Book review: In Shock: From Doctor to Patient — How Nearly Dying Made Me a Better Intensive Care Doctor by Rana Awdish

A medic’s traumatic experience opened her eyes to the failings of her profession, and led to this outstanding memoir

Review by James McConnachie

Getting on with the job: a medical team wheel a patient on a gurney
Getting on with the job: a medical team wheel a patient on a gurneyVINCENT HAZAT/GETTY IMAGES

Survivors of sudden, shocking illnesses, notes the American doctor Rana Awdish, always comment on how “bland and unremarkable” the day was, right up to the moment when they were struck down.

When it happened to Awdish, she was shopping for shoes. She was six-months pregnant and still working as an intensive-care doctor. Her feet were swollen.

It began as “a vague sense of disequilibrium”. Then, “in a breathtaking wave”, the pain hit. A hidden tumour in her liver had started to bleed. Within two hours almost all the blood circulating in her body had poured out invisibly inside her, shutting down her liver’s capacity to stop it by making her blood clot. When she arrived at hospital, the staff prioritised her unborn child. She was given an ultrasound before any other treatment and had to convince the obstetrician that her baby’s heart was no longer beating.

Meanwhile, her condition plummeted. Despite surgery and blood transfusions, she slipped into what trauma medics call the “triad of death”: hypothermia, acidosis and coagulopathy. Her blood became too cold and too acidic to clot, in other words, triggering further bleeding, intensified cold and more acidity. She was experiencing an “unremitting, suicidal spiral of the blood”.

She survived, of course, to write this book. And it is no ordinary memoir of illness. What marks it out is not the scale or urgency of the trauma, although I read the first chapters at such pace that I almost had to remind myself to breathe. It is the writing.

It sparks and crackles with a dark energy. On the gurney in the triage room, Awdish’s face as she lay next to the tiled wall “was close enough to the squares to pick up the scent of bleach embedded in the grout”. Resurfacing after anaesthesia, she finds herself “pale and turgid … as if I had been dredged up from the bottom of a lake”. Seeing her newborn son in an incubator when she eventually becomes pregnant again, she observes how everything is “incredibly minute and precise, like wiring a doll’s house for electricity”.

The writing is not just intense, but intelligent. She describes how she resisted false optimism, as a doctor, because “it was hard to palpate the borders of authentic hope”. She praises colleagues for supporting her recovery so that “the nidus of hope buried within my debris could grow in the direction of the light”. A nidus is a site of growth, and Gavin Francis is perhaps the only other doctor-writer I can think of who would be bold enough to deploy the word.

In Shock stands above other patient memoirs for another reason: Awdish’s experiences unleash a profound reevaluation of her own profession. Throughout the book, she quivers with cold rage at the inappropriate, dismissive, condescending or heartless things that medical staff say to her — or about her, within her hearing. “Maybe you’re just anxious.” “At least you didn’t die.” Worst, when she is lying on the operating table, conscious but close to death, she hears the anaesthetist shout: “Guys! She’s circling the drain here!”

Awdish’s anger sometimes feels self-righteous, a kind of entitlement to customer service that feels distinctively American, and sits awkwardly with the fact that those same medical staff did, in fact, stop her going down the drain. I struggled to see what was so wrong with doctors telling her that “you really scared me” and “that was a bad night for me”. Is this not a kind of reaching out, with a little understandable gallows humour?

Her ultimate response, though, is deeply thoughtful. She questions why doctors fail to empathise with their patients. She finds her answers thoroughly ingrained in medical culture, where coolness and distance are deliberately cultivated. The mantra is “if you want to treat disease, become a doctor. If you want to care for patients, become a nurse”, and she was trained “to be sparing of myself … as if I were made of some quantifiable measure of stuff that once given away would leave me depleted”.

From the moment a medical student starts work on a cadaver, she concludes, “the true relationship is forged between the doctor and the disease”, not between doctor and patient. The doctor-patient relationship, as a result, is fundamentally “antagonistic”.

This is not just a problem for patients. Developing a professional carapace does not allow for flexibility when doctors are severely emotionally tested — as they inevitably are. Awdish describes her tearing guilt when patients die, and how expressing that guilt is professionally unthinkable. She writes about the colleagues who turn to alcohol and about the endemic sleeplessness and disregard for the body. She recalls the suicides of two interns during her residency.

As a remedy, she offers empathy. In truth, this idea has featured in medical schools for many years now, and has always been present in the best individual doctors. Awdish captures something important, nonetheless. Doctors have “imagined ourselves as barriers perched at the top of a steep cliff”, she writes, standing between patients and the void. Instead, “we could turn and stand at the edge of the chasm and face it together”.

Bantam Press £14.99 pp272

Book review: In Shock: From Doctor to Patient — How Nearly Dying Made Me a Better Intensive Care Doctor by Rana Awdish | Culture | The Times & The Sunday Times

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The Unbelievable Skepticism of the Amazing Randi

The New York Times · by ADAM HIGGINBOTHAM · November 7, 2014

James Randi in front of a painting done by his partner, the artist José Alvarez. Jeff Minton for The New York Times

A few minutes before 8 o’clock one Sunday evening last July, around 600 people crowded into the main conference hall of the South Point casino in Las Vegas. After taking their seats on red-velvet upholstered chairs, they chattered noisily as they awaited the start of the Million Dollar Challenge. When Fei Wang, a 32-year-old Chinese salesman, stepped onto the stage, they fell silent. Wang had a shaved head and steel-framed glasses. He wore a polo shirt, denim shorts and socks. He claimed to have a peculiar talent: from his right hand, he could transmit a mysterious force a distance of three feet, unhindered by wood, metal, plastic or cardboard. The energy, he said, could be felt by others as heat, pressure, magnetism or simply “an indescribable change.” Tonight, if he could demonstrate the existence of his ability under scientific test conditions, he stood to win $1 million.

The Million Dollar Challenge was the climax of the Amazing Meeting, or TAM, an annual weekend-long conference for skeptics that was created by a magician named the Amazing Randi in 2003. Randi, a slight, gnomish figure with a bald head and frothy white beard, was presiding from the front row, a cane topped with a polished silver skull between his legs. He drummed his fingers on the table in front of him. The Challenge organizers had spent weeks negotiating with Wang and fine-tuning the protocol for the evening’s test. A succession of nine blindfolded subjects would come onstage and place their hands in a cardboard box. From behind a curtain, Wang would transmit his energy into the box. If the subjects could successfully detect Wang’s energy on eight out of nine occasions, the trial would confirm Wang’s psychic power. “I think he’ll get four or five,” Randi told me. “That’s my bet.”

The Challenge began with the solemnity of a murder trial. A young woman in a short black dress stood at the edge of the stage, preparing to mark down the results on a chart mounted on an easel. The first subject, a heavyset blond woman in flip-flops, stepped up and placed her hands in the box. After two minutes, she was followed by a second woman who had a blue streak in her hair and, like the first, looked mildly nonplused by the proceedings. Each failed to detect the mystic force. “Which means, at this point, we are done,” the M.C. announced. With two failures in a row, it was impossible for Wang to succeed. The Million Dollar Challenge was already over.

Stepping out from behind the curtain, Wang stood center stage, wearing an expression of numb shock, like a toddler who has just dropped his ice cream in the sand. He was at a loss to explain what had gone wrong; his tests with a paranormal society in Boston had all succeeded. Nothing could convince him that he didn’t possess supernatural powers. “This energy is mysterious,” he told the audience. “It is not God.” He said he would be back in a year, to try again.

After Wang left the stage, Randi, who is 86, told me he was glad it was all over. For almost 60 years, he has been offering up a cash reward to anyone who could demonstrate scientific evidence of paranormal activity, and no one had ever received a single penny.

But he hates to see them lose, he said. “They’re always rationalizing,” Randi told me as we walked to dinner at the casino steakhouse. “There are always reasons prevailing why they can’t do it. They call it the resilience of the duped. It’s with intense regret that you watch them go down the tubes.”

The day before the challenge, Randi was wandering the halls of the casino, posing for snapshots and signing autographs. The convention began in 2003 in Fort Lauderdale, with 150 people in attendance, including staff. This year, it attracted more than 1,000 skeptics from as far away as South Africa and Japan. Often male and middle-aged, and frequently wearing ponytails or Tevas or novelty slogan T-shirts (product of evolution; stop making stupid people famous; atheist), they came to genuflect before their idol, drawn by both his legendary feats as an illusionist and his renown as an icon of global skepticism.

One fan, in his early 20s, with a thick mop of dark hair, introduced himself with, “So, I read that you spent 55 minutes in a block of ice.”

“A cinch,” Randi replied.

Ajay Appaden was 25 and had come from the Indian city Cochin. He was attending the conference for the second year with the help of a travel grant from the James Randi Educational Foundation (JREF), which was established with donations from the Internet pioneer Rick Adams and Johnny Carson. In addition to offering grants, JREF holds the $1 million in bonds that back the challenge, and pays Randi’s annual $200,000 salary.

Raised as a Catholic, Appaden told me that he discovered Randi in 2010, when he watched the magician in an online TED talk discussing homeopathy. At the time Appaden was a student at a Christian college, struggling with his faith; two years later, during Randi’s first visit to India, he took a 13-hour bus ride across the country to see Randi in person. “It literally changed my life,” he told me, and explained that he now hopes to help teach skepticism in Indian schools.

The magician looked small and frail, lost in the folds of his striped dress shirt, leaning on his cane, but he mugged gamely for every acolyte. For many of his most zealous followers, the opportunity to meet Randi at TAM may be as close as they will ever come to a religious experience. “It’s an obligation, it’s a very heavy obligation,” he said. “I can’t stand one person being turned away and not being given the same attention that others have been given.”

A few days before the conference, I visited Randi at his home, in Plantation, Fla. The modest octagonal house was almost hidden from the street by a lush garden of finger palms, elephant ears and paperbark trees. As we sat upstairs, surrounded by some 4,000 books — arranged alphabetically by subject, from alchemy, astrology, Atlantis and the Bermuda Triangle to tarot, U.F.O.s and witchcraft — he said that he disliked being called a debunker. He prefers to describe himself as a scientific investigator. He elaborated: “Because if I were to start out saying, ‘This is not true, and I’m going to prove it’s not true,’ that means I’ve made up my mind in advance. So every project that comes to my attention, I say, ‘I just don’t know what I’m going to find out.’ That may end up — and usually it does end up — as a complete debunking. But I don’t set out to debunk it.”

Born Randall James Zwinge in 1928, Randi began performing as a teenager in the 1940s, touring with a carnival and working table to table in the nightclubs of his native Toronto. Billed as The Great Randall: Telepath, he had a mind-reading act, and also specialized in telling the future. In 1949 he made local headlines for a trick in which he appeared to predict the outcome of the World Series a week before it happened, writing the result down, sealing it an envelope and giving it to a lawyer who opened and read it to the press after the series concluded. But no matter how many times he assured his audiences that such stunts were a result of subterfuge and legerdemain, he found there were always believers. They came up to him in the street and asked him for stock tips; when he insisted that he was just a magician, they nodded — but winked and whispered that they knew he was truly psychic. Once he understood the power he had over his audience, and how easily he could exploit their belief in the supernatural to make money, it frightened him: “To have deceived people like that . . . that’s a terrible feeling,” he said.

