Why Us? A Synopsis
The triumph of science now seems almost complete. The extraordinary developments in cosmology and astronomy, the earth and atmospheric sciences and many other disciplines in the past sixty years allow us for the first time in human history (astonishingly) to hold ‘in our mind’s eye’ the entire history of the universe: from the moment of the Big Bang to the creation of our solar system, the formation of the earth and the subsequent emergence of life – culminating five million years ago when the earliest of our ancestors first walked upright across the plains of central Africa.
There remained, however, till recently two great unknowns, two final obstacles to a truly comprehensive theory that would also explain our place in that universe. The first is how it is that all living things reproduce their kind with such precision from one generation to the next. The ‘instructions’, as is well recognised, come in the form of genes strung out along the two intertwining strands of the Double Helix in the nucleus of every cell. But the question still remained, how do those genes generate that near infinite diversity and beauty of form, shape and size and behaviour that distinguish one form of life from another?
The second of those ‘great unknowns’ concerns the workings of the brain: how does the electrical firing of its billions of nerves ‘translate’ into our perception of the sights and sounds of the world around us, our thoughts and emotions and the rich inner landscape of personal memories.
But then, from the mid-1980s onwards, remarkable advances in genetics and neuroscience promised to resolve these final questions. They were the astonishing and technical achievement of spelling out the full complement of genes – the genome – of worms, flies, mice, primates and humans; and second, the immensely sophisticated brain scanning techniques capable of observing the brain ‘in action’ – seeing, thinking and acting on the world.
Their findings have indeed transformed, beyond measure, our understanding of ourselves – but in a way quite contrary to that anticipated. The genome projects were predicated on the reasonable assumption that spelling out the full complement of genes would clarify, to a greater or lesser extent, the source of that diversity of forms that marks the major categories of life. It was thus more than disconcerting to discover that virtually the reverse is the case the near equivalence of a (surprisingly modest) 20,000 genes across the vast spectrum for a millimetre long worm to ourselves. It was similarly disconcerting to learn that the Human Genome is virtually interchangeable with that of our fellow vertebrates the mouse and our primate cousins. “We cannot see in this why we are so different from chimpanzees,” remarked the director of the Chimp Genome Project. “The obvious differences cannot be explained by genetics alone.” This would seem fair comment but clearly leaves unanswered the vital question of what does account for those distinctive features of standing upright and our prodigiously large brain.
More unexpected still, the same regulatory genes that cause a fly to be a fly, it emerged, cause humans to be humans with not the slightest hint of why the fly should have six legs, a pair of wings and a brain the size of a full stop, and we should have two arms, two legs and a turbo sized brain. Those ‘instructions’ must be there, of course, but we have moved in the wake of these genome projects from supposing we knew the principles of that greatest of marvels, the genetic basis of the infinite variety of life, to recognising we have no conception of what they might be.
Paralleling such perplexities, neuroscientists observing the brain ‘in action’ discovered that it fragments the sights and sounds of every transient moment into a myriad of separate components, with no compensatory mechanism that would reintegrate them together into that personal experience of being at the centre of a coherent, ever-changing world.
Meanwhile, the greatest conundrum of all remained unresolved – how the monotonous electrical activity of those billions of neurons the brain becomes the limitless range and quality of subjective experiences of our everyday lives – where every fleeting moment has its own distinct unique intangible feel: whether cadences of a Bach cantata are so utterly different from the lingering memory of that first kiss.
The implications are clear enough while theoretically it might be possible for neuroscientists to know everything about the physical structure of the brain, its ‘product’ the mind with its thoughts and ideas, impressions and emotions, would still remain unaccounted for. “We seem as far from understanding the brain as we were a century ago,” remarked the editor of Nature John Maddox. “Nobody understands how decisions are made or how imagination is set free.”
These twin setbacks to the scientific enterprise might, at any other time, have been relegated to the category of problems for which science does not, as yet, have the answer. But when cosmologists can reliably infer what happened in the first few minutes of the birth of the universe, and geologists can measure the movements of vast continents to the nearest centimetre then the inscrutability of the genetic instruction that should distinguish worm from mouse, man from fly, and the failure to explain something as elementary as what constitutes a thought suggests we are in some way profounder and more complex than the physical world to which we belong.
