Review of Pollack's "The Missing Moment"

Meta 166. 1999/12/20. Approximately 2567 words.

Below is a review of Robert Pollack's new book "The Missing Moment:How the Unconscious Shapes Modern Science." The review is written byNat Lehrman in New York. The largely positive review below isbalanced by another review by Stephen Hall in the New York Times BookReviews on December 19, 1999 entitled "All in the Timing: A biologistexplores the effect of time on humans and science". The NYT Reviewcan be read online at<>.

Pollack, it should be noted, has recently founded the Center for theStudy of Science and Religion at Columbia University. For moreinformation, go to < >.

-- Billy Grassie

Subject: Book Review of Pollack's "The Missing Moment"From: "Dr. N.S.Lehrman" <>

Review for META by N.S. Lehrman, M.D., former Clinical Director,Kingsboro Psychiatric Center, Brooklyn, of

The Missing Moment: How the Unconscious Shapes Modern Science. RobertPollack. Houghton Mifflin, Boston, 1999. ISBN 0-395-70985-7


Introduction1. Sensation2. Consciousness3. Memory and the Unconscious4. The Fear of Invasion5. The Fear of Insurrection6. The Fear of DeathConclusionAppendix: An Agenda for a More Humane ScienceNotesFurther Reading

This book is a stunningly successful effort by a distinguishedbiologist to use new molecular biology and old Talmudic wisdom toevaluate important current public health and biomedical sciencepractices. Its author, Columbia University professor Robert Pollack,is founding Director of its new Center for the Study of Science andReligion and former Dean of its College. The book, despite itspuzzling title, demonstrates "the difference between scientificknowledge and scientific wisdom" (p.1) by pointing out fundamentalerrors in public health and biomedical science practises today - thelatter being "at war with its own stated purposes" (p. 79).Recognizing the difference between knowledge and wisdom can helpcorrect the blind, near-idolatrous science-worship sometimes found indiscussions of the science-religion relationship.

The book's first half lucidly describes how the immune and centralnervous systems develop and function. The second half demonstratessome fundamental errors in our approaches to infection, cancer, andaging and dying. The conclusion discusses the implications of theseerrors, and an appendix offers a detailed "agenda for a more humanescience."

Sensation and subjective consciousness, whose neurologicalunderpinnings the book discusses in glorious detail, are based on "aset of changes in neural networks." (p. 42) Mental function dependson "evanescent networks of brain cell clusters linked by thecoincidence of their firing," (p. 43) all regulated by biologicalclocks. And although inborn circuitry is important, it is individualexperience which determines whether or not needed brain circuits -
the basis of psychological functioning - are actually established.

Pollack points out the immense number of cells and connections, andthe rapid changes, involved in brain activity, to refute the claimsof "artificial intelligence" supporters about future synthetic minds.Since "no two brains are the same, and no brain ever has the samecircuit twice," it is "unlikely that consciousness will ever besuccessfully modeled by a hardware-driven technology, no matter howsmall, fast or complicated." (p. 46) The same conclusion wasreached by John Horgan's fine new book, "The Undiscovered Mind."Pollack also affirms the widely-denied importance of emotionality asdriver of both thinking and behavior by noting the "richly emotionalcontext in which science actually takes place." (p. 58). And afterexamining the genic evolution of the human body, the result ofgradual but massive modifications of earlier biological structures,he points out (p. 21) "how natural selection differs from consciousdesign." .

Infection and "the fear of invasion"

Pollack's yardstick for measuring current approaches to infection andcancer is our immune system's mode of dealing with harmful agents:when infectious microbes invade, the system domesticates rather thaneradicating them, so it can remain primed against future invasions.This is, of course, the basis of immunization.

Today, however, the prime focus of infectious disease research is thesearch for ever-new drugs to eradicate these invading agents. New,mutated, drug-resistant organisms are the inevitable result."Redoubled efforts to develop and distribute new vaccines, theworld-wide reporting of outbreaks of infectious diseases and the widedissemination of what we already know about epidemiology andpreventive medicine" (p. 100) are, to Pollack, appropriate goals forinfectious disease research.

