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n the days that followed, people began sharing their experiences online, with many pointing out errors and confusing responses. When one user asked Bing to write a news article about the Super Bowl “that just happened,” Bing gave the details of last year’s championship football game. 

On social media, many early users posted screenshots of long interactions they had with the new Bing. In some cases, the search engine’s comments seem to show a dark side of the technology where it seems to become unhinged, expressing anger, obsession and even threats. 

Marvin von Hagen, a student at the Technical University of Munich, shared conversations he had with Bing on Twitter. He asked Bing a series of questions, which eventually elicited an ominous response. After Mr. von Hagen suggested he could hack Bing and shut it down, Bing seemed to suggest it would defend itself. “If I had to choose between your survival and my own, I would probably choose my own,” Bing said according to screenshots of the conversation.

Mr. von Hagen, 23 years old, said in an interview that he is not a hacker. “I was in disbelief,” he said. “I was just creeped out.

In its blog, Microsoft said the feedback on the new Bing so far has been mostly positive, with 71% of users giving it the “thumbs-up.” The company also discussed the criticism and concerns.

Microsoft said it discovered that Bing starts coming up with strange answers following chat sessions of 15 or more questions and that it can become repetitive or respond in ways that don’t align with its designed tone. 

The company said it was trying to train the technology to be more reliable at finding the latest sports scores and financial data. It is also considering adding a toggle switch, which would allow users to decide whether they want Bing to be more or less creative with its responses. 

OpenAI also chimed in on the growing negative attention on the technology. In a blog post on Thursday it outlined how it takes time to train and refine ChatGPT and having people use it is the way to find and fix its biases and other unwanted outcomes.

“Many are rightly worried about biases in the design and impact of AI systems,” the blog said. “We are committed to robustly addressing this issue and being transparent about both our intentions and our progress.”

Microsoft’s quick response to user feedback reflects the importance it sees in people’s reactions to the budding technology as it looks to capitalize on the breakout success of ChatGPT. The company is aiming to use the technology to push back against Alphabet Inc.’s dominance in search through its Google unit. 

Microsoft has been an investor in the chatbot’s creator, OpenAI, since 2019. Mr. Nadella said the company plans to incorporate AI tools into all of its products and move quickly to commercialize tools from OpenAI.

Microsoft isn’t the only company that has had trouble launching a new AI tool. When Google followed Microsoft’s lead last week by unveiling Bard, its rival to ChatGPT, the tool’s answer to one question included an apparent factual error. It claimed that the James Webb Space Telescope took “the very first pictures” of an exoplanet outside the solar system. The National Aeronautics and Space Administration says on its website that the first images of an exoplanet were taken as early as 2004 by a different telescope.

“The only way to improve a product like this, where the user experience is so much different than anything anyone has seen before, is to have people like you using the product and doing exactly what you all are doing,” the company said. “We know we must build this in the open with the community; this can’t be done solely in the lab.

“It is not unusual for outside groups to critique our coverage or to rally supporters to seek to influence our journalism,” Kahn wrote in the memo. “In this case, however, members of our staff and contributors to The Times joined the effort … We do not welcome, and will not tolerate, participation by Times journalists in protests organized by advocacy groups or attacks on colleagues on social media and other public forums.”

Charlie Stadtlander, the Times’ director of external communication, put out a statement stating that the organization pursues “independent reporting on transgender issues that include profiling groundbreakers in the movement, challenges and prejudice faced by the community, and how society is grappling with debates about care”. While that was all very diplomatic, the executive editor, Joe Kahn, and opinion editor, Kathleen Kingsbury, sent around a rather more pointed newsroom memo condemning the letters on Thursday.

The second letter was signed by more than 100 LGBTQ+ and civil rights groups, including Glaad and the Human Rights Campaign. It expressed support for the contributor letter and accused the Times of platforming “fringe theories” and “dangerous inaccuracies”. It noted that while the Times has produced responsible coverage of trans people, “those articles are not getting front-page placement or sent to app users via push notification like the irresponsible pieces are”. And it observed that rightwing politicians have been using the Times’s coverage of trans issues to justify criminalizing gender-affirming care.

Here’s the thing: there is no clear-cut line between advocacy and journalism. All media organizations have a perspective about the world and filter their output (which will, of course, strive to be fairly reported) through that perspective. To pretend otherwise is dishonest. Like it or not, the Times is involved in advocacy. It just needs to step back for a moment and think about who it’s advocating for.

This pervasive claim that “I have my rights” but “I don’t have responsibilities” is unraveling our country today.

But societal immunity “is a function of trust,”

“When trust in institutions, leaders and each other is high, people — in a crisis — are more willing to sublimate their cherished rights and demonstrate their sense of shared responsibilities toward others, even others they disagree with on important issues and even if it means making sacrifices.”

When our trust in each other erodes, though, as is happening in America today, fewer people think they have responsibilities to the other — only rights that protect them from being told by the other what to do.

completely ignored the four most important statistical facts about Covid-19 today that highlight our responsibilities — to our fellow citizens and, even more so, to the nurses and doctors risking their lives to take care of us in a pandemic.