“There is a powerful impression,” writes James Le Fanu, “that science has been looking in the wrong place, seeking to resolve questions that somehow lie outside its domain. It is not just a matter of not knowing all the facts but rather a sense that something of great importance is ‘missing’, that might conjure the richness of the human experience from the bare bones of our genes and brains.”
We are, argues James Le Fanu, on the brink of a major intellectual shift – comparable perhaps to that of Galileo’s liberation of astronomy from an earth centred cosmos. We are compelled by the recent findings of genetics to recognise the deep inscrutability of the near infinite variety of forms of the living world. Again we are led through the recent findings of the neurosciences to recognise the insuperable gap that separates the working of the brain’s neuronal circuits from the powers of perception, reason and imagination of our extraordinary minds. Certainly, for the foreseeable future, there seems no need to defer to those who would appropriate our sense of wonder at the glorious panoply of nature by their claims to understand it. Rather, every aspect of the living world from a humble fly to ourselves now seems once again infused with that deep sense of mystery of ‘how can these things be?’
Reviews and Comments
‘Scientifically erudite and beautifully written… a sense of wonder is evident on every page’<
Christopher Booker: The Spectator
‘An extraordinary work of science… quite wonderfully refreshing.’
A N Wilson: Readers Digest
The Rise and Fall of Modern Medicine: A Synopsis
The Rise and Fall of Modern Medicine investigates a baffling contemporary paradox. The medical achievements of the post-war years rank as one of the supreme epochs of human endeavour. It is now almost impossible to imagine the world of sixty years ago when children still died from polio and diphtheria; when there were no drugs for treatment of Parkinson’s, rheumatoid arthritis or schizophrenia; and when open-heart surgery, kidney transplants and test-tube babies were unrealisable fantasies.
Yet despite this exemplary vindication of the power of science, the future of medicine is dark and uncertain, its practitioners no longer sustained by the sense of optimism of earlier decades. Meanwhile the public are encouraged quite wrongly to believe their everyday lives are full of hidden hazards and the escalating costs of medical care undermine the ideal of a universal and equitable treatment for all.
The answer to this paradox, James Le Fanu argues, lies in the changing fortunes of the intellectual forces that created the post-war medical achievement –clinical science, technology and pharmaceutical innovation. He describes the people and events of medicine’s ‘Golden Age’ of the three decades following the end of the Second World War during which virtually all the most significant medical developments occurred. And then, for complex reasons, medicine’s apparently relentless march of progress confronted a seemingly insuperable barrier to further advance. This created an intellectual vacuum rapidly filled by two powerful and radical ideas: The Social Theory that proposes the cause of most common illnesses lies simply in people’s social habits; and The New Genetics which promises to explain disease at its most fundamental level of the genes strung out along the Double Helix. These theories are certainly plausible and still dominate medical research – but their promises remain unfulfilled. Meanwhile the last great problem confronting medicine, the causes of common diseases, remain unresolved.
The Rise and Fall of Modern Medicine is a riveting human drama in which the virtues of imagination and perseverance give way to the vices of hubris and self deception. It illustrates both the power of the scientific method in pushing forward the boundaries of knowledge, but also the constraints imposed by the inscrutable mysteries of biology.
Reviews and Comments
"The best book on the history of medicine I have ever read. Thoroughly fascinating, immensely readable."
Norman F Cantor, Professor Emeritus of History at New York University.
"Perhaps the finest, most informative, most interesting historical review of modern medicine now available. The book is a gem." Robert J White, Professor of Neurosurgery, Cleveland, Ohio
"Well written, fascinating and informative …"
Anthony Daniels, Sunday Telegraph
"Le Fanu’s book is as lucid as it is comprehensive … An easy and fascinating read, studded with little-known facts …"
Thomas Stuttaford, Literary Review
"The skill [of medical journalism] is to write with humanity and objectivity, a dual responsibility brilliantly fulfilled by the author … This excellent book has changed many of my views."
David Owen, Spectator
"James Le Fanu writes with clarity and authority and has the great knack of making even the most complex technical developments exciting and intelligible … Erudite and absorbing."
Roy Porter, The Observer