Wednesday, 4 August 2010

Disease is multi-factorial?

So the situation that sparked off the initial thought for this monologue was my mother's insistence on my living in my hostel. I don't want to divulge too much, but to briefly explain:

just recently I finished my first degree, now I'm headed for Med School, as most pre-med students aim to do. That's all fine and exciting and my parents are thrilled that soon they'll have a qualified doctor in the family (soon, huh! more like 6 years) but the top-most issue or fear in their minds is the fact that I won't have accommodation.

'SHOCK, HORROR', they exclaimed (pardon my use of caps, but that's just how my folks sound), while I sat opposite them, irritated and annoyed at the fact, that once again I had surrendered another opportunity to hone my independence and decision-making skills. You see, at the start of this summer I had promised them I would look at hostels, houses, etc prior to actually moving out to campus. 'Nyahaha', I thought, 'This time I can have it all my way'. Wrong.

Due to the relatively closer proximity of the second institution of my further education, my folks, recognised an opportunity to once again take matters into their own hands and leave me out of the say. It started of harmlessly, an email correspondence between my mother and her brother in Australia. Soon enough, a plan had been hatched and now a further relative had been involved in the matter. I was previously happy with the calls I was receiving from overseas aunts, uncles and cousins, congratulating me on getting into med school. 'Yes, this is the way it should be. I will be the first doctor in this large family.', I kept thinking to myself. (when I say large I mean large. Both of my parents have 6 siblings each. On average each sibling has 2 children.) But I hadn't expected my uncle's involvement in the decision-making as to where I was going to live.

You see, my first degree I spent entirely living in hostels or university-associated accommodation. Sure there are benefits, such as added security, the opportunity to meet different people, proximity to campus, hostel-organised events, and in my latter two years, cooked meals. However, a number of my friends lived in non-university accommodation (a.k.a. flats and houses) and after being at their places most of the time for the majority of the week, you feel ashamed of inviting them around to your dingy hostel room. Yes room. First year I shared with one girl, who was sweet enough, but the next two years I was in a triple, where my roommates were continously rotated each term. That was hard to get used to. Now, I'm an amiable person, and I know I shouldn't be complaining, loads of kids have to stay at home, don't meet new people, haven't experienced university life to the max that way. Yes, I understand, but I have. To The Max! And I've found it tough to deal with when you have exams looming over your shoulder and your roommate happens to be a very chatty person. Sometimes, just having a door to shut so that you don't have to partake in every single of your roommate's actions can be a great help.

So, you can imagine that I was hoping to finally move into a house or an apartment, shared of course with a max of 2 others this fall. I've even been looking up some places and people who were offering or looking for people to live with them in apartments. And I've found the perfect place with a seemingly lovely person starting med school this autumn as well. Brilliant! So I tell my folks about it, really optimistic and excited. It all goes over well and I seem to have convinced them that it will work.

Little did I know that my mother had been scheming. Because today I receive an email from her, a forwarded message from my uncle who's organised a place in a hostel through his friend. Now hostels are fine, they have their advantages (see above) but I'm done with them. Additional disadvantages this hostel would have: a. the kids I'd be living with don't speak English, b. The kids I'd be sharing with wouldn't necessarily be studying medicine (which leads to that well-known ordeal of having to rush to the library to get some peace and quiet time), c. I'd be sharing with 3 others. After my first degree, I swore to myself, never again am I sharing ONE room with 2 other people for an ENTIRE YEAR!

I put these three points to my dad this morning and he seemed thoughtful. You can always trust my father to weigh out both sides of the argument and depend on his own morals and experience to make a decision. Or a compromise. His reply was: 'Talk to your mother about it.' Great. Now I'd have to face the dictator.

And this is where my monologue comes in. You see, these kind of talks you need to prepare. Think of a strategy. Formulate your argument. Find supporting evidence. Draw a conclusion or in the worst case, a compromise. Structured speeches, that's what it's all about.
And of course, a good rhetorician will always consider their opponent's possible counter-arguments. In my case, think of what you're mother will say to discourage you.