He turned instead to escapology — as The Amazing Randi: The Man No Jail Can Hold — and feats of endurance. He broke a record for his 55-minute stint encased in ice, and bested the time his hero Houdini had spent trapped in a coffin on the bottom of the swimming pool at the Hotel Shelton in Manhattan. But Randi never forgot the believers, and how susceptible they were to exploitation by those who lacked his scruples. And so, as his reputation as a magician grew, he also began to campaign against spiritualists and psychics. In 1964, as a guest on a radio talk show, he offered $1,000 of his own money in a challenge to anyone who could show scientific evidence of supernatural powers. Soon afterward, he began broadcasting his own national radio show dedicated to discussion of the paranormal. He bought a small house in Rumson, N.J., and installed a sign outside that announced randi — charlatan. He lived there alone, with a pair of talking birds and a kinkajou named Sam. Although Randi had known he was gay since he was a teenager, he kept that to himself. “I had to conceal it, you know,” he told me. “They wouldn’t have had a known homosexual working in the radio station. This was a day when you had to keep it completely hidden.”

During the late ’60s and early ’70s, popular interest in the paranormal grew: There was a fascination with extrasensory perception and the Bermuda Triangle and best sellers like “Chariots of the Gods,” which claimed Earth’s ancient civilizations were visited by aliens. There were mystics, mind-readers and psychic surgeons, who were said to be able to extract tumors from their patients using only their bare hands — and without leaving a mark. Randi continued on his crusade. Few of his fellow illusionists were interested in exposing the way that conjuring tricks were used to dupe gullible audiences into believing in psychic abilities. “Everybody else just kind of rolled their eyes,” Penn Jillette, a good friend of Randi’s, told me. “’Why is Randi spending all this time doing this? We all know there is no ESP. It’s just stupid people believe it, and that’s fine.’ ”

Randi kept up his $1,000 challenge — and eventually increased it to $10,000 — but found few takers. Then in 1973, he met the nemesis who would define his struggle: Uri Geller, who had recently arrived in the United States from Israel. Geller was a charismatic 26-year-old former paratrooper who performed mind-reading feats similar to those with which Randi baffled audiences as a young mentalist. But Geller said that his powers were real and also claimed to have psychokinetic abilities: He could bend spoons, he said, using only his mind. His supposed gifts were studied by a pair of parapsychology researchers at Stanford Research Institute, who were persuaded that some of them, at least, were genuine. Randi told me that he met Geller soon afterward. “Very flamboyant,” he recalled venomously. “Very charming. Likable, beautiful, affectionate, genuine, forward-going, Handsome — everything!” His manner, Randi explained, was the key to the techniques employed by Geller and others like him. “That’s why they call them con men. Because they gain the confidence of the victim — and then they fool ‘em.”

Geller provided Randi with an archenemy in a show-business battle royale pitting science against faith, skepticism against belief. Their vendetta would endure for decades and bring them both international celebrity. Recognizing that the psychic’s paranormal feats were a result of conjuring tricks — directing attention elsewhere while he bent spoons using brute force, peeking through his fingers during mind-reading stunts — Randi helped Time magazine with an exposé of Geller. Soon afterward, when Geller was invited to appear on “The Tonight Show Starring Johnny Carson,” the producers approached Randi, who had been a frequent guest, to help them ensure that Geller could employ no tricks during his appearance. Randi gave Carson’s prop men advice on how to prepare for the taping, and the result was a legendary immolation, in which Geller offered up flustered excuses to his host as his abilities failed him again and again. “I sat there for 22 minutes, humiliated,” Geller told me, when I spoke to him in September. “I went back to my hotel, devastated. I was about to pack up the next day and go back to Tel Aviv. I thought, That’s it — I’m destroyed.” But to Geller’s astonishment, he was immediately booked on “The Merv Griffin Show.” He was on his way to becoming a paranormal superstar. “That Johnny Carson show made Uri Geller,” Geller said. To an enthusiastically trusting public, his failure only made his gifts seem more real: If he were performing magic tricks, they would surely work every time.

Randi decided Geller must be stopped. He approached Ray Hyman, a psychologist who had observed the tests of Geller’s ability at Stanford and thought them slipshod, and suggested they create an organization dedicated to combating pseudoscience. In 1976, together with Martin Gardner, a Scientific American columnist whose writing had helped hone Hyman’s and Randi’s skepticism, they formed the Committee for the Scientific Investigation of Claims of the Paranormal. Csicop, as it became known, was funded by donations and by sales of a new magazine, which became The Skeptical Inquirer. Randi, Hyman and Gardner and the secular humanist philosopher Paul Kurtz took seats on the executive board, with Isaac Asimov and Carl Sagan joining as founding members. Soon Randi was traveling across the globe, often “as the ambassador” of Csicop, Hyman told me recently, “the face of the skeptical movement all over the world.”

In his new role as a paranormal investigator, in books and on TV shows, Randi debunked everything from fairies to telekinesis. But he also stalked Geller around the chat-show circuit for years, denouncing him as a fraud and duplicating his feats by levering spoons and keys against the furniture while nobody was looking. In 1975, Randi published “The Magic of Uri Geller,” a sarcastic but exhaustive examination of the psychic’s techniques, in which he argued that any scientist investigating the paranormal should seek the advice of a conjurer before conducting serious research. The campaign helped make them both more famous than ever. Even today, Geller credits Randi with helping him become a psychic phenomenon — “My most influential and important publicist,” as Geller described him to me.

In 1989, Randi and Geller were booked to appear together on a TV special, “Exploring Psychic Powers, Live!” According to Randi, before the broadcast, Geller pulled him into his dressing room and offered to end the feud. “There’s no way that we are going to make peace until you level with your audiences,” Randi replied. “Until you say that you are a magician like the rest of us, and that you don’t have supernatural powers.” Geller refused. (Geller says he does not recall the incident.) Soon after, Geller brought the first of several libel actions against Csicop and Randi — who, among other things, had characterized him as a sociopath and suggested his psychic feats had been learned from the backs of cereal boxes. Geller’s suits in the United States were eventually dismissed. But the legal costs of fighting the cases were overwhelming, and Randi went through almost all of a MacArthur Foundation grant of $272,000 awarded to him in 1986 for his paranormal investigations. Finally, the struggle with Geller even cost Randi his place in Csicop; when Paul Kurtz told him it had become too expensive to keep going after such a litigious target, and demanded he stop discussing Geller in public, Randi resigned in fury.

Geller, who now lives in a large house beside the Thames River in England, says he long ago put the feud with Randi behind him. He claims to have used his show-business career as a cover for paranormal work on behalf of Mossad and the C.I.A., but he no longer calls himself a psychic. “I changed my title to ‘mystifier,’ ” he told me. “And I love it — because it means nothing.” But Randi’s contempt for him still burns brightly. “He knows he is deceiving these people — individuals, in most cases — and he doesn’t care what damage he does to them,” Randi said. “They depend on the paranormal after they have met Geller, and you cannot talk them out of it. And that has crippled them for life.”

Early one morning last summer, on a visit to Randi’s house in Florida, I drew up outside a few minutes later than we had agreed. Randi, wearing a canary yellow sweatshirt, was waiting at the front door, holding his watch in his hand. “You’re late!” he barked, and it was hard to tell if he was joking. We sat down in the living room to talk, and Randi spent half an hour laboriously adjusting his watch, winding the hands to display the correct date. “I am a little bit obsessed with having the right time,” he said. “I’ve always been very, very, big on knowing what time it is. That’s one of my connections with reality.”

Randi has never smoked, taken narcotics or got drunk. “Because that can easily just fuzz the edges of my rationality, fuzz the edges of my reasoning powers,” he once said. “And I want to be as aware as I possibly can. That may mean giving up a lot of fantasies that might be comforting in some ways, but I’m willing to give that up in order to live in an actually real world.”

That fixation on science and the rational life — and a corresponding desire to crusade for the truth — has a long history among magicians. John Nevil Maskelyne, who founded a dynasty of English conjurers in 1855 and became a prolific inventor, began his career by exposing fraudulent spiritualists and reproducing their tricks. Houdini turned to debunking mediums in his middle age as his career as an escapologist went into decline. He offered his own $10,000 reward to any spiritualist who could perform a “miracle” he could not duplicate himself. Martin Gardner, whose book “Fads and Fallacies in the Name of Science” is a founding text of modern skepticism, was also fascinated by magic, and became well known for his books explaining how many conjuring and mind-reading tricks rely upon strict laws of probability and number theory. Penn and Teller have since followed Randi down the path of conjurers who have become debunkers.

Randi now sees himself, like Einstein and Richard Dawkins, in the tradition of scientific skeptics. “Science gives you a standard to work against,” he said. “Science, after all, is simply a logical, rational and careful examination of the facts that nature presents to us.”

Although many modern skeptics continue to hold religious beliefs, and see no contradiction in embracing critical thinking and faith in God, Randi is not one of them. “I have always been an atheist,” he told me. “I think that religion is a very damaging philosophy — because it’s such a retreat from reality.”

When I asked him why he believed other people needed religion, Randi was at his most caustic.

“They need it because they’re weak,” he said. “And they fall for authority. They choose to believe it because it’s easy.”

In the 1980s, Randi turned his talent for deception to debunking the supernatural. He set out to expose New Age channelers, mediums who — on shows and in profitable public appearances — purported to be possessed by ancient spirits. One, JZ Knight, a former cable TV saleswoman, claimed to be the terrestrial mouthpiece of Ramtha, a 35,000-year-old warrior from Atlantis who could predict the future.

To show how credulous audiences could be in the face of such claims, in 1987 Randi collaborated with the Australian version of “60 Minutes.” He invented Carlos, a 2,000-year-old entity who, his publicity material stated, had last appeared in the body of a 12-year-old boy in Venezuela in 1900 but had now returned to manifest himself through a young American artist named José Alvarez. He prepared to take Alvarez on a tour of Australia.

The Amazing Randi’s Great Escapes

Charles Reynolds

Alvarez, at the time a 25-year-old student at the Art Institute of Fort Lauderdale, was in fact Randi’s boyfriend, and also his assistant. They met the year before in a Fort Lauderdale public library, where Alvarez was seeking visual references for a ceramics project. Randi, who had only recently relocated to Florida from New Jersey, struck up a conversation with him. They talked all afternoon and moved in together soon afterward.

Randi coached Alvarez carefully for his role as Carlos, rehearsing him through mock news conferences and TV appearances. He taught him how to squeeze a Ping-Pong ball in his armpit so that his pulse would appear to slow as he became “possessed” — “an old, old thing from Boy Scout camps,” Randi told me. Before the trip, Randi sent out press kits to Australian TV networks and newspapers, filled with reports charting the apparently sensational — but fictional — progress of Carlos across the United States.

Soon after they arrived in February 1988, Alvarez was booked on many of the country’s leading TV shows. Through an earpiece, Randi fed him answers to interview questions and the lines of doomsday prophecies. The climax of his tour was an appearance at the Sydney Opera House, after which the audience was invited to place orders for crystal artifacts, including the Tears of Carlos, priced at $500 each, and an Atlantis Crystal, offered at $14,000. Each proved popular — though Randi’s team never accepted any money for them.

When the hoax was revealed a few days later on “60 Minutes,” the Australian media was enraged at having been taken in; Randi countered that none of the journalists had bothered with even the most elementary fact-checking measures.

