Henry Marsh’s Diary: how will self-driving cars navigate British politeness?

I had visions of autonomous cars paralysed at street ends, unable to compute whether to be English and give way or Russian and barge ahead.

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I had a Russian friend staying with me last week. I live on a suburban street in south London narrowed down to a single lane by the parked cars lining it on either side. He was very impressed at how I gave way to oncoming traffic, or how the oncoming traffic gave way to me, and the ritual of the politely waved thank you or flashed headlights. “In Russia we would fight,” Kolya observed. I wondered how an autonomous car would cope with the problem. I had visions of autonomous cars sitting paralysed at either end of the street, unable to compute whether to be English and give way, or to be Russian and barge ahead.

As I get older, I find driving more and more boring and would be delighted to have a car that did it for me, but I am sceptical about all the prophecies being made in recent years for machine-learning AI. Genome cracking, facial recognition, Amazon’s recommendations and winning at Go are remarkable achievements. But these are all based on machine learning and pattern recognition, carried out at speeds of which our own brains are certainly quite incapable.

Feeling machines

What is special about human decision-making and creativity is that they involve feelings – it is not a question of remorseless logic and pure reason. Even the most enthusiastic prophets of superintelligent machines (that some implausibly claim are a much greater threat to humanity than global warming and nuclear warfare) have nothing to say about whether such machines would have feelings or not.

Mathematicians talk of the elegance and aesthetic beauty of proofs. People with damage to the emotional areas of their brain called the amygdala are hopeless at making decisions which involve assessing risk and other people. Of course, some people claim that as all thinking and feeling are the electrochemical activity of nerve cells, it follows that conscious experience is simply data processing and therefore will one day be emulated by computers. Big Data as the Philosopher’s Stone. But I find it hard not to believe that in some way the tremendous structural complexity of brains – quite unlike computer architecture – is important. On the other hand, we may never understand how our brains work. As an eminent neuroscientist said to me recently: “You can’t cut butter with a knife made of butter.”

Running to stand still

I have been running, off and on, for much of my adult life. I quite enjoyed athletics at school, and did rather well at it, as it did not involve team spirit, which I disliked, and which I have only begun to find congenial in recent years. Perhaps this is because of the fall in my testosterone levels that comes with age. A few years ago, I was running daily up to 50 miles a week. I was partly driven by hypochondriasis (exercise is supposed to reduce your risk of Alzheimer’s along with many other diseases), by the beauty of Oxford and its surrounding countryside, but above all by the intense feeling of relaxation, mental clarity and well-being that would persist for an hour or so afterwards.

I never experienced the “runner’s high” when actually running – indeed, as I got older, it became more and more of an effort. Forcing myself out in the mornings required ever greater willpower, which meant frightening myself with thoughts of illness and death. But I was vainly proud of the fact that unlike other elderly hypochondriacal runners, I had no problems with my legs or joints whatsoever.

I was completing an eight-mile run round Port Meadow in Oxford before Christmas when I felt a severe pain developing in the back of my right thigh. Over the next few days this became incapacitating, and Google told me that I had developed chronic proximal hamstring tendinopathy – a rare problem exclusive to excessive runners. Treatment would take months to work. Some websites even talked of surgery. The thought of an orthopaedic colleague with his fists in my buttock did not appeal. So I started exercising instead with weights and push-ups, something I cordially detest, but it was amusing to see myself in the bathroom mirror after a few weeks, looking not just a little senile but also a little ripped.

My leg is now almost pain-free but I have mixed feelings about the intense effort of willpower that will be required every day once again. Perhaps it’s this mental rather than physical effort that keeps the dreaded dementia at bay.

The virtue of patients

I have started doing outpatient clinics again, helping my hospital meet its waiting list targets. I do this in the evenings, and get quite well paid for seeing eight patients in three hours. I find I have the same love-hate relationship with the clinic that I had when I was still working full-time. Once a patient is sitting in front of me, I am happy, focused and interested. But in between, I feel like beating my head against the desk in desperation. I have never quite understood why this should be so. It is probably something to do with having to switch from being myself to acting a professional role; also, effective communication is intensely hard work. Operating is much less tiring. The clinic is a bit of a Salon des Refusés, as almost all the patients I see have spinal problems that do not need surgery and to which my colleagues, with more pressing and important cases to deal with, have assigned a low priority.

Yet the work is fascinating because patients (aka people) are fascinating. And the challenge is to explain their problems to them as clearly and sympathetically as possible, and why usually little can be done to help them. Many of them are immigrants and all of them have interesting stories to tell, almost always much more interesting to me than their back pain, so I have to control my questioning carefully as I have only 20 minutes per patient. I always finish by extolling the virtues of exercise to them, but I doubt if this has much effect.

Admissions: a Life in Brain Surgery” by Henry Marsh is published in paperback on 17 May by Weidenfeld & Nicolson.

This article appears in the 11 May 2018 issue of the New Statesman, Israel vs Iran

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