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Why was the morning paper suddenly in a foreign tongue?

Oliver Sacks, A Neurologist's Notebook, "A Man of Letters," The New Yorker, June 28, 2010, p. 22

A NEUROLOGIST'S NOTEBOOK
An abstrct about a man suffering from alexia, an inability to recognize written language.

In January of 2002, Canadian novelist Howard Engel sent the writer a letter about his experience with alexia sine agraphia, a form of visual agnosia which results in an inability to recognize written language. On the morning of July 31, 2001, Engel awoke and discovered that he could not read the newspaper. His room looked normal, and he could still read his clock, but his books were all unintelligible, all full of the same "Oriental"-looking script. At the hospital, it was determined that he had had a stroke which had affected a limited area of the visual parts of the brain, on the left side. He spent the next week in the neurology ward at Toronto's Mount Sina Hospital. He also had difficulties recognizing colors, faces, and everyday objects, yet he was surprised to find that he could still write. 

Yet he was surprised to find, as a nurse reminded him, that he could still write, even though he could not read; the medical term, she said, was "alexia sine agraphia." Howard was incredulous: how could he lose one but not tbe other? 

The nurse suggested that he sign his name. He hesitated, but, once he started, the writing seemed to flow all by itself, and  he followed his signature with two or three sentences. The act of writing seemed quite normal to him, effortless and automatic, like walking or talking. The nurse had no difficulty reading what he had written, but he himself could not read a single word. To his eyes, it was the same indecipherable "Serbo-Croatian" he had seen in the newspaper.

Two months after his stroke, Engel had moved to a milder form of alexia. He would slowly and laboriously puzzle out words, letter by letter. Whatever language a person is reading, the same area of inferotemporal cortex, the visual word form area, is activated. Why should all human beings have this built-in facility for reading when writing is a relatively recent cultural invention? We might call this the Wallace problem, for Alfred Russel Wallace, who discovered natural selection independent of Charles Darwin. Mark Changizi and his colleagues at Caltech examined more than a hundred ancient and modern writing systems. They have shown that all of them, while geometrically very different, share certain basic topological similarities. Writing, a cultural tool, has evolved to make use of the inferotemporal neurons' preference for certain shapes. The origin of writing and reading cannot be understood as a direct evolutionary adaptation. It is dependent on the plasticity of the brain, and on the fact that experience is as powerful an agent of change as natural selection. We are literate not by virtue of a divine intervention but through a cultural invention and a cultural selection that make a creative new use of a preëxisting neural proclivity. While Howard was still in the rehab hospital, he began keeping a "memory book," to record his thoughts. More than three months after his stroke, he returned home and decided to write a new novel, "Memory Book," which was published in 2005. It was followed by a memoir, "The Man Who Forgot How to Read," which came out in 2007.

Read more: www.newyorker.com/reporting/2010/06/28/100628fa_fact_sacks - ixzz0u5nhoEa1
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How Babies Think, Scientific American, July 2010, By Alison Gopnik

Even the youngest children know, experience and learn far more than scientists ever thought possible.

Key Concepts

          Babies' and young children's cognitive abilities far surpass those that psychologists long attributed to them. They can, for instance, imagine another person's experiences and grasp cause and effect.

          Children learn about the world much as scientists do—in effect, conducting experi­ments, analyzing statistics and forming theories to ac­count for their observations.

          The long helplessness of babies may be a . . . trade-off, a necessary consequence of having brains wired for prodigious feats of learning and creativity.  —The Editors

Thirty years ago most psychologists, philosophers and psychiatrists thought that babies and young children were ir­rational, egocentric and amoral. They believed children were locked in the concrete here and nowunable to understand cause and effect, imagine the experiences of oth­er people, or appreciate the difference between reality and fantasy. People still often think of children as defective adults.

