Body and Soul and Robotic Surgery

By Corby Kummer

The Buddha-like Deepak Chopra sits down with physicist Leonard Mlodinow, and Ira Magaziner discusses his work to lower the price of AIDS drugs at The Atlantic Meets the Pacific event


I write this just off several planes from San Diego, where The Atlantic Meets the Pacific finished up late Wednesday and provided those of us lucky to be there plenty to think about: I defer to and echo Steve Clemons's praise of the level of sessions, and hope you watched the sessions too, courtesy of the miracle of live streaming.

Like Steve, I enjoyed the first morning's counterpoint of the Buddha-like Deepak Chopra, leaning forward and extending his outstretched arms as if to his thousands of followers, and the physcist Leonard Mlodinow, who would dryly break in with spirituality-deflating remarks about what is and is not scientifically provable. Chopra: "Science is a fragmented view of the universe." Mlodinow: "I don't think scientists are banished to hell." It was an obviously choreographed but nonetheless enjoyable routine.

The crux of their debate is over whether or not science can explain consciousness, and Mlodinow made what seemed the most reasoned and least treacly summation when he said:

I say that science doesn't know how to define consciousness, but not that it can't. No one thinks he doesn't have free will. No one wants to hear that their loved ones have turned to dust after death and have rejoined the earth and they'll never be reunited. I do feel we're governed by physical laws.

James Bennet, our editor-in-chief, bravely moderated -- no easy task given how often these two are performing together on tour for their new book -- and managed to ask a provocative question about how to explain evil and intentionality. Chopra had a fairly Panglossian view:

If consciousness is infinite, it excludes nothing, and the question of good and evil remains. Collective psychosis gives rise to Hitler. This does not excuse evil. It says to us that we have a responsibility, because we have free will to favor the forces of evolution and kinship to the universe we came from. Morality is the undeniable expression of the inseparability of love, compassion, truth, beauty -- an idea that I relate experientially to the web of life. If I don't, that means I am evil.

He offered what sounded like an explanatory excuse for most people who are evil: they were abused as children.

Mlodinow was predictably more rational, reiterating that all behavior all behavior originates in the "laws of nature":

Evil doesn't come from randomness. It comes from evil people or a nervous system that doesn't have the same social spirit other human beings have. Religions never did a good job of explaining evil. Humans in the wild regularly murder each other far more often than we do today; societies today teach us love. I admire Deepak's writings about humanity and taking care of each other. I take both sides of human nature and hope for the best.

There were no applause meters, but I suspected who most members of the audience instinctively sided with.

On the last morning, I interviewed Ira Magaziner about his work at the Clinton Health Access Initiative and the remarkable work it has done to lower the price of AIDS treatment drugs and new vaccines and speed and streamline their distribution. CHAI (an appealing acronym to which the session introduced me) works closely with the Gates Foundation, creating an alliance to help put in place the initiatives and goals the foundation funds.

Using Gates's "balance sheet, which is quite ample," as Magaziner dryly put it, CHAI guaranteed a minimum volume of sales for developers of a new rotavirus vaccine so that it would be accessible to people who needed it in many countries. "Forward pricing," with tiers of price levels for the poorest, middle-income, and developed countries, played off CHAI's earlier success in focusing the minds of drug manufacturers to lower the price of AIDS drugs by working directly with the Indian factories that produce most of the world's pills.

Even more ambitiously, CHAI is committed, Magaziner said, to keeping to the same schedule for the rollout of new vaccines in Africa and Asia as in developed countries, rather than the usual five-year delay. This involves work with a whole range of developers, producers, providers, and governments in more than 35 countries.

This successful and innovative model of international comity among stakeholders with very different incentives and beliefs naturally led me to ask about Magaziner's experience trying to implement health-care reform in the years when his current boss and longtime friend was president. Magaziner held fast to his opening premise that the one thing he'd learned in Washington was to answer the question he intended to rather than the one that was asked. But then he said, pointing his finger for emphasis: Let me be plain. Health care in this country is not broken. We deliver the best care in the world, and quickly. What's broken is health care financing. Not enough people have access to that care. (It was such a clear sound bite and take-home message -- as I'd asked him to give -- that James Fallows immediately tweeted it.)

The panel that followed focused principally on global AIDS work and progress being made in both basic research and experimentation -- and the threats to the budgets of the panelists there, who came from the UC San Diego School of Medicine and Sanford-Burnham Medical Research Institute, right down the street(s); the UC Davis College of Biological Sciences; and the National Institute of Allergy and Infectious Diseases. James Hildreth, at Davis, described trials of a vaginal spermicide that, if effective, could cost only 10 cents a dose -- an enormous breakthrough in prevention. Carl Dieffenbach, in charge of the Division of AIDS at NIAID (part of the National Institutes of Health) emphasized the importance of work toward both prevention and cure -- and of course treatment, an integral part of both.

Describing potential cuts to the NIH's budget and state budgets that would decimate the multidisciplinary work she is initiating at the UC San Diego School of Medicine, Steffanie Strathdee ran her finger across her throat in the visual bite of the morning. "My young researchers and fellows are waiting to hear if their studies will get funding," she said. "And waiting some more. I tell some of them, 'You might have to go back to clinical medicine for a while.' We're at risk of losing a whole generation of researchers." John Reed, of Sanford-Burnham, nodded in vigorous agreement.

Dieffenbach echoed their urgency, saying that if current NIH funding does receive the 10 percent cut that the current super-committee deliberations could result in, we could lose decades of progress against AIDS (I hope we'll be hearing more on this from him on the Life Channel).

The urgency, and hope mixed with apprehension, echoed themes that had begun at the very first session described by Steve Clemons, when James Fallows asked Elon Musk why he remained enchanted by the idea of space exploration when so many domestic programs remain to be funded. Surprisingly, Musk didn't reply with the argument any of us was ready to make: that national focus on one shared goal, and government funding of basic research in multiple disciplines, leads to the inventions, technologies, and new products that excite Musk and the rest of the conference-goers.

It was an argument explicitly made by Catherine Mohr, director of medical research at Intuitive Surgical, a high-technology surgical robotics company. (Mohr is one of the many protean figures at the conference, with a dizzying number of degrees and a past that includes racing alternative-energy cars and helping developing them before she decided to go to medical school; she was responsible for sending me the picture that spread through the world, a sign reading "In case of fire, exit building before tweeting about it.") Mohr described the Da Vinci, a robotic improvement that improves on standard laparoscopic and arthroscopic instruments by including a "wrist" -- that is, a swiveling joint that allows far more precise manipulation of the pincers at the end of the previous generation of instruments.

The device, which Intuitive has found the most success with in prostate surgery rather than the heart-valve repair it initially envisioned (it is now used, she said, in 85 percent of prostatectomies performed in this country), was made possible by DARPA funding of robotic surgery for use in war zones. Without those innovations and gains, she emphasized, the private sector could never have developed instruments of the kinds she now works with and is helping test for use in many kinds of delicate surgery (heart, eye) currently difficult or impossible to perform. Dieffenbach made a similar point when he said that treatment breakthroughs won't be made without funding of basic research -- expensive research that might have no immediate prospects of utility.

National focus, cooperation across a broad range of disciplines and borders, a united government that cares about the health of its citizens: those were some of the themes I heard throughout a really stimulating couple of days. And maybe new collaborations will come of the people who listened both in San Diego and on our livestream -- the best result of a conference like this one.

Image: Wikimedia Commons.

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