotionally and spiritually for the possibility that my life was nearing its end.

Naively, I saw dying in surgery as the worst-case scenario. But the pandemic year brought a torrent of suffering to my family, including the sudden death of one daughter, the very slow death of another's husband (as we cared for three young grandchildren), a third's miscarriage, and roughly a dozen surgeries, debilitating illnesses, and other emergencies in my immediate family. As the pandemic raged, our family was broken with grief.

As a mathematically minded person, all through this I kept musing on the unlikeliness of encountering so many crises and tragedies in such a short time, in stark contrast to the experience of my previous six decades. It was an impressive streak of bad luck, but luck is a concept that only makes sense in a world with a purpose. In a purposeless world, events are random. Past effects do not predict future events, and no mysterious cosmic hand is guiding events. Over the long run, things even out, or more technically, "revert to the mean." I took a great deal of comfort from the thought of reversion to the mean. I wanted to believe that the next year was likely to be just "average," a big step up from the nightmare I was living. My belief in reversion to the mean was more comforting than any God so cruel as to treat me like Job, or any supernatural world where such tragedies served a necessary purpose. At least in a random world, the universe wasn't conspiring against me.

With my son-in-law dying I did not, as planned, have my big surgery in December 2020. I decided to put it off one more year, though my symptoms were slowly worsening. By June, I couldn't climb more than a dozen or so steps without being out of breath. I was phasing myself into retirement, reaching out to old friends about unfinished business, and generally trying to prepare myself to face the surgery without regrets.

And then a miracle occurred.

I enrolled in a clinical trial of a new medication. Within a week, all of my symptoms completely vanished. But it didn't stop there: my lifelong heart murmur vanished as well. Even more surprisingly, I was also relieved of lifelong athletic limitations I had never known were due to HCM. A few weeks after starting the drug, I climbed 300 steps and immediately began jogging out of sheer elation. I found I could run more than I ever could when I was as a child. At 63, I was in the best shape of my life.

This triggered a series of insights into my childhood, epiphanies about my life experience, and -- instead of retirement -- an exciting new job at 64. After my hellish 2020, there was no doubt that 2021 was the best year of my life. As I write this, nine months after the miracle, I am healthier, happier, and more hopeful than I have ever been.

The apparent randomness of all of this was inescapable. I had done nothing to cause or deserve my miracle. With my year of tragedies fresh in mind, I knew my fortunes could reverse again at any moment. I had always believed in savoring the good in the present moment, but had found it hard to do in practice. Now, knowing randomness to my bones, savoring the moment feels like the most natural thing in the world. My belief in life's randomness had been a comfort to me in hard times, and it became a constant reminder to savor the good times.

Obviously my cure was the kind of miracle anyone would rejoice in. But having it happen almost immediately after all that illness and death was like going straight from a sauna to an icy pond. Having survived the shock, I feel like I am seeing things more clearly than ever before.

I don't pretend to actually know whether life has a purpose. I've looked pretty hard for one, but then I'm just a short-lived primate orbiting a minor star among 200 sextillion others. If there is a purpose, I doubt that I could understand or affect it, even if I somehow managed to find it. Whether or not the world is random and purposeless, it will always seem that way to my limited mind.

What I've come to realize, however, is that this is great news. The big questions are simply unanswerable, and there's no beyond-doubt evidence of a greater purpose -- of God, karma, or destiny plotting a coherent path for us. We have to make do with the information we have, and there's no point in asking, "Why?"

In a random universe, no one is watching over us, but no one is out to get us either. Even the longest streak of apparent "luck" can turn on a dime. In bad times, we can take comfort from reversion to the mean, while in good times it can remind us to cherish what we have now. Bad luck doesn't mean you're bad, and good luck doesn't mean you're good. People who are doing better or worse than you aren't doing so because of some cosmic design or justice. We're all in this together, and the best strategy for a happy life is to help each other out when we can.

Assuming a world without purpose frees us to live our best lives, without trying to curry favor with, second-guess, or rail against something incomprehensibly larger than ourselves. It illuminates the futility of wishing things were other than they are. But we can use this knowledge to savor and share our transient joys, to comfort and relieve each other's transient suffering, and to help each other enjoy the ride. 

