Thursday, December 14, 2017

A Conversation with Ockham

The following is a recollection penned by a Franciscan Friar, one Brendan of Dublin, a physician trained at Oxford, Montpellier, and Bologna, and serving the Court in England. It recounts a trip to visit William of Ockham in the Spring of 1347, just prior to the massive outbreak of the plague. This is a translation from the original Latin, although it has been converted into a twenty-first century American-English dialect. Certain phrases were difficult to translate and certain English words are employed to best reflect the mid-Fourteenth Century intent.

It was the Spring of 1347, and I went to see Ockham on my way to Prague. He was still being protected by Ludwig and resided in his castle grounds in Munich. I had left London in early February, and had a rough crossing of the Channel and then a circuitous route down the Rhine, then cross to Munich. It was a six week journey when I arrived in mid-March, and Spring had yet to arrive. Ludwig was at war with some and aligned with others. He was close with Edward, King of England, and this allowed him some leverage, since he had positioned himself against the French King John, the rather stumbling egoist who was attempting to rule France. Although I was off to see King Charles in Prague, a putative adversary of Ludwig, as a Friar I could hopefully navigate amongst these competing players. The Battle of Crecy had been a bloody mess with so many killed and yet there was no peace between England and France. It encompassed almost all the Principalities and Kingdoms in Christendom.

Added to this was the continual turmoil in Avignon with the Popes in residence. John XXII was dead several years now and despite attempts to come back to a sense of normality after his extremely arrogant dicta, some thought his rulings even heretical, and having the Bishop of Rome appointed by French Cardinals rather than the people of Rome, had always been a stumbling block. Worse yet, this Bishop of Rome refused to go to Rome. Instead this Bishop built a massive castle in Avignon, surrounded by riches and staffed with enough people to populate a small country.

It was Ockham, my old teacher and friend, who had spent the last twenty years under the protection of Ludwig, with his writings had introduced concepts in political governance, secular as well as religious, which I saw as the basis for dramatic changes, whose time would eventually come.

Ockham had examined several areas whose influence was slowly penetrating the minds and thoughts of those would in turn were to spread it across our domains. First was his understanding of nominalism. Namely that there are only individuals, and there is no ultimate single essence, man is nothing more than a collection of people, men and women, and there is no abstract whose existence we refer all to. Namely individuals are the elements of the world, and individuals who are born free, no matter what their ultimate state may be, individuals who are equal as humans.

Second, the derivation from the poverty debate with the Pope. Namely, poverty if it were to be observed needed to have a clear definition of property, and property meant the understanding of rights. Rights in turn linked to individuals, since ownership inured to a person not some class.

Third, was the concept of how our leaders should be chosen, namely by the people. For it was for centuries that the Pope was the Bishop of Rome selected by the people of Rome. The people selected a Pope, a leader. Now we had a "Pope" selected by a class of incentivized "Cardinals" who were also selected by Kings and Princes in most cases.

Fourth, and furthermore, the Pope had managed to interject himself into secular matters in contradistinction to the Gospel.

Fifth and finally Ockham had stressed Faith and the Bible as the two elements of our religious belief. It was not to be left to the complexities of reason as attempted by Aquinas and the Bible is and must always be the cornerstone of what we believe in.

These elements had been mulling in my mind over the past decades, even though my focus as a Friar was to be a physician to the body, rich and poor alike, but Ockham was always in the back of my mind. He had a sense of clarity and a sense of correctness that was overwhelming. All one had to do was to see to what irrational ends John XXII went to try to silence him, and then to see that Ockham's assertion of the heresy of such actions of John, for all this was enlightening. The Pope was not infallible, he was a man and as a man prone to error. As our Saint Francis has said to his followers more than a century ago, we must follow our vows of poverty and chastity, and we must be obedient only to the extent that it does not conflict with our Faith. Obedience for Francis was the delimited vow, poverty and chastity had bright lines.

Francis also was a believer of the individual. Charity was an individual to another individual. It was not the "Church" as a group, nor the "King" as a ruler to dispense to the poor. My practice of medicine was a "giving" to the individual whose body I served as a healer.

I thus looked forward to seeing Ockham again. I suspected that like many of us he was aging, and although a somewhat healthy man he was always somewhat on the frail side. Ockham resided in a residence aside the main castle. Munich was an interesting city, it has its strong Germanic ties, and the people were themselves Germanic but lively. They lived in relative peace and there were many craftsman resident in the city. What amazed me each time I came here was that beer was consumed like water. There were open halls where men would congregate and consume what appeared to be volumes. Even in winter one saw this phenomenon.

I came to Ockham's residence and asked the young man who greeted me for Ockham and told him who I was. In a matter of mere seconds Ockham came forth with a great smile on his face. I was a bit set aback because the gaunt man I knew well had put upon himself a great girth. I gathered it may have been the beer. Yet it may also have been the proximity to good food and the lack of the arduous travel I have set myself upon over the years. He was cheerful, a ruddy face with a grey beard, and he retained his tonsured and word his Franciscan attire. We embraced and he ushered me to the rear, which was a small room with a fire looking out onto a small garden area, still barren from the winter.

We sat down in front of a large fireplace in a heavily beamed room. It was warm, pleasant, and a far cry from the rather Spartan quarters we had in London at Greyfriars. Ockham asked how I was doing and what news I had. I recounted the past few years and he was a bit surprised as to my proximity to King Edward. I reminded him that I had spent time as his tutor and knew his mother, the Dowager Queen. Ockham expressed his concern as to Isabella and her reputation as a rebel who had worked to overthrow her husband with her lover, Mortimer. I muted my reply saying that royalty seems always to be at each other's throats. Ockham smiled and said it reminded him of theologians as well. I smiled and said it did, the difference is that royalty hacks each other to death, theologians burn each other to death! To that he let out a hearty laugh. I let it sink in a bit and then continued:

"Yet William, although Royalty use the ax, sword, and arrow as means to death, they fight equally, no side claiming Divine correctness. In contrast, and perhaps this is from my associations with Gui and the Inquisition, the battle between believers, over differences in interpretation, is a bit one sided, with the Church having the ultimate say, and any new voice silenced by fire."