Afterward, Randi and Alvarez returned to Florida together, and Alvarez’s reputation as an artist blossomed. For the next 14 years, he toured the Carlos persona around the world as part of a performance piece, appearing onstage in Padua, Italy, and sitting for photographs on the Great Wall of China re-enacting the hoax. In 2002, the work Alvarez created from the Carlos episode was exhibited at the Whitney Biennial in New York.

Meanwhile, the establishment of the James Randi Educational Foundation in 1996 allowed Randi to continue his own pursuits with the foundation’s headquarters, a Spanish-style stucco building in Fort Lauderdale, as his base of operations. He created the Million Dollar Challenge and regularly wrote bulletins for the foundation’s website, where the message boards formed an online hub for skeptics worldwide. In recent years, he began making regular podcasts, and he also created his own YouTube channel to discuss everything from Nostradamus to cold fusion. In 2007, during his TED talk taking aim at quackery and fraud, Randi delighted his audience by gobbling an entire bottle of 32 Calms homeopathic sleeping tablets — which Randi speculated was certainly a fatal dose.

Disappointed by what he saw as the media’s indifference to the Million Dollar Challenge, that same year Randi revised the rules and announced a plan to take the challenge to high-profile psychics, including Sylvia Browne, John Edward and — once again — Uri Geller. None of them agreed to participate. He had more success in 2008, when he invited James McCormick, a British businessman, to take the challenge. McCormick had built equipment that could supposedly detect explosives from afar, which Randi recognized was simply a telescoping antenna swiveling on a plastic handle — a dowsing rod. Randi publicly offered the million-dollar prize to McCormick if he could prove that the device worked as claimed. McCormick, who was selling his product to security forces in the Middle East, never responded. But the British Police began an investigation, and last year McCormick was found guilty of fraud and sentenced to 10 years in prison, having sold at least $38 million worth of his miraculous device to the Iraqi government.

Recently, age and illness have begun to slow Randi down. In 2009, following chemotherapy for intestinal cancer, he presented the opening address at TAM from a wheelchair. Earlier this year, JREF’s Fort Lauderdale building was sold, and its reference library and collection of memorabilia were boxed up and relocated to Randi’s home. When I visited, many of the cartons remained unpacked; the portrait of Isaac Asimov that once hung above the fireplace in the JREF library was propped against a wall.

Randi was all but marooned in the house — he was forbidden to drive while he awaited cataract surgery — and Alvarez had been forced to surrender his driver’s license, after a series of events that began on Sept. 8, 2011. That morning there was a knock on the front door. When Randi opened it, a pair of federal agents stood before him. They asked to speak to Alvarez. Outside, Randi could see two unmarked S.U.V.s blocking the driveway and at least half a dozen agents surrounding the perimeter of the property. When Alvarez came downstairs from his room, the agents explained there was a problem. They wanted to talk to him about passport fraud. They cuffed him and took him out to the car. Randi was left alone in the house, holding business cards from State Department agents, who, Randi said, gave him instructions to wait 24 hours before calling them.

The agents took Alvarez directly to Broward County Jail, where he was photographed, issued a gray uniform and registered as FNU LNU: “first name unknown, last name unknown.” In an interview room at the jail, he told an agent everything: He had fled homophobic persecution in Venezuela and had come to the U.S. on a two-year student visa. He met Randi and knew he wanted to stay with him. But when his visa expired, there was no way to renew it. He said he was given the name and Social Security number of José Alvarez by a friend in a Fort Lauderdale nightclub, and used it to apply for a passport in 1987. Alvarez told the agent he was deeply sorry for the trouble he had caused the real Alvarez — who he believed was dead but turned out to be a teacher’s aide living in the Bronx. FNU LNU said his real name was Deyvi Orangel Peña Arteaga.

Randi with his partner of more than 25 years, the artist José Alvarez, at their Florida home. Jeff Minton for The New York Times

Charged with making a false statement in the application and use of a passport and aggravated identity theft, Peña faced a $250,000 fine, a sentence of up to 10 years in prison and deportation to Venezuela. After six weeks in jail, he was released on a $500,000 bond, and he subsequently agreed to plead guilty to a single charge of passport fraud. At a sentencing hearing in May 2012, the judge considered letters of support from Randi and Peña’s friends from the world of art, science and entertainment, including Richard Dawkins and Penn Jillette, as well as from members of charities to which Peña had given his time and work. The judge considered Peña’s long relationship with Randi, and Randi’s failing health. He gave him a lenient sentence: time served, six months’ house arrest and 150 hours’ community service.

But Peña still had to contend with the immigration authorities. After the sentencing hearing, he had been home for five days when Immigration and Customs Enforcement agents appeared at the door. “Say goodbye,” they told him. Peña assured Randi he would be back that afternoon. He was taken to the Krome detention center in Miami, and remained there while his lawyer tried to find a way of keeping him in the United States. After two months of incarceration, Peña was finally released from Krome on the evening of Aug. 2, 2012, to find that Randi had spent half the day waiting outside the front gate for him. The couple were married in a ceremony in Washington the following summer.

Today, Peña remains on probation and no longer holds any identity documents except a Venezuelan passport with his birth name. United States immigration authorities have agreed not to deport him for now, but he has no formal immigration status in the United States: were he to leave the country, he would be unable to return. Since his arrest, Peña has not entirely shrugged off his former persona. He signs his paintings with the name he has exhibited under for 20 years — but now followed by his true initials, D.O.P.A.

Sometimes when Randi forgets himself, he still refers to his partner as José. Yet exactly how much Randi — the master of deception and misdirection — knew about his partner’s duplicity, and how complicit he may have been in it, is unclear. When Randi first met him in the Fort Lauderdale public library, it seems certain that Peña would have introduced himself by his real name: A profile of Randi published in The Toronto Star the following year describes the magician’s young assistant, named David Peña, struggling through La Guardia Airport with Randi’s luggage. When they traveled to Australia together for the “60 Minutes” stunt, Randi may have been masterminding a deception one level deeper than he ever acknowledged: Deyvi, pretending to be José, masquerading as Carlos, the 2,000-year-old spirit from Caracas. What followed might be the longest-running hoax of The Amazing Randi’s career.

When I asked Randi how much he knew about Peña’s true identity before the federal agents came to his door, he demurred, citing legal concerns. “This is something I don’t think I’d like to get into detailed discussion about,” Randi said. “Simply because it could prejudice our status in some way.”

When he was still a young man appearing in Toronto nightclubs and pretending to predict the future, Randall Zwinge created what he hoped would be his greatest trick. Each night before he went to bed, he wrote the date on the back of a business card along with the words “I, Randall Zwinge, will die today.” Then he signed it and placed it in his wallet. That way, if he were knocked down in the street or killed by a freak accident, whoever went through his effects would discover the most shocking prophecy he ever made. Zwinge kept at it for years. Each night, he tore up one card and wrote out a new one for the next day. But nothing fatal befell him; in the end, having wasted hundreds of business cards, he gave up in frustration. “I never got lucky,” he told me.

Since then, Randi has had several brushes with death. But nothing has shaken his steadfast rationalism: neither the heart attack he suffered in 2006, nor the cancer that followed. Nor, for that matter, did a conversation he had with Martin Gardner a few years before Gardner’s death in 2010, when his friend confessed to having chosen to believe in the possibility of an afterlife. “That really surprised me, because he was the rationalist supreme,” Randi recalled. “He said: ‘I don’t have any evidence for it, you have all the arguments on your side. But it brings me comfort.’ ”

Randi told me that he now feels mild trepidation each time he goes to sleep at night, and pleasant surprise that he wakes up in the morning. But he insists he does not need the sort of reassurance that Gardner sought in his own last days. “I wouldn’t have any comfort from it — because I wouldn’t believe in it,” he said. “Oh, no, I have no fear of my demise whatsoever. I really feel that sincerely.”

Most mornings, Randi is already awake at 7 o’clock, when Peña comes in to check on him; sometimes he’s up at 6. “I’ve got a lot of work to do, still,” he told me, “and I’ve got to make use of my viable time.” He is currently completing his 11th book, “A Magician in the Laboratory,” and spends several hours a day responding to emails from his desk in the chaotic-looking office he maintains upstairs. He Skypes with friends in China or Australia once a week. Peña likes to cook, and paints downstairs, beside the framed lithograph recalling the triumphs of the Man No Jail Can Hold. The couple have spent much of the last year traveling to film festivals and screenings across the United States, helping to promote a new documentary about Randi’s life, “An Honest Liar,” which will be released in February. Randi has been surprised by the response. “Standing ovations, the whole thing,” he told me.

In July last year, Randi came closer than ever to the end. He was hospitalized with aneurysms in his legs and needed surgery. Before the procedure began, the surgeon showed Peña scans of Randi’s circulatory system. “Very challenging, a very difficult situation,” the surgeon told him. “But he lived a good life.” The operation was supposed to take two hours, but it stretched to six and a half.

When Randi began to come to, heavily dosed with painkillers, he looked about him in confusion. There were nurses speaking in hushed voices. He began hallucinating. He was convinced that he was behind the curtain before a show and that the whispering he could hear was the audience coming in. The theater was full; he had to get onstage. He tried to look at his watch, but he found he didn’t have it on. He began to panic. When the hallucinations became intensely visual, Peña brought a pen and paper to the bedside. It could prove an important exercise in skeptical inquiry to record what Randi saw as he emerged from a state so close to death, one in which so many people sincerely believed they had glimpsed the other side. Randi scribbled away; his observations, Peña thought, might eventually make a great essay. Later, when the opiates and the anaesthetic wore off, Randi looked at the notes he had written.

They were indecipherable.

Adam Higginbotham is the author of “A Thousand Pounds of Dynamite,” published by The Atavist.

A version of this article appears in print on November 9, 2014, on Page MM48 of the Sunday Magazine with the headline: The Disillusionist.

My dad, Peter Preston, has gone: a long goodbye and a deadline missed for the first time

The former editor of The Guardian died a good death at home. It was one last brave act, writes his son.

Ben Preston, Sunday Times Executive Editor
January 7 2018, 12:01am,
The Sunday Times

I always thought the only good death was a quick one. Keeling over in the kitchen or, preferably, simply going to bed and never waking up. Anything must be better than a cancer death: vital organs being eaten up; the pain of your body’s random collapse while wasting away to a living cadaver.

I was wrong. My dad died last night, 10 years after melanoma first struck, 20 months after it returned and barely four weeks since those clever doctors finally shrugged and said there was nothing else they could do for him.

Dad died a good death, one that amplified the qualities we so admired while he lived. Resilience, bravery, wisdom — he was loved and loving until the end. The fulcrum of our family.

Dad died at home, retreating only in his last hours to the bedroom he shared with my mum for 48 years. Until then he spent his days in a chair in the living room. He watched westerns and too much football. He soaked up and returned the love from a Christmas procession of visitors — family and the dearest of friends — even though he snoozed more and said less with each passing day.

It takes courage to decide to die at home. Many don’t have the choice because of their illness. Others, unsurprisingly, are too scared by the unknown, or just swept along by the momentum of medical practice.

Of course there are many people to thank for allowing my dad a good death. If my mum was daunted by the burden of being appointed both chief mourner and chief carer, she didn’t show it. Our family rallied, the clan came together — my sisters from Manchester and Barcelona, my brother from Dorset. There was lots of chatter, not red eyes and wailing.

