Text by Stephen Palmer, artwork by Vincent Chong.

Fictions: Health and Care Re-Imagined presents world-class fiction to inspire debate and new thinking among practitioners and policy-makers. To find out about the project, the authors and to read other stories in the collection, click here.

Read the associated “Getting Real” blog, exploring the technology, science, policy, and societal implications of the themes from the story here.

Genomancer

Stephen Palmer

Twenty-five years since she last stood at her Aunt Alice’s front door Holly again found herself studying it. Then, aged fifteen, she had seen a varnished, pristine exterior. Now she saw exposed wood and peeling paint. The sight worried her.

Twenty-five years in Australia: a student, leaving home, science at university, then a career researching Alzheimer’s disease. Now she was back in her home country, divorced, melancholy, alone. That feeling nagged at her… yet she was not entirely alone. In Britain her aunt lived, and over the internet they had developed a relationship of sorts.

This house in a leafy suburb of London would be her home for a few months while she looked for a flat and gathered the threads of her sundered life. She knocked on the door, feeling nervous. She remembered her aunt well from childhood family outings, though they had not talked since then, except recently. What would this visit be like? Embarrassing in the British way, or unexpectedly warm?

She fidgeted. No reply. At least the house was large and Alice’s son had left home. There would be plenty of nooks in which to hide should the relationship turn cold.

The door opened and she saw her aunt’s face. “Hello?”

Holly smiled as the tension in her body faded. “I made it! I navigated the tube.”

For a few moments Alice stared at her, before blinking and saying, “Holly. Yes! Holly, it’s you. Do come in. I was just making…”

She left the statement unfinished, but already Holly could smell jam. “Autumn treats,” she said. “How are you?”

“As well as can be expected,” came the reply.

Alice shut the door as Holly looked around. Newspapers lay on the floor, which had not been hoovered for some time. Old rugs looked stained. This was not the tidy, bright, cheerful home she remembered. But Alice lived alone now, and had perhaps retreated into lazy isolation.

“Thank you for taking me in, Aunty. I really appreciate it.”

“It’s no problem. Are you tired? Plenty of space here for my favourite cousin.”

“Niece,” Holly said.

In the kitchen she surveyed what lay around her. The place was a mess, cooking utensils everywhere, a stack of washing up, smeared windows, and the door into the rear garden ajar, its handle hanging off. Alice too was divorced.

She wanted to say how different it looked, wanted to express concern. “It’s basically as I remember,” she said, taking care not to catch Alice’s gaze.

“Is that the scientist’s view?”

Holly heard something odd in the tone, something distrusting. “I suppose so,” she replied with a laugh. Alice stared at her. In a meek voice she added, “I am a scientist.”

“Yes.”

Now Holly felt uncomfortable. Over the internet her aunt’s manner had felt odd – perhaps explained by the vagaries of the internet. Here in the flesh it still felt wrong. Something had happened.

She said, “You know I research Alzheimer’s disease, and other degenerative conditions? So, yes, I am a scientist.”

Alice nodded, dipping a spoon into a pot of steaming jam. “Are you tired? Plenty of space here for you.”

Holly hesitated, alerted now to some deeper significance. The question sounded genuine, though this was the second time it had been asked. She shivered. Surely not…?

“How are you feeling in yourself, Aunty?” she asked, allowing concern to sound in her voice. “You are still happy here, aren’t you? I mean… you seem somehow…”

Alice turned, her face lacking warmth. “Seem what?”

“I don’t know. Tired. Have I upset you, asking to stay for a while? I could find a hotel if you’d prefer.”

“Well, it’s the diagnosis,” Alice replied.

“What diagnosis?”

“Early onset Alzheimer’s. I’ve known for a while. An act of fate that you called me up, don’t you think?”

Shocked, Holly sat down at the jam-stained kitchen table. “Alzheimer’s? You had a diagnosis?”

“Oh yes. From Cassie.”

Holly nodded. “Dr Cassie.”

“No, Cassie. The online doctor.”

Holly watched a couple of tears trickle down Alice’s face, yet her aunt’s expression remained set. She frowned, then said, “What online doctor? Don’t you have a GP?”