His smile disappeared and he looked at me and replied:

"I know that all too well. Yet I have continued to write, excommunication and all. Now tell me, I gather you were at the Battle of Crecy, a bit of a hero on the battle field, a physician at war, so they say. Tell me some details."

I now began to understand the phrase, "War stories". Those not there want to hear what they want to hear, perhaps glory, perhaps fine deeds. I replied:

"William, I was there as a physician to the King and his son the Prince of Wales. Yet the brutal battles, the blood shedding, the dismemberment, left me more as a priest administering Last Rights to dying men than a physician healing wounds. William, there is no glory in war, no dignity in a battle. The Knights take glory of a conflict, in the killing of an adversary. In reality it is an argument between two men, the King of England and King of France, over who is to claim what under what conditions. All that will change with the next succession, yet men go to kill each other. The reality as I saw it was that the battle enriched hose who survived, taking whatever they could, and often choosing who they would slay based upon what they could get in ransom if they kept their captive alive. On one hand it was a battle of Kings, on the other, and this I believe is the true reality, it was a barbarian assault of one group upon another. The men at arms as they went to battle, and then upon their return, took freely from those whose lands were in their path. They committed acts that they confessed as they died in my arms, and as a priest I gave them absolution, knowing full well that these men if allowed to live by God, would continue their barbaric acts on a successful return. William, war brings out the evils of the human soul, and I can do more as a physician than as a priest, that at times is truly terrifying. The beasts of the forest are often more gentle that a good Christian soldier."

I gathered that Ockham was a bit taken aback by my response. It had been but a year from Crecy but I, at times, still has the scent of the spilled human blood in my nostrils, the sight of hacked limbs in my eyes, and the screams of dying men in my ears.

We sat quietly for a while, Ockham drinking a large stein of beer, and I a cup of a white wine, for I never truly had a taste for beer, the drink that was everywhere. I then told him of my travel to Prague and my meeting of King Charles. He said he had never been to Prague and that he heard it was a beautiful place. He knew little of the Czechs, the Slavic people, yet he did indicate they were unlike the Germans, more quiet and thoughtful. We had dinner and rested.

Over the next few days we had long conversations regarding the development of his thought. My objective was to distill what he had developed in a manner in which I may be able to convey to other people, those not trained in the Scholastic manner. Ockham's work was elegant but ponderous, enlightening, but demanding too great a preparation to absorb. The following recounts my discussions. I have left it in a dialog manner to demonstrate my own need for clarity. Although trained under Ockham, my reach was as a Bachelor of Arts, a mere tyro in a land of giants. Yet perhaps to spread his insight, such a simplification was demanded. Besides, as I was to spend time in Prague with Charles and the many who would come and go there, this would be an opportunity to develop a precis, as accurately as I could, regarding Ockham and his work.

We started our discussion on his now somewhat accepted understanding of nominalism. I began by phrasing what I saw as his proposition:

"William, as I recall, your acceptance of nominalism, namely that there are no universals and that the terms we general use as a universal is nothing more than a name, thus nominal. There is no ideal "red rose", there is only this red rose and that red rose. That the accident of redness is merely an attribute of a specific red rose and not a manifestation of some ideal, some abstract essence of redness. Is that a reasonable approach to your thought?"

Ockham replied:

"Yes. One can also say that "The red rose is a plant" and yet this does not imply the existence of some universal essence called a plant. It is a plant because it has a root, it grew from a seed, in a soil, and it needs the sun to exist. Now even more deeply, it needs this specific soil, or perhaps that soil over there. It needs a specific embodiment of soil, not a universal called soil. Indeed the universal does not exist. It is not the argument between Plato and Aristotle, that the universal flow from the individuals or the individuals are manifestations of the universals. There are just individuals. The rest are just names we throw about to try to get the listener to stay attuned to what we are arguing or explaining. Redness is an abstraction, the reality is the specific red we observe. Remember that when we say red, we can hold in front of our eyes say a dozen roses, and each we call red, but each may be slightly different from each other."

"Then is it fair to say that the redness of the rose is the result of what specific rose plant I have, and what sol I have grown it in, and how much I may have watered it, and how much sun it is exposed to?" I continued, "Thus indicating that the redness is an accident at best but one based upon some specific set of processes in the growth of the flower over time."

"Interesting" he replied, "Indeed we can always take this accident related to color and explain it more so in terms of things, individual things, that impact and result in that color. Yes indeed, this is a good simple example."

"Now on to the issue of Individualism." I replied, "You have essentially used the term regarding individuals as individualism. The meaning here is that each human is an individual, and individual person. You then investigate this inn terms of individual rights, or Natural Rights coming from Natural Law. You also argue if I am correct that the Bible focuses on individual salvation, individual good deeds, individual redemption. Christ did not demand that Rome and the Emperor follow the Gospel teachings, only those who were individual Christians. In fact the Gospel teaching separates the Church and the State, more so, the individual's commitment to God from the individuals commitment to Rome or the State. It was even Saint Francis who in his rule of obedience gave a caution that the individual member of the order would have to make the individual decision. Finally, in the argument regarding poverty, it was driven by the individual possession and use of property, use such as consumption of food, and ownership of that food. It was the individual member of the Order, be they a Friar, a Third Order, a Poor Sister, we were equally and individually so obliged. From this amalgam of insights, we then can understand that the individual person, be they man or woman, free or slave, have a duty but moreover we have individual rights, Natural Rights, given equally by God to all people. Is that a reasonable articulation of what you have said William?"

He sat back and smiled. He then said:

"Brendan, you have simplified my many words, you sound like a preacher. Yes that is the non-academic answer."