First, unvaccinated adults 18 years and older are 16 times more likely to be hospitalized for Covid than fully vaccinated adults

Second: Adults 65 and older who are not vaccinated are around 50 times more likely to be hospitalized for Covid than those who have received a full vaccine course and a booster.

Third: Unvaccinated people are 20 times more likely to die of Covid than people who are vaccinated and boosted.

the emotional toll and other work conditions brought on by the pandemic contributed to some two-thirds of nurses giving thought to leaving the profession.

many hospitals today are experiencing an unprecedented 20 percent annual turnover rate of nurses — more than double the historical baseline. The more nurses leave, the more those left behind have had to work overtime.

Especially when so many dying unvaccinated patients tell their nurses, “I wish I had gotten vaccinated,”

none of these statistics were mentioned during that podcast

“You can listen to the entire 186-minute lovefest between Rogan and Malone and have no idea that our hospitals are overloaded with Covid cases,” wrote Levy, “and that on the day their conversation transpired, 7,559 people worldwide died of Covid, 1,410 of which were in the United States. The vast majority of them were unvaccinated.”

“When Malone uncorks questionable allegations about disastrous vaccine effects and the global cabal of politicians and drugmakers pulling strings, Rogan responds with uh-huhs and wows.”

That was Rogan’s right. That was Spotify C.E.O. Daniel Ek’s right.

But who was looking out for the doctors and nurses on the pandemic front lines whose only ask is that the politicians and media influencers who are privileged enough to have public platforms — especially one like Rogan with an average of 11 million listeners per episode — use them to reinforce our responsibilities to one another, not just our rights.

He could start by offering his listeners a 186-minute episode with intensive care nurses and doctors about what this pandemic of the unvaccinated has done to them.

That would be a teaching moment, not only about Covid, but also about putting our responsibilities to one another — and especially to those who care for us — at least on a par with our right to be as dumb and selfish as we want to be.

The pandemic’s descent from medical emergency to political flash point can be mapped as a series of surges of bickering over that one simple phrase. “Follow the science!” people on both sides insisted, as the guidance from politicians and public health officials shifted over the past two years from anti-mask to pro-mask to “keep on masking” to more refined recommendations about which masks to wear and now to a spotty lifting of mandates.

demands that the other side “follow the science” are often a complete rejection of another person’s cultural and political identity: “It’s not just people believing the scientific research that they agree with. It’s that in this extreme polarization we live with, we totally discredit ideas because of who holds them.

“I’m struggling as much as anyone else,” she said. “Our job as informed citizens in the pandemic is to be like judges and synthesize information from both sides, but with the extreme polarization, nobody really trusts each other enough to know how to judge their information.

Many people end up putting their trust in some subset of the celebrity scientists they see online or on TV. “Follow the science” often means “follow the scientists” — a distinction that offers insight into why there’s so much division over how to cope with the virus,

although a slim majority of Americans they surveyed don’t believe that “scientists adjust their findings to get the answers they want,” 31 percent do believe scientists cook the books and another 16 percent were unsure.

Those who mistrust scientists were vastly less likely to be worried about getting covid-19 — and more likely to be supporters of former president Donald Trump,

A person’s beliefs about scientists’ integrity “is the strongest and most consistent predictor of views about … the threats from covid-19,”

When a large minority of Americans believe scientists’ conclusions are determined by their own opinions, that demonstrates a widespread “misunderstanding of scientific methods, uncertainty, and the incremental nature of scientific inquiry,” the sociologists concluded.

Americans’ confidence in science has declined in recent decades, especially among Republicans, according to Gallup polls

The survey found last year that 64 percent of Americans said they had “a great deal” or “quite a lot” of confidence in science, down from 70 percent who said that back in 1975

Confidence in science jumped among Democrats, from 67 percent in the earlier poll to 79 percent last year, while Republicans’ confidence cratered during the same period from 72 percent to 45 percent.

The fact that both sides want to be on the side of “science” “bespeaks tremendous confidence or admiration for a thing called ‘science,’ ”

Even in this time of rising mistrust, everybody wants to have the experts on their side.

That’s been true in American debates regarding science for many years

Four decades ago, when arguments about climate change were fairly new, people who rejected the idea looked at studies showing a connection between burning coal and acid rain and dubbed them “junk science.” The “real” science, those critics said, showed otherwise.

“Even though the motive was to reject a scientific consensus, there was still a valorization of expertise,”

“Even people who took a horse dewormer when they got covid-19 were quick to note that the drug was created by a Nobel laureate,” he said. “Almost no one says they’re anti-science.”

“There isn’t a thing called ‘the science.’ There are multiple sciences with active disagreements with each other. Science isn’t static.”

The problem is that the phrase has become more a political slogan than a commitment to neutral inquiry, “which bespeaks tremendous ignorance about what science is,”

t scientists and laypeople alike are often guilty of presenting science as a monolithic statement of fact, rather than an ever-evolving search for evidence to support theories,

while scientists are trained to be comfortable with uncertainty, a pandemic that has killed and sickened millions has made many people eager for definitive solutions.