“I didn’t think I’d need one after I joined Cassandra.”

Holly froze. She knew that company name.

In a cool voice she said, “Would you show me please, Aunty? This is something I think I should read.”

Alice nodded, took a deep breath, then sighed. “I suppose it wouldn’t hurt if you glanced over it. But the diagnosis is set. You can’t do anything about it, even if you are a scientist.”

Holly ignored the barb. Alice picked up an electronic pad, tapped it, then opened a document.

Sitting on the opposite side of the table, she slid it over, then clicked her fingers and said, “Pass me the thingy, would you?”

Holly glanced up, seeing where Alice pointed – a jar of utensils. “The what?”

“The… whatsit.”

Holly stood up to take the jar over, then sat down again.

She read.

The diagnosis came direct from a genomancer at Cassandra Ltd. And she did know that company’s name. They were small, but notorious in health circles because of their lack of ethics and flashy social media presence. The internet loved their brazen pseudoscience: memes a-plenty. Their operation was all about so-called divination, using their customers’ genetic data to assess the chances of developing diseases, predictions they then passed on, along with health care plans tailored to the incomes of their…

Victims, Holly thought. My own aunt has become a victim of these charlatans.

*

Later, in her room, she checked the company out. They were British with a global reach: Give Cassie your gene code. Our genomancers will divine your health future! We’ll hold your genetic data. Cassie will look after you!

They had no qualms about telling their customers that they would hold and use genetic data. They were blatant, brash. This was 2030 after all, when very few people cared about the niceties of internet activity, because life without it was unimaginable.

Not to Holly, though. She saw through this diagnosis at once. What the genomancer had done was make a best guess based on Alice’s genetic code – the diagnosis was not necessarily a true assessment, it was a probability at best. Yet here her aunt lived, mouldering away in a big old house, believing she had Alzheimer’s disease. Did she? Possibly. No real doctor had taken her aunt’s case on.

She logged onto the company’s website and set up a video call, but at each try she was thwarted by Cassie, who demanded she set up an account. She checked what that involved to find it meant taking a swab and sending it off, her account following a few days later. No gene code, no account. No account, no communication.

So she trawled the internet for views on Cassandra. The weight of their social media strategy was considerable, and they swaggered, even boasted about owning genetic data. Yet nobody seemed to care much. In some scientific quarters there was resistance, but it was ineffective. Cassie’s customers were blinded by hokum not blinded by science. They believed this divination stuff.

She looked up. Believed… what if that was Cassandra’s business model?

Back in the kitchen she sat at the table opposite her aunt. She said, “Did I ever tell you exactly what I did in Australia?”

Alice shook her head.

“I really am a scientist. We use experiments to determine how degenerative diseases affect the brain. It’s a very… complicated affair, Aunty. It’s not easy. It’s for experts, in fact. That’s why science is the best way forward. Trained experts–”

“Experts!” Alice interrupted. “What do they know? It’s only opinion, like everything these days. I don’t trust experts. We’ve all heard enough of experts in Britain. I don’t suppose you know that, living away for so long.”

“But you’ve got to trust experts because they’re the ones who know things.”

“Experts stumble from one thing to the next, and their predictions change all the time. I do watch the news. Science is different one year to the next.”

“Not at all! No, you’ve got it all wrong. Science develops. New things mean enthusiasm for sophistication, hypotheses to theories.”

Alice laughed. “I’m sceptical. It’s best to be sceptical these days.”

For a few moments Holly marshalled her arguments. She realised this conversation was not going to be easy. “You’ve been taken in by Cassandra,” she said. “I know this – I work in the field of degenerative diseases. You need to see your own GP as soon as possible.”

“What GP? You can’t get an appointment these days. Besides, with people like Cassie around, we don’t need doctors, we have AIs to do it all.”

Holly saw now the depth of her aunt’s belief. Converted by the internet: little chance of apostasy. What could she do? “Aunty,” she said, “you can’t rely on these people. It’s all style and no substance. What about facts? Don’t you care about facts? How can one of these so-called genomancers know anything by divination? It’s no different to the Romans divining from animal entrails.”