I then replied:

"The advantage that one has with many hours riding a horse, a boat, waiting in a battle field, is that one thinks. I have tried from time to time to explain your thinking, but I learned that most men have to be fed simple yet compelling ideas. The do not sit for long periods of contemplation. I have an opportunity with King Charles to perhaps convey some of these ideas, yet simply. I have tried in the Court of Edward, not the best place to convey my thoughts, I have even tried with good Queen Isabella, the strongest supporter of royalty I have seen, but a willing listener."

"Your approach, William, takes a person from a subject to a citizen, from a part of a collection to a separate and independent individual. As Marsilius of Padua had also noted, I believe, the individual has both status and rights."

"Indeed" replied Ockham, "And there is both a civil as well as theological issue here. For being just a subject one has to obey no matter what. As a citizen, one has a duty and in return certain rights. Thus a Knight may have a duty to serve the Lord but he in return has the right to ownership in land. The same is our relationship with God. It is the individual who has that relationship as, if you will, a citizen in the family of Christ. We are held individually to account for our deeds. We are individually given Grace for redemption."

"Then I would ask, if this is the case, why then do we have such a concern for Original Sin?" I asked, "Why have this communal guilt for which Christ came and died for us? After all we as an individual, with no nexus to our deep dark past, may have had no part in that sin, and thus how does one look back and retain that sin?"

"Your question has merit. But allow me to return to it when we discuss Faith. The day is long, I am getting old. Perhaps a good dinner?" Ockham smiled and went forth to eat.

We spent a bit longer simplifying the idea of individualism. It was not an idea of selfishness, not an idea of separation, but an idea of individual duties and rights. Duties as regards to the understanding of what the individual was obliged under the law of the land and the law of God. The rights were rights rendered by God to the individual. These were Natural Rights. There were other rights, such as those that the King or other ruler may give to their subjects, but those were not Natural Rights, they could be taken away, changed, or even negated without reason. Natural Rights superseded these and were the result of Natural Law.

I began by asking Ockham:

"William, in your work, Decretum, you articulate three types of Natural Law. May we discuss them a bit. I understand that a great deal of your motivation was directed at the choosing of and powers relegated to a Pope. But let us leave that to the side for a moment, let us discuss just the definitions of natural Law, and then we can move to Natural Rights."

Ockham replied:

"Excellent, this is always a complex issue but a critical one for the understanding of the Pope and his powers."

"There are three types or understandings of Natural Law. The first understanding is based upon law in conformity with natural reason which never fails. Gratian uses this definition. It means that "thou shall not kill" is understood by all by means of our natural reason as a human. This First Natural Law definition is one concomitant with the existence of humans."

I interjected:

"However, and excuse me if I am inferring incorrectly, but your define Natural Law as something from Natural Reason. This seems to me to have the risk of circular logic, for in both cases the predicate "Natural" infers it is part of our nature as a human, all humans. You then relate it to say, "Do not kill" and unfortunately I have seen much too much slaughter. It thus raises two questions. First if something is "Natural" then it must be inherent in our nature, and our nature must somehow be the same in all humans. Does this not then conflict with individuals? My second point, is that again if in all humans, we see what we understand to be humans slaughtering incessantly then are then they not humans or are they then just sinning all the time?"

Ockham smiled and replied:

"Brendan, you have spent too much time in the real world. Let me continue with my other two definitions. You raise valid concerns. On the second, yes indeed this is sinful, unless it is dealt with as an unjust aggressor issue. That you know. It is the basis of a valid war. The first question is perhaps at first sight circular, but as we would have started with natural reason as a philosophical construct we would not have found a circular reasoning. Let me continue to the issue of the other definitions."

He continued:

"The Second Natural Law is the one where one uses only natural equity without reference to any human law or custom. For example it is the law that was present in nature when first initiated. It was the law at the time of the Fall of Man, yet this Natural Law definition can be mutable. Again the definition here is as Rufinus and others has agreed to. It may be disturbing as to its mutability. And yes Brendan, it relies on natural equity, fairness, or even justice if you will. My usage here is I believe consistent with the Gratian and the Decretum. But here in the Second Natural Law, that consistent with the Decretum, I also find that one sees that such things as property were thus created after the Fall, were part of the evolving Natural Law."

"Now the Third Natural Law builds upon the above two. In this case Natural Law is defined as that which can be ascertained by evident reason from the law of nations or some other law or even from some divine or human act, unless the evidently contrary can be established by those concerned. This I call the natural law by supposition. This is a conditional natural law, derived from rational responses to contingent situations. I was to understand this from a statement by Isidore of Seville. He noted that "the common possession of all things" and "the return of a thing deposited or money loaned" These he relates to Natural Law. Thus this refers to property, to the individual ownership of property. Moreover the repayment refers thusly to actual private property. Finally, private property as instituted by man. We thus have both common property by understanding the Second Natural Law and private property as understanding the Third Natural Law. Private property is an alienation concept, the taking of what was in common and making it private. Yet it is a Natural Law. A law based upon a temporal evolution of agreed principles with agreed to equity. As I will argue later, this Third Natural Law also is the basis by which we individuals have the right to elect our leaders, civil and spiritual."

I replied:

"I believe we can relate this one. Yet there is a concerning note. You state that it may be changed if "the contrary to those concerned". Thus this Natural Law is not only a contingent law but one which is changeable, and changeable by those concerned, namely I would gather the people?"

"Yes and the point then leads to the understanding of Natural Rights." Ockham replied. "If one can alienate, change, refine, then one has a right. Can you see where I am going? I am working with those who came before, working within the law as we know it, consistent with the Bible, and from this we can now start to understand the scope of Natural Law and from it the clear presence of Natural Rights. A very basic right is to elect our leaders. That include the Pope, as was the case from the time of Christ. We elect the leader, not some appointment by those of political stance."