In a week when no one talks about the NHS without adding the word “crisis”, we all simply gave thanks. A flotilla of carers, hospice workers, palliative nurses, assistants and doctors were our family’s cornerstone for three long yet strangely comforting weeks. They brought calm and cheer with each daily visit, helping Dad get up and go to bed.

NHS bureaucracy? Incompetence? Inefficiency? A hospital bed, industrial quantities of morphine, umpteen prescriptions, a hoist to lift my dad out of bed and another to winch him into his armchair, all arrived promptly without fuss. Telephone numbers for out-of-hours help were freely given. Every call answered, whenever and whatever.

Peter Preston in 1990. He filed his last column for The Observer a week before he died
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But most of all, we have my dad to thank for his good death. Dad wasn’t scared of dying, even if he was surprised at how quickly it came. Long ago, this most temporal of men had explained why. My dad recounted how, as a 10-year-old stricken by polio, which had killed his father days before, he had found himself floating up and away from his body. All was peaceful and serene — until, to his surprise, he started drifting down and back into his body, entombed within an iron lung.

Dad wasn’t scared of death then or later — so how could the rest of us be?

Polio left dad with rickety limbs that somehow he made work like a Heath Robinson machine. It robbed him of youthful sporting dreams, so he lived them instead through his four children and eight grandchildren. Yet polio gave him astonishing self-reliance and helped him find his greatest talent: writing.

My dad was a journalist until the very end. The Guardian, which he edited for 20 years, was the second love of his life after Mum and family. There wasn’t time for much else.

He filed what proved to be his last column for The Observer barely a week before he died: 1,800 words were by then easier to write — pecking, one-fingered at the keyboard — than to speak. It wasn’t supposed to be valedictory. But his plea for his rough trade to forge anew some semblance of public trust and “treat readers in a jam like human beings” was exactly that. And within minutes of sending it, he started fretting about what he’d write the next week.

Regrets? We have a few. This was a good death, not a perfect one. My dad wanted to tape some memories that would otherwise be lost for ever. He wanted to leave the sound of his voice behind (not out of vanity but because, since his mother died almost four decades ago, he’d forgotten how she spoke and didn’t want us to feel the same). But he — we — broke the first rule of hackery for the only time and missed his deadline.

And I never had The Funeral Conversation. Twice I tried; twice he moved on. That was Dad’s way. He never told me or my brother and sisters what to do. Instead, he showed us who we should aspire to be. If only we could be so resilient, humane and wise — in life as well as death.

via My dad, Peter Preston, has gone: a long goodbye and a deadline missed for the first time | News Review | The Times & The Sunday Times

The Dying Algorithm

New York Times Magazine

By SIDDHARTHA MUKHERJEEJAN. 3, 2018

Of the many small humiliations heaped on a young oncologist in his final year of fellowship, perhaps this one carried the oddest bite: A 2-year-old black-and-white cat named Oscar was apparently better than most doctors at predicting when a terminally ill patient was about to die. The story appeared, astonishingly, in The New England Journal of Medicine in the summer of 2007. Adopted as a kitten by the medical staff, Oscar reigned over one floor of the Steere House nursing home in Rhode Island. When the cat would sniff the air, crane his neck and curl up next to a man or woman, it was a sure sign of impending demise. The doctors would call the families to come in for their last visit. Over the course of several years, the cat had curled up next to 50 patients. Every one of them died shortly thereafter.

No one knows how the cat acquired his formidable death-sniffing skills. Perhaps Oscar’s nose learned to detect some unique whiff of death — chemicals released by dying cells, say. Perhaps there were other inscrutable signs. I didn’t quite believe it at first, but Oscar’s acumen was corroborated by other physicians who witnessed the prophetic cat in action. As the author of the article wrote: “No one dies on the third floor unless Oscar pays a visit and stays awhile.”

The story carried a particular resonance for me that summer, for I had been treating S., a 32-year-old plumber with esophageal cancer. He had responded well to chemotherapy and radiation, and we had surgically resected his esophagus, leaving no detectable trace of malignancy in his body. One afternoon, a few weeks after his treatment had been completed, I cautiously broached the topic of end-of-life care. We were going for a cure, of course, I told S., but there was always the small possibility of a relapse. He had a young wife and two children, and a mother who had brought him weekly to the chemo suite. Perhaps, I suggested, he might have a frank conversation with his family about his goals?

But S. demurred. He was regaining strength week by week. The conversation was bound to be “a bummah,” as he put it in his distinct Boston accent. His spirits were up. The cancer was out. Why rain on his celebration? I agreed reluctantly; it was unlikely that the cancer would return.

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When the relapse appeared, it was a full-on deluge. Two months after he left the hospital, S. returned to see me with sprays of metastasis in his liver, his lungs and, unusually, in his bones. The pain from these lesions was so terrifying that only the highest doses of painkilling drugs would treat it, and S. spent the last weeks of his life in a state bordering on coma, unable to register the presence of his family around his bed. His mother pleaded with me at first to give him more chemo, then accused me of misleading the family about S.’s prognosis. I held my tongue in shame: Doctors, I knew, have an abysmal track record of predicting which of our patients are going to die. Death is our ultimate black box.

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Credit Photo illustration by Cristiana Couceiro Cat: Iakov Filimonov/Shutterstock
In a survey led by researchers at University College London of over 12,000 prognoses of the life span of terminally ill patients, the hits and misses were wide-ranging. Some doctors predicted deaths accurately. Others underestimated death by nearly three months; yet others overestimated it by an equal magnitude. Even within oncology, there were subcultures of the worst offenders: In one story, likely apocryphal, a leukemia doctor was found instilling chemotherapy into the veins of a man whose I.C.U. monitor said that his heart had long since stopped.

But what if an algorithm could predict death? In late 2016 a graduate student named Anand Avati at Stanford’s computer-science department, along with a small team from the medical school, tried to “teach” an algorithm to identify patients who were very likely to die within a defined time window. “The palliative-care team at the hospital had a challenge,” Avati told me. “How could we find patients who are within three to 12 months of dying?” This window was “the sweet spot of palliative care.” A lead time longer than 12 months can strain limited resources unnecessarily, providing too much, too soon; in contrast, if death came less than three months after the prediction, there would be no real preparatory time for dying — too little, too late. Identifying patients in the narrow, optimal time period, Avati knew, would allow doctors to use medical interventions more appropriately and more humanely. And if the algorithm worked, palliative-care teams would be relieved from having to manually scour charts, hunting for those most likely to benefit.

Avati and his team identified about 200,000 patients who could be studied. The patients had all sorts of illnesses — cancer, neurological diseases, heart and kidney failure. The team’s key insight was to use the hospital’s medical records as a proxy time machine. Say a man died in January 2017. What if you scrolled time back to the “sweet spot of palliative care” — the window between January and October 2016 when care would have been most effective? But to find that spot for a given patient, Avati knew, you’d presumably need to collect and analyze medical information before that window. Could you gather information about this man during this prewindow period that would enable a doctor to predict a demise in that three-to-12-month section of time? And what kinds of inputs might teach such an algorithm to make predictions?

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Avati drew on medical information that had already been coded by doctors in the hospital: a patient’s diagnosis, the number of scans ordered, the number of days spent in the hospital, the kinds of procedures done, the medical prescriptions written. The information was admittedly limited — no questionnaires, no conversations, no sniffing of chemicals — but it was objective, and standardized across patients.

These inputs were fed into a so-called deep neural network — a kind of software architecture thus named because it’s thought to loosely mimic the way the brain’s neurons are organized. The task of the algorithm was to adjust the weights and strengths of each piece of information in order to generate a probability score that a given patient would die within three to 12 months.

The “dying algorithm,” as we might call it, digested and absorbed information from nearly 160,000 patients to train itself. Once it had ingested all the data, Avati’s team tested it on the remaining 40,000 patients. The algorithm performed surprisingly well. The false-alarm rate was low: Nine out of 10 patients predicted to die within three to 12 months did die within that window. And 95 percent of patients assigned low probabilities by the program survived longer than 12 months. (The data used by this algorithm can be vastly refined in the future. Lab values, scan results, a doctor’s note or a patient’s own assessment can be added to the mix, enhancing the predictive power.)

So what, exactly, did the algorithm “learn” about the process of dying? And what, in turn, can it teach oncologists? Here is the strange rub of such a deep learning system: It learns, but it cannot tell us why it has learned; it assigns probabilities, but it cannot easily express the reasoning behind the assignment. Like a child who learns to ride a bicycle by trial and error and, asked to articulate the rules that enable bicycle riding, simply shrugs her shoulders and sails away, the algorithm looks vacantly at us when we ask, “Why?” It is, like death, another black box.

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Still, when you pry the box open to look at individual cases, you see expected and unexpected patterns. One man assigned a score of 0.946 died within a few months, as predicted. He had had bladder and prostate cancer, had undergone 21 scans, had been hospitalized for 60 days — all of which had been picked up by the algorithm as signs of impending death. But a surprising amount of weight was seemingly put on the fact that scans were made of his spine and that a catheter had been used in his spinal cord — features that I and my colleagues might not have recognized as predictors of dying (an M.R.I. of the spinal cord, I later realized, was most likely signaling cancer in the nervous system — a deadly site for metastasis).

It’s hard for me to read about the “dying algorithm” without thinking about my patient S. If a more sophisticated version of such an algorithm had been available, would I have used it in his case? Absolutely. Might that have enabled the end-of-life conversation S. never had with his family? Yes. But I cannot shake some inherent discomfort with the thought that an algorithm might understand patterns of mortality better than most humans. And why, I kept asking myself, would such a program seem so much more acceptable if it had come wrapped in a black-and-white fur box that, rather than emitting probabilistic outputs, curled up next to us with retracted claws?

Siddhartha Mukherjee is the author of “The Emperor of All Maladies: A Biography of Cancer” and, more recently, “The Gene: An Intimate History.”

sovereignty

by justin hall (medium dec 7 2017)

Our daughter learned to crawl in March 2017. She was soon traversing the wood slats of our old floors, heading for whatever object looked worthy of gumming. Occasionally she would cruise toward something perilous, like an open front door, so I would reach down with my large adult hands, grab her about her tiny infant midriff, and hoist her off the ground to change her direction.

Aloft, she would instantly arch her back and unleash a loud cry, fists and toes clenched, eyes and nose meeting in a frustrated knot. At first I was inclined to chuckle: This small body was protesting so hard! It was a miracle to see this little thing already have a preference and a direction! What a delight to see her articulate herself so! My daughter and her fruitless tiny frustration!

But I was quickly chastened by her protestations. I saw myself patronizing her as I upended her forward momentum and chuckled in her screaming face. And it began to dawn on me that if I want my daughter to be able to establish personal boundaries in her life, I should encourage her self-determination.

“Sovereignty” popped into my head in May as I raised my daughter aloft once more. I was interfering with my daughter’s sovereignty: her right to run her life without interference. The term is primarily applied to states and polities. In 2017, other struggles for sovereignty competed with my daughter’s foiled crawling.

In September 2017, the U.S. president expressly espoused “sovereignty” to the UN General Assembly to promote a more go-it-alone global order of independent self-interested powers. His vision for sovereignty suggests globalization in retreat against a more Westphalian vision of sovereignty, where nations run their own affairs and stay out of each other’s business.

I don’t personally wave a flag for increased national sovereignty — shared issues like human rights and environmental collapse do not end at borders. I believe we’re all riding Spaceship Earth together, so let’s work toward shared solutions to our complex problems. Enforcing “universal human norms” is a fraught task; still, in my leader’s speech, I would like to see more focus on peace and prosperity and less focus on bellicose sovereignty. Granted how frightening the world can be, I like to think my daughter would be better protected by community than armory.

We didn’t find out the sex of our child while she was living in my wife’s amniotic jacuzzi; we found out she had ladyparts after she emerged.

Once I realized we would be raising a daughter, I stood in new apprehension of my own experience of heterohunger. I have seen some sliver of what men can do; I’ve witnessed my own desire to have stranger-women pay attention to me and to win access to their bodies.

Now, as a father, I want to prepare my daughter to stand for herself, to assert her boundaries as men might approach her. I decided I should demonstrate that a man-type person in her life would respect her preferences. By September 2017, she was saying “no,” and I loved it. Some of her earliest “nos” were repeating what we had warned her against doing: “No throwing food on the floor!” we might exclaim. “N’yoh n’yoh n’yoh,” she would repeat, grinning and wagging her finger back at us.

Yay! We could celebrate her budding refusal power. But her “nos” were more difficult for me when I wanted to pick her up, to squeeze her and smell her and smile in the face of her existence. “No!” she often exclaims when I might lean in to kiss her cheek before I’m headed away from home. This woman, I’m learning, often prefers her personal space free from my close-up stinky dadface.

So far, this is a most important lesson of sovereignty from my daughter: She doesn’t owe me physical affection or even proximity.

As the first full calendar year of her life draws to a close, America is debating a woman’s right to be free from unwanted touch and predatory harassment. This female sovereignty in 2017 did not come with the ascent of our first XX-chromosome public servant to the American throne. This female sovereignty emerged from journalists outing predator men in positions of power. This foment against sexual harassment and assault is a welcome sign of personal sovereignty for a father concerned for his independent daughter: Perhaps she can grow up in a social context that affirms her boundaries. So, a celebration of sovereignty is in order!

Except sovereignty this year has not been uniformly easy for me to swallow. On November 8, 2016, I strapped my daughter onto my chest and headed to a party of pantsuited engineers at a former San Francisco pipe organ factory. I was beaming in advance to be with my daughter to watch the televised election returns as the first woman was elected president of the United States. Instead, electoral America affirmed a sovereignty that overruled my own.

Between the two party choices in November 2016, I preferred dignity in diversity, belief in science, optimism about immigrants, and affirming a woman’s right to choose. I might call this “sovereignty through progressive solidarity.” But instead, another vision of sovereignty won the day—what seems to me to be a more untrusting zero-sum America first.

I know otherwise-smart people who voted for Donald J. Trump for president. Some did it to express disdain for a corrupt political class unbothered by the concerns of working-class folks. Others I know voted Trump for cupidity. The architecture of our political system allowed the sovereign vision of the sprawling middle to overrule the more populous edges. Or perhaps our sovereignty was tipped by Russian meddling, a 21st-century violation of the spirit of the Peace of Westphalia.

It’s enough to make this urban California resident fret for his sovereignty. My nation now has a leader who enjoys picking petty fights, denigrating minorities, and promoting his family business from the White House. He demands petty fealties that upend our attention spans through social media; we’re enmeshed in a wounded narcissist septuagenarian’s fever dreams of sovereignty. And his victory challenges female empowerment: Today, this predatory man preens in a position of supreme power.

In November 2008, the streets of San Francisco’s Mission District filled with dancing celebrants who felt their vision of righteous power had been affirmed after too long wandering in the Bush. Eight years of soothing, rational Obama cool had lead me to imagine that our collective U.S. political spiral might wind upwards. But after November 2016, I imagined that sustained sovereignty from anyone is impossible. We think we’re in control, crawling toward our desires, when some larger force reaches down, picks us up, and changes our direction.

What is personal or even national sovereignty when so many forces impinge on our autonomy? It was more simple to understand sovereignty in earlier times: royal family members jousting and jostling. Now, so many various institutions and agents reach into our personal sovereign space. In the face of security breaches and systemantics, we have barely the illusion of personal sovereignty over our data, let alone our politics. We can learn and relearn that we have so little control, while we constantly work to preserve what little power we have.

I can believe I’m saving my daughter from injury when I pick her up: I figure it’s worth interfering with her sovereignty since she doesn’t know better. If we both live long enough, there will be plenty more I might wish to prevent her from doing. But at the root, I celebrate her indomitable spirit; I’m glad she doesn’t want to be deterred from her goals. I’m not sure what exactly I can say about the indomitable spirit of the American electorate — I wasn’t pleasantly surprised by this election, but I can ruefully admire the appetite for chaos that elected Donald Trump. Maybe Trump voters thought they were saving our collective lives by picking us up from crawling forward into traffic with ongoing Democratic party presidents.

Like my infant daughter inspired by her mobility and curious about what lies over the steep edge, we humans eagerly crawl toward danger, satisfying our curiosity, eating our earth and pooping our trash. If you stop us, we’ll arch our backs and wail and work to escape bondage so we can continue our unsettling struggles for sovereignty.

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Damien Hirst on how money destroyed art — The Sunday Times Magazine

Worldwide launch of 'Mother Of Pearl' by Maia Norman at The Double Club, London, Britain - 26 Nov 2008

Damien Hirst is remarkably buoyant for an artist whose latest show was described as “the shipwreck of his career”. Breezing into his very own museum, Newport Street Gallery in Vauxhall, south London, the man famous for making a fortune from pickled sharks is as colourful as one of his spot paintings. A sporty yellow jacket over bright red-and-blue cashmere: it’s a punchy, hipster look for a 52-year-old.

Treasures from the Wreck of the Unbelievable, Hirst’s vast exhibit of 189 works spread over two of Venice’s grandest galleries, has just closed.

Ten years and about £50m of Hirst’s own money in the making, the exhibition invited prospective collectors to buy into the most expensive “fake news” show ever staged. Given the term hadn’t even been coined when he came up with the concept, it was remarkably prescient. That ability to read the future is perhaps his superpower; long before the hedge-funders piled into art as the ultimate commodity, Hirst was playing around with the links between art and money. It was almost to prove his undoing.

These latest works were “said to derive” from the lost treasures of Cif Amotan II, an imaginary 2nd-century freed slave, who amassed a dazzling hoard of sculptures and religious relics that were lost at sea and “discovered” off the east African coast in 2008. Visitors were asked to suspend their disbelief about the origins of the coral-encrusted marbles, bronzes and gold treasures “pulled from the sea” by Hirst’s personal shipwreck-recovery team. His private joke was barely disguised; Cif Amotan II is an anagram for “I am a fiction”. Prices ranged from £150,000 to more than £3m.

The reviews were Marmite, which is just how he likes them. One dismissed it as a “spectacular, bloated folly” that should be dumped “to the bottom of the sea”. Our own critic, Waldemar Januszczak, was enthused, calling it “the most ambitious solo exhibition any artist has ever mounted”. Hirst would rather divide than unite the critics: “I only ever did one show where I got slagged off and I agreed with it and felt terrible [the Elusive Truth exhibition in New York, 2005]. I think you’ve got to be in a strong position to deal with the barrage of negative press.” Surely the cushion of his £270m fortune helps? “Is that a lot?” he grins.

The show came with a large dollop of self-parody, the legendary former slave Cif described as “bloated by excess wealth”. A note to self? “I think so,” he says, fiddling with rose-gold chains around his neck. I can’t help admiring his emerald and diamond knuckle-dusters. Immediately, he whips them off and lets me try them on. He is all bonhomie, wisecracks and lightning wit.

Hirst says the Treasures show was his attempt to take a “sidestep from the gallery system”, where, for more than 20 years, he constantly fed the booming contemporary art market during the 1990s and 2000s. “When I was a student, I had this idea of creating an artist that was like a machine. So, the spot paintings, the spins, the butterflies — I created these endless series, like being immortal. I was just gonna always make these paintings and never die.”

It may have been a noble idea, but to many the factory churn grated. When, in 2012, his dealer Larry Gagosian showcased nothing but his spot paintings in all 11 of his galleries, one critic observed: “We hate this shit. Everyone hates this shit. These spots reflect nothing about how we live, see, or think, they’re just some weird meme for the impossibly rich.” Hirst concedes the work morphed into something he began to loathe: “They fit the market brilliantly, but then I created this market where they were just buying, selling, and it felt like there was no enjoyment of the art. It was about trading paintings rather than looking at them. I was giving friends gifts and they were selling them. People were selling them to buy handbags. When the market went a bit wobbly and they couldn’t sell as easily, people were, like, ‘What am I gonna do with my Hirst now?’, and I was thinking, ‘Stick it on your wall?’ ”

The slow burn of Treasures got the galleries off his back. “I thought, ‘Once I have a 10-year plan, they won’t want to know.’ I remember explaining it and they were, like, ‘When can you show it? Ten years? Have you got anything else?’ — and they leave you alone.”

Hirst says that “after the auction” he needed time to recover. In 2008, weeks before the global financial crisis reached its peak, an epic two-day Sotheby’s sale of more than 200 Hirst works spanning his 20-year career raised £111m. Entitled Beautiful Inside My Head Forever, it set a record for a one-artist auction. One critic claimed that in just 48 hours, Hirst had earned more money than all the artists exhibited in the National Gallery did in a lifetime. “I couldn’t really process it at the time. When they were giving me the number of what things were signing off for, I was saying, ‘Is that the right amount?’ I just couldn’t focus on it. I thought, ‘If I’ve made more than da Vinci, something’s wrong.’

“There was the temptation to think I’m a great artist, to think everything I make sells for huge sums and you want to think it’s got nothing to do with the world. But I remember thinking at the time that something’s not right. There was so much money around from the hedge fund guys, and when the market had that stumble after the auction, that was the real market. Artists just want to paint, even though I do think about a lot more things beyond.” Does he mean he thinks about money? “I don’t think you can make art without considering it”.

He certainly considers it, a lot. Through his Other Criteria company, Hirst has expanded into the cheaper end of the market with endless limited-edition prints and art books. There are also Hirst restaurants, jewellery, even collaborations with Lalique crystal. Has he sold his artistic soul? “I wanted to make art affordable,” he insists. “At an opening, people come up and say, ‘I’ve got seven pieces of yours — the spot print, the diamond skull print, the butterfly print.’ They’re exactly the same as [those owned by] massive collectors. As an artist, you want to go across the whole range.”

But are things really going so well? Earlier this year he closed the Other Criteria shops in Devon and New York, and shut several of his UK companies. He has also parted with his business manager, James Kelly. Has the Hirst ship hit troubled waters? No, he insists. Treasures is selling well. “We’ve already sold double what the auction made,” he says. Double? According to Hirst, Treasures has already made £250m in sales. But what of the changes in his team? He says Kelly left for health reasons and “once he left, we shut all the dormant companies, got rid of anything we didn’t need. I closed Other Criteria, but it’s still online. It’s a small percentage of the business, but takes up a big percentage of my employees’ and my time. I wanted to draw it back to the core of what it was.”

And what of Toddington Manor, the 300-room, grade I listed, dilapidated 19th-century pile in Gloucestershire that he bought in 2005 for £3m, with grand plans to renovate it with English Heritage as a museum for his own works and as a “weekend home”?

