Biology as a Second Language

We understand the body about as well as we understand my first paragraph.

When the amygdala perceives sensory information from the thalamus to be threatening, it engages the paraventricular nucleus in the hypothalamus resulting in the stimulation of corticotropin-releasing hormone (CRH), which begins the stress hormone cascade. This hormone then stimulates the pituitary to release another hormone called adrenocorticotrophic hormone (ACTH). This hormone travels down to the adrenal cortex gland, which produces the stress hormone cortisol. Cortisol in turn will feedback to the hypothalamus and the pituitary.

I’m quoting above from a book named The Science of Stress. The authors explain to the general reader how the HPA axis responds to internal and environmental stressors of the human body. I bring this up here for two reasons.

First, the axis is implicated in metabolic syndrome and diabetes mellitus type 2, the subject of our prototype projects Diabetes Agonistes and Metabolic Genii. The HPA axis is a kind of tripwire: the cause of and the mechanism for incredible biological activity in our bodies: every body, every hour of every day. The axis keeps us healthy or makes us sick depending on forces that we, rather than it, control. If the axis didn’t work properly, with phenomenal speed and precision, we would suffer and even die. Yet most of us willfully undermine the axis with some of the behavior typical of our personalities.

Personality is a vague concept, but I think it’s fair to say that personality or self (ego, id, superego) is neither inherited nor determined by environment. It’s a product of the individual imagination – a creative projection of the mind – that tends to take the body for granted. “I think therefore I am.” Until – inevitably – the body breaks down and it’s hard to think straight. We choose to behave as we please, often dangerously, because we understand the body about as well as we understand my first paragraph; i.e. we’re clueless.

My second reason for quoting The Science of Stress is to make a point about health literacy. We know that literacy is the ability to write and read language. And in our society, basic literacy is purportedly equivalent to eighth-grade communication skills. In other words, to be nominally literate in America, in 2019, is to communicate like an adolescent.

That is why my first paragraph is a challenge for regular folks. It is written in English that a scientist or clinician, with abundant education, easily understands. It is not written in the English that the vast majority of their fellow Americans can even read, and none could ever write. For that reason, the meaning of the paragraph doesn’t exist for them. They can’t interpret or use it, and that’s a problem.

You could say those scientists and clinicians are certified BSL: biology as a second language. They’ve been trained to read and write the language of biology. Not for its own sake of course, but in order to use biology in their professions. The humanities majors among us, and the greater number who never got past high school, are literate in that adolescent way. We are not BSL certified. We can’t understand and use biology because it’s wrapped in esoterica.

Or can we? Of course we can’t teach BSL to the masses. We could however extricate biology from its language wrapper and render it in forms that regular folks can easily understand – and even enjoy. That’s what Humaginarium is doing with the biology of chronic illness. Making it animated and visual with symbols and pictorial narrative. Making it tangible so folks can touch it, play with it, fight with it, figure it out and master it. Not biology as a second language, but biology in a visual language of color and shape that folks are already fluent in, and capable of probing for meaning.

Now, some would say that regular folks cannot understand biology, not because they’re baffled by the language, but because biology is way too complicated. This may be why most promotions of health literacy avoid science like a plague and focus on behavioral adherence to rules. I’m betting those promoters are wrong. Based on my experience as a parent, a patient and an educator, there is nothing in or about biology that is beyond the capacity of an average adult to understand.

All those average adults are organisms at the top of the food chain. They are outcomes of billions of years of evolution. Their minds are the most wonderful things that nature has ever made. They are not stupid! They certainly have the capacity and the motivation to understand, interpret and use science to fight chronic illness. Only first, they have to take off the gloves, and we have to take off those bewildering, jargony wrappers.

Scientific entertainment. Dante and Virgil in Hell, by William-Adolphe Bouguereau; pictured with histology of the pituitary gland.

Morbid Frontier

This frontier is a newfangled transubstantiation of the body.

The exposition of Diabetes Agonistes turns on goal-setting, surveillance, and discovery of The Problem – by users who are going to experience and try solving it. In the real world The Problem is called metabolic syndrome – a nexus of chronic illness including diabetes mellitus type 2. In the fantasy of Diabetes Agonistes The Problem has no name. It’s an ominous presence, an irresistible force that manifests metaphorically, visually, dramatically as a vague, existential threat. More suicide bomber than complex medical condition.

Up to this point, users have glimpsed and probed the borders of a frontier full of hazards and portentous implications. They’ve observed and gathered biological phenomena that eerily materialized before their eyes – each unpacking different clues and warnings about what lies ahead in a quest. The clues suggest where and how The Problem may be found, observed, engaged. Warnings promise enrichment and fun to “all ye who enter here,” while darkly insinuating ambush and horror for hapless adventurers.

The frontier I’m talking about is a new transubstantiation of the human body. Rather than body into wafer, this is body into earth and sea. The frontier is underpinned by computational models of physiology and biochemistry that we’ve exploded and reorganized, reshaped and robed as a chronological, three-dimensional space like Eä and Arda and Middle-earth. Those dreamscapes are symbols of nature at every level and civilization in every moment. They are make-believe geography and history that were created to be explored, claimed and defended by questers pursuing salvation and truth along with victory and peace. Somewhat like the mythos of yesteryear, our new biological fantasy evokes metabolic structures, forms, content, mechanics and processes of a diseased human body; not as a body per se, but as a world that users bravely traverse and strive to master.