I returned to the issue which had led to the fact that Ockham was here in Munich and not back at Oxford. Namely the issue of poverty, and the driving issue of property and use versus ownership. Until John XXII entered the fray, Franciscans and the Pope were satisfied with the vow of poverty as one where Franciscans had use of things but their ownership was held by the Pope. Now I always felt that this was a splitting of hairs but everyone was comfortable. It was when the conservative Franciscans, called the Spirituals, took the position that poverty was the way of Jesus and the Apostles and it was that way that they were following. That put John XXII in a bit of a tight spot. Here he was turning Avignon into a palatial estate, a castle to compete with any King or Emperor, clothes that shamed all of them, jewels, food, wines, while the poor wandered about helpless. The Spirituals walked about barefoot and with rags, often unclean as well. As Franciscans we spent our time not in a monetary hidden from the world but as an integral part of it. As a physician I was intimately so involved. Ockham was an academic and not truly a Spiritual but when he saw the arguments that the Pope was promulgating he began to study it and in no time saw the Pope was in error.

Ockham being Ockham then went and exposed this to the Pope, as well as the Order, and then all Hell broke loose. Popes as it would seem do not like being told they are wrong, after all they are Popes. Academics also enjoy an intellectual battle. Thus off it went. But no sooner than telling the Pope he was wrong, and having is reasonable well accepted the Pope rebelled. But to Ockham, and many others, this made the Pope a heretic. Thus did Ockham state. On to Munich he went. Excommunicated. But many felt Ockham was correct. The Pope is a man, he can err, and he is not infallible. Popes have made errors again and again, and if precedent is any claim, then Popes seems to err more frequently than most. Yet one does not tell the Pope this to his face, especially an English Friar to a French Cardinal, now Pope.

I had gotten to know John, the current Pope, quite well when I worked with Umberto Gui, helping him with those who were ill. John was imperious, arrogant, and prone to dicta which were baseless in fact but subsumed in form. He knew the techniques of a Canon lawyer, the Code of Justinian, the twists and turns of battles at court. None of that related to reality. Frankly many who I knew about this man disliked him, yet the feigned recognition as well as adulation. That was the way at Court, it was the way at Avignon.

I replied:

"William, it would be of interest to consider the following. It is an example from commerce called bailment. Bailment is the process whereby a third party take possession but not ownership of an item. For example, my mother's family had ships, and they carried goods from Bristol to Marseille or Brest or Bordeaux. At no time did they "own" the property, they just held it in the possession to transport. At the other end another party held a contract to receive the property in payment. Then my uncle for example would return with the payment, which may have been other goods, again having possession but not ownership. Now consider the case of the "locked chest", tried at Court in 1315 under Edward II.

The locked chest case was one where the bailee had a chest which was locked and the goods or property was in the locked chest. The chest was stolen but while locked. If the goods had been stolen with the chest open the bailee was liable but since the chest was closed when stolen then the bailee had kept his duty and was not liable. Thus in the understanding is that if the bailee keeps his duty of care and security then he has no liability if the property is lost or stolen. However it does not release the bailee or carrier from a duty. The have been several other similar cases recently just before my departure under Edward III our current King. Specifically the case was of a pledge which came up, which seems always to have been regarded as a special bailment to keep as one's own goods.

The defense was, that the goods were stolen with the defendant's own. The plaintiff was driven to reply a tender before the theft, which would have put an end to the pledge, and left the defendant a general bailee. The issue was taken which confirms the other cases, by implying that in that event the defendant would be liable. Thus the issue of property and possession is a key to commerce and frankly it supports your position regarding Franciscan poverty! Frankly it may also presage why England may develop an excellent system of commerce, where in France the rules are still too complex and dated."

Ockham replied:

"Yes, I see, and this is an example of the law being reflective of the Third Natural Law definition. It is reflexive and adjustable. As new facts are ascertained it adapts to the facts. This is an intriguing approach, yet so foreign to Roman Law, or worse Canon Law. Gratian would never have considered this. It is a law of cases not of codes. The Civil Law tends to have the ability therefore to adapt. The basic Law from the Bible provides core elements but it too is open to interpretation. One must just think of the tale of the prostitute who sought forgiveness, of the thief who sought the same at the crucifixion."

He continued:

"If you recall, part of my arguments were related to two issues. The right of use, or ius utendi, was the legal right of an individual, one not expressly not the owner, to utilize some external entity, which if not warranted by the owner would be illegal. The second id ownership itself, or dominium, which is the right of the individual owner who lays claim to an entity and furthermore has the right to deny access or use by any third party. You see that here I have included two elements. First the element of the individual, for the property has been now associated with this person, not the Prince, the Lord, the state, but the very singular person. Second, and this I believe is most critical, is the fact that this is a right, in fact a Natural Right, as we have already discussed. If everything was common in the Garden of Edan as is understood, then after the Fall, mankind began to acquire individual ownership, usually perforce of labor, such as the clearing of a field, the planting of a crop, the raising of a sheep, the building of a house. The result then of man's actions was ownership, by the individual, and then the natural right resulting from that action allowed for an alienation in the use by others."
We would spend time discussing rulers and their powers. I recall my discussing with him my observations of the city states in Italy. I stated:

"William, I understand some of your thoughts on rulers and their powers, and what is the best form of rulers. But allow me to give you some observations which I have made in my travels. As you know, I had spent time in Bologna, and as I went about the northern cities in Italy, I found a new form of rule, let us call it leadership. People chose their rulers, not everyone participated in the process, but it often was enough to make many feel they had a voice.  Rulers thusly chosen had then a sense that their duty was to the people whom they governed. Unlike Kings, who often believe that they have a Divine Right of ruling, somehow being chosen by God, and the result is that their acts are beyond reproach."

Ockham replied:

"You are aware that it my contention that monarchy is the best form of governing. My reasons are many, but ultimately it comes down to the inability of the masses to act reasonably. The masses become the mob and mob rule is always the worst kind. Your argument of city states has merit, but it does so because of two reasons. First the populace in those states who select their leaders are educated and enlightened. The selection is not open to all, only those who have an interest in good governing. The second reason is size. These are rulers of city states, small with common interests. Now take England, a King must deal with a massive and disparate set of interests. He cannot reflect the interests necessarily of all, but must seek a common good. Furthermore in England, France, and many other locales, the people have no knowledge of what the needs of a kingdom are, they see at most their local and personal needs, their individual needs if you will."