It is currently languishing under scaffolding, and he admits it is on the back burner .“I’m looking for cash at the moment. I had that idea [Toddington] in the boom time, when there was lots of cash everywhere. And then I kind of stopped everything for Newport Street. Then I bought the house in London that I’m looking at doing, which is quite a big one.” He paid £39.5m for the house overlooking Regent’s Park.

“I remember saying to myself, ‘I’ll finish every project by the time I’m 50.’ Now I’m 52 and I’m, like, ‘Oh.’ ”

Hirst tells me he has just this month bought a studio space in Soho, and he also ploughed £25m into the Newport Street Gallery ahead of its opening in 2015. A free public museum, it exhibits pieces from his personal Murderme collection of 3,000 works by artists including Banksy, Picasso, Francis Bacon and Tracey Emin.

The gallery is also home to Pharmacy 2, a revamped version of his former restaurant in Notting Hill, the scene of much of the cocaine- and booze-fuelled hedonism that surrounded Hirst and his crew back in the day.

Born in Bristol and raised in Leeds, Hirst studied at Goldsmiths college in London. While still a student, he curated the now infamous 1988 Freeze exhibition in an abandoned warehouse in Docklands, showing his work alongside Sarah Lucas, Gary Hume and several others.

They became known as the Young British Artists (YBAs). A Turner prize win in 1995 and two decades of hard partying followed. “I celebrated for 20 years, had a really good run. Twenty years of drinking continuously felt amazing,” he laughs, remembering a particularly wild night with Keith Allen and Robbie Williams at the Groucho Club. But he admits that, much of the time, he was “out of my mind and a complete dick”.

He tried to give it all up in 2002, but “kept relapsing”. He has been sober since 2006, and with sobriety come twinges of cringe at his former inebriated alter ego. “I remember talking to [the film director] Rob Altman and his wife at a party. People took loads of cocaine, it was probably falling out of my nose, and I was thinking they loved me. Years later, I’m sober and thinking, ‘Oh no, one of those nightmare idiot babblers.’ ”

What triggered the change? “It had just stopped becoming fun and became a habit. I was waking up in the morning and thinking, ‘I’ve got to drink, I feel so shit.’ It wasn’t a drink to celebrate, it was escaping. Also, I was a dad, getting in a mess with that.” Hirst has three sons with his ex-partner Maia Norman: Connor, 22, Cassius, 17, and Cyrus, 12.

“I remember there was a story where I got my c*** out in a bar in Dublin, and thinking, ‘I’m gonna go to court over this and I don’t give a f***.’ Then Maia said, ‘What about the kids?’ ”

We meet amid the wave of sexual harassment claims against powerful men. What does he make of it all? “Times change, so it’s difficult to know what’s acceptable and what’s not. The laws are pretty clear, aren’t they? With minors, it’s bad. I don’t know, two consenting adults? With Harvey Weinstein, it’s just a sad fact of human nature. People in positions of power abuse people with dreams to follow.”

With the hindsight of sobriety, does he feel he may have ever overstepped the mark? “I hope not,” he says. “When you’re drinking, you have periods that you can’t remember, but nothing like that. A friend said to me the thing about sex, drugs and rock’n’roll is a myth, because if you focus on one it’s at the expense of the other two. I was drinking too much to really get into a lot of anything else.”

Anyone in his life now? “Not that I want to talk about.” The shutters come firmly down. It has been reported that he recently split from the writer and producer Katie Keight, 27, whom he met at a party hosted by Weinstein in 2014.

Booze blackouts are a thing of the past for Hirst, who is now a bit of a gym bunny. “I love yoga. I started three years ago and do it a few times a week.” He’ll be drinking green juices next. “I don’t know about that,” he laughs. “I tried a bit of gluten-free, but it didn’t work. I like a KFC too.”

Hirst clearly takes pride in his role as father to three sons, who live with him in Richmond. He and Maia, who lived together in Devon before splitting five years ago, maintain a good relationship, despite the fact he was reported to be “devastated” when she left him after nearly two decades for Tim Spicer, a former British Army officer.

“When we broke up, I was the one taking care of that side of things. Maia was leaving me, leaving the family home, off travelling and doing her own thing. Connor was going to school in London, so I just made a decision: ‘I’m moving near the school.’ ” Cassius and Cyrus are privately schooled at the Harrodian School in west London, and Hirst says their mum recently moved to be nearer them. “They go to her two nights a week. I just say, ‘Whenever you want to see them, you work it out.’ I’ve a nanny and a teacher to do their homework with them.”

It can’t always be easy, having a household name as your dad. Hirst says that Connor was accepted at his alma mater, Goldsmiths, to read film and English, but has deferred until next year. “It’s really good he took time out, because he was struggling with it. He thought, ‘I don’t really want to go to the college my dad went to.’ ”

Hirst was concerned a few years ago during a chat with his youngest. “Cyrus came up to me and said, ‘Dad, when I’m older I want to be like you, I want to be famous.’ And I remember thinking that’s a bit of a weird one — fame is a by-product, not a goal. So I remember having conversations with him about that.” Did he understand the difference afterwards? “I think he did.”

Homework is non-negotiable, but they have as much screen time as they like. “I’ve always encouraged them because my mum wouldn’t let me watch The Sweeney when I was in school. I’ve got a huge TV and I push them — ‘Play video games, you need to do it.’ Trick is, they get bored. If you let it go, they censor themselves.”

When talking about his boys, Brexit bothers him. He is “more horrified by Brexit” than by President Trump. A firm Remainer, Hirst, who shies away from political art because “you don’t want the art to get lost in the mess”, made an exception for the referendum, producing “In” butterfly posters.

“It [Europe] is about freedom, flexibility, being able to travel,” he says. “I feel sad that my children won’t have that kind of access and sad we would limit our options in that way. It doesn’t make any sense. But it’s not really the people of Britain, is it? To choose something as small-minded as that. A lot of young people didn’t vote.”

However Brexit goes, and even if Corbyn comes to power and hikes up his taxes, Hirst won’t hotfoot it to one of his many holiday homes. “It would take a lot to move me. Everyone likes to moan about tax, but you’ve just got to pay them, haven’t you? I like being British and I’ve loved being a British artist.”

Yet he winces at the YBA moniker. “I hate it. I’d prefer it to be BBA — Bad British Artist.” Why? “By the time it becomes stuck, you’re an OAP, but you still get called a YBA.” He’s not a fan of having any other letters after his name, either. He lets slip that he has been offered a gong, but turned it down without a second thought. He thinks it was a CBE. “It was a few years ago, but I don’t think it was made public. I don’t really like that stuff. I got where I was going by myself. The letters after your name thing just feels a bit uncool.”

Hirst has been invited to meet the Queen on other occasions. “I wouldn’t go. Too scary, isn’t it? Though I’d quite like a royal warrant. William and Harry, they’re good boys. We should get them buying contemporary art.” Maybe he could send a Hirst original as a royal wedding gift? “Who’s getting married?” he asks, 24 hours after blanket news coverage of Prince Harry’s engagement to Meghan Markle. He is blissfully unaware. “Maybe I’ll send that,” he says, motioning to a purple butterfly painting on the wall of his restaurant.

Hirst can’t fathom the thought of retirement any time soon, but having passed his half-century marker, finds himself in a reflective mood. One thing that has dawned on him as he looks backwards and forwards, is that less is more: “As you get older, you want your life to become simpler.” For now.

via The Magazine Interview: Damien Hirst, the original YBA on how money destroyed art — and why he hates that acronym | The Sunday Times Magazine | The Times & The Sunday Times

Versbloed – New Scientist

Versbloed by Sally Adee

Kunnen we werkelijk onze jeugd terugkrijgen door het bloed van jonge mensen door de aderen te laten stromen? Een kijkje in de keuken van een Californische verjongingskliniek.

In het kleine winkelcentrum ontwaar ik, tussen een ijzerhandel en een kapperszaak in, de Franse bistro. De man met wie ik een afspraak heb, had mij gevraagd hierheen te komen in plaats van naar de kliniek. Hij heeft er namelijk geen zin in geïnterviewd te worden terwijl hij aan de transfusie ligt.

Ik word naar de tafel geleid waar hij een glas wijn zit te drinken. Zoals je bij durf- kapitalisten wel meer ziet, draagt hij een T-shirt met een jasje erover. En hoewel zijn jeugdige trekken enigszins griezelig aandoen, ben ik oprecht geschokt als hij mij vertelt dat hij 65 is. Om zijn privacy te beschermen, kiest hij er overigens voor om in dit artikel JR genoemd te worden.

JR is uitgegroeid tot een bescheiden beroemdheid in deze streek. Het is de vijfde keer dit jaar dat hij vanuit Atlanta is ingevlogen om zijn behandeling te ondergaan, en Monterey krijgt niet veel bezoek van mensen zoals hij.

Je zou kunnen denken dat de kust van Californië één stuk zonovergoten strand is vol rijke mensen. Maar in het midden van de staat worden de dingen anders. Wanneer je vanuit San Francisco zuidwaarts rijdt, verdwijnt de zon al snel achter een permanente deken van mist. De centrale kust is lang, vlak en bespikkeld met non-descripte gebouwen waarachter nog net de staalgrijze golven te ontwaren zijn.

Het is dus best een beetje raar dat dit het epicentrum is van een fenomeen dat Silicon Valley op een dag naar de kroon zou kunnen steken: kuren met jeugdig bloed. JR is een van de honderd mensen die 8000 dollar hebben betaald om deel te nemen aan een controversieel experiment waarbij ze zich bloed laten toedienen van donoren tussen de 16 en 25 jaar, met de bedoeling de klok in hun lichaam terug te draaien. Deze honderd mensen zijn afkomstig uit alle windstreken, waaronder Rusland en Australië.

Het is niet moeilijk te begrijpen waarom. Na de recente stortvloed aan onderzoeksresultaten die verjongingseffecten in oude muizen lieten zien, is het idee om je vaten te vullen met bloed van jonge mensen in één klap van een Dracula-verhaal veranderd in een typische Silicon Valley-hype over de ‘disruptie van de dood’.

Geen wonder dus dat start-ups, universiteiten en farmaceutische bedrijven over elkaar heen buitelen om de beloften van jeugdig bloed te commercialiseren. Volgens de geruchten roeren zich achter de schermen ook durfkapitalisten en vooraanstaande zorgondernemers. De populariteit van het concept wakkert inmiddels de vrees aan voor het ontstaan van een ‘rode markt’, en het ontluiken van een dystopische toekomst waarin grijze rijkaards jonge mensen – niet langer alleen in metaforische zin – van hun jeugd beroven.

Maar wanneer je het dunne laagje van de hype afkrabt, wordt al snel duidelijk dat we helemaal verkeerd tegen het bloed van de jeugd aankijken. Nieuwe inzichten kunnen misschien al binnen een paar jaar leiden tot een veiligere en effectievere manier om met bloed het onvermijdelijke verval van de veroudering te stoppen.