“It’s very different, what with AIs and everything. Didn’t Cassie tell me? She told me, and that was all done from genetics. It’s the truth. I’ve got this horrible disease. If they stop caring for me I’m done for.”

“But what if the diagnosis was wrong? What if…” She paused, wondering if she dared infuriate her aunt by making the suggestion.

“What if they’re exploiting me?”

Holly nodded, lips compressed.

“They wouldn’t dare, would they?”

Holly sat back, appalled. Her aunt didn’t trust her, and no appeal to facts was going to change that. She whispered, “But what if you haven’t got Alzheimer’s?”

“I’ve got the symptoms.”

“You could have those because you believed the diagnosis. There’s any number of explanations for loss of memory – age, for one. You’re not so young.”

“I’ve got the disease. I just know it.”

“This isn’t a body thing, Aunty. It’s a mind thing. It’s auto-suggestion, started by that lying, fraudulent company.”

Alice shook her head. “Everyone knows they’re the best. Haven’t you visited their website?”

Holly shook her head. There was no answer to that.

*

Holly lay in bed as the house at midnight creaked in a warm westerly. She couldn’t sleep. The shock of hearing about her aunt’s diagnosis had worn off, and now she was angry. Dismayed, afraid, and angry. Cassandra Ltd were ripping off millions of people, selling them fake futures cooked up from half-understood genetics, sheathed in social media and fed like refined sugar to the waiting, mewling masses. Cassie was a pusher giving the people what they craved. Something to believe in – some hint of their future. Junk.

But she needed a new plan to counter her aunt’s fall. Mere facts, mere theories, mere work, mere science… none of them would do. Yet science was her meaning and belief, her profession, her very own future. The scientific method probed the world, then science explained the world. What else could she use to oppose Cassie and the genomancers?

She realised trust was key. Though she was Alice’s niece, she had turned up unexpectedly, and something had happened to create distrust. So she needed to show her aunt that they shared the same fundamental values, that they were not so far apart in culture and profession. Perhaps what was needed was to give Alice a different story to follow.

In a dingy Hammersmith pub Holly faced Sammie, who turned out to be a seventeen-year-old girl, and not the forty-year-old genomancer she had been told to expect. At once she smelled a rat.

“You’re Sammie?” she asked.

“Yeah.”

Tracking Sammie down had taken a lot of work – Holly felt disappointed. That Sammie had turned up however did suggest she was amenable to bribery.

“Sorry,” Sammie said. “We’re told to describe ourselves as older so people think we’ve got experience in divination. You know the score.”

Holly nodded. “But you can’t possibly know anything about… divination at your age.”

“Oh, yeah. It’s been in my family for generations. Irish genes, you see? My real name is Mary. I started on Cassie’s scheme when I was thirteen – the youngest, you know? – and got taken on because they liked my video style. I did well – left school as soon as I could. I rent a flat in Richmond now.”

Holly didn’t know the place, but she grasped the implications. Wealth. “Okay,” she said, “so you know what I want?”

“Of course. You ain’t the first and you won’t be the last.”

“You need to prove to me first that you are an employee of Cassandra Ltd.”

Sammie glanced around the pub, bit her lip, then pulled out a small cube, which she twisted until it caught the light. “You see it?” she asked. “Cassie’s hologram.”

Holly studied the gleaming surfaces of the cube. Various internet searches had suggested this would be the method used. “All right,” she said, “so you’re genuine. But tell me straight. I want to hear you say it. You really are a genomancer?”

“I really am a genomancer!” Sammie grinned. “Cool, isn’t it? So… who’s the guy you want the genome of?”

“Guy?”

Sammie laughed. “It’s always a guy or a girl. Blackmail, divorce, whatever. Nothing changes.”

Holly twisted her lips into what she hoped would look like a sarcastic smile. “Yes, it’s a guy,” she said.

“Well, I didn’t need to be a diviner to know that. What’s his name?”

Holly shrugged, as if it didn’t matter. “Roland Dee.”

“Any other ID?”