"Brendan, you recall my fundamental thesis. The people cannot render more power to a ruler than that which they possess themselves. There are thus limits to the power of any ruler. The people fundamentally have conveyed willing the power to a ruler, if that ruler be selected directly by them or via kingship, or even if you will the Pope himself."

I interjected:

"But William, as regards to a Pope, we have the biblical dictum that Peter has the power to bind, namely Christ has given Peter, and perforce of continuity, the Pope a set of powers supra to that of a civil ruler. For in Mathew 18:18 we have:

Verily I say to you, Whatsoever ye shall bind on the earth shall be bound in heaven, and whatsoever ye shall loose on the earth shall be loosed in heaven.

How then can we delimit the powers of a Pope? Does this not give to a Pope almost an unlimited power?"

Ockham replied:

"Your point has been well taken. In my work Contra Benedictum and An princeps I noted that it is accepted Canon Law, as evidenced in Gratian, that evangelical liberty limited papal power. The very natural and civil rights we possess delimit the powers as presented under Mathew. If this were unlimited power, religious and civil, then the Pope could overthrow a King, and in contrast Christ also said to give to God what is God's and to Caesar what is Caesar's. There is a natural liberty whereby men are free and not slaves. In Dialogus I extended this by the argument with my Student, my interlocutor. The Pope cannot regulate or command things, that would be against our liberty, our free will. Each individual gains or loses redemption by their individual acts, by their individual choices. Not by Papal dicta.

After discussing civil rulers we had finally got to the ultimate ruler, the Pope. I had read and re-read Ockham's "Work of Ninety Days", the brutal and brilliant response to John XXII attack on the Franciscans. It left any who read it with the clear understanding of John's heresy and of Ockham's correctness. It was so compelling that the Popes would pretend it did not exist so as not to confront it.

I began by asking:

"William, when discussing the Papacy you said:

We are left with the conclusion that papal principate was instituted for the utility of its subjects and not for its own utility or honour, and. in consequence is worthy to be called not 'of lordship' but 'of service' ٠ In which ... it is assimilated (more than any worldly principate instituted in practice) to the most noble form of royal principate ... and m which it excels all other principates in dignity.

This clearly is consistent with what Gregory I said of himself, namely he was the "Servant of the Servants of God". Namely he was there for the utility of the Faithful, not to rule them. He eschewed the trappings of a religious ruler, at least in his sayings. He entered into dialogue with those with whom he disagreed. The most famous to us Irish is he dialogue with Columbanus on the argument on the choice of the date of Easter. Columbanus and the Irish state, at the time the only remaining stable and educated state in what was left of the Western world, sided with the Greek Patriarchs, and it was Gregory who stood alone, rejecting their selection of a date. But that debate became a debate on frankly a scientific basis of a new calendar, solar versus lunar, and Columbanus gracefully acceded to Gregory. Thus we have a clear precedent of Papal authority and behavior. Yet we have had Popes since who have taken the "purple" if you will. Whereas Gregory was a Benedictine, eschewing the riches, John XXII was regal, and covering himself and his office with unlimited wealth. How do the Faithful come to deal with the changing disparity?"

His response:

"We have a Pope, and originally that Pope was the Bishop of Rome, and that Bishop was selected as were all Bishops by the people they represented. Like your City State examples Brendan. For Gregory I was himself so selected, despite his please against being so. Yet Gregory was also delimited by the Emperor in Constantinople. So with Gregory we have an example of a saintly monk, selected by his people, approved by his Emperor. Now we have a Pope selected by Cardinals which in turn he has the authority to appoint. It is circular reasoning, and the Pope now tells the Emperor what to do, and unlike Gregory sees all the Faithful as his servants. The Pope does not see individuals, he sees a mass of people who must comply with his every word, and that often includes the controlling of Kings and Princes. Just look at Ludwig, he was duly appointed but Pope John did not want him. What power does the Pope have to overthrow a leader? Frankly what power does a Pope have over any leader. The leader is an individual and has a moral responsibility as an individual. The King will face God alone, not with his armies."

It was clear that as Ockham spoke he had not only hardened his position but had dramatically strengthened it as well. We began a discussion regarding faith and reason. Ockham commenced:

"Brendan, you have known for quite a while the limits of human reason, do you not?"

I replied:

"William, more now than ever. I am a physician by practice and education. Unlike many, I have taken a Bacon like approach, namely I must observe what is there, not just rely upon what is written, and less upon reason. Medicine is akin to philosophy. It often rested upon the ancients. But for example, when at Bologna, under Mondino, we studied anatomy, and in that context I saw things that Galen had said which were false. Had I relied upon Galen and just reason, rather than facts, I would have made great errors. For example, I have seen men whose hearts are on the right side, very few, but they exist. Reason would have told me otherwise. Actually hearing and feeling and understanding tells me otherwise. There are many things which are well beyond reason. Cancers, the growths that kill, I have seen many, what is their cause, how do I treat them. They are not a result of bad humors, that are unknown but I firmly believe are knowable, yet only with a better understanding of the facts. Moreover, permit me an example. Tools, instruments, which allow me to examine what before one could not see. Each time I get a new tool, such as a lens, I can see more and understand more. It is the reality of what I observer rather than the internal process of just reason which allows me to expand my understanding.

Ockham replied:

"Yes then I have asserted that human reason is not up to many tasks and especially many that relate to our religion. I take the example of the Trinity. It lies beyond any reason. The same holds for the Eucharist. The complexity of the Trinity requires, no demands, faith, not reason. In the case of the Eucharist one believes via Faith that Christ is present. To reason a process which we cannot either understand no less demonstrate makes the result a farce. Thus sola fide, by faith alone, do we come to this and many other mysteries of the Faith. We have had many, especially amongst the Dominicans, who try to create what are at best word games to explain these Mysteries. They are Mysteries of Faith and by Faith alone can we accept them."