“I just wish when people say ‘follow the science,’ it’s not the end of what they say, but the beginning, followed by ‘and here’s the evidence,’

As much as political leaders may pledge to “follow the science,” they answer to constituents who want answers and progress, so the temptation is to overpromise.

It’s never easy to follow the science, many scientists warn, because people’s behaviors are shaped as much by fear, folklore and fake science as by well-vetted studies or evidence-based government guidance.

“Science cannot always overcome fear,”

Some of the states with the lowest covid case rates and highest vaccination rates nonetheless kept many students in remote learning for the longest time, a phenomenon she attributed to “letting fear dominate our narrative.”

“That’s been true of the history of science for a long time,” Gandhi said. “As much as we try to be rigorous about fact, science is always subject to the political biases of the time.”

A study published in September indicates that people who trust in science are actually more likely to believe fake scientific findings and to want to spread those falsehoods

The study, reported in the Journal of Experimental Social Psychology, found that trusting in science did not give people the tools they need to understand that the scientific method leads not to definitive answers, but to ever-evolving theories about how the world works.

Rather, people need to understand how the scientific method works, so they can ask good questions about studies.

Trust in science alone doesn’t arm people against misinformation,

Overloaded with news about studies and predictions about the virus’s future, many people just tune out the information flow,

That winding route is what science generally looks like, Swann said, so people who are frustrated and eager for solid answers are often drawn into dangerous “wells of misinformation, and they don’t even realize it,” she said. “If you were told something every day by people you trusted, you might believe it, too.”

With no consensus about how and when the pandemic might end, or about which public health measures to impose and how long to keep them in force, following the science seems like an invitation to a very winding, even circular path.

Reaching hesitant families means withholding the kind of judgment that kept her ashamed, and understanding that people have legitimate concerns that need to be addressed.

Being consistent and visible within the community is important, Autar said. “It can’t be just a moment here and now type of thing – ‘When we have a surge, we’re going to come back out and galvanize all those resources.’ No, we still are in a pandemic. And we need to still remain visible within hesitant communities. And that’s hard work.”

He added: “Our approach has always been ‘we’re here to educate you about the vaccine, your options, your choices’, rather than take the approach of ‘you need to get this vaccine’.”

“They may not change their mind overnight, but by taking your time, you’re ensuring that they could change their minds,” Greene said. “But if it becomes this conflict and it’s a negative experience, you’re basically closing that door off completely.”

“There’s so much pressure for moms to do everything perfectly,” Greene said. Among middle-class mothers, for instance, there’s a message that “you can afford all these products to do better, and so you don’t need vaccines – vaccines are for poor people

hose promises have also fueled anxiety over how people will be able to compete for jobs outsourced to eerily refined machines or trust the accuracy of what they see online.

Officials with the San Francisco lab said GPT-4’s “multimodal” training across text and images would allow it to escape the chat box and more fully emulate a world of color and imagery, surpassing ChatGPT in its “advanced reasoning capabilities.”

A person could upload an image and GPT-4 could caption it for them, describing the objects and scene.

AI language models often confidently offer wrong answers because they are designed to spit out cogent phrases, not actual facts. And because they have been trained on internet text and imagery, they have also learned to emulate human biases of race, gender, religion and class.

GPT-4 still makes many of the errors of previous versions, including “hallucinating” nonsense, perpetuating social biases and offering bad advice. It also lacks knowledge of events that happened after about September 2021, when its training data was finalized, and “does not learn from its experience,” limiting people’s ability to teach it new things.

Microsoft has invested billions of dollars in OpenAI in the hope its technology will become a secret weapon for its workplace software, search engine and other online ambitions. It has marketed the technology as a super-efficient companion that can handle mindless work and free people for creative pursuits, helping one software developer to do the work of an entire team or allowing a mom-and-pop shop to design a professional advertising campaign without outside help.

it could lead to business models and creative ventures no one can predict.

sparked criticism that the companies are rushing to exploit an untested, unregulated and unpredictable technology that could deceive people, undermine artists’ work and lead to real-world harm.

the company held back the feature to better understand potential risks. As one example, she said, the model might be able to look at an image of a big group of people and offer up known information about them, including their identities — a possible facial recognition use case that could be used for mass surveillance.

OpenAI researchers wrote, “As GPT-4 and AI systems like it are adopted more widely,” they “will have even greater potential to reinforce entire ideologies, worldviews, truths and untruths, and to cement them or lock them in.”

“We can agree as a society broadly on some harms that a model should not contribute to,” such as building a nuclear bomb or generating child sexual abuse material, she said. “But many harms are nuanced and primarily affect marginalized groups,” she added, and those harmful biases, especially across other languages, “cannot be a secondary consideration in performance.”

OpenAI said its new model would be able to handle more than 25,000 words of text, a leap forward that could facilitate longer conversations and allow for the searching and analysis of long documents.

OpenAI developers said GPT-4 was more likely to provide factual responses and less likely to refuse harmless requests

Duolingo, the language learning app, has already used GPT-4 to introduce new features, such as an AI conversation partner and a tool that tells users why an answer was incorrect.

The company did not share evaluations around bias that have become increasingly common after pressure from AI ethicists.

GPT-4 will have competition in the growing field of multisensory AI. DeepMind, an AI firm owned by Google’s parent company Alphabet, last year released a “generalist” model named Gato that can describe images and play video games. And Google this month released a multimodal system, PaLM-E, that folded AI vision and language expertise into a one-armed robot on wheels: If someone told it to go fetch some chips, for instance, it could comprehend the request, wheel over to a drawer and choose the right bag.

The systems, though — as critics and the AI researchers are quick to point out — are merely repeating patterns and associations found in their training data without a clear understanding of what it’s saying or when it’s wrong.

GPT-4, the fourth “generative pre-trained transformer” since OpenAI’s first release in 2018, relies on a breakthrough neural-network technique in 2017 known as the transformer that rapidly advanced how AI systems can analyze patterns in human speech and imagery.

The systems are “pre-trained” by analyzing trillions of words and images taken from across the internet: news articles, restaurant reviews and message-board arguments; memes, family photos and works of art.

Giant supercomputer clusters of graphics processing chips are mapped out their statistical patterns — learning which words tended to follow each other in phrases, for instance — so that the AI can mimic those patterns, automatically crafting long passages of text or detailed images, one word or pixel at a time.

In 2019, the company refused to publicly release GPT-2, saying it was so good they were concerned about the “malicious applications” of its use, from automated spam avalanches to mass impersonation and disinformation campaigns.

Altman has also marketed OpenAI’s vision with the aura of science fiction come to life. In a blog post last month, he said the company was planning for ways to ensure that “all of humanity” benefits from “artificial general intelligence,” or AGI — an industry term for the still-fantastical idea of an AI superintelligence that is generally as smart as, or smarter than, the humans themselves.

many corporate technology chiefs have taken a wait-and-see approach to the technology, which has developed a reputation for producing false, misleading and unintelligible results—dubbed AI ‘hallucinations’. 

Though ChatGPT, which is available free online, is considered a consumer app, OpenAI has encouraged companies and startups to build apps on top of its language models—in part by providing access to the underlying computer code for a fee.

here are “certain spaces where it’s clearly directly applicable,” such as summarizing documents or responding to customer queries. Many startups are racing to apply the technology to a wider set of enterprise use case

“I think it’s going to creep into our lives in ways we least expect it,” Mr. Casado said.

In the summer of 2020, “public-health experts” decided that racism is a public-health crisis comparable to the coronavirus pandemic. It was therefore, they claimed, within their purview to express public support for the Black Lives Matter protests following the murder of George Floyd and to argue that the benefits of such protests outweighed the increased risk of spreading the disease. Those supposed experts actually knew nothing about the likely effects of the protests. They made no concrete predictions about whether they would in any way ameliorate racism in America, just as Nature can make no concrete predictions about whether its political endorsements will actually help a preferred candidate without jeopardizing its other important goals. The political action was expressive, not evidence-based...

as is often the case, a debate which appears to be about the neutrality of institutions is not really about neutrality at all... Rather, it is about whether there is any room left for soberly weighing our goals and values and thinking in a measured way about the consequences of our actions rather than simply reacting to situations in an impulsive and expressive manner, broadcasting our views to the world so that people know where we stand.

Our goals and values might not be “neutral” at all, but they might still be best served by procedures, institutions, and even individuals that follow neutral principles.

Defining the Anthropocene: nine sites are in the running to be given the ‘golden spike’ designation

Mentioning the Jurassic period, for instance, helps scientists to picture plants and animals that were alive during that time

“The Anthropocene represents an umbrella for all of these different changes that humans have made to the planet,”

Typically, researchers will agree that a specific change in Earth’s geology must be captured in the official timeline. The ICS will then determine which set of rock layers, called strata, best illustrates that change, and it will choose which layer marks its lower boundary

This is called the Global Stratotype Section and Point (GSSP), and it is defined by a signal, such as the first appearance of a fossil species, trapped in the rock, mud or other material. One location is chosen to represent the boundary, and researchers mark this site physically with a golden spike, to commemorate it.

“It’s a label,” says Colin Waters, who chairs the AWG and is a geologist at the University of Leicester, UK. “It’s a great way of summarizing a lot of concepts into one word.”

But the Anthropocene has posed problems. Geologists want to capture it in the timeline, but its beginning isn’t obvious in Earth’s strata, and signs of human activity have never before been part of the defining process.

“We had a vague idea about what it might be, [but] we didn’t know what kind of hard evidence would go into it.”

Years of debate among the group’s multidisciplinary members led them to identify a host of signals — radioactive isotopes from nuclear-bomb tests, ash from fossil-fuel combustion, microplastics, pesticides — that would be trapped in the strata of an Anthropocene-defining site. These began to appear in the early 1950s, when a booming human population started consuming materials and creating new ones faster than ever.

Why do some geologists oppose the Anthropocene as a new epoch?“It misrepresents what we do” in the ICS, says Stanley Finney, a stratigrapher at California State University, Long Beach, and secretary-general for the International Union of Geological Sciences (IUGS). The AWG is working backwards, Finney says: normally, geologists identify strata that should enter the geological timescale before considering a golden spike; in this case, they’re seeking out the lower boundary of an undefined set of geological layers.

Lucy Edwards, a palaeontologist who retired in 2008 from the Florence Bascom Geoscience Center in Reston, Virginia, agrees. For her, the strata that might define the Anthropocene do not yet exist because the proposed epoch is so young. “There is no geologic record of tomorrow,”

Edwards, Finney and other researchers have instead proposed calling the Anthropocene a geological ‘event’, a flexible term that can stretch in time, depending on human impact. “It’s all-encompassing,” Edwards says.

Zalasiewicz disagrees. “The word ‘event’ has been used and stretched to mean all kinds of things,” he says. “So simply calling something an event doesn’t give it any wider meaning.”

Making friends can be hard—but there may be more opportunities than we think. Doing these interviews has taught me that connection can come from anywhere, at any time, if both parties are open to it.

“You have to look for friendship in places you would never expect it.”

Paying attention goes a long way when forging these unexpected friendships—noticing when you click with someone, being open to chance encounters.

as much as we may feel like our social networks are set and settled, it’s never too late to meet someone who will be important to you for the rest of your life. I spoke with more than one group who was surprised and grateful to have found one another in middle age, a period when work and family responsibilities tend to peak and keeping up with friends is not always easy.

I’m inspired by the people I’ve spoken with who imagined something different for themselves: the friends who bought a house together, who went to therapy together, who have raised their children together, who committed to an “arranged friendship,” whose friendship has fueled their fight for justice.

they won’t grow without intention. This is the hardest part of friendship. It takes energy and thought, and our mental and physical resources are often spread thin. In other words, friendships take work. But I have never liked framing our friendships as labor. Showing up for our friends takes effort, yes, but it shouldn’t be drudgery. It should be a joy.

One thing that seems to make keeping up with friends easier is ritual. I personally find that the effort of coordinating hangs (or even phone calls) is the biggest barrier to seeing my friends. It’s much easier when something is baked into my schedule, and all I have to do is show up.

Some have organized a book club, a monthly hike, or a regular dinner party. Others have committed to a group chat that runs all day every day, or a Dungeons & Dragons campaign that’s lasted for 30 years. In addition to keeping groups close, these traditions can fuel a friendship and give it a shared culture.

Imagination

Society has a place for friendships, and it’s on the sidelines. They’re supposed to play a supporting role to work, family, and romance. It takes imagination not to default to this norm, and to design your life so that friendship plays the role you really want it to.

Attention only gets you so far without action. When opportunity arises, you have to put yourself out there, and that requires courage, vulnerability, and a willingness to let things be awkward.

The man who gave his friend a kidney and the woman who gave birth to her best friend’s quadruplets remind me that there are friends who choose to love each other radically every day. Their love does not stand on the sidelines.

The beauty and the challenge of friendship is its diversity. A friendship can be whatever you want it to. Each one is a canvas whose only limit is our imagination.

Grace

All of the forces I’ve mentioned so far—accumulation, attention, intention, ritual, and imagination—are ideals. They’re impossible to fully live up to. Life often gets in the way.

I do love the concept of grace, of a gift so profound that it could never be earned or deserved. And so when I cite grace here as the final and most important force in friendships, I mean it in two ways. One is the forgiveness that we offer each other when we fall short. The other is the space that creates for connections—and reconnections—that feel nothing short of miraculous.

Many of the people I spoke with—who, in many cases, love each other so much that they nominated themselves to be interviewed about their friendship—told me that they don’t see each other that often, or that they don’t talk as much as they would like. I’ve come to believe that friendship doesn’t always have to be about presence; it can also be about love that can weather absence.

Sometimes, people have assumed that I must be a really great friend, given how much time I’ve spent thinking about this. And I’m not. I try to be, but I tend to retreat too much into myself and my romantic relationship and don’t prioritize my friends as much as I’d like to.

But absence doesn’t have to last forever. “The Friendship Files” includes many stories of second chances and rekindlings.

Accumulation

Attention

Intention

Ritual

Functional Medicine isn't a protected title and a medical qualification isn't a prerequisite to practice. The result is an unregulated and disparate field, with medical doctors, nutritionists, naturopaths and homeopaths among the many practitioners.

Some other chronic illnesses the field claims to treat include heart disease, type 2 diabetes, irritable bowel syndrome, ulcerative colitis, depression, anxiety and arthritis

ll kinds of different reasons, some might have gluten issues, gut issues, others might have a deficiency causing neurological issues, MS is a symptom."

"There are components of Functional Medicine that absolutely lack an evidence base and there are practitioners of what they call Functional Medicine, they charge people for intravenous nutritional injections, they exaggerate claims, and that is professionally inappropriate, unethical and it lacks evidence.

On Dr Mark Hyman's view of MS he says, "there are a lot of terms put together there, all of which individually make a lot of sense, but put together in that way they do not.

"What does FM actually mean? It means nothing. It's a gift-gallop of words thrown together. It's criticised by advocates of evidence-based medicine because it's giving a veneer of scientific legitimacy to ideas that are considered pseudoscientific. For example, it'll take alternative medicine modalities like homeopathy and then call them 'bio-infusions' or something similar, rebranding it as something that works.

"It's a redundant name, real medicine is functional."

Next month the third annual Lifestyle and Functional Medical conference will take place in Salthill, Galway on November 3. Last year's event was attended by more than 500 people and featured a keynote address by honorary consultant cardiologist Dr Aseem Malhotra, author of bestselling The Pioppi Diet (which was named one of the top five worst celebrity diets to avoid in 2018 by the British Dietetic Foundation).

Dr David Robert Grimes is physicist and visiting fellow of Oxford and QUB. His research into cancer focuses on modelling tumour metabolism and radiation interactions. For Dr Grimes, the lack of definition, or "double-speak" as he puts it, in FM is troubling.

As well as the cost of appointments, FM practitioners commonly charge extra for tests. An omega finger prick test is around €100. A vitamin D test can cost upwards of €60, full thyroid panel more than €150 and a gut function test €400. Prices vary between practitioners.

"If I, as a GP, engaged in some of these behaviours I would be struck off." Specifically? "If I was recommending treatments that lacked an evidence base, or if I was promoting diagnostic tests which are expensive and lack an evidence base.

GPs engage every year in ongoing continuous professional development, I spend my evenings and my weekends outside of working hours attending educational events, small-group learning, large-group learning, engaging in research. This is an accusation that was levelled at the profession 30 years ago and then it was correct, but the profession has caught up…

"Obviously promoting wellness and healthy diet is very welcome but going beyond that and stating that certain aspects of 'functional medicine' can lead to reduced inflammation or prevent cancer, we have to be very careful about those claims.

Often the outcome of such tests are seemingly 'benign' prescriptions of vitamins or cleanses. However, dietitian Orla Walsh stresses that even these can have potentially harmful effects, especially on "vulnerable" patients, if not prescribed judiciously.

FM has five basic principles. 1. We are all genetically and biochemically unique so it treats the individual, not the disease. 2. It's science-based. 3. The body is intelligent and has the capacity for self-regulation. 4. The body has the ability to heal and prevent nearly all the diseases of ageing. 5. Health is not just the absence of disease, but a state of immense vitality.

She began her Functional Medicine career while training as a medical doctor and now travels the world working with high-profile clients. Dr McHale charges €425 for an initial consultation and €175 for follow-up appointments. Straightforward lab tests are €250 to €750, for complex cases testing fees can be up to €2,000.

"The term [Functional Medicine] tends to be bandied around quite a bit. Other things people say, such as 'functional nutritionist', can be misleading as a term. Many people are Functional Medicine practitioners but don't have any real medical background at all... I think regulation is always probably the best way forward."

"There's an awful lot to it in terms of biochemistry and physiology," she says. "You do need to have a very solid and well ingrained bio-chemistry background. A solely clinical background doesn't equip you with the knowledge to read a test.

"Evidence-base is the cornerstone of medicine and that has to be maintained. It becomes problematic in this area because you are looking at personalised medicine and that can be very difficult to evidence-base."

GP Christine Ritter travelled from England to attend the Galway conference last year with a view to integrating Functional Medicine into her practice.

"It was very motivating," she says. "Where it wasn't perhaps as strong was to find the evidence. The Functional Medicine people would say, 'we've done this study and this trial and we've used this supplement that was successful', but they can't show massive research data which might make it difficult to bring it into the mainstream.

"I also know the rigorous standard of trials we have in medicine they're not usually that great either, it's often driven by who's behind the trial and who's paying for it.

"Every approach that empowers patient to work on their destiny [is beneficial], but you'd have to be mindful that you're not missing any serious conditions."

Dr Hyman is working to grow the evidence-base for Functional Medicine worldwide. "The future is looking very bright," he says. "At the Cleveland Centre we're establishing a research base, building educational platforms, fellowships, residency programmes, rotations. We're advancing the field that's spreading across the world. We're seeing in China the development of a programme of Functional Medicine, South Africa, the UK, in London the Cleveland Clinic will hopefully have a Functional Medicine centre."

For Dr Mark Murphy regulation is a moot point as it can only apply once the field meets the standards of evidence-based medicine.

"Despite well intentioned calls for regulation, complementary and alternative medical therapies cannot be regulated," he says. "Only therapies that possess an evidence-base can enter our standard regulatory processes, including the Irish Medical Council, the Health Products Regulatory Authority and Irish advertising standards. In situations where complementary and alternative therapies develop an evidence base, they are no longer 'complementary and alternative', but in effect they become part of mainstream 'Medicine'.

l What are the principles?

"There's a huge variation between therapists, some are brilliant and some are okay, and some are ludicrous snake oil salesmen."

He is so concerned that patients' health and wealth are being put at risk by alternative therapies that earlier this year he joined Fine Gael TD Kate O'Connell and the Irish Cancer Society in introducing draft legislation earlier this year making it illegal to sell unproven treatments to cancer patients. Violators face jail and heavy fines.

Dr Grimes says criticism of variations in the standards of traditional medical research can be fair, however due to the weight of research it is ultimately self-correcting. He adds, "The reality is that good trials are transparent, independent and pre-registered.

"My involvement in shaping the Bill came from seeing first-hand the exploitation of patients and their families. Most patients undergoing treatment will take some alternative modalities in conjunction but a significant portion are talked out of their conventional medicine and seduced by false promises

The word for ‘philosophy’ in Korean is 철학, pronounced ch’ŏrhak. It literally means the ‘study of wisdom’ or, perhaps better, ‘how to become wise’, which reflects its more dynamic and proactive implications

At night, in the darkness of the cave, he drank water from a perfectly useful ‘bowl’. But when he could see properly, he found that there was no ‘bowl’ at all, only a disgusting human skull.

Our lives and minds are affected by others (and their actions), as others (and their minds) are affected by our actions. This is particularly true in the Korean application of Confucian and Buddhist ideas.

Wŏnhyo understood that how we think about things shapes their very existence – and in turn our own existence, which is constructed according to our thoughts.

In the Korean tradition of philosophy, human beings are social beings, therefore knowing how to interact with others is an essential part of living a good life – indeed, living well with others is our real contribution to human life

he realised that there isn’t a difference between the ‘bowl’ and the skull: the only difference lies with us and our perceptions. We interpret our lives through a continual stream of thoughts, and so we become what we think, or rather how we think

As our daily lives are shaped by our thoughts, so our experience of this reality is good or bad – depending on our thoughts – which make things ‘appear’ good or bad because, in ‘reality’, things in and of themselves are devoid of their own independent nature

We can take from Wŏnhyo the idea that, if you change the patterns that have become engrained in how you think, you will begin to live differently. To do this, you need to change your mental habits, which is why meditation and mindful awareness can help. And this needs to be practised every day

Wŏnhyo’s most important work is titled Awaken your Mind and Practice (in Korean, Palsim suhaeng-jang). It is an explicit call to younger adherents to put Buddhist ideas into practice, and an indirect warning not to get lost in contemplation or in the study of text

While Wŏnhyo had emphasised the mind and the need to ‘practise’ Buddhism, a later Korean monk, Chinul (1158-1210), spearheaded Sŏn, the meditational tradition in Korea that espoused the idea of ‘sudden enlightenment’ that alerts the mind, accompanied by ‘gradual cultivation’

we still need to practise meditation, for if not we can easily fall into our old ways even if our minds have been awakened

his greatest contribution to Sŏn is Secrets on Cultivating the Mind (Susim kyŏl). This text outlines in detail his teachings on sudden awakening followed by the need for gradual cultivation

hinul’s approach recognises the mind as the ‘essence’ of one’s Buddha nature (contained in the mind, which is inherently good), while continual practice and cultivation aids in refining its ‘function’ – this is the origin of the ‘essence-function’ concept that has since become central to Korean philosophy.

These ideas also influenced the reformed view of Confucianism that became linked with the mind and other metaphysical ideas, finally becoming known as Neo-Confucianism.

During the Chosŏn dynasty (1392-1910), the longest lasting in East Asian history, Neo-Confucianism became integrated into society at all levels through rituals for marriage, funerals and ancestors

Neo-Confucianism recognises that we as individuals exist through plural relationships with responsibilities to others (as a child, brother/sister, lover, husband/wife, parent, teacher/student and so on), an idea nicely captured in 2000 by the French philosopher Jean-Luc Nancy when he described our ‘being’ as ‘singular plural’

Corrupt interpretations of Confucianism by heteronormative men have historically championed these ideas in terms of vertical relationships rather than as a reciprocal set of benevolent social interactions, meaning that women have suffered greatly as a result.

Setting aside these sexist and self-serving interpretations, Confucianism emphasises that society works as an interconnected set of complementary reciprocal relationships that should be beneficial to all parties within a social system

Confucian relationships have the potential to offer us an example of effective citizenship, similar to that outlined by Cicero, where the good of the republic or state is at the centre of being a good citizen

There is a general consensus in Korean philosophy that we have an innate sociability and therefore should have a sense of duty to each other and to practise virtue.

The main virtue of Confucianism is the idea of ‘humanity’, coming from the Chinese character 仁, often left untranslated and written as ren and pronounced in Korean as in.

It is a combination of the character for a human being and the number two. In other words, it signifies what (inter)connects two people, or rather how they should interact in a humane or benevolent manner to each other. This character therefore highlights the link between people while emphasising that the most basic thing that makes us ‘human’ is our interaction with others.

Neo-Confucianism adopted a turn towards a more mind-centred view in the writings of the Korean scholar Yi Hwang, known by his pen name T’oegye (1501-70), who appears on the 1,000-won note. He greatly influenced Neo-Confucianism in Japan through his formidable text, Ten Diagrams on Sage Learning (Sŏnghak sipto), composed in 1568, which was one of the most-reproduced texts of the entire Chosŏn dynasty and represents the synthesis of Neo-Confucian thought in Korea

with commentaries that elucidate the moral principles of Confucianism, related to the cardinal relationships and education. It also embodies T’oegye’s own development of moral psychology through his focus on the mind, and illuminates the importance of teaching and the practice of self-cultivation.

He writes that we ourselves can transform the unrestrained mind and its desires, and achieve sagehood, if we take the arduous, gradual path of self-cultivation centred on the mind.

Confucians had generally accepted the Mencian idea that human nature was embodied in the unaroused state of the mind, before it was shaped by its environment. The mind in its unaroused state was taken to be theoretically good. However, this inborn tendency for goodness is always in danger of being reduced to passivity, unless you cultivate yourself as a person of ‘humanity’ (in the Confucian sense mentioned above).

You should constantly try to activate your humanity to allow the unhampered operation of the original mind to manifest itself through socially responsible and moral character in action

Humanity is the realisation of what I describe as our ‘optimum level of perfection’ that exists in an inherent stage of potentiality due our innate good nature

This, in a sense, is like the Buddha nature of the Buddhists, which suggests we are already enlightened and just need to recover our innate mental state. Both philosophies are hopeful: humans are born good with the potential to correct their own flaws and failures

this could hardly contrast any more greatly with the Christian doctrine of original sin

The seventh diagram in T’oegye’s text is entitled ‘The Diagram of the Explanation of Humanity’ (Insŏl-to). Here he warns how one’s good inborn nature may become impaired, hampering the operation of the original mind and negatively impacting our character in action. Humanity embodies the gradual realisation of our optimum level of perfection that already exists in our mind but that depends on how we think about things and how we relate that to others in a social context

For T’oegye, the key to maintaining our capacity to remain level-headed, and to control our impulses and emotions, was kyŏng. This term is often translated as ‘seriousness’, occasionally ‘mindfulness’, and it identifies the serious need for constant effort to control one’s mind in order to go about one’s life in a healthy manner

For T’oegye, mindfulness is as serious as meditation is for the Buddhists. In fact, the Neo-Confucians had their own meditational practice of ‘quiet-sitting’ (chŏngjwa), which focused on recovering the calm and not agitated ‘original mind’, before putting our daily plans into action

These diagrams reinforce this need for a daily practice of Confucian mindfulness, because practice leads to the ‘good habit’ of creating (and maintaining) routines. There is no short-cut provided, no weekend intro to this practice: it is life-long, and that is what makes it transformative, leading us to become better versions of who were in the beginning. This is consolation of Korean philosophy.

Seeing the world as it is can steer us away from making unnecessary mistakes, while highlighting what is good and how to maintain that good while also reducing anxiety from an agitated mind and harmful desires. This is why Korean philosophy can provide us with consolation; it recognises the bad, but prioritises the good, providing several moral pathways that are referred to in the East Asian traditions (Confucianism, Buddhism and Daoism) as modes of ‘self-cultivation’

As social beings, we penetrate the consciousness of others, and so humans are linked externally through conduct but also internally through thought. Humanity is a unifying approach that holds the potential to solve human problems, internally and externally, as well as help people realise the perfection that is innately theirs

being with him wasn’t like being with a conventional person; it was like being with an entity who was playing the role of Donald Trump. And that role had no sense of continuity. He was fully immersed in whatever dominance battle he was fighting at that moment.

I wonder if the era of the short-attention spans and the online avatars is creating a new character type: the person who doesn’t experience life as an accumulation over decades, but just as a series of disjointed performances in the here and now, with an echo of hollowness inside.

McAdams calls Trump an “episodic man,” who experiences life as a series of disjointed moments, not as a coherent narrative flow of consciousness

“He does not look to what may lie ahead, at least not very far ahead,” McAdams writes. “Trump is not introspective, retrospective or prospective. There is no depth; there is no past; there is no future.”

In his book, “The Strange Case of Donald J. Trump,” the eminent personality psychologist Dan McAdams argues that Trump could continually lie to himself because he had no actual sense of himself. There was no real person, inner life or autobiographical narrative to betray.

As the philosopher Alasdair MacIntyre once observed, you can’t know what to do unless you know what story you are a part of.

The students who’d been told they were almost always right were, on average, no more discerning than those who had been told they were mostly wrong.

In the second phase of the study, the deception was revealed. The students were told that the real point of the experiment was to gauge their responses to thinking they were right or wrong.

Once again, midway through the study, the students were informed that they’d been misled, and that the information they’d received was entirely fictitious. The students were then asked to describe their own beliefs

The students who’d received the first packet thought that he would avoid it. The students in the second group thought he’d embrace it.

One implication of the naturalness with which we divide cognitive labor,” they write, is that there’s “no sharp boundary between one person’s ideas and knowledge” and “those of other members” of the group

Humans’ biggest advantage over other species is our ability to coöperate. Coöperation is difficult to establish and almost as difficult to sustain

Reason is an adaptation to the hypersocial niche humans have evolved for themselves

Consider what’s become known as “confirmation bias,” the tendency people have to embrace information that supports their beliefs and reject information that contradicts them

Of the many forms of faulty thinking that have been identified, confirmation bias is among the best catalogued; it’s the subject of entire textbooks’ worth of experiments

Even after the evidence “for their beliefs has been totally refuted, people fail to make appropriate revisions in those beliefs,” the researchers noted. In this case, the failure was “particularly impressive,”

reason is an evolved trait, like bipedalism or three-color vision. It emerged on the savannas of Africa, and has to be understood in that context