Chapter 2

Chapter 2#

Hide code cell source 
import networkx as nx
import matplotlib.pyplot as plt

# Create a directed graph (DAG)
G = nx.DiGraph()

# Add nodes and edges based on the neuron structure
G.add_edges_from([(1, 4), (2, 4), (3, 4), (4, 5), (5, 6)])

# Define positions for each node
pos = {1: (0, 2), 2: (1, 2), 3: (2, 2), 4: (1, 1), 5: (1, 0), 6: (1, -1)}

# Labels to reflect parts of a neuron
labels = {
    1: 'Directed', 
    2: 'Games', 
    3: 'Allegory', 
    4: 'Tradition',
    5: 'Innovation', 
    6: 'Revolution'
}

# Draw the graph with neuron-like labels
nx.draw(G, pos, with_labels=True, labels=labels, node_size=5000, node_color='lightblue', arrows=True)
plt.title("Tension in Bow (Inherited & Added Constraints) +\n Release of Arrow (For Loftiest Goals)")
plt.show()
../_images/2768d544d818523b4303120addc46d235a2be4b04389205a94fcf39fec48f86f.png
../_images/blanche.png

Fig. 19 Medicine in a Nutshell. Innovation serves as the crucial middle step between tradition and revolution. It represents the creative process of reimagining or improving upon established ideas, methods, or structures without completely discarding the past. This is where the seeds of revolution are sown, but innovation still maintains some continuity with tradition, unlike revolution, which breaks away or redefines the status quo entirely#

Clinical Trials through a Game Theory Lens#

Infectious Disease Treatment as Adversarial Games#

When it comes to infectious disease treatment, we’re in the heart of an adversarial game. The pathogen is the enemy, and the drug is the player. Here, efficacy is the payoff—how well the drug “plays.” But the game isn’t just about winning; adverse effects become the cost of doing business, a negative payoff that shapes the equilibrium. It’s a battle between two forces, and the drug’s strategy is to outmaneuver the pathogen, while minimizing collateral damage to the host.

Vaccination as a Cooperative Game#

Prevention through vaccination plays out as a cooperative game. Here, the vaccine teams up with the immune system, and together, they work toward a common goal—immunity. The broader public plays its part too, with herd immunity forming a kind of collective defense strategy. Adverse effects aren’t just unfortunate side outcomes but part of the natural equilibrium of the game. Everyone benefits from the cooperation, but the strategy has to balance risk and reward, making sure adverse effects don’t undermine the overall efficacy.

The Immune System as the True Agent of Cooperation#

Now, flip the perspective. The real player in this game isn’t the vaccine—it’s the immune system. The vaccine becomes the facilitator, guiding the immune system to mount a strategic response. The equilibrium here is a finely tuned system that balances preparation against future threats and the costs of side effects. The more efficiently the immune system “learns” the lesson the vaccine is teaching, the better the outcome, the higher the efficacy.

Autoimmune Disease: Betrayal in Dante’s Inferno#

But what happens when the immune system betrays the body? Autoimmune disease is the ultimate act of treason—straight out of Dante’s Inferno. What should be a cooperative agent turns adversarial, mistaking the host for the enemy. It’s a catastrophic breakdown in trust, where the body becomes the battleground. In game-theoretic terms, this is a collapse of the equilibrium, with no winners, only loss. The deeper you dive, the more profound the betrayal becomes, echoing the darkest circles of Dante’s hell.

Solid Organ Transplantation: Misguided Cooperation#

In organ transplantation, we’re dealing with a high-stakes cooperative game, but with an immune system that still thinks it’s in an adversarial fight. The immune system attacks the newly introduced organ, sabotaging what could have been a life-saving partnership. Rejection is another form of betrayal—like a player refusing to cooperate in a game where cooperation is essential for survival.

Immunosuppression as a Defensive Strategy#

The introduction of immunosuppressive drugs is like recalibrating the adversarial game. Here, the drugs are the player, and their strategy is to block the immune system’s attacks, keeping it from rejecting the organ. But suppressing the immune system too much leaves the body vulnerable to other invaders. It’s a delicate balancing act—navigating between adversaries on all sides, trying to hold the line at equilibrium without tipping into chaos.

Living Kidney Donation: A Strategic Masterstroke#

Living kidney donation represents a proactive strategy—a move that gives both the recipient and medical team the upper hand. By eliminating the waiting list, you avoid the unpredictability of deceased donor transplantation. The known player (the living donor) makes the cooperative game more predictable, reducing rejection risk and optimizing the outcome. This isn’t just a game of defense; it’s a pre-emptive strike, setting the terms of the game from the start.

Deceased Donor Transplantation: An Adversarial Waiting Game#

Contrast that with deceased donor transplantation, where unpredictability reigns. Timing, organ condition, and immune response are all variables outside the recipient’s control. The strategy here is more reactive, relying heavily on immunosuppressive defenses to fend off an immune system that’s primed for war. The waiting list is the game’s wild card, introducing uncertainty and risk management into the strategy. It’s a defensive game where every move has to account for potential complications.

Strategic Patience and Risk Management in Deceased Donor Transplantation#

For patients on the waiting list, patience becomes the core strategy. Their health may decline as they wait for a match, adding pressure to the game. The waiting list introduces another level of risk—the longer you wait, the more precarious your position. It’s a test of endurance and preparation, with patients balancing their own health against the timing and availability of a suitable organ.

Resilience in Academia: The Real Game#

But what about the academic game? When mentors leave your institution with their funding and you’re forced to “change topic,” it feels like betrayal, doesn’t it? Are we in Inferno, navigating this academic wasteland? Yet, the real strategy here is resilience—like the mentee who stayed true to her research and built new alliances, forging a path despite the obstacles. In the game of academic survival, resilience isn’t just a strategy—it’s the ultimate payoff.

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