As yet poorly understood

My clever friend Liz wrote her internal medicine primaries on Friday. This meant establishing a solid grasp on everything about how the human body works (“normal physiology”) and also everything about how it goes wrong (“pathophysiology”). So for the last while her living room has been a kind of open-plan textbook, with index cards, files and drawings spread across every horizontal surface. Nothing in Ganong’s Physiology indicates that knowledge can be absorbed via respiration, but if there’s a way they haven’t identified yet, she was prepared.

On Thursday night I made her supper, and hung around trying to radiate support and a studious atmosphere (another as yet poorly understood physiological process, but it was worth a shot), while she crammed and tried not to freak out. Feeling a bit futile and deeply ignorant, I decided to page through an unattended textbook, which happened to be the near-biblical Kumar & Clark’s Clinical Medicine.

Oh my goodness.

I opened on the chapter on the immune system, and read about innate and acquired immunity, and lymphocytes and phagocytosis and opsonisation and the complement system and cytokines. Cytokines! Tiny proteins that, released in pico-molar concentrations by a cell in one part of the body, can trigger a cell somewhere else to develop a sensitivity to the specific pathogen it should seek and destroy. And another cell to do something entirely different, depending on what kind of cell it is and what other cytokines are in the area, and possibly what the receptors embedded in the cell wall lipid bilayer had for breakfast.

Those were only the bits I can sort of remember, and I almost certainly got most of it wrong. The complexity is dazzling, the orders of microtude (which is not a word) overwhelming. At every level, a question about how and why reveals a further layer of transaction, specific, finely tuned and impossibly elegant. Until a question is raised to which the answer remains out of reach. “The role of [polysyllabic chemistry word] in [extremely specific process the purpose of which I have already forgotten] is as yet poorly understood.” It surfaces more often than I expect.

Obviously, this didn’t help with the futility or ignorance, but did trigger awe and a touch of vertigo. Should we be more surprised that this is what we find – order beneath order beneath order? That at no point yet have we simply hit… soup? In the beginning, science required as its first assumption, that pattern was there to be found, that rules exist which can be uncovered and understood. The first scientists based this belief on their knowledge of God, an intentional and supremely organised creator (with, in the words of J.B.S. Haldane, an inordinate fondness for beetles). Without this starting assumption, the whole project of science was a dubious enterprise. After multiple centuries of unraveling seemingly endless order, we forget to find that surprising.

I have no intention of arguing that God, my God, is a logical conclusion drawn from the state of the universe. Logic is a fairly feeble tool for the bigger questions in life, being based on what we think we know rather than what is. Science has taken its greatest bounds where existing human logic failed entirely to explain what was being observed. A “logical” God would be frankly disappointing.

I will however observe that it’s hard to feel too complacent about human intelligence in the face of Kumar & Clark. We didn’t even know the immune system existed until fairly recently. The task of wrapping one’s head around just that one aspect of one species’ daily existence is enough to befuddle. Ten minutes and two pages, and I understood exactly why my poor friend was fighting utter panic at the prospect of Friday morning’s exam.

Against the odds, Liz studied what she still could, and then slept, and then wrote the exam, without losing the plot. She is incredibly intelligent and hard-working, but this was still kind of a miracle. Attributable perhaps to respiratory-mediated knowledge absorption or physiological positivity radiation. Or divine intervention. Or soup.

As yet, poorly understood.






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