"In many such cases we see a dilemma." I replied, "A dilemma in that adherence demands belief but that belief is to be buttressed by reason, and yet faith abandons reason and is then the only door to belief. We must abandon reason, and thus our very humanity if you will, if not also our very individualism. Are you saying then that we must accept all just by faith?"

"No," he replied, "like you and your medicine, reason is a tool, to use the tool you need something tangible to work upon. Your lens is an example. You mention the man sick with what you say are worms. You can examine his droppings without a tool and you see nothing. There are no worms. Yet you use the lens as a tool and you get to see the worms, what was small is now large, what was unseen is now seen. In my view faith is such a tool. What was unseen in the Trinity, faith allows us to see, what was unfathomable in the Eucharist, faith allows us to accept. Moreover as you note, these tools evolve, improve, overtime, and as we the Faithful do likewise, we will be better able, through Faith, to grasp these facts of our belief."

As we got to the end of our discussions I raised a critical issue with Ockham. Namely the issue of words and their meaning, especially as they may change over time. I began by asking Ockham the following:

"William, as we have been discussing these issues, and I believe that now in our later years they become more clear and concise, I have noticed that we often use words, such as ius, in a manner which is not necessarily what it may have meant not a millennia ago but even a century ago. As such this raises several issues. First, and this is most critical, when reading the Bible, are we seeking understanding in the words as they are understood now or as they were understood then? Furthermore, if we seek clarity, who has such clarity to give, a Pope, a Council, or is it to be left to each person. All have faults, all are subject to error. Second, when looking to the Bible as God's word, we look at translations. Not only in Latin do words change over time, namely the same word gets a different meaning, but in translating we get a double problem; first the selection of a Latin word for a Hebrew or Greek word, and then the time at which the Latin word was selected may have been of such a past that we no longer accept its meaning now. How do we ever try to reconciles these issues?"

"You raise a very good point. I give you a simple example. Take the word fundus, a field, a piece of land. To the Romans a fundus was not just the earth, the field, but it entailed all rights we have to a field." he continued, "Yet to may in our current time, depending on where one lives, it is merely a thing, a piece of land, and the rights of use accrue from laws which are enacted apart from the piece of dirt. We have managed to separate rights and even obligations from the thing itself. Thus in this simple example, we are using the simple word fundus and over time its meaning has changed dramatically."

I responded:

"Then it is important to understand that time, and in a sense history if you will, is a progression and reflection of human understanding. The more we learn, and even the more we may forget, changes the way we see the world, the meanings we give to words, which are merely a reflection of our combined understanding of this reality."

As we finished our discussions on philosophical issues Ockham proceeded to ask me about the wars. He had heard a great deal but he had never been a part of a battle, had not seen the carnage that I had. As a philosopher he inquired about the issue of a "just war" which was the theologians way to justify this carnage. This was not an area for which he had any exposure or understanding, and mine was limited to that of a physician trying to heal or as a priest trying to comfort.

I told Ockham:

"William, war is as close to hell as one can consider. One side attacks the other. That I can see, armed men trying to overcome one another. But what I cannot understand is the brutality on poor people, unarmed peasants, where the men at arms ride horses, setting fire to homes, crops, killing the farm animals, poisoning the water, salting fields. This is a tactic to deprive the Lords and Kings from profiting from the taxes on these poor people. Frankly William I can see how there could ultimately be a revolt, a revolt against the privileged Knights and Lords, whose sole interest is self-aggrandizement."

Ockham's response was as one would expect from a theologian and philosopher. He came back with the "just war" theory. He said to me:

"Brendan, I understand your intensity. But often war is justified. Is it not, to defend one's own subjects. From my understanding a war is just if it were to meet the five requirement. Permit me to discuss them. They are persona, res, causa, animus and auctoritas. That is the persona must not be religious. I assume that you were brandishing a sword. The second is res, the fundamental cause of the action would be defence of the country or the seeking return of a purloined possession or person, causa was the necessity of the act of war in that there was no other alternative, animus or the spirit in which the war was executed was to be one of justice and avoiding hatred and unjust acts, and finally auctoritas, namely the war must be waged under the authority of a prince or similar accepted lord. If these are met then is not this a moral and just act?"

I replied:

"William, in a world where all is logic and all men are rational and act according to both reason and God's law, then yes, a just war exists and can be a moral act. But I have seen men act as beasts, nay beasts are more kind and moral. God does not permit the bear or wolf to slaughter for pleasure, leaving decaying men, women and children in barren fields. The chevauchees wherein the men at arms ride their massive steeds through peasant lands slaughtering all violates the very rules you have just presented. Yet the Popes never protest. In fact the Popes often embolden the Lords in such acts as they do in attacks in Crusades. The result is often bilateral butchery. Then again, William, who is to say that the cause of action is correct and not just an excuse to engage in war, is the decision of a cause solely in the eyes of the beholder? As to the causa, the necessity to act if you will, if there be a just cause is there then a true necessity to act, that there is not alternative. I await the day when a Pope leads an army!  Indeed, with some of the Bishops and Cardinals in the Italian states, I can see that as a possibility also. That would I believe be a fundamental violation of the persona clause, would it not?"

Ockham burst into laughter and noted:

"A Pope leading an army! Yes, that would perforce of definition be an Unjust War!"

We both laughed but I privately wondered if the Church would ever be exposed to such. I have seen Kings, Princes, leading charges, being slaughtered and laying in pools of their own blood. I have heard the same voices from Popes, and wondered what it would take to get them to the field of battle. At least in Avignon they were too comfortable and not inclined to act personally. Yet.