Holly handed over a sheet of paper.

“Handwritten,” Sammie remarked. “You should have printed it.”

“Why?”

“Some people can tell things from handwriting.”

“Of course they can,” Holly replied with all the gravitas she could muster. “Listen… you really believe this stuff?”

“What stuff?”

“Genomancy.”

“I did at first, I bought the Irish thing. But then they promoted me and I began to see how the operation worked. It’s so cool. They pay me a fortune to use AIs to be genuine online with the customers… sympathise, empathise, whatever’s needed. And I can do that!” She shrugged. “Some are born to do it, most can’t. Acting with an AI riding you is like surfing a wave. You feel the flow and go with it. I was born to act, I’m sure. It’s in my genes.”

“Are you being genuine now?”

“Oh, yeah.”

“So this is the real you?”

Sammie laughed. “There’s no real me! Didn’t you know? Nobody’s real these days, at least, nobody my age.” She studied Holly then added, “Perhaps it’s different for your generation.”

Holly nodded once, then sat back. “So there’s a gene for acting, is there?”

“There’s a gene for everything. Everybody knows that.”

Holly looked away. “How much?” she asked.

“Five thousand.”

“Now?”

“Yeah – this is off the record. It’ll help pay for my new conservatory.”

Holly nodded. “Off the record,” she said, passing her phone over to make the cryptopayment.

Sammie smiled, then departed.

Holly checked the miniature camera on her jacket. All recorded. Then she turned her lapel so that the camera saw her face. She smiled, though that wasn’t easy.

#

Holly sat Alice before the laptop, which she placed on the kitchen table. Then she sat next to her aunt. Alice seemed disconcerted by the closeness, but she didn’t move.

“What’s this all about, Holly?” she asked.

“I want to tell you two stories. One is the story of a company trying to help people by working with what they really suffer from. The other is the story of a different sort of company.”

“Go on, then. But don’t get your hopes up. I forget things more and more.”

Holly pressed the return key. On the laptop screen people in white coats worked, the voice-over artist speaking with an Australian accent.

“Are these your people?” Alice asked.

Holly didn’t reply. Already one of her colleagues was speaking about personal family history, which led her to join the fight against degenerative diseases. The speech was emotive, the woman impassioned. This was her family she was fighting for. Then other speakers explained why they had got into Alzheimer’s research. Story after story after story. Real people doing real work: that was obvious from the video.

After ten minutes it ended.

“Now,” Holly said, “something I put together.”

She played the unedited version of her interview with Sammie.

Alice said nothing.

Holly gestured at the screen. “Sammie was real, the hologram ID proved that, and there I am. The end of the story. The twist in the tale, Aunty. It was me all along.”

Alice stared at her. “But… but… what did she mean by, I did at first, I bought the Irish thing?”

“People imagine that genes determine everything about us, and, in one sense, they do. But what people don’t realise is the enormous amount of other factors that apply. There’s no gene for being a scientist. There’s no gene for acting. There’s no gene for many things in our lives. But the people at Cassandra want to tell you a different story. They want you to believe that a diagnosis of future illness can always be assessed from a genome. It can’t. You’ve got to trust me here. You’ve got to see we share the same values in life. When I turned up, you classified me as a scientist. But I do what I do to help people. Cassie does what she does to exploit people.”

“But, everybody knows it’s true–”

“I’m not asking you to decide what’s true,” said Holly. “I’m asking you to trust me, because then you’ll see the validity of my life, and the lives of my fellow researchers in Australia. I really want to halt this hideous disease. Cassie doesn’t. Cassie wants guaranteed, consistent, reliable income. It’s why they tailor so-called health packages to their customers’ incomes.”

“And the money?”

“The money?” Holly asked.

“Yours… on the phone. It was fake?”

“No, Aunty. It was real. My own money. That’s the real twist in this story.”

Alice looked down, sighing. For a long time she said nothing.

“Then, Holly… I owe you,” she murmured.

Holly glanced away, relieved, though still concerned. Her aunt could remain susceptible to the platitudes of the internet, but at least now she had a more wholesome story to follow. That was progress.