But in the past three decades scientists have discovered that even the youngest children know more than we would ever have thought possible. Moreover, studies suggest that children learn about the world in much the same way that sci­entists doby conducting experiments, analyz­ing statistics, and forming intuitive theories of the physical, biological and psychological realms. Since about 2000, researchers have started to understand the underlying computational, evo­lutionary and neurological mechanisms that un­derpin these remarkable early abilities. These revolutionary findings not only change our ideas about babies, they give us a fresh perspective on human nature itself.

Physics for Babies

Why were we so wrong about babies for so long? If you look cursorily at children who are four years old and younger (the age range I will discuss in this article), you might indeed con­clude that not much is going on. Babies, after all, cannot talk. And even preschoolers are not good at reporting what they think. Ask your average three-year-old an open-ended question, and you are likely to get a beautiful but incomprehensible stream-of-consciousness monologue. Earlier researchers, such as the pioneering Swiss psy­chologist Jean Piaget, concluded that children's thought itself was irrational and illogical, ego­centric and "precausal"with no concept of cause and effect.

The new science that began in the late 1970s depends on techniques that look at what babies and young children do instead of just what they say. Babies look longer at novel or unexpected events than at more predictable ones, and exper­imenters can use this behavior to figure out what babies expect to happen. The strongest results, however, come from studies that observe actions as well: Which objects do babies reach for or crawl to? How do babies and young children im­itate the actions of people around them?

Although very young children have a hard time telling us what they think, we can use lan­guage in more subtle ways to tease out what they know. For example, Henry Wellman of the Uni­versity of Michigan at Ann Arbor has analyzed recordings of children's spontaneous conversa­tions for clues to their thinking. We can give children very focused questions—for instance, ask­ing them to choose between just two alternatives, rather than asking an open-ended question.

In the mid-1980s and through the 1990s, sci­entists using these techniques discovered that babies already know a great deal about the world around them. That knowledge goes well beyond concrete, here-and-now sensations. Researchers such as Renée Baillargeon of the University of Il­linois and Elizabeth S. Spelke of Harvard Uni­versity found that infants understand funda­mental physical relations such as movement tra­jectories, gravity and containment. They look longer at a toy car appearing to pass through a solid wall than at events that fit basic principles of everyday physics.

By the time they are three or four, children have elementary ideas about biology and a first understanding of growth, inheritance and ill­ness. This early biological understanding reveals that children go beyond superficial perceptual appearances when they reason about objects. Susan A. Gelman, also at Michigan, found that young children believe that animals and plants have an "essence"an invisible core that stays the same even if outside appearances change.

For babies and young children, the most im­portant knowledge of all is knowledge of other people. Andrew N. Meltzoff of the University of Washington showed that newborns already un­derstand that people are special and will imitate their facial expressions.

In 1996 Betty Repacholi (now at Washington) and I found that 18-month-olds can understand that I might want one thing, whereas you want another. An experimenter showed 14- and 18-month-olds a bowl of raw broccoli and a bowl of goldfish crackers and then tasted some of each, making either a disgusted face or a happy face. Then she put her hand out and asked, "Could you give me some?" The 18-month-olds gave her broccoli when she acted as if she liked it, even though they would not choose it for themselves. (The 14-month-olds always gave her crackers.) So even at this very young age, children are not completely egocentricthey can take the per­spective of another person, at least in a simple way. By age four, their understanding of every­day psychology is even more refined. They can explain, for instance, if a person is acting oddly because he believes something that is not true. . .

The Statistics of Blickets

In 1996 Jenny R. Saffran, Richard N. Aslin and Elissa L. Newport, all then at the University of Rochester, first demonstrated this ability in stud­ies of the sound patterns of language. They played sequences of syllables with statistical regularities to some eight-month-old babies. For example, "bi" might follow "ro" only one third of the time, whereas "da" might always follow "bi." Then they played the babies new strings of sounds that either followed these patterns or broke them. Babies listened longer to the statistically unusual strings. More recent studies show that babies can detect statistical patterns of musical tones and visual scenes and also more abstract grammati­cal patterns.

Babies can even understand the relation be­tween a statistical sample and a population. In a 2008 study my University of California, Berke­ley, colleague Fei Xu showed eight-month-old babies a box full of mixed-up Ping-Pong balls: for instance, 80 percent white and 20 percent red. The experimenter would then take out five balls, seemingly at random. The babies were more surprised (that is, they looked longer and more intently at the scene) when the experiment­er pulled four red balls and one white one out of the boxan improbable outcomethan when she pulled out four white balls and one red one.

Detecting statistical patterns is just the first step in scientific discovery. Even more impres­sively, children (like scientists) use those statistics to draw conclusions about the world. In a version of the Ping-Pong ball study with 20-month-old babies using toy green frogs and yellow ducks, the experimenter would take five toys from the box and then ask the child to give her a toy from some that were on the table. The children showed no preference between the colors if the experi­menter had taken mostly green frogs from the box of mostly green toys. Yet they specifically gave her a duck if she had taken mostly ducks from the box—apparently the children thought her statis­tically unlikely selection meant that she was not acting randomly and that she must prefer ducks.

In my laboratory we have been investigating how young children use statistical evidence and experimentation to figure out cause and effect, and we find their thinking is far from being "pre­causal." We introduce them to a device we call "the blicket detector," a machine that lights up and plays music when you put some things on it but not others. Then we can give children pat­terns of evidence about the detector and see what causal conclusions they draw. Which objects are the blickets?

In 2007 Tamar Kushnir, now at Cornell Uni­versity, and I discovered that preschoolers can use probabilities to learn how the machine works. We repeatedly put one of two blocks on the machine. The machine lit up two out of three times with the yellow block but only two out of six times for the blue one. Then we gave the chil­dren the blocks and asked them to light up the machine. These children, who could not yet add or subtract, were more likely to put the high-probability yellow block on the machine.

They still chose correctly when we waved the high-probability block over the machine, acti­vating it without touching it. Although they thought this kind of "action at a distance" was unlikely at the start of the experiment (we asked them), these children could use probability to discover brand-new and surprising facts about the world. . .

These studies suggested that when children play spontaneously ("getting into everything") they are also exploring cause and effect and do­ing experimentsthe most effective way to dis­cover how the world works. . .

The brain region called the prefrontal cortex is distinctive to humans and takes an especially long time to mature. The adult capacities for fo­cus, planning and efficient action that are gov­erned by this brain area depend on the long learning that occurs in childhood. This area's wiring may not be complete until the mid-20s.

The lack of prefrontal control in young chil­dren naturally seems like a huge handicap, but it may actually be tremendously helpful for learn­ing. The prefrontal area inhibits irrelevant thoughts or actions. But being uninhibited may help babies and young children to explore freely. There is a trade-off between the ability to ex­plore creatively and learn flexibly, like a child, and the ability to plan and act effectively, like an adult. The very qualities needed to act efficient­lysuch as swift automatic processing and a highly pruned brain networkmay be intrinsi­cally antithetical to the qualities that are useful for learning, such as flexibility.

A new picture of childhood and human na­ture emerges from the research of the past de­cade. Far from being mere unfinished adults, ba­bies and young children are exquisitely designed by evolution to change and create, to learn and explore. Those capacities, so intrinsic to what it means to be human, appear in their purest forms in the earliest years of our lives. Our most valu­able human accomplishments are possible be­cause we were once helpless dependent children and not in spite of it. Childhood, and caregiving, is fundamental to our humanity.

Alison Gopnik is professor of psycholo­gy and affiliate professor of philosophy at the University of California, Berkeley. She has done groundbreaking research into how children develop a "theory of mind," the ability to understand that other peo­ple have minds and may believe or want different things than they do. She helped to formulate the "theory theory," the idea that children learn in the same way that scientists do. Investigations of chil­dren's minds, she argues, could help us resolve deep philosophical questions such as the mystery of consciousness.

Alison Gopnik's Web site: alisongopnik.com

Photographs by Timothy Archibald

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The End of Medicine As We Know It
  

The End of Medicine: Not With a Bang, But a Whimper 

by Theodore Levy
The Freeman, April 2010 • Volume: 60 • Issue: 3

Social change can be revolutionary, sudden, and swift, but more commonly it moves at a glacial pace. Yet glaciers work great change, and great damage, given enough time.

There has been much talk of people leaving the medical profession if government further bureaucratizes health care. But the odds are great that there won't be any dramatic job stoppage. No medical "Galt's Gulch" will form where masses of physicians on strike will live in peace and solitude, some building cars and others mining copper, all vowing never to return to medicine until their demands are met. Such is the stuff of fiction. But the reality is much worse.

What will happen is more insidious, though over time no less damaging. There will be an increase in early retirement, as more physicians tire of their jobs. More physicians will take time off and let their practices suffer at the margin. Patients will have slightly more difficulty making appointments . . . each year . . . year after year, though never so quickly as to lead to mass complaints or a recognition that things are obviously worse.

Coverage will be shunted to physicians' assistants, nurse practitioners, emergency department physicians, hospitalists, and partners. Fewer patients will feel they have their own doctors. This will not necessarily be worse—I don't feel I have my own McDonald's, yet the food remains as I expect—but it may be worse, to the extent quality of care depends on background knowledge of individuals.

The filter of who gets into medical school will change. Fewer will enter the field due to intellectual curiosity. More and more people who cannot tolerate bureaucracy will be weeded out. Questioning authority will become as dangerous in medicine as it is in policing or the military. The 40-hour physician work week, on the other hand, will become commonplace, and the type of person attracted to medicine will not be the type who is willing to work any longer, or any harder.

Health care will be less a service than a commodity. All your complaints will have answers, if not always the right answers. Workups will be standardized by "expert panels" allegedly educating physicians as to "best practices." And if the "best practice" is to not treat you because it is not cost-effective to society, the fact that you want and are willing to pay for the treatment will be seen as a problem rather than a solution. . . .

Does this sound unbelievable? It is happening already. In the 1990s the Office of Inspector General investigated major teaching hospitals in America. Taxpayers are billed by such institutions for training new generations of physicians. PATH (Physicians at Teaching Hospitals) audits found patients in these hospitals were commonly evaluated by medical students or interns only. Attending senior physicians were fraudulently simply "signing off," saying, "I agree," without ever seeing the patient. The University of Pennsylvania Hospital settled a PATH dispute for $30 million, and Thomas Jefferson University Hospital did so for $12 million. Anecdotes describing such problems abound, including hospital charts saying, "Physical exam shows both pupils equally reactive to light," when the patient had actually been blind in one eye for decades, a mistake much more easily attributable to the exam's never having been done than to error. . .

Pharmaceutical innovation, produced by those evil for-profit companies that even doctors love to denounce, will drop off. Not precipitously, but eventually. And people will die, as they have died since time immemorial, without anyone ever knowing what drugs might have improved or extended their lives, if only there had been greater incentives to produce them. . .

There is already a spectrum of quality available in medicine, and those with means can obtain better medical care than those without, just as O.J. Simpson was able to obtain better legal services than your average defendant—the first time. But that spectrum risks becoming more rigid, more settled. What has been, in America, health care for the poor will become health care for all but the very rich. But the cost curve will bend downward.

Or will it? Medical salaries will bend downward, certainly, but administrative costs associated with government programs are always huge, and always underestimated. Medicare spending now is an order of magnitude higher than the projections in 1965 of what it would be now. But we do know this: Bending the cost curve of medical care in either direction comes with costs. . .

We'll pride ourselves, as we do now, on "the best health care system in the world," even while we also brag that we have universal care, just like the great nations of Europe. And we'll suffer with double-digit unemployment, just like the great nations of Europe. And we'll have lower growth in productivity, just like the great nations of Europe. And we'll have smaller houses and cars, just like the great nations of Europe. But it will be all right, because we'll be able to wait . . . and wait . . . and wait . . . for our turn at the health care that is our right.

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