What follows are excerpts taken from the 12th edition of Science and Postmodern Medicine, which is a popular textbook among introductory history of medicine courses.
Chapter 64: The Empathy System
The first discovery was made in 2042 when neuroscientist Nahima Khan discovered the location of a network of mirror neurons deep within the amygdala – the almond-shaped structures classically associated with emotions and memory. In a landmark Nature paper, using data obtained from functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) with subdermal electrodes, she discovered neuronal activity within this region of the brain both when research participants themselves experienced as well as when they saw others experiencing a wide range of emotions. She named this region the Empathy System, and this discovery sparked the hopes of countless researchers, physicians, and government officials who envisioned an exclusively empathetic society free of crime, war, and many psychological disorders. All that remained to be discovered was the ability to manipulate this region of the brain. Dr. Khan received many awards for her work, including both the Nobel Prize in Physiology or Medicine as well as the Nobel Peace Prize, becoming only the fifth person in history to win two Nobel Prizes.
Funding and interest poured into this area of research. After Dr. Khan’s findings were confirmed in multiple international studies involving tens of thousands of participants and spanning dozens of emotions, the next set of experiments focused on stimulating the Empathy System to augment the empathetic response. While most research groups used conventional deep brain stimulation, others used transcranial magnetic stimulation, ultrasound stimulation, and even chemical compounds whose structures had been discovered using the latest techniques in artificial intelligence drug discovery. However, none of these experiments led to any noticeable effects.
At the Ninth International Conference in Empathy Sciences in 2052, it was agreed upon by a panel of research experts that enormous advancements in the fields of neurobiology, embodied cognition, and neural stimulation techniques were required before the world’s ambitions could be accomplished. Thus, research interest in the Empathy System subsided, but a decade of excitement led to some lasting effects, which have been extensively studied by sociologists.
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One peculiar consequence of the discovery of the Empathy System was a new requirement by the AAMC for medical school admissions. To fulfill their mission statement of “transforming medical education and creating a legacy of diverse, competent, and empathetic physicians,” the AAMC required every pre-medical student to obtain an fMRI and encouraged medical school admission committees to incorporate into their holistic reviews the three-dimensional volume of applicants’ Empathy Systems.
While Empathy Science was still primitive and causal links between empathy and gray matter volume had not quite been established, the new requirement persisted without any significant resistance. Medical schools, who were now regularly faced with over a hundred thousand applicants, were happy to have an additional metric to filter applications. Due to its convenient, precise, and quantitative nature, the Empathy Score became so popular that it entirely replaced interviews, vastly streamlining medical school admissions.
Students were also happy but in general were divided into two camps. One camp, which later became known as the neuronurturers, believed that Empathy Scores were the product of conscious and subconscious processes in the brain and could be changed using the neuromodulating techniques that were being researched. They believed they could augment their Empathy Scores and gain an edge in the admissions process. As a result, an underground market of Empathy System neuromodulation strategies emerged. These strategies were not dissimilar to the MCAT prep courses, cheat sheets for pre-med courses, and medical tourism “volunteer opportunities” that had existed for decades. It became common for students to spend thousands of dollars on unproven deep brain stimulation therapies and pills containing chemical compounds that were still in the in vitro stage of research development.
The other camp, the neuronaturalists, believed that an individual’s Empathy Score was the fixed product of their genetics, early childhood experiences, and personality. They believed that the Empathy Score was a good way to incorporate subjective data into the initial phases of applicant evaluation to balance out previous screens that often consisted solely of GPA and MCAT score. Companies offered Empathy Score “pre-screening” targeted at middle school students to predict their Empathy Scores by the time cognitive development was complete at age 25. Because it was rather expected to have dozens of research publications, meaningful healthcare-related experiences, and multiple leadership positions for even a chance to obtain an interview, most students who aspired to become physicians started working on their resumes for medical school in 9th grade or earlier. Empathy Score pre-screening was useful for students to determine whether it was worth investing their time and effort in the pre-medical track. The pre-screening procedure involved conducting fMRIs at ages 12 and 14 and correcting for various confounders like gender, race, and socio-economic status to enable the most accurate prediction.
The impacts of the Empathy Score far surpassed medical school admissions. Because empathy screening was done at the pre-medical level, medical schools did not feel the need to maintain an active standardized patient curriculum to teach communication skills. Doctoring or Practice of Medicine curricula were also phased out. Comments from preceptors during clinical rotations were viewed as far too subjective and prone to individual bias, and students’ Medical Student Performance Evaluation (Dean’s letter) included their Empathy Scores instead. As with most metrics used for admissions processes and according to the principle of “if you measure it, it will improve,” average scores increased each year. Qualitative interviews of junior students revealed many complaints about how easy their seniors had it.
By 2056, the first several classes with an Empathy Score had completed their residency training and begun independent practice as physicians. The healthcare landscape at this time was dominated by two massive integrated health systems – Kaiser covered the West and South while Penn-MGB Partners covered the Northeast and Midwest. All outpatient practices and hospitals, including university medical centers and most research institutes, belonged to one of these two systems. Due to their power as the sole two employers of physicians, Kaiser and Penn-MGB Partners required their physician employees to renew their Empathy Score measurements every 3 years in lieu of other continued medical education.
Over the next several years, as the average Empathy Scores of new hires steadily increased, health economists and administration noticed system-wide decreases in patient medication adherence, cancer screening, and vaccination rates. They noted it had been several years since there had been any truly ground-breaking medical research. Health system executives were puzzled but ultimately decided not to intervene, especially since, as one hospital CMO explained, “there has also been encouraging increases in electronic medical record documentation and total hours worked, all without any complaints from the medical staff.”
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It wasn’t until 2068 that the second discovery was made, this time by a physicist-neuroscientist team. The physicist, Jason Kohler, had discovered a method to selectively shield organic molecules from gamma radiation. While his work was obscure, it was noticed a few years later by neuroscientist Ezekiel Mishra, who had observed that gamma radiation strengthened synaptic transmission and stimulated gray matter expansion but led to massive DNA damage. Together, they developed a method to use gamma radiation to strengthen the Empathy System while shielding neuronal DNA. Their clinical trial easily attracted thousands of participants, many of whom were pre-medical students. However, their findings were completely unexpected and quite bizarre. After undergoing the procedure, participants publicly renounced their families and friends. They begged the research team to give them consent forms to sign to make them permanent research participants. Careful analysis revealed that those who had their Empathy Systems strengthened willingly and unconditionally gave up their free will and independent thought. They became slaves to their immediate surroundings, easily manipulable, and incapable of seeing the larger picture.
As a consequence, the Tenth and final International Conference in Empathy Sciences was convened. The panel unanimously agreed to call for an international ban on all study and measurement of the Empathy System. While sociologists continue to study the long-lasting effects of the Empathy System on the healthcare system, the true extent of damage may never be found.
Parth Shah is an MS4 at the Perelman School of Medicine.
Image by Phoebe Cunningham, an MS1 at the Perelman School of Medicine.