I would bade Ockham farewell soon as I went forward to Prague. Spring was on its way and the Bavarian country side was just about to turn green. I wondered how I would tell Charles some of these things. Kings are not the best of listeners, and as we have found Popes are even less so. Thus far I have seen three Popes, and John XXII was clearly the most intransigent. A lawyer, Canon Lawyer, trained in the Justinian tradition with the Decretum of Gratian. Ockham, a Theologian, and Philosopher. Each talking past each other, each with strong egos. I knew enough to understand some of the moves, some of the games. As one would say, my main task was as a physician, and yet even there I could often do so little. I tried to follow Friar Bacon and his method of scientific proof, namely deal with facts, observables. I took it a bit further and tried to measure and quantify, compare and contrast, but always built upon observables. The metaphysician has no solid ground, no independent fact checker, the theologian in contrast has the Word of God, and the believer has but Faith.

Net Neutrality: The Full Employment Act for Lawyers

Beware of what you ask for. You see as a Common Carrier you received all types of protection. Since Elizabeth I you got lots of assurance that your liability was limited. Now that the big carriers got what they asked for, perhaps they may want to explore that a bit.

I wrote an extensive piece some ten years ago. It may really be worth looking at now! I also wrote a draft book on the subject, including interconnection.

This may easily lead to a massive number of large class action suits. For example:

1. What the FCC in its wisdom did was remove Common Carrier protection. Under such a class, common carrier, your liability was limited to what you were paid for the transport. As no longer being a common carrier you become a party to any claim resulting from what the service being provided is used for and the damages resulting therefrom. Yep, send a noisy CAT of a mammogram and misread the lesion, you are now a party.

2. In classic common carriage, you sell access to your network according to standard prices.If you have a subsidiary that competes with some third party then you are safe from any antitrust claims. Both Sherman (criminal) and Clayton (FTC). But now you can compete with price discrimination, namely discriminatory pricing. Welcome to Clayton. This will keep antitrust attorneys fully occupied, and it is a class.

3. I remember when I first started at Bell Labs in 1964. The turned Beverly Hills over with ESS No 1. It crashed at 12:45 PDT, which was 3:45 EDT and just before the Stock Market closed. Millions of lost trades. But too bad, as a common carrier your were safe. But now as a party to the transaction you become a party to the claim.

I can see this list just expanding! Having been an Expert at a few dozen trials, I just am amazed at how some folks just do not think, unless .... well I will just keep that one to myself.

Wednesday, December 13, 2017

Healthcare in New Jersey

NJBIZ reports on demands of the incoming Governor as to how to "improve" the State's Healthcare system.

Some observations:

Amend state law so that health care related state boards are not self-governed. Instead, require that at least half of any of these individual board’s memberships be comprised of individuals whose professions are not directly regulated by that board, and who would be representative of consumers that utilize the services overseen by the board. In addition, the state should examine and issue a report on best practices utilized by other states for health care related state boards.

That would mean politically appointed and motivated individuals having no knowledge of or interest in medicine but promulgating a politically supported agenda.

Revise state law to allow for the electronic delivery of insurance materials and provide for such delivery as the default method, while allowing consumers to opt in to the delivery of paper materials if they wish.

Opt out seems to be pervasive in NJ. Especially with the Democrats. This would make every older person require electronic delivery and thus open it up to massive data fraud.

Amend state law (through the Division of Consumer Affairs) to expand the kinds of services nurses, physician assistants or therapists can perform without supervision and in general.

This is the Nurses full employment act. They are cheaper and even thought not qualified they become your only choice!

That New Jersey adopt a standard that imposes requirements that providers offering services at hospitals participate in the same networks as such hospitals, and that providers and facilities publicly disclose the networks in which they participate.

 If you are a specialist and the hospital at which you have privileges serves Medicaid then you must also! This will drive all specialists to private "clinics".

If you did not like Obama Care your will really thrill to Murphy Care! Another gift from Goldman Sachs.

Cancer Treatment and Unintended Consequences

The recent explosion in immunotherapy targeting such elements as PD-1 or PD-L! and others has demonstrated a significant positive step forward. However recent results indicate that there may also be a dark side to this process.

As Sarkizova and Hacohen have noted:

The T cells of the immune system have a key role in the identification and elimination of cells that pose a threat to the body, such as infected cells and cancer cells. ….(authors) propose a framework to assess how effectively tumours can be detected by T cells — a tumour property known as immunogenicity. The authors demonstrate that their models for assigning tumour-immunogenicity scores can be used to predict clinical responses to a type of cancer immunotherapy called checkpoint blockade.

Most cells in the body present peptide fragments known as antigens on their cell surface, which are generated from intracellular proteins. Each peptide is bound in a complex with a specialized receptor called an MHC class I protein (HLA class I in humans). T cells known as cytotoxic T cells police the body in search of cells displaying specific antigens, especially antigens from infectious organisms, or in the case of cancer, antigens known as neoantigens that have arisen as a result of a mutation. If the T-cell receptor (TCR) of a cytotoxic T cell recognizes and binds an antigen that is not normally present, the T cell will often unleash an attack that kills the cell displaying that antigen. TCRs are highly variable and have slightly different antigen-binding regions, enabling the immune system to recognize millions of antigens. Antigen binding to MHC proteins and TCR recognition of antigen–MHC complexes are key determinants of an immune response.

They continue with the discussion of checkpoints as follows:

Tumour cells often fight back against this immune-system surveillance by hijacking the natural mechanisms that dampen immune responses, which are normally intended to block autoimmmune attacks against healthy tissue. Checkpoint-blockade therapies can block these immuno-inhibitory signals, such as those generated by the ‘checkpoint’ PD-L1 protein4. However, only a subset of tumours treated with such therapies regress. Therefore, approaches are needed to identify the tumours that are most likely to respond to immunotherapy.

Current ways of predicting the effectiveness of checkpoint-blockade therapy rely on measuring the level of PD-L1 protein expressed by tumour cells, counting the number of T cells in a tumour, and estimating the number of different neoantigens that a tumour contains5. The work by Łuksza and Balachandran and their respective colleagues offers a new type of integrated model to predict whether a tumour will be attacked by T cells, a characteristic that they refer to as tumour fitness (low fitness being associated with a strong immune response against the tumour).

Thus in the best of worlds we see the result below. As Ludin and Zon note:

PD-1 is expressed on the surface of immune cells called T cells. When PD-1 is bound by a ligand produced by tumour cells, PD-1 signalling renders the T cell inactive, preventing immune responses that would destroy the tumour. Treatment with an antibody to PD-1 blocks ligand binding and so PD-1 signalling, instead promoting the PI3K signalling pathway, which is involved in T-cell activation. As such, anti-PD-1 treatment triggers an immune response,

Wartewig et al. have demonstrated that PD-1 signalling in a mouse model o f T cell non- Hodgkin’s lymphoma prevents proliferation of cancerous T cells (the source of the PD-1 ligand was not defined). In these mice, anti-PD-1 treatment can aggravate disease by reactivating the cancerous cells to enable then continuous proliferation.

Namely a tumor cell having a PD-L1 can be attacked by the T cells when we block this suppressor. We demonstrate this below. If PD-1 is matched with a PD-L1 then the T cell remains inactive. If we have an antibody used to block either PD-1 or PD-L1 then we can get T cell activation.

  In contrast if the bad cell is the T cell, or if there is such a cell present in addition to the other tumor, then removing this block may activate the malignant T cell and off we go with a second malignancy. The example we show below.

As Wartewig et al note:

By contrast, a homo- or heterozygous deletion of PD-1 allows unrestricted T cell growth after an oncogenic insult and leads to the rapid development of highly aggressive lymphomas in vivo that are readily transplantable to recipients. Thus, the inhibitory PD-1 receptor is a potent haploinsufficient tumour suppressor in T cell lymphomas that is frequently altered in human disease. These findings extend the known physiological functions of PD-1 beyond the prevention of immunopathology after antigen-induced T cell activation, and have implications for T cell lymphoma therapies and for current strategies that target PD-1 in the broader context of immuno-oncology

Namely we have the potential that certain cells have managed to block malignant T cells from multiplying and thus keep a hematological cancer under control. When attacking another cancer with a blockade it may then allow this blocked cell to proliferate.

As Giladi and Amit note:

The cells of the immune system, which patrol the blood and dwell in tissues, have many functions. They protect the body from pathogens and cancer, and orchestrate metabolism and the formation of organs. They are involved in almost every activity that regulates the body’s internal environment, from the development and remodelling of tissues to the clearance of dying cells and debris. So their dysfunction can cause many problems

This may be an obvious statement but it sets the path for what is to follow. The more one learns about the immune system the more we find a complexity of cells, not just T or B cells but T cells which perform different sets of functions. To understand this we need tools that allow us to ascertain what happens on a single cell basis. The authors continue:

First, it is clear that many of the current categories of immune cells, such as T cells or monocytes, encompass heterogeneous populations. To probe cellular complexity, researchers must therefore cast their nets wide, and try to collect all immune cells within a tissue or region of interest. This is a very different approach from that used with methods based on cell-surface markers, which aim to obtain as pure a sample as possible.

Second, success will depend, in part, on the extent to which researchers preserve the states of cells and the original composition of a tissue. Cell stress or death should be minimized to ensure that tissue preparation does not favour specific cell types. …

Third, bioinformaticians will need to develop scalable and robust algorithms to cope with greater numbers of cells, conflicting or overlapping programs of gene expression and fleeting developmental stages.

Fourth, after researchers have characterized all of the immune cells in a sample, they will need to find molecular markers that can be used to either enrich or deplete certain cell types in further samples.

The issue then is that it is essential to have in the "tool box" methods to carefully examine individual cells in situ. There are clear indications that cell interactions are complex, and also are extremely dynamic. The real question is: what level of depth of differentiation is essential for what level of patient care? As we noted above, there are cases where PD-1 blockage can on the one hand activate the immune system against the cancer and on the other hand suddenly activate dormant malignancies. Is this then just a "whack a mole" strategy against cancer, namely attacking one only to have then to attack a second resulting from the success of the first?

Fox and Loeb had previously attacked this issue from the perspective of breast cancer. They noted:

The total number of mutations that a tumour genome carries, including those present in only a small subset of cells, may in fact underlie the aggressiveness of different cancer subtypes. For example, the extent of genetic diversity within a tumour, and its divergence from normal tissue, probably influences the ability of the immune system to distinguish malignant cells from normal cells. Identifying the mechanisms by which cancer cells generate mutational heterogeneity may therefore present previously unexplored targets.

Single-cell sequencing will allow us to detect rare mutant subpopulations hidden within cancers that could expand and lead to drug resistance, and thus to avoid unnecessary and potentially harmful administration of ineffective, toxic therapies. Ultimately, the exceptional plasticity of the tumour genome may well prove to be a key characteristic of cancer11 and a major, as yet untapped, therapeutic vulnerability.

There clearly is a growing need to perform a multiplicity of single cell analyses. However this is a complex spatio-temporal result, with a great deal of extraneous information. We should understand how cells genetic makeup changes as a function of time and of location. Location is itself complex because it refers to what cells are adjacent and even just close. Furthermore many gene expressions or suppressions are irrelevant, just chaff in an attempt to track a target. The desire to measure single cells is but a first step. A "model" or paradigm of what is essential for understanding the "system" is essential.

1.     Fox and Loeb, One cell at a time, Nature, August 2014.
2.     Giladi and Amit, Immunology, one cell at a time, 6 July 2017 | Vol 547  | Nature | 2 7
3.     Ludin and Zon, The dark side of PD-1 receptor inhibition, Nature, 7 December 2017, VOL 552, p 41
4.     Lukasz et al, A neoantigen fitness model predicts tumour response to checkpoint blockade immunotherapy , Nature November 2017
5.     Sarkizova and Hacohen, How T cells spot tumour cells, Nature November 23 2017.
6.     Wartewig et al, PD-1 is a haploinsufficient suppressor of T cell lymphomagenesis, 7 December 2017, Vol 552, Nature, p. 121