Geheimzinnige ingrediënten

Al sinds het midden van de negentiende eeuw wordt vermoed dat jeugdig bloed over verjongende krachten beschikt. Dat is te danken aan een wrede chirurgische techniek die parabiose wordt genoemd. Hierbij naaiden onderzoekers twee dieren – doorgaans ratten – aan elkaar vast. Binnen ongeveer een week ontstonden er dan nieuwe bloedvaten en ontwikkelden de dieren een gezamenlijke bloedsomloop. Dit bleek het opmerkelijke effect te hebben dat de oudste van de twee ratten zich in zowel fysiek als cognitief opzicht aan de jongste aanpaste. Rond 1972 leek onderzoek zelfs uit te wijzen dat de oudere ratten er langer door leefden.

Kort na de eeuwwisseling stortten onderzoekers van Stanford University in Californië zich opnieuw op de techniek. Deze keer richtten ze hun aandacht op het terugdraaien van specifieke verouderingskwalen. Ze beschadigden de levers en spieren van oude muizen, voordat ze deze boven op een onbeschadigde muis bevestigden. Degenen met jonge partners genazen goed. Die met oude partners niet. De onderzoekers behaalden vergelijkbare resultaten met het hart en met leeftijd- gerelateerde cognitieve aandoeningen.

Wat in het bloed kon voor deze verjongende effecten verantwoordelijk worden gehouden? De meest voor de hand liggende verdachte is het plasma, de gele vloeistof die uit donorbloed wordt gefilterd. Bestanddelen zoals rode bloedlichaampjes worden gebruikt voor bloedtransfusies, terwijl het plasma veelal als restproduct wordt behandeld.

Omdat plasma rijk is aan allerlei soorten eiwitten en andere stoffen, zou dit spul het het antwoord in zich kunnen dragen op de vraag waarom jonge mensen jong zijn en oude mensen oud. Hoewel nog niet alle componenten in plasma geïdentificeerd zijn, weten we dat van allerlei bestanddelen de hoeveelheden en verhoudingen tijdens het verouderingsproces veranderen. Zo bevat ouder bloed hogere niveaus van ontstekingsfactoren die weefsels kunnen beschadigen. En ontstekingen worden in verband gebracht met kanker, hart- en vaatziekten en depressie. Jonger bloed bevat daarentegen hogere concentraties stimulerende en helende factoren.

Dat is op zich een fantastische ontdekking. Maar om ook medisch relevant te zijn, dienen we jong bloed toe te kunnen dienen zonder dat we gepensioneerden aan twintigers hoeven vast te naaien. In 2014 gaven onderzoekers onder leiding van neurowetenschapper Tony Wyss- Coray van de Stanford University muizen van middelbare leeftijd een injectie van plasma afkomstig uit jonge muizen. Na drie weken vertoonden de behandelde dieren, in vergelijking met muizen die een placebo kregen toegediend, anatomische verbeteringen in de hersenen en een cognitieve opleving. Elke andere lichaamsfunctie die ze onderzochten, liet vergelijkbare effecten zien.

Jonger bloed bevat hogere concentraties helende factoren

Het plasma blijkt niet eens van dezelfde diersoort afkomstig te hoeven zijn. Oude muizen worden evengoed kwieker van plasma afkomstig van jonge mensen. ‘Zulke verbazingwekkende effecten hebben wij inderdaad waargenomen’, vertelde Wyss-Coray in 2014 tegen New Scientist. ‘Het mensenbloed had een heilzaam effect op ieder orgaan dat we tot dusver onderzocht hebben.’

Placebo-effect

Wyss-Coray had nu het bewijsmateriaal in handen dat hij nodig had om een experiment met mensen te kunnen starten. In oktober 2014 begon zijn start-up Alkahest deelnemers te werven voor een aan de Stanford School of Medicine uit te voeren experiment waarbij mensen in een late fase van alzheimer bloed van jonge mensen toegediend zouden krijgen. Het jaar daarop lanceerde het Bundang CHA General Hospital in Zuid-Korea een goudenstandaardonderzoek waarin de antiverouderingseffecten van navelstrengbloed, jong plasma en een placebo met elkaar werden vergeleken. Beide onderzoeken werden met enthousiasme ontvangen. Wyss-Coray werd een veelgevraagd spreker die onder meer een TED-lezing gaf en optrad voor het World Economic Forum.

En dan is er het Ambrosia-experiment waaraan JR deelneemt. Ambrosia is een start-up waarvan het hoofdkwartier gevestigd is in Washington DC. De trial heeft geen toestemming van de regelgevende instanties nodig, omdat behandeling met plasma al wordt toegepast om patiënten met zeldzame genetische aandoeningen van essentiële eiwitten te voorzien. De deelnemers aan deze trial lopen geen risico een placebo toegediend te krijgen. Alles wat ze nodig hebben om zich van een dosis levenssap verzekerd te weten, is een geboortedatum die aantoont dat ze ouder zijn dan 35 – plus 8000 dollar.

Voor dat geld word je ingespoten met twee liter bloedplasma die over is van bloeddonaties door jonge mensen (zie kader ‘Bloedmythen’). Anders dan de trials die het effect van jeugdig bloed op specifieke ziekten onder de loep nemen, heeft Ambrosia een bescheidener doelstelling: het verlichten van de algemene malaise van de ouderdom. Het bedrijf brengt weliswaar de veranderingen in kaart in ongeveer honderd biomarkers in het bloed, maar ‘let vooral op gezondheidsverbetering in het algemeen’, zegt oprichter en ceo Jesse Karmazin.

Omdat deze methodologie niet beantwoordt aan de gebruikelijke standaarden van wetenschappelijke degelijkheid, mag het geen verbazing wekken dat zowel wetenschappers als ethici Karmazins team ervan beschuldigen een slaatje te slaan uit de publieke opwinding rond het idee. ‘Ik denk niet dat het Ambrosia-experiment überhaupt een experiment genoemd kan worden, aangezien ze gezonde mensen behandelen die geen bruikbare data opleveren’, zegt Wyss-Coray.

Dit maakt elk resultaat bij voorkeur onpublicabel – wat mogelijk verklaart waarom Karmazin zijn eerste resultaten bekendmaakte ten overstaan van een technisch gehoor op de Silicon Valley Code Conference, in plaats van op een medisch congres of in een vakblad. De getallen waren even onverifieerbaar als indrukwekkend. Een maand na de behandeling was – aldus Karmazin – bij zeventig deelnemers een afname waarneembaar van bloedfactoren die in verband worden gebracht met het risico op kanker, alzheimer en hart- en vaatziekten. Ondertussen was de cholesterolafname vergelijkbaar met het effect van een statinebehandeling.

Karmazin zegt dat dit mogelijk zijn observaties aan de cliënten verklaart. Een vrouw met chronische vermoeidheid is weer in staat haar bed uit te komen en een normaal leven te leiden. En een deelnemer die de eerste verschijnselen van alzheimer vertoonde, is volgens klinische criteria patiënt-af. ‘Er zit iets in jeugdig bloed dat het verouderingsproces lijkt terug te draaien’, zegt Karmazin. Zelfs gezonde deelnemers ‘hebben gewoon meer energie’.

Dat is ook JR’s ervaring. ‘Ik voel het een beetje’, zegt hij. ‘Ik ben weer begonnen met hardlopen.’ Maar hoewel Karmazin beweert dat het bloed hetzelfde effect uitoefent op deelnemers van verschillende leeftijden, zegt JR dat zijn 39-jarige vriendin na twee behandelingen nog geen verschil voelt. Wat zijn eigen, nogal jeugdige uiterlijk aangaat, zegt hij dat hij veel van de behandelingen waar zijn bedrijf in investeert persoonlijk uitprobeert.

‘Er zit iets in jeugdig bloed dat veroudering lijkt terug te draaien’

Desondanks valt er wel het nodige op de behandeling af te dingen. Veel van de gezondheidsverbeteringen die Ambrosia claimt, zouden aan placebo-effecten te wijten kunnen zijn. Maar voor Karmazin spreken de cijfers voor zich. Oorspronkelijk was hij van plan om zeshonderd deelnemers te werven. Dankzij de resultaten is hij echter dermate optimistisch geworden dat hij zijn aanbod aan het uitbreiden is. Toen ik in juni 2017 naar Monterey reisde, had Karmazin juist zijn derde kliniek geopend. En dankzij recente geldinjecties van durfkapitalisten hoopt hij in 2018 over zes klinieken in de VS te beschikken.

Wil ik hiermee doorgaan?

Ik kwam in Monterey terecht omdat ik mij het afgelopen jaar voor deelname aan de trial heb voorbereid. Net als bij anderen had zich in mijn hoofd het beeld van een soort ‘bloed-kuuroord’ van Silicon Valley-achtige allure gevormd. In werkelijkheid valt de kliniek nogal tegen. Het lage gebouw wordt geflankeerd door een afbladderend opslagruimteverhuur- bedrijf en een parkeerterrein vol gaten. De inrichting is al even bescheiden. De patiënten komen via een met hout betimmerde keuken bij de receptie aan. In de behandelruimte kijkt een rij leunstoelen – ieder voorzien van een infuusstandaard – uit over een rommelig landschap dat uitmondt in de nauwelijks van de mist te onderscheiden Stille Oceaan. De meeste van de niet meer zo jonge cliënten die deze stoelen bezetten, krijgen geen plasma toegediend, maar vloeistoffen.

De dag dat ik de kliniek bezoek, staat de trial onder leiding van Craig Wright, Karmazins partner van het eerste uur. Karmazin heeft weliswaar een medische graad, maar geen behandelbevoegdheid. Vandaar dat hij samenwerkt met Wright, een immunoloog die eerder verbonden was aan het Walter Reed Army Medical Center in Washington DC. Wright beschikt over de vergunning om een van de infuusdiensten aan de westkust te leiden die niet gelieerd zijn aan een bepaald ziekenhuis.

Hoewel hij op zijn 67e recht heeft op zijn welverdiende pensioen, houdt Wright de kliniek aan vanwege zijn patiënten. ‘De gezondheidszorg in dit land geeft geen moer om oude mensen’, zegt hij. Een van zijn cliënten lijdt aan een vorm van dementie die hem herhaaldelijk op de eerste hulp deed belanden vanwege vochtgebrek. Een andere kampte na een aantal behandelingen tegen lymfklierkanker met een beschadigd immuunsysteem waardoor ze te maken kreeg met terugkerende infecties. Nadat Wright haar voor de Ambrosia-trial had ingeboekt, verdwenen de infecties als sneeuw voor de zon. Toch twijfel ik, nadat ik bij de kliniek ben aangekomen, er serieus aan of ik hier wel mee door wil gaan. In zijn kantoor overhandigt Wright mij het toestemmingsformulier. Wanneer ik hem vertel dat ik mijn deelname heroverweeg, probeert hij mij – tot mijn verbazing – niet om te praten. ‘Voordat je dit doet, moet je er diep over te hebben nagedacht’, zegt hij. Voor sommige van zijn oudere, minder gezonde patiënten is plasma heilzaam gebleken. Jongere mensen die deelname overwegen stellen zich echter bloot, zo waarschuwt hij, aan een waslijst van mogelijke bijwerkingen.

Tot de bekendste risico’s van plasmatransfusie behoren longschade, hypervolemie (bloedovervulling) en allergische reacties. Tot de zeldzamere bijwerkingen behoort besmetting met een infectieziekte. De kans is ten minste één op een miljoen dat bloedproducten hiv overbrengen. Voor JR is dat een onaanvaardbaar hoog risico, zo vertelt hij. Daarom slikt hij voorafgaand aan iedere behandeling een dosis van het preventieve hiv-medicijn PrEP.