How Bad Could the Coming Cryptodisasters Be?

The International Monetary Fund has just issued an urgent call for cooperative international regulation of cryptocurrencies.  They are worried about multiple plausible scenarios in which the new technology could have disastrous economic and social consequences. 

Traditionally, bankers tend to err in the direction of conservatism, so one would expect them to be cautious about such a radical, disruptive new financial technology.  However, you'd also expect them to speak in measured terms framed not to cause panic, but their warnings about cryptocurrencies are uncharacteristically dire, verging on apocalyptic.  Unfortunately, they may still understate the dangers.  

Human financial systems have evolved over thousands of years and, like the human body, have all sorts of adaptations for times of crisis.  A human-designed system (like any or all cryptocurrencies) has not been shaped by evolution, but by programmers who NEVER anticipate everything.  The likelihood of collapse in a crisis is simply much higher in an artificial system.  

That's what happened in 1987 when program trading crashed the stock market.  Fortunately in that case the damage was relatively contained, and regulations were quickly introduced to reduce the risks. Unfortunately, there's no guarantee that every collapse will have so few lasting effects.  Moreover, cryptocurrency is much more important and dangerous than program trading ever was.

It seems to me that if cryptocurrency isn't properly regulated by governments, it will be controlled by the most ruthless and greedy among the 1%.  Those are the only two choices I see.  Governments are far, far, far from perfect, but the ruthless rich are even less likely to anticipate and avoid a crypto-precipitated economic collapse.  

Unfortunately, political reality means that cryptocurrency won't even begin to be properly regulated until we've endured some predictable disasters.  Every technology enables new disasters, and the cryptodisasters are coming soon.  Because we cannot anticipate the precise form disasters will take, we can only hope that the coming cryptodisasters will be as minor as the stock market dropping 20% one day in 1987.

 

I am reborn after a medical miracle!

I didn't come into 2021 even daring to hope for a miracle. I was pinning my hopes on a simple reversion to the mean; anything, it seemed, would be better than the year my family and I had in 2020.  But a miracle is what I got, and after spending much of last year complaining, I now want to share my good news with everyone in my life. 

I was doing my best to prepare myself for likely open heart surgery this winter. But thanks to an experimental drug in a clinical trial, I have, stunningly and suddenly, found myself not only relieved of my symptoms, but possibly, at 63, in the best shape of my life.  

I didn't learn that I had a congenital heart malformation (hypertrophic cardiomyopathy, or HCM) until I was in my 40's, and I wasn't aware of its lifelong effect on me until just this year.  I was a terrible athlete as a child, always the last kid chosen, and never sure whether to blame my deficiencies on nature, will, or character.  But I was fortunate in many other ways.  My hyper-intellectual family put almost no value on physical achievements, so I never had a disappointed parent pushing me beyond my capability.  (As it turns out, that could actually have killed me, as HCM is the leading cause of sudden cardiac death in young athletes!)  Moreover, in non-athletic venues I was a superstar, a child prodigy, and I grew up certain that I preferred my lot to my opposite number, the proverbial dumb jock.

Still, I was hard on myself, always feeling that if I just tried hard enough, I ought to be able to at least, say, jog a half mile.  I ignored the fact I was otherwise quite persistent, and never saw my mix of physical abilities and limitations as any kind of clue.  For example, although I could never jog more than a few hundred yards, I was always an epic walker -- hiking on the Appalachian Trail as a teenager, and walking several miles daily most of my life, generally briskly enough that people with longer legs asked me to slow down.  I was also a dancer, even occasionally teaching and performing, but generally needing to rest between the most vigorous dances.  No one ever thought to view this as a medical mystery.

I did know that the men in my father's family nearly all suffered sudden cardiac death in their 40's, 50's, or 60's, and I never expected a long life.  My father's terror of that legacy led -- after enough false alarms to raise the issue of hypochondria -- to his diagnosis with what is now known as HCM.  Because the condition is congenital, I got tested in my 40's and learned that I, too, was born with this abnormal thickening of the heart wall.  Although I had a heart murmur, I didn't appear to have any other symptoms, and the doctors basically just told me to get checked regularly.  

After I turned 60, however, the symptoms began.  Previously I ran out of breath quickly if I tried to run, but I could walk more or less indefinitely.   Now my breath began to run out walking up hills or stairs.  I pushed myself blindly until the hot August day 2 years ago when I landed in a Manhattan emergency room.  After incorrectly being diagnosed with a heart attack, I learned that my symptoms were due to HCM, and was directed to a specialist.

At the HCM clinic in Ann Arbor, I learned that I was likely to need a septal myectomy.  I had always hoped that, if the day came when a doctor delivered bad news, I would be calm and philosophical.  So I listened quietly as my doctor explained the plan to crack open my chest, stop my heart, thread a knife through my aorta into my heart, and shave down the muscle of the heart wall.  After they picked me up off the floor and revived me, I also learned that, horrible as that sounds, the surgical mortality is less than 1%, with a major complications rate under 5%.

Those are good odds, but I was a math major, and if I heard of a lottery where my odds of winning approached 1%, I might actually buy a ticket.  Moreover, there was no rush.  HCM patients have "nearly normal" life expectancy if treated properly, but often with increasingly restricted abilities.  I could defer the myectomy almost indefinitely, but my symptoms would only grow worse, as would my ability to recover from surgery as I aged.  The timing of the surgery was largely up to me, and I began to plan to have it during the approaching winter.

So I started putting my affairs in order, and even increased my walking in hope of losing weight before the surgery.  Then larger matters put my little problems in perspective:  over the next year, while a pandemic ravaged the globe, multiple illnesses and deaths hit my family.  While I had relatively minor heart surgery to implant a cardiac defibrillator in my chest (a requirement for that "near normal" life expectancy),  I deferred the big surgery for a year as my HCM symptoms slowly worsened.  By June of 2021, I could only climb 15-20 steps before I needed to stop and catch my breath.  And then, after the hardest year of my life, came the miracle.

As luck would have it, my cardiologist was the lead investigator in a clinical trial of the first drug ever specifically designed for HCM.  Within my first month on the drug, I returned to Iargo Springs, a beautiful local spot I had doubted I would ever visit again because it required climbing 300 steps.  When I reached the top after stopping just once -- and only because the people I was with wanted to stop! -- I was so excited I actually jogged around the parking lot in my exuberance!  

As of this writing, my symptoms are almost completely gone -- my cardiologist no longer even hears a heart murmur! -- and I won't need the surgery unless they return.  I feel healthier and more athletic than I did even as a child, and I'm in a nearly constant state of joy and gratitude.  For the first time in years, I can imagine my best days may yet be ahead of me.  I am excited to see what comes next!

The Year of the Geese

 It is the year of the goose at Guppy Lake.  Well, geese, really -- the most ever on our little pond.  

We've often had nesting geese here, but never more than one pair at a time.  This year we have three pairs.  It's been pretty noisy, but gradually the three allegedly-monogamous couples are settling down to being simply picturesque -- though that changes, of course, if there's the slightest hint of new arrivals, as in this video I managed to capture:

In my mind, however, I also hear the ominous soundtrack of a Hitchcock movie.

Every year or so, in the spring, a pair decides to try to raise a family here.   It's a big mistake; tragedy inevitably ensues.

The problem is that the body of water we call Guppy Lake is actually quite small and shallow, and not really much of a barrier to predators.    But even in high water years, there are several islands in Guppy Lake that apparently look safe to geese, so they lay their eggs on them.  

There are few predators around here that would tangle with an adult goose, so they're mainly looking for turf on which they can defend their eggs against a direct assault.  They guard the eggs well, and soon we're treated to a line of adorable little goslings, following their parents around the lake like soldiers.

Alas, it is the goslings, not the eggs, that are vulnerable.  The lake's size permits weasels/stoats/ermines/fishers to attack from below, snagging a gosling before the parents have a moment's warning.   A great honking lament ensues from the parents, which can last for days, reinforced as the remaining goslings are picked off, one by one.  I don't think I've ever seen one survive.  And the geese really do mourn.

So this year three pairs of geese are visiting the Guppy Lake Gosling Abattoir.  Usually, peace and quiet are among the first words you'd use to describe Guppy Lake, but we can safely expect a record cacophony of mournful honking in the weeks to come.   But timing is everything.  Trina and I are about to spend a month in New York, for the birth of our newest granddaughter.  If we're lucky, the folks watching our house will bear the brunt of it, while we're enjoying Manhattan's relative quiet and serenity.

Modern Medicine: Our Selfishness is Our Doom

I am deeply appreciative of the miracles of modern medicine.  I cannot help but feel grateful, in particular, for being able to participate in a clinical trial of a new drug that might help me avoid open heart surgery.  Few living creatures can escape a certain level of selfishness when it comes to the desire to stay alive.

But as we all should know by now, our miraculous technologies come at a cost.  In her fascinating book "Lightning Flowers," Katherine Standefer investigates the ecological and human cost of the computer that lives inside her chest -- and mine -- in the astonishing expectation that it will bring us back from the dead if necessary.  That cost is measured, among other ways, in Third World mines that destroy forests, rivers, and communities of human beings.  

How much collateral damage is acceptable as the cost of saving a geriatric life?  I fear that modern medicine has largerly failed to properly consider the broader cost of many of its interventions.  

Case in point:  Every month, my clinical trial requires me to go to the hospital in Ann Arbor for some tests and to be given my new month's dosage of the experimental drug or placebo.  It's important that they take back any pills I have left, and give me all new pills, because the ghost in the machine at the heart of the study may have changed my dosage for the month.

Unfortunately, one month I couldn't hang around long enough for the new pills.  I could have come back, but they offerred to send the pills by courier.  It seemed a little decadent, but they offered, so I said yes, and the pills were promptly delivered.  What was delivered was 30 ordinary sized pill capsules.  They did not need refrigeration, and were not toxic to touch like chemotherapy drugs.  Perfectly ordinary capsules, probably containing nothing but sugar.  For some reason, they put them in two bottles, either of which would be big enough for all of them:

They put each of these little pill bottles inside a larger pill bottle:

Despite the fact that the medicine is not toxic to touch and does not require refrigeration, they included a mask and gloves, and an electronic temperature monitor that documented the temperature in transport:

They put all this inside an 8" x 8" cardboard box, "protected" by 12 Koolit gel packs:

They then put that box inside another cardboard box, this one 9" x 9" with lots of styrofoam glued onto it, rendering it unrecyclable.  They then put that box inside a 17" styrofoam cooler, specially shaped to fit around the styrofoam glued onto the 9x9 box and immobilize it.  Before closing the top on the styrofoam box, they threw in four more Koolit gel packs, each of them 3 times as large as the previous 12.  The styrofoam box was then placed inside a final cardboard box, 17.5"x17.5", and proudly labelled "KoolTempGTS  Excel Qualified Shipping System"

I'm 63 years old.  It would certainly be nice to have a couple more decades, but modern technology has already made that pretty likely -- the heart surgery that would fix my problem is astonishingly invasive, but the mortality is less than 1%, and the serious complication rate under 4%.  This new medication is being developed not so much to save my life as to do so more *conveniently*.

I'm not fishing for compliments when I say that I don't think destroying habitats, rivers, watersheds, and the entire cultures of some ancient communities we dismiss as "primitive" can possibly be justified by it making my path to a longer life more convenient.

Fortunately, I really don't believe it's an all or nothing game.  The whole point is how unnecessary this waste is.  For 30 pills, they sent me four plastic bottles, an electronic temperature monintor (disposable, apparently), twelve POUNDS of gel pack at God knows what environmental cost, three cardboard boxes, one of them bristling with non-recyclable styrofoam, and a styrofoam cooler big enough for two dozen beverage cans.  

They could have delivered me these pills in the smallest size of plastic bag the supermarket sells.  I'm deeply grateful that so many people are doing research and studies that could extend and enhance my life.  But couldn't they think about the planet at the same time?  Shouldn't the professional vows that doctors take, which are focused on the welfare of the patient, take into consideration the longer-term well-being of the patients and their descendants?