“Suppose now I say ‘I’m incapable of being wrong about this: that is a book’ while I point to an object. What would a mistake here be like? And have I any clear idea of it?” There are fake books, tricks are played, there are mind altering substances, coincidences happen, there could be a secret society of magicians controlling public perceptions, or our world could be some kind of solipsistic melting pot of dreams and hallucinations. We could list things like these all day. There are simpler examples for common situations as well, like, somebody might be unquestionably convinced they are seeing a magazine when it is a zine, or a cow when it is in fact a bull. It’s also pretty common for people to think that they know a person made a mistake that they did not actually make. Consider that the way the future is headed, there is a good chance we will all have 3d printers that run on practically free energy and make everything out of basic materials like sand and vegetation, be free to travel around the universe with access to trillions of planets, and so forth. In that reality, theme planets are all but inevitable. There will be planets for specific ecological niches and time periods. People will be able to set up Plato’s Cave, Truman Show style planets, and countless other scenarios. Being that this seems so inevitable (read The Singularity is Near if you are not convinced), why would we assume that we are not in a scenario like that right now?

What happens though, is if we were to take the groundlessness of surety into account in our day to day communication, we wouldn’t be able to say anything. It seems we might almost be cornered into adopting language games. “This game proves its worth. That may be the cause of its being played, but it is not the ground.” The temptation to stay locked into them is almost irresistible, especially the hereditary ones. “[W]ould it be unthinkable that I should stay in the saddle however much the facts bucked?” It isn’t unthinkable because the entire purpose of the game is to ride unreasonable broncos and we have been training since we were born. Wittgenstein goes on to ponder, “Certain events would [put] me into a position in which I could not go on with the old language-game any further. In which I was torn away from the sureness of the game. Indeed, doesn’t it seem obvious that the possibility of a language-game is conditioned by certain facts?” It’s possible but usually very difficult because safeguards and defense mechanisms are built into them too. When a person does something detrimental, “it is what it is” — when evidence bucks, faith grips tighter — another team might have won the super bowl, but their quarterback threw for more yards in the season.

There are a lot of incompatible language games being played around the world. If you tell a person embedded in another one that they are wrong, it’s almost as if they cannot know it because if they were to consider that they should doubt parts of it, it would open the door to the slippery slope leading to the “annihilation of all yardsticks”, and it is difficult, maybe nearly impossible, to live in a world without them. “If something happened calculated to make me doubtful of my own name, there would certainly also be something that made the grounds of these doubts themselves seem doubtful, and I could therefore decide to retain my old belief.” In order to take action, you have to make decisions, and in order to make decisions, some of the patterns in your mind need to win out over the others. If there aren’t any execute commands in the code, then the code is lifeless and goes nowhere.

Does this mean that we have to permit some unsubstantiated assertions? All of them? Do we have the right to dismiss any of them? If it turns out to be true that there is no foundation for knowledge or contemplation, then how could we draw such a line? I think a lot of it comes down to what I talk about in terms of how much we are willing to bet at a given time, and the use of words like “seems”. “We just do not see how very specialized the use of ‘I know’ is. For ‘I know’ seems to describe a state of affairs which guarantees what is known, guarantees it as a fact. One always forgets the expression ‘I thought I knew’ “.
It’s not that we know, it’s that certain things look very likely to us from our current perspective, and we all know that our perspectives have changed, and therefore that more of them will likely change as well. We should learn to expect this, and if we are honest with ourselves, be proactive about it. I believe that is the common language game we can all play. It is like we are trying to play blackjack with people who are trying to play poker, war, concentration and rummy with us. If we all played poker, our individual bets would still range in scale depending on our hands at any given time but we would all be playing a compatible game.

When it comes to the concept of “seems”, I have found that there doesn’t seem to be a lot of alternatives, which sometimes makes it difficult to talk in terms of it in a stylistically appropriate way. Being that people are prone to asserting the uncertain so pervasively, it makes sense that we might end up with so few words for expressing variations and shades of doubt. Wittgenstein uses a variety of phrasing throughout the book that give us some ideas on how we might expand it. I pulled many of them together and summed them up:

“Suppose I replaced Moore’s ‘I know’ by ‘I am of the unshakeable conviction’?”
“It stands fast for me and many others…”
‘That’s how it is — rely upon it.’
“I learned it years and years ago”
“I am sure it is so.“
“is an irreversible belief.“
“it gives us a right to assume it.”
“Suppose it were forbidden to say ‘I know’ and only allowed to say ‘I believe I know’?”
“excludes a certain kind of failure”
“I can hardly be mistaken”
“That is the truth — so far as a human being can know it.“

That is not to say that every communication should necessarily be tentative. One of the main conclusions that Wittgenstein reaches is that our beliefs can be justified, but not certain. “[…] I find it quite correct for someone to say ‘Rubbish!’ and so brush aside the attempt to confuse him with doubts at bedrock, — nevertheless, I hold it to be incorrect if he seeks to defend himself (using, e.g., the words ‘I know’).” I think of that in terms of calculated risk. Sometimes you have to remove the language of doubt in order to favor the patterns in life that seem most important. That, though, is less like certainty and more like leadership. All confidence is either bluff or ignorance. If we have calculated the potential value in bluffing our certainty, that is one thing, but to do it blindly, unknowingly, is another.

Wittgenstein talks about how if existential certainty is there to be found, it would probably be in a form similar to a mathematical proposition and proof. “If the proposition 12x12=144 is exempt from doubt, then so too must non-mathematical propositions be.” “If” being a key word there. He reminds us that it seems as though they cannot be certain either but goes out on a short limb to humor that they are. In that process he makes what I find to be one of the most profound and rather Godel-esque insights of the book: ”there ought to be a proposition that is just as certain, and deals with the process of this calculation, but isn’t itself mathematical. I am thinking of such a proposition as: ‘The multiplication 12x12, when carried out by people who know how to calculate, will in the great majority of cases give the result 144.’ Nobody will contest this proposition, and naturally it is not a mathematical one.” That might be a key to extinguishing existential angst and establishing the foundation of common meaning.

It is true that the universe might be infinite and that even if it isn’t, the work to reach certainty might still end up being like trying to reach zero by continuously dividing by half, always inching closer, impossible to reach. In the meantime, we wait in suspense as patterns wind their way through the chaos like armies meandering through mine fields. Certainty is no more than the soldiers out ahead who haven’t been blown up yet, standing in the middle of the field with a universe of unknown mines ahead. Some evolutionary lineages successfully walk on for hundreds of millions of years before they are blown up and consumed by the blur. What choice do we have, what else might we do, use patterns we don’t understand or that are wrong more of the time? We don’t know if we will make it or not. Maybe it is too difficult. Maybe it will take a hundred million additional years. Maybe we are in the home stretch and artificial intelligence of the near future is the calculator of existential proofs. We just don’t know.

We don’t know how long it might take to get a better grip on the nature of certainty, and death is barreling down on us, hence the movement for indefinite life extension. It is tragic to be uncertain about everything, which includes our own wants and needs, when the stakes are so high. It is tragic to live and die as a captive in a dark basement. Earth is that basement and our lifespans are the walls. Some people don’t see that, like captives of Plato’s cave.

As things stand, the best we can do is be willing to make educated bets at any given time. The only thing we know for sure is that we don’t know anything for sure. We don’t even know if we don’t know. That is good news though, therein sneaks the foundation that begins to unravel the absurd. If the only thing we know is that nothing makes sense until we know, and that by working to figure stuff out, we could end up knowing, that small patch of philosophical ground in the quicksands of uncertainty becomes the launchpad upon which we begin stringing lines of certainty together. Anything else would be illogical, against our nature, detrimental to our fitness. Standing on this platform is a stage in our evolutionary trajectory.

“We all believe that it isn’t possible to get to the moon; but there might be people who believe that that is possible and that it sometimes happens. We say: these people do not know a lot that we know. And, let them be never so sure of their belief — they are wrong and we know it. If we compare our system of knowledge with theirs then theirs is evidently the poorer one by far.”

How will you die? The four deadly killers

Ever since science effectively cured infectious disease through antibiotics, vaccinations and the like, there has been a distinct shift in what kills humans to the four deadly killers, which are considered ‘age related diseases’. These are — cardiovascular disease, neurodegenerative disease, metabolic disease and cancer. If you manage to escape the most likely causes of death as a young person, which are largely accidental accidental death (mostly car accidents), homicide or mental illness related (suicide) — then it is most likely that one of those four deadly killers will end your life.

But here’s the good news — there’s a growing body of immediately actionable longevity technologies that you can engage with to offset your risk of dying of these diseases. In a series of posts on the topic, I’m going to cover a few key resources at your disposal for minimising your risk for each of these four categories. First-up, cardiovascular disease.

Deadly Killer #1 — Cardiovascular disease

Heart attack, stroke, thrombosis, heart failure — the chances are overwhelming that you have lost someone important to you in your life to one of these causes. It is often seemingly sudden, but in most cases, the acute cause of death by cardiovascular disease has been brewing for a very long time — decades even.

The term ‘cardiovascular’ encompasses disease of both the heart and blood vessels, which is driven by the build up and eventual displacement of plaque that accumulated in the arterial wall in a process called ‘atherosclerosis’.

It’s not my role here to explain all of the mechanisms of this disease. Instead, I want to focus on four actionable tools you can work with your doctor to obtain access to, which will help you assess your risk profile and detect any elevated risk of an acute event (e.g. heart attack, stroke) at an early, treatable stage:

1. Test your ApoB (“A-PO-B”)

Stop using your LDL-C as your primary risk assessment tool (The “LDL” value too commonly called the “bad” cholesterol), and start tracking your ApoB. ApoB is a particular type of molecule attached to the types of lipoproteins carried by your LDL (and VLDL) that are the most likely to enter the arterial wall and lead to plaque formation. You need to know *how many* of these atherogenic particles you have present in a given volume of you blood — this drives your risk. Your ApoB value is influenced by diet and lifestyle and can be controlled with pharmaceutical intervention and possibly through certain forms of supplementation.

Learn more about ApoB at Healthline.

2. Do you have elevated Lpa (”L-P-little-A”)?

Lpa is another cardiovascular disease bad guy that may be in your bloodstream. Lipoprotein-a is a particle which carries cholesterol, fats and proteins and is made by your body, and how much of it you make is inherited. Elevated levels of Lpa increase your risk of a heart attack or stroke as they are known to cause atherosclerosis. You certainly need to know if you carry the genetic risk factor, and the earlier the better (i.e. get this test done as early as possible)! Levels of Lpa don’t change much over one’s lifetime, so testing it once is enough in most cases! Know your Lpa status, and better know your risk, and whether or not you should modify your diet, lifestyle and treatment options.

Learn more about Lpa from the lipoprotein-a foundation

3. Know your Coronary Artery Calcium scan score

Coronary artery calcium (CAC) scans are created by using computed tomography (CT) scans, which are a type of X-ray scan, to detect the presence and quantity of coronary artery calcification (the warning signs of atherosclerosis).

A CAC test reveals both the location and quantity of calcium located in three of the main coronary arteries. The scan provides a score which represents your risk. The lower the better! This score will change over time, and is known to increase with age, so it is important to record it regularly (in a manner that balances the downsides of the X-ray radiation — ask your doctor what’s best for you). Atherosclerosis is a disease of ageing, and that means your risk is increasing over time. If you are aged 50 or above and have never had one — work with your doctor to get one performed.

4. Track your inflammation with C-Reactive Protein (CRP)

At its roots, atherosclerosis is known to be intimately connected with inflammation. In fact, it is often damage to the arterial wall that attracts the formation of plaque in the first place. This damage occurs over time, and is known to be increasingly likely with high blood pressure and high blood glucose levels. CRP is a very common and relatively low cost blood test that can be easily ordered up by your doctor, and should be tested annually at the very least. High levels of CRP are indicative of increased risk of cardiovascular disease, and once again can be influenced by changes in diet and exercise. If you have the option, go for the high-sensitivity CRP (hsCRP) test if possible!

Know thy risk, and save thy life!

Everything that I have discussed in this post encompasses longevity technologies that are available to you NOW. And ultimately, it is up to YOU to demand access to these technologies, in one way or another. I’d suggest that you don’t take NO for an answer, and that you allocate whatever resources (time, energy, money) you have available to assessing and managing your risk of cardiovascular disease. If you are aged 50 or older, the importance of getting each of these tests performed is exponentially more important with each decade of life!

I hope you enjoyed this post. I’ll be sure to come along with my follow-up posts on the topic of the four deadly killers in the coming weeks. In the meantime, check-out these other great Lifeboat Foundation blog posts on the topic of aging, and don’t forget to checkout the Longevity Blog on my website.

Wishing you a long and healthy life!

Dr Nick Engerer