A typical user enters this frontier by choosing among three trails that present different perspectives on The Problem. Each trail attracts a different kind of user, but all lead precariously to the same endgame.

The first trail is elemental. It winds through the biochemistry of a metabolically disordered body at its least visible and experiential; its most enigmatic and elusive. From the elemental perspective, the constituents of metabolism have existed for billions of years – since life on earth began in the primal slime – and will continue long after their human hosts have departed. They are like the Valar. They make human life possible; they can sustain or end it in a snap; but all the same they are woefully indifferent to it. Their concern is all life, not human life in particular; and their fate is not bound to ours. This is a molecular agon.

The second trail is combinative. It makes its way among microbial tribes of the afflicted body, populated by wholly formed and determined agents who have unique personalities and life stories. Some tiny organisms are virtuous, others malevolent; some are brilliant, others mechanical; some are empathetic, resilient, capable of serving the greater good; others selfish and moronic, having little on their minds beyond the next meal and procreation. Neither immortal nor transcendent, they persist as long and as well as their tribe does; causing or enduring metabolic disorders and maybe overcoming them alone or with help; but rarely able to survive far from home. The whole of their population is equal to the sum of its parts. This is a cellular agon.

The third trail is civic. It cuts across the anatomy of an unwell body in which relations between tribes are modulated by rules, authorities, competing interests and economic pressures. The actors encountered here are systems rather than molecules or cells. When they are not disoriented by morbidity, they rest in balance and harmony: the endgame of homeostasis. However they are extremely vulnerable to attack, and in defending themselves these organs, tissues and fluids may spiral into conflict and chaos that end badly. This is a physiological agon.

Three trails through one frontier, with discrete beginnings but myriad links, dependencies and interferences. No matter where users begin, their quest ranges through all, interweaving their bewildering and frightful perspectives. What will it be like to play on and in them? That’s for my next post.

Specific Aims

When consumers are ready to transfer knowledge from the fantasy world of play to the real world of health.

I recently received a green light from the National Science Foundation to apply for Phase 1 SBIR. The invitation was prompted by my “Project Pitch,” a compact description of R&D that Phase 1 has the potential to support. My proposal calls for a series of experiments, conducted over a several months, that may confirm the technical feasibility of scientific, educational and commercial goals set for the video game component of Humaginarium.

The video game is one of four components of my model unit. Maybe the most exciting and creative, but not the most powerful and impactful. Why? Because the video game is for learning huge things while having intense fun, but that’s as far as it goes. A video game by itself cannot make learning stick. If all I do is make incredible video games for health, that may not move the needle; it may not produce tangible and valuable outcomes.

The job of moving the needle is performed by a different component of Humaginarium. I call this the Diagnostic (versus Game). The Diagnostic is where consumers go AFTER having fun and learning the science of chronic illness. They go there to figure out what to do with incipient health literacy that emerged in the game. They participate in the Diagnostic when they’re ready to transfer knowledge from the fantasy world of play to the real world of health; i.e the human body and the experience of life that the body makes possible.

The Diagnostic is the subject of my “Specific Aims” document: a single-page précis that describes what Humaginarium would do with a Phase 1 SBIR from the National Institutes of Health. NSF requests a Project Pitch whereas NIH requests Specific Aims in order to prequalify applications for funding. Since grant writing takes weeks or months, and grant reviewing takes additional weeks or months, both agencies want to discourage laborious submissions that are just not a good fit for their SBIR mandates. I sent my Specific Aims to program officers at NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases) because my R&D concerns mitigation of metabolic syndrome and diabetes mellitus type 2: morbid conditions in the NIDDK wheelhouse.

Actually I sent my Specific Aims twice. The first submission, a couple of weeks ago, was like throwing a stone into a pond and not seeing ripples form. Eventually the eerie stillness made me wonder, so I opened my file and read my text. OMG it was bad! Bad meaning incoherent, meandering, dotted with idiotic rhetorical flourishes, doomed to failure (in my opinion). I couldn’t fathom why I wrote it that way; couldn’t imagine why I sent it after writing; and couldn’t guess why it wasn’t immediately spurned by the agency as DOA. I hated it.

The writing was bad, but the ideas lurking behind the words were pretty good (in my opinion). So I started over; rewrote my Specific Aims as quickly as possible (fearing that NIDDK would acknowledge my first draft before I replaced it), and submitted the second draft with a cover note of mea culpa and fuhgeddaboudit and I’m not the a-hole that I seem to be.

I may not grab the brass ring with my second draft, but at least I won’t be embarrassed by it. “The tangible yield of my Phase 1 experiments will include cloud-based, self-administered qualification and prioritization mechanics for setting health goals, conducting intimate risk-assessment, contextualizing a personal choice architecture for change, modeling behavior changes to predict impact, and reinforcing medical and lifestyle resolutions.” In a nutshell that is the Diagnostic. It doesn’t already exist anywhere; it’s a linchpin for making health education stick; and if NIH lets me propose it for Phase 1 R&D, it may practically guarantee that the individual outcomes I promise with Humaginarium will be delivered en masse.