Tuesday, March 29, 2011

Asset Allocation and Healthcare


The Healthcare Reform is in full swing. All sides come to the plate swinging away at the ball. No one seems to have figured out the “knuckle-balls’ being thrown.

Of Aging and Debt:
The Baby-boomers are in full blossom. Lots of them have been laid-off due to cost-restructure and others from early retirement. The projected data from the CDC shows us that a person at age 65 years in good health has a 50% chance of living to 85 and a 25% chance to seen age 92! Okay, that is good news for all. Or is it? Continue the line of reasoning to the current state of affairs with healthcare reform and we end up with a larger then previously anticipated population in the next two decades, who will be around to collect on the “government owed debt” to them in both Social Security and Medical Health benefits. This has been a steady-state rise from 8.03% in 1910 to 41.3% in 2009 of Gross Domestic Product  (GDP). The 2010 public debt stands at a $14.1 Trillion or 60% of GDP! Unfortunately public debt only creates more debt through interest but does not create a single widget to help the Gross Domestic Product.. So then what? You say.



Spend, Borrow and Print - Asset Allocation:
Aha! And here is the juxtaposed alarming problem. With a population consistently rising in average age and lower than average people at work, given the steady trend of the employed, unemployed and the underemployed the people funding those treasure chests cannot maintain the rate of withdrawal. So if that cannot be done, what happens next? Oh simple, you answer, if you are in the government, “we print more money, devalue the dollar make artificially higher the costs of things.”  Ah! But then the sad face of inflation rears its ugly head and the interest on that extra printed money goes up too raising the debt higher and higher, until the piper calls in the debt and the whole house of cards is in jeopardy. Well what then? You ask. And that is where we have to pause and take a deep information gleaned, knowledgeable, well-reasoned breath. For up until then, which by way of simple mathematics is NOW, life has been humming along in debt land very well. Payments were slower then expenses but we manage to print and sell our debt to everyone with shaky futures or shaky systems. But now the countries financing our debts are reconsidering and their thoughts will turn into action one day. It may be that their circumstance change, for example, Japan, or they feel the value of their savings is declining or they just get plain tired of financing our life-styles and refuse to allocate more of their savings in our Treasuries or worse simply recall their debt (Recall: Iceland, Ireland, Greece).

Costs and Benefits of Medicine:
Keeping the same window of view open we also see the rising cost of health care due to anticipated newer modalities of treatments. (Costs of PET scans, Monoclonal antibodies like “Provenge” therapy for Prostate Cancer, Organ transplants and their upkeep etc.) These newer modalities have already paid dividends in various fields of medicine, including orthopedics; more patients are now “un-crippled” to live healthier lives, cardiology: more patients live longer with known heart disease, Infectious Disease; more people survive deadly infections than before, case in point 1.1 million individuals living with HIV, Cancer: there are 9.8 million cancer survivors in 2001 compared with 3 million in 1972. The burden of those living and being cared for will exponentially rise to keep them alive.


The answers I have are few but they are worth sharing;

  1. Project more personal responsibility by raising the premiums for the elderly with means (Medicare recipients) and limit Prescription drug entitlements for the needy.
  2. Limit the expansion of the signatories to free medical entitlements.
  3. Medical Malpractice reform with capped limits on losses against pain and suffering. 
  4. Encourage R & D in all medical fields and allow the private sector to continue to take the lead without unnecessary regulations.
  5. Foster “Fee-for-service” that puts the onus of responsibility on the individual rather then a third party (If I do this then I have to pay for the consequence to get rid of it, mentality)
  6. Allow decision-making in medicine to remain in the realm of the physician.
  7. Allow Insurance companies to a competitive bidding rather then become the “market-makers”.
  8. Limit patents on orphan drugs and medical products exclusivity for 7 and 10 years respectively (this will accelerate the pipelines).
  9. Limit the regulatory costs on the practice of medicine.
  10. Encourage health-savings at individual level.
  11. Stop special committees of the FDA and make the process user-friendly (It will reduce costs of newer innovation and allow the companies to recoup their R&D costs faster). There are 2000 applications under review by the FDA and 800 Applications are filed annually. (The FDA currently charges $86,520 per (NDA)New Drug Application).

In medicine, caring for a small wound requires limited assets and is quickly cured but allow it to fester it can become gangrenous requiring large number of assets and potentially can be fatal. We are beyond the band-aid state

Thursday, March 24, 2011

Lung Cancer Energetics

J.W. Rohen and Yokochi, C., 1983. Color Atlas of Anatomy. Igaku-Shoin, New York, N.Y. pgs. 247
Lungs Anatomy
Lung Cancer

It snuffs life!
It kills!
It cripples!
It suffocates!
It devastates!

And so it does. Lung cancer is the most common form of cancer in humans. Yet the public perspective differs to a degree:

Normal Microscopic Lung Tissue

Things we think we Know:

a.  Only 1 out of 5 (21.6%) people acknowledge the fact that lung cancer is the leading cause of cancer deaths in the US.

b.  8 out of 10 (80%) of all lung cancers are related to smoking.

c. 25 of 100 (25.4%) people realize that lung cancer kills more men then prostate cancer.

d. 17 of 100 (17.8%) women understand that more women die from lung cancer then from breast cancer.

e. 18 out of 100 (16-20%) of smokers develop lung cancer from smoking however the risk from smoking is projected on to other ailments that include, heart disease, stroke, emphysema and peripheral vascular disease, which are also slow killers.

Another truism that seems at odds with public awareness is that a fair number of smokers usually quit smoking spontaneously without knowing that they have developed the malignancy. Unfortunately lung cancer also occurs in non-smokers especially those exposed to Radon gas emanating from the ground only 12% of people are aware of that.


Lung Cancer Research and Funding:

From the research perspective lung cancer receives the lowest dollar amounts in grants, contracts and funding: Lung cancer ($ in millions) $188 versus Breast cancer at $765, Prostate cancer at $329 and colon cancer at $297. This disparity follows from the stigmata that rule the public and political forums that lung cancer is induced by smoking and therefore the patients, so afflicted, brought it upon themselves. 
Age adjusted incidence of Lung Cancer


The hue and cry over Breast Cancer surpasses Lung Cancer funding nationwide in the US and has a significant impact. Although more women are diagnosed with breast cancer then lung cancer, a larger percentage of women die with lung cancer then breast cancer (as mentioned below is due to early diagnosis and funding). In the case of men this is the largest “cancer-killer” of all. Since there are a larger proportion of patients alive with breast cancer, they are able to motivate a stronger advocacy group.

World wide Distribution of Cancer


Worldwide Incidence of Lung Cancer:

Worldwide 1.6 million people are diagnosed with Lung cancer and 1.4 million die from it. The high death rate is predictably due to the fact the since the lungs are air-filled cavity the tumor mass does not displace enough normal function until it is too late. Persistent cough, shortness of breath and chest pains are fairly late stage occurrences, except when the location of the tumor dictates these symptoms early. When the location is near the lobar bronchus (cough and shortness of breath) or a peripheral tumor located next to the pleura (lining of the lung that carries nerves) causing pain, the patient is more likely to seek help.

Early Detection and Screening:

Early diagnosis remains elusive although a recent study by the National Cancer Institute called the NLST (National Lung Screening Trial) involved 53,000 high-risk individuals (deemed high risk from current and former smoking history). The screening was based on Chest X-Rays or Low Dose Spiral CT scans done annually for five years. The data clearly showed a bias towards the Spiral CT scanning technique’s superiority by 20%. The dilemma remains about the inherent slightly increased risk of radiation exposure from the Spiral CT scanning technique and its potential DNA mutational possibility. Besides affordability of the technique (X-Rays cost $40 vs., Spiral CT scan $400) and accessibility the radiation risk for early detection remains a troubling fact. IN other words detecting the disease early is the goal however given repeated CT scans raises the risk of radiation induced lung cancer. Comparatively X-Rays yield 15 times less Radiation then the CT scan. Emerging technologies will solve this dilemma in the very near future.
VisionGate Technology



The sputum cytology is also being used for early detection based on the epigenetic damage of the DNA within the cell. The cells are subjected to DNA analysis and known mutations or high irregularity of the DNA itself raise the suspicion index for further study. Another technology under way is the Cell-CT, which is a non-invasive procedure that determines the probability of cancer on the basis of the sputum cell morphological characteristics via multi-view (500 different angled 2-dimension views) scanned visualization of the individual cell as it passes through light-microscopy and is represented in a 3-D image. The accuracy is unsurpassed based on initial data and a company called VisionGate is in the process of obtaining FDA approval for creating a diagnostic machine for use in large-scale laboratories.

Types of Lung Cancer:


Alveolar Cell
Squamous Cell
Lung Cancer is divided into two main groups: 80% NSCLC (Non small cell lung cancer) and 20% SCLC 
Adenocarcinoma
(Small cell lung cancer). Although the former (NSCLC) has four distinct pathological presentations, (Adeno-carcinoma, Squamous cell carcinoma, Large Cell carcinoma and Alveolar Cell Carcinoma) they have been lumped under the same category due to near identical responses to past chemotherapy and radiation therapy treatments. However with new understanding of the biology of each cell type the distinctions are becoming obvious. These distinctions will help stratify and tailor therapy for the individual patients, rather than lumping them into one category and using the same shot-gun approach. The process of defining the differences is underway.
SCLC (Oat Cell)

Risk Factors:

a.  Smoking accounts for 80% of the lung cancer in males and 50% in females. Interestingly the incidence is highest in North America, Northern Europe, New Zealand and Australia where there is the lowest prevalence of adult smokers at 4%. While in Italy with 20% adult smokers the incidence rates are lower. Chinese women have 21.3 cases per 100,000 and Germany has a16.4 while Italy is at 11.4. This disparity may indicate a genetic weakness to cancer and the environmental risks. Male lung cancer incidence and death rates however are declining in the Western Countries due to cessation of smoking. The female incidence has stabilized after rising in the past decade. This is due to women having taken up smoking later. However the intensity of smoking is declining in both genders in the younger populations. It is no longer hip to smoke.


b.  Radon (Rn86) is a radioactive gas that emanates as a natural decay byproduct of Uranium. It is found naturally in the earth soil. It has a short half-life of 3.8 days but has intense radioactivity. It is odorless and colorless. It collects in the attics and the basements and in natural spring water. Radon is implicated in 21,000 lung cancer cases per year in the United States.
Worldwide distribution of Radon Intensity

c.  Indoor air pollution from unventilated coal-burning stoves – exposure to Polycyclic Aromatic Hydrocarbons.

Asbestos
Asbestos Fibers



Fibers in the Lung
Mesothelioma
d.  Asbestos is a naturally occurring silicate used for fire and heat resistance. It was used extensively in buildings, especially ceilings and roof tiles, in naval shipyards and talc powder. Asbestos comes in 6 different forms but all are considered carcinogens in humans. Long-term exposure causes a disease called Mesothelioma and due to the chronicity of the persistence of the insoluble fibers it is implicated in lung cancer. Patients with Mesothelioma have a higher incidence of lung cancer.


e.  Arsenic is found in the earth. It occurs naturally in the underground water. There is an epidemiological link between lung cancer and the exposure to the arsenic. The risk increases even more when tobacco smoking.
Arsenic


f.  Polycyclic Aromatic Hydrocarbons (PAH) are known risks for lung cancer. PAH are involved in aluminum production, coal gasification, coke production, iron and steel foundries, tar distillation, shale oil extraction, wood impregnation, roofing, road paving, carbon black production, carbon electrode production, chimney sweeping, and calcium carbide production. In addition, workers exposed to diesel engine exhaust in the transport industry.

Genetics:

Family history of lung cancer usually suggests that there may be a genetic defect especially if no external agencies as identified above have been established. Family history of a younger individual getting diagnosed is of concern and family members of individuals with lung cancer should be alert to the familial possibility in spite of the smoking history that may have been a contributory causative agent in that person. This may suggest a weak genetic basis for the external influence of smoking.



Noguchi M. Stepwise progression of pulmonary adenocarcinoma–clinical and molecular implications. Cancer Metastasis Rev. 2010;29:15-21.
Springer Science 1 Business Media
Similar to other cancers like for example Colon cancer, there is linear, cumulative and progressive mutational events on the DNA. The most frequent genetic aberrations are the p53, KRAS, FHIT, EGFR, CDKN2, RB and Myc genes. Additionally deletions in chromosomes 1 (1p36), 3 (del 3p), 9 (del 9p) are also seen not uncommonly.
Epigenetic modulation via DNA mehylation or Hypermethylation has been seen in protein p16 (TP16), CDH13 (Cadherin 13), APC and RASSFIA genes.
Recently younger non-smoker patients have been found with NSCLC with inversion in Chromosome 2 with fusion of EML4 gene and the ALK gene. This and several other gene/protein targets are being investigated in therapeutic trials against the cancer. (To be discussed in a later entry)

Prevention:

  1. Stop Smoking.
  2. Stop Coal burning in unventilated environments.
  3. Check basