Map of life expectancy at birth from Global Education Project.

Friday, November 18, 2011

Communicative action

For those not familiar with the philosophy of Jurgen Habermas (Stanford Encylopedia of Philosophy article is here), one of his central interests is in how we go about constructing knowledge together, through discourse.

To crudely summarize (and these conventional English translations of the terms may not be the best) we can engage in either communicative action, or strategic action. The latter is basically when I'm trying to get over on you -- I have a desired outcome, I want you to do something or believe something that's going to get you to do what I want, and I engage in speech or other forms of communication to bring about that end. Communicative action is when we talk with each other, openly and transparently, to discover how we might come to agree. Any one of us may engage in strategic action at one time or another, but it is pretty much impossible for the institutional interests labeled by Habermas as "the system" to do anything else. Corporations try to sell you stuff, political action committees try to get you to vote for the interests of their donors -- you're never going to have a dialogue with them.

I expect Habermas must love the Occupy movement -- they are totally committed to communicative action, at least internally. It does have the downside that they can't state exactly what they want to happen, but then again, maybe we'll all get there together some day.

But, if I may abruptly change the subject, what about doctors and patients? You might think, since the whole point is that the doctor is looking out for your well being, that you and your doctor would be having a lot of conversations about what, exactly, you think that is, and sharing thoughts about how to get there. Well, you may not have thought about this much, but you probably aren't really doing that. I could go on about this at great length, but here's a quick story.

I met the other day with some people who are living with HIV. I was interested in how they would explain what a virus is, and basically, none of them could say much about it. A virus is something that causes disease, that's about all they knew. Now, all of these people thought their doctors were the greatest thing since oxygen, and had been living with HIV and getting treatment for it for years. But the doctor had never bothered to say how she understood the nature of a virus and the way the drugs work to control it.

So, in about two minutes, I explained it, like this. As you know, your body is made up of billions of cells, and in the center of each cell -- the nucleus -- there's a molecule called DNA. That consists of very long strings of smaller molecules which spell out the instructions for making the proteins that carry out the functions of the cell and make up the tissues of your body. The instructions are carried from the DNA into the cell by a molecule called RNA, which directly controls the assembly of the proteins.

Well, most viruses are just little pieces of DNA that contain the instructions to make more of the virus. One way or another, the viral DNA gets into a cell and its instructions take over, turning the cell into a factory that just makes more and more of the virus. HIV is a little bit different because it consists of RNA instead of DNA. Same instructions, just in a different form. You have cells circulating in your blood called T-cells, that are part of the immune system that combats viruses. Some of these T-cells have a so-called receptor -- a channel for getting stuff in and out of the cell -- called a CD4 receptor, and when HIV bumps into one of those, it injects its RNA into the cell. The RNA immediately causes a protein to be made which causes the cell to write the instructions for making HIV into the cell's DNA. At some point, that DNA will be activated and the cell will turn into an HIV factory. Over time, as more and more of these CD4+ cells are destroyed, your immune system becomes less and less effective and you start getting weird infections.

That was it. They got it. They were all astonished. It's really that simple, they understood it, and we went on to understand drug resistance and how the various drugs work, among other things. Oh yeah, exactly what those T-cells do when they're working correctly. Other stuff. In about 5 minutes. So why, in maybe 10 years, had their doctors never told them this?


Anonymous said...

Because the Doc has his expertise and he is paid for it. The relationship is by its very nature unequal, and stays that way. Also, the Doc is not trained to teach or explain, only to cure, or alleviate. Mind you, personality does intervene. I have had mechanics who tried to explain my car and their actions to me - others do not. Docs, as well, are often afraid of being mis-interpreted, or of having their words inflated, conflated, etc. They don’t know and don’t like to guess what their patient actually knows, understands, and asking is time consuming and complicated. I have had Docs speak to me as if I was a 5-year-old, in terms of ‘nasty little bugs’ and others who spoke way above my head, as they figured out I am highly educated.

I guess Cervantes can do it because he is not - their Doc.

Habermas seems to be having a come-back! Which is great.


Cervantes said...

Insightful comments, as usual.

Habermas never really went away, I think, although philosophy in general is out of fashion.