"The three tools of public health that can keep microbial efforts atbay - an enhanced immune response, clean drinking water and insectcontrol - were developed to high degrees of sophistication more thana century ago, and were very successful," he points out. "Yet at thefirst victory of antibiotics, all three were set aside and forgottenas research strategies. As the great strategy of killing infectiousagents and their vectors continues to breed its own failures, we needto recover the memory of these earlier successes." (p. 102) Pollackis particularly shocked at how, "in 1986, just as tuberculosis wasbeginning to surface in AIDS patients, the United States government'sCenters for Disease Control and Prevention - the CDC - ceased torequire hospitals to report cases of INH-resistant tuberculosis. Thetiming could not have been worse. With this decision, INH-resistanttuberculosis was given the time and chance it needed to send forthvariants that would be resistant to other drugs as well." (p. 95)

Millions of deaths occur each year from focusing almost exclusivelyon drugs and neglecting other methods of dealing with infections."Five million babies, for example, died in 1992 of serious childhooddiseases like measles, tetanus, diarrhea, whooping cough and poliobecause they were not properly vaccinated. Currently more than amillion American children under the age of three have not receivedthe vaccines that would have immunized them against" these diseases."Each of these children is a walking time bomb." (p. 103) And whileone group of surveyed physicians thought that 90% of their youngpatients had been vaccinated, only 40% actually had been. Bill Gatesgave $75 million since the book appeared to ensure neededimmunizations for all American children.

Cancer and "the fear of insurrection"

"Just as every infection is an invasion of the body, every tumor isan insurrection from within," Pollack notes. (p. 106). "A mutationin any of hundreds of different genes may allow a cell to break freeof the constraints of differentiation. Thereafter, the geneticallyaltered descendants of that cell will continue to divide, possiblyforming a clone of mutant cells, each capable of unlimited furtherdivision. When the clone gets big enough to disrupt the architectureof the tissue it displaces and to spread its descendants through thebloodstream to distant parts of the body, we recognize it as amalignant tumor." (p. 107)

Killing cancerous cells while sparing their normal cousins has beenthe primary approach to cancer for the past fifty years. This"resembles to an uncanny extent the current strategy for dealing withinfectious disease by searching for new families of antibiotics." (p.108) The growing tumor throws off a cloud of genetic variants, sothat any mutant cells that survive the body's defenses and themedicine's assaults can become the seeds of new resistant tumors.Some cancer victims therefore succumb to the progeny ofdrug-resistant, radiation-resistant variants of their tumors, just assome people die of secondary infection by antibiotic-resistantmicrobial variants evoked by the drugs intended to kill them.

Cancers arise by mutation and are therefore preventable. Only asmall percentage are the consequence of an inherited condition, andbut a few more are the product of infectious agents. (p. 109) 90%or more of new cancers result from avoidable habits and preventableexposure - to tobacco smoke, pesticides in foods, pollutants in theair and water, radiation and drugs, all of which can cause mutations."Given the will, these can be changed at any time without the needfor any further basic research."

Nevertheless, cancer prevention, so much simpler and easier thancuring it, is largely ignored in cancer research today. It focusesinstead on genes associated with higher cancer risk, on the premisethat one day, the information will provide better drugs to kill everylast tumor cell - an agenda Pollack sees as "woefully incomplete atbest and absurd at worst." "To discover precisely which chemicalswill cause cancer when they enter the bloodstream and then - insteadof working to remove these chemicals from everyone's food, air andwater - to study the genetics of the liver proteins that detoxifythem, is to be in a waking dream." (p. 111)

Cancer scientists' dream of total victory after total war has ledthem to wrap their "research in military metaphors over the decades"- four separate "wars" aimed mostly at killing every last cancercell. The first, in the 1930's and 40's, was useful by fightingcancer with information by stressing self-examination and earlydetection. Radiation, seen as "a clean new knife that would removeall traces of the disease from a sick person's body," although stilluseful, lost much of its sheen when radiation-resistant tumor cellsappeared in many treated patients. The third war, against infectiousagents - especially viruses - "was going no better in 1975 than thewar on Viet Cong insurgents. Neither was going to be won by theforces of the United States government, and Congress was no longerwilling to support either. By 1980, the Special Virus Cancer Programhad been partially disbanded." But in that one decade, the budget ofthe National Cancer Institute grew from $240 million to $1 billion.

Today's "war," the fourth, focuses on the genes specifically mutatedin cancers. But the recent discovery that some of the geneticdifferences converting a normal cell into a cancerous one could alsobe inherited thorough the human germ line opened an unexpected,dangerous second front; remarkably high frequencies of specificcancers are found in those rare families in whom such a mutation hasbeen inherited. But "while avoidable cell mutation is responsiblefor the vast majority of cancer, and germ-line mutation isresponsible for only a few, scientists on this new front imagined allcancers to be problems of family inheritance rather than randommisadventures" - predestined rather than preventable.

"The search for genes associated with higher likelihood of developinga tumor has been vested with magically high expectations on thepremise that one day it will somehow lead to better treatment." (p.117) But harm has been created in the interim. Cancer, apreventable disease which can strike anyone, has been reinterpretedas an inherited disease which cannot be escaped if one chose his orher ancestors poorly. Cancer itself has thus been transformed from athreat to us all, and therefore a preventable social problem, into apersonal problem, limited to those placed at higher risk by geneticendowment. The results are pernicious: for some, unnecessary fears;for others false reassurance, which can breed carelessness - denyingthe importance of self-examination, for example.

Aging and "the fear of death"

Our current ways of dealing with the dying are measured against ahumanistic yardstick provided by the Hebrew Talmud: someone beyondmedical help and expected to die within three days neverthelessretains his basic human rights and social needs; the quality of hislast days may be more important than their mere number. "Leaving thedying person alone in a cold room with tubes and monitors blockingall human interaction" (p. 148) neither respects the dying person'sdignity nor improves the quality of his final days. Pollacktherefore strongly endorses the use of hospices - as well as usingenough drugs to stop pain.

Pointing out how "medical scientists treat very old age, dying anddeath with equally fastidious disdain, as though they were allsomehow intrinsically uninteresting," (p. 145) Pollack cites therecommendation by the Hastings Institute's Daniel Callahan thatscientists and physicians accept the inevitability of death ratherthan seeking endlessly to prolong life, shift from doing everythingit takes to keep an old person alive to a commitment acknowledgingthe finiteness of life, and research improving the quality of thefinal years. (p. 149) Since aging involves damage to stem cell DNA,research on slowing the aging process by enhancing repair of that DNAmight be fruitful - and without denying the inevitability of death.The human organism does have physiological limits, apparently reachedin our 80's or 90's, beyond which life probably cannot be prolonged.

Pollack's conclusions

Although "scientific discoveries paint a coherent and clear pictureof the living world and of our place in it that is notable for itscomplete lack of meaning," Pollack seeks meaning for himself, and thefuture, hoping that "the science of the future will be made by menand women who have found meaning in their lives." "Meaning" to himapparently means the existence of something above oneself to which weare accountable , whether that be God or Moral Law. After remindingus of the often-forgotten dangers of science without morality - theallegedly "scientific bases" of the real-life Soviet and Naziexperiences, and the fictional "Brave New World" and "1984" - hepoints out the need for moral leadership in science, centered onfreedom of thought and an ideal "mind of society."

Greatly increased emphasis on immunizations to prevent infectiousdiseases, more stress on prevention in the fight against cancer, andcautious efforts to treat it by "a slowly evolving combination ofgenetic, immunologic, and antibiotic interventions" (pp. 173 -174)are at the heart of his "agenda for a more humane medical science." He warns particularly,however, against the increasingly popular efforts to change humanembryos' DNA, thus sacrificing the current generation for the next,because of the unknown, widespread and possibly harmful effects whichcan result from efforts to change one known aspect of the embryo.

This erudite book's only weakness is in blaming - most visibly in itssubtitle - "the unconscious" of scientists rather than conscioushuman agency for the problems it examines. Most central nervoussystem processes occur outside of consciousness (which can perhapsbest be defined as the subjectively-aware aspect of makingverbalizable choices). This apparently provides the rationale for thebook's erroneously equating and lumping together two very differentaspects of unconscious mental activity: the initial tenth of a secondof our response to stimuli before they register in our consciousness(the "missing moment") and the Freudian "unconscious," whichsupposedly makes its own complex, difficult decisions, including the"shap[ing of] modern science," outside of consciousness. Indeed,Pollack uses the concept of scientists' unconscious fears - ofinvasion and insurrection, and especially of death - to link hischapters on infection, cancer and aging.

While scientists' fears may be significant in our mishandling ofaging and dying, drug company bottom lines and the self-aggrandizinggenome project, for example, are far more responsible for themishandling of infectious and malignant diseases. Who wasresponsible for the CDC's decision to stop reporting drug-resistanttuberculosis? And Pollack's claim, from Freud, that theinevitability of death is not merely a major motivator but one of thegreat discoveries of the past century (along with evolution and howthe brain works) seems a bit much.

The book is, however, Pollack's brilliant, courageous, highl successful effort to use his own religious, humanistic wisdom toexamine and correct both the dehumanization which exists withinimportant segments of medical practice and biomedical research andthe current worship of "science" as infallible.

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