Van tevoren had Karmazin mij verzekerd dat geen van de risico’s die in verband worden gebracht met plasmatransfusie een percentage van 1 of 2 overstijgen. Die getallen zijn gebaseerd op de trial zelf. In zijn presentaties houdt hij potentiële cliënten voor dat ‘geen’ van de deelnemers negatieve effecten heeft ondervonden. ‘Niemand.’

Complicaties

Wanneer ik JR en Wright op de tweede dag van mijn bezoek opnieuw ontmoet, ogen ze allebei zichtbaar aangedaan. Eerder die dag was er een bezoeker uit Moskou gearriveerd. Toen hij aan zijn tweede verpakking met plasma begon, vertoonde hij plotseling een anafylactische reactie. Zijn gezicht en tong zwollen op, en overal op zijn lichaam verscheen uitslag. ‘Zelfs het wit van zijn ogen werd rood’, zegt JR. ‘Hij zat duidelijk flink in de problemen.’ Wright wist hem met een spoedbehandeling te stabiliseren, en stuurde hem terug naar zijn hotel.

Ik zeg dat ik ervan versteld sta dat mijn eerste bezoek aan de kliniek precies samenvalt met de eerste complicatie ooit. Er valt een ongemakkelijke stilte waarbij JR en Wright de nodige blikken uitwisselen. ‘Het is niet de eerste keer’, zegt Wright. Wanneer ik aandring op meer informatie, weifelt hij. ‘Je kunt beter met Jesse praten.’ Wanneer ik Karmazin bel, vertelt hij dat er zich ook een keer een ooglidzwelling heeft voorgedaan, en een geval van acute longontsteking die waarschijnlijk al latent was toen de patiënt de behandeling onderging. Maar in latere gesprekken vertelt Wright mij verhalen over ernstiger gevallen. Zonder publiekelijk beschikbare data is het echter onmogelijk deze tot op de bodem uit te zoeken.

Dit gaat dan nog over de bekende problemen. Daarnaast bestaan ook nog de onbekende problemen die gepaard gaan met het injecteren van materiaal van een genetisch verschillend persoon, aldus Irina Conboy van de University of California in Berkely, co-auteur van een Stanford-studie die het toepassen van jeugdig bloed mede op de kaart heeft gezet.

Zo zou er het risico kunnen bestaan op het ontwikkelen van auto-immuunaandoeningen. Anderen vrezen dat het jarenlang toedienen van stimulerende eiwitten kan leiden tot kanker. ‘Naarmate je langer bloed blijft toedienen, neemt het risico op ongewenste reacties toe, zegt immunoloog Dobri Kiprov van het California Pacific Medical Center in San Francisco. ‘Omdat de meeste mensen gewoon graag jong willen blijven en niet aan een bepaalde ziekte lijden, is dat niet bepaald verantwoord.’

Het is gemakkelijk om Ambrosia te bekritiseren vanwege het hoge bedrag dat mensen voor een onbewezen therapie betalen (zie kader ‘Waarom kost het 8000 dollar?’), maar er bestaan tegelijkertijd geen bewijzen dat andere trials veelbelovender zijn. Hoewel Alkahest al in 2014 vrijwilligers is beginnen te werven, heeft het bedrijf nog geen resultaten gepubliceerd. Wyss-Coray verwacht in november met de eerste resultaten te komen.

Omdat er zo veel onzekerheid heerst over zowel de risico’s als de voordelen, zijn anderen op zoek naar gerichtere methoden. Wanneer er in bloed een of meerdere werkzame stoffen ontdekt zouden worden die ondubbelzinnig veroudering tegengaan, zou er misschien een veilige en handzame pil ontwikkeld kunnen worden.

Een tijd lang luidde de naam van de belangrijkste kandidaat GDF11 – een verjongend eiwit dat in hoeveelheid afneemt naarmate we ouder worden. In 2013 wist Amy Wagers van Harvard University te melden dat dagelijkse doses GDF11 in oudere muizen de spieromvang, conditie en kracht herstellen tot niveaus die normaal zijn voor veel jongere exemplaren.Ook is er het eiwit osteopontine, dat bloedlichaampjes jong lijkt te houden en het immuunsysteem versterkt. De nieuwste vondst is een uit de navelstreng afkomstig eiwit met de naam TIMP2, dat de prestaties van oude muizen in cognitieve tests blijkt te verbeteren.

Maar hoe aantrekkelijk de eiwitoptie ook klinkt, de realiteit is weerbarstig. ‘Er bestaat een heleboel hype rond deze geïsoleerde eiwitten’, zegt Hanadie Youzef, die eveneens aan Stanford met plasma werkt. ‘Maar in de biologie is 1 plus 1 niet altijd 2. We weten niet welke bestanddelen met elkaar samenwerken, en hoe.’

GDF11 bracht aanvankelijk een golf van enthousiasme teweeg, totdat verschillende labs er niet in slaagden Wagers’ resultaten te herhalen. Het is zelfs mogelijk dat de helende eigenschappen van jeugdig plasma geheel op een misvatting berusten. De meeste beweringen over de kracht van jong bloed berusten immers nog altijd op experimenten met parabiose.

Het probleem is dat parabiose om meer gaat dan bloed. Er kunnen dus andere redenen zijn waarom oudere muizen er voordeel van hebben. ‘Deze oude muizen krijgen plotseling toegang tot veel meer dan alleen jong bloed’, zegt Conboy. Namelijk een jonge lever om gifstoffen uit te filteren, een jong hart met een betere pompfunctie, jonge longen en ga zo maar door.

Bovendien wordt hun omgeving interessanter. Conboy: ‘In plaats van in een hoekje te zitten, worden ze de hele dag door de jonge muizen rondgedragen.’ Conboy besloot daarom uit te zoeken in hoeverre de effecten van het vastgenaaid zitten aan een andere muis verschillen van het louter toedienen van jong bloed. Gefinancierd door onder meer Calico, het door Google opgerichte biotech-bedrijf dat zich richt op de bestrijding van veroudering, ontwikkelde haar team een experiment waarbij de helft van het bloed van de ene muis via een pomp werd overgebracht naar een andere. ‘We transplanteerden de helft van de bloedvoorraad naar de oude muis, en niet alleen een beetje plasma’, zegt Conboy. ‘Als je dit bij een mens zou proberen, zou dat fataal uitpakken.’

Het jonge bloed bleek niet zo veel voor de oude muis te doen – de effecten waren veel geringer dan bij parabiose. Maar wat Conboy vooral verbaasde, was de schade die het experiment berokkende aan de jonge muizen. ‘Al na een enkele uitwisseling bleken ze dommer te zijn geworden’, zegt ze, ‘terwijl de hoeveelheid ontstekings- factoren toenam.’

Wat wil dit zeggen? Het lijkt er op z’n minst op dat de heilzame effecten van jong bloed snel teniet worden gedaan door kwalijke substanties in oud bloed. Verder heeft het er alle schijn van dat de verjongende effecten niet zozeer veroorzaakt worden door het jeugdige bloed zelf, als wel door het feit dat het slechte spul in oud bloed erdoor verdund wordt. Dat betekent dat het effect hooguit tijdelijk is – wat in overeenstemming is met Karmazins observatie dat klanten regelmatig dienen terug te komen voor een vers infuus.

Geen plezierige ervaring

Om werkelijk baat te hebben bij het bloed van een jong persoon zou je jezelf een paar weken aan de miserabele millennial moeten vastnaaien. (Misschien dat daar ooit een rode markt voor ontstaat, maar dat zal dan zeker ook een zwarte markt zijn.) Dat betekent echter niet dat we het kind met het badwater hoeven weg te gooien. Het enige wat we moeten doen, is de zaak omgekeerd benaderen, zegt Conboy. In plaats van dat we uit jong bloed het goede proberen te winnen, zouden we uit oud bloed de schadelijke stoffen moeten verwijderen.

Samen met de antiverouderingsstart-up Unity Biotechnology, die gefinancierd wordt door het investeringsvehikel van Amazon-oprichter Jeff Bezos, ontwikkelt Conboy momenteel een soort dialyse- apparaat voor ouderen dat een waslijst van schadelijke stoffen uit het bloedplasma filtert. Gebruikers lopen geen risico op immuuneffecten of infecties, aangezien het om hun eigen bloed gaat. Evenmin is er toestemming nodig van medische toezichthouders, omdat de dialyse-filters al gebruikt worden – onder meer om cholesterol te verwijderen uit mensen die aan bepaalde erfelijke aandoeningen lijden. Het team van Unity ontwikkelt ook sensoren die in de gaten houden of bepaalde bloedfactoren boven een kritische waarde uitstijgen en het dus tijd is het verwijderen van schadelijk stoffen.

De filters zijn inmiddels in vitro getest op muizenbloed. Unity zegt de resultaten op korte termijn te publiceren. Het bedrijf hoopt binnen vijf jaar met menselijke proefpersonen aan de slag te gaan. Overigens betreft het geen procedure die te licht moet worden opgevat. ‘Het is geen plezierige ervaring wanneer je bloed gefilterd wordt’, zegt Douglas Kiel van het Institute for Aging Research van Harvard. ‘Vraag dat maar aan dialyse-patiënten.’

Niettemin verwachten Conboy en Yousef dat wanneer we het probleem van oud bloed weten te overwinnen, ons een gezonde toekomst wacht. Ze voorzien zelfs een tijd waarin we, in plaats van schadelijke stoffen uit ons bloed te filteren, we het probleem bij de wortel zullen weten aan te pakken (zie kader ‘Bronnen van slecht bloed’). Ze beschikken namelijk over aanwijzingen dat de bloedbestanddelen die verantwoordelijk zijn voor veroudering afkomstig zijn van zogenoemde senescente cellen. Wanneer je hier iets aan kunt doen, dan zou je een 75-jarig lichaam weer kunnen laten functioneren als dat van een 35-jarige, zo denken ze. ‘De ouderdom is niet in graniet gebeiteld’, zegt Conboy.

Nieuwe klinieken bieden voor 500 dollar een behandeling van een half uur aan

Maar hoe zit het ondertussen met plasma? Karmazin is van plan zijn diensten toegankelijker te maken. Zijn nieuwe kliniek zal niet langer 8000 dollar rekenen, of gedurende twee dagen twee liter toedienen. In plaats daarvan, zo vertelt hij mij, experimenteert hij met een procedure die maar een paar uur in beslag neemt. Uiteindelijk wil hij kleinere hoeveelheden plasma leveren tijdens sessies van een half uur. Prijs: 500 dollar per shot.

Uiteindelijk waren het deze plannen die een wig dreven tussen Karmazin en Wright. Als ontwikkelaar van het originele behandelprotocol vindt Wright de nieuwe, snellere behandeling te riskant. In juli, een maand na mijn bezoek aan Ambrosia, diende hij zijn ontslag in.

Zelfs zonder de risico’s zijn de effecten – of die nu reëel zijn of op placebo-werking berusten – bescheiden te noemen, zo geeft JR toe. ‘Dit is geen wondermiddel. Ja, je voelt je een beetje beter. Je slaapt beter. Maar het is niet alsof je hele leven veranderd is.’ Maar, zo besluit hij enigszins klagelijk, ‘als je er nou eens tien gezonde jaren bij zou kunnen krijgen…’