Now, I'm quite lucky to have at least 19 years of knowledge of what kind of arguments my mother is going to bring. For example:

* Don't do it, you might hurt yourself
* I'm not doing this to hurt you, I'm doing this so you avoid getting hurt
* You saw what happened last time you tried to do this. Do you want that to happen
* I've told you this a million times before

As you can tell, these aren't very constructive or useful arguments. No solid evidence in fact rather emotional, the line of thought is pretty much the same (i.e. always opposing my actions or thoughts) and very weak. This means I might actually have a chance of putting through my opinion and driving home the point.

However, there is one strong argument she might bring. I failed a bunch of my exams in my first year. She clings to this point and insists that this was because I spent more time cooking for myself than actually studying.

Now, as a life sciences graduate, I say this is bad science. That's a bad assumption, with a correlation between two distinctly unrelated variables. Why?
Because I know the truth. (Let's not go into how she is misinformed, due to false or incomplete reporting of the going-ons of my first year on my part. She's a laymen and my mother, so she always thinks she's right and will not hesitate to bring together two such far-fetched statements.)

You see, (and this is how I will explain it to her tonight, if she brings up the point - which she's bound to do) my failure to pass a number of exams in first year, was the consequence of multi-factorial reaction. For example, the manifestation of a genetic disease in an individual depends on a number of variables:

*Is the disease recessive or dominant? In which case, if it's recessive is the second allele present?
*For recessive disease, is it sex dependent (i.e. will it be cancelled out by an intact allelle on the second sex chromosome?) or is it an autosomal disease?
*Will the consequences of the activation of the faulty gene manifest? Is the cellular machinery required for the synthesis of the gene product available or is it itself faulty due to another mutation?
*Will the fault in the gene even allow viable cells to form? Will the organism itself be viable?

As you can see a number of questions pop up, as you carry on down the check-list and you become aware of the number of hurdles one has to overcome to even reach a state of fault. The same can be applied to a less scientific, more general human behaviour analogy:

For example, our subject Rose has been considering purchasing an article from a tele-shopping channel. Her friend, Sam has previously praised this article's function and usefulness. Now Rose may purchase the article or not, depending on number of factors, or variables, that come into the picture.

- What does she herself think about the article? Is she convinced of its function and value? Is it an impulse buy? Does she usually impulsively buy or does she prefer to weight out pros and cons before purchasing?

- What are her previous experiences with tele-shopping? Are the products generally good or low quality? Does she trust the salespeople? Where the telephone operators friendly to her last time? Has she had a bad experience?

- Does she trust Sam's judgement? Has a previous recommendation of Sam's proven to be wrong before? Has Sam lied to her before? How close is their relationship? Does she even trust Sam? Does she generally have issues trusting her friends? What does she even consider friendship? How close was she to her friends during her childhood and how much did she trust them back then?

- What if we introduce an additional factor? Rose's relative has preached to her about the inefficiency of this article. So Rose will wonder: How much do I trust this person's judgement (depending on the type of relation, past experiences with this relation, the relationship with her relative, etc)

Now you may think that this is somewhat exaggerated, particularly with the example of Rose's blast to the past to remember childhood experiences. But there is an inkling of truth. Humans, like apes, learn from previous experience. Just as babies learn not to touch the stove due to the memory of the sensation of pain and possibly the telling-off received from the mother associated with this action, monkeys have been shown to use objects as tools once they have done this before. But I'm going off into the nature vs. nurture argument now..

But as you can see, all these things are multi-factorial and not determined by a single causative factor. In fact, in life, hardly anything is. Which leads me to my conclusion. Which in effect is, that there is none. Everything is multi-factorial, but I knew and was convinced of that before I started writing. I guess there is no conclusion. Maybe that's the conclusion. There is not always a lesson to be learned from each story or stream of thought.

If this conclusion disappoints you, go back to the header of this blog. It reads:
'Incessent ramblings of the mind'
I'm sorry if I wasted your time, but I did warn you at the start.

much love from the rambler



Hello. I will be writing here more often than on the other blog so make sure to come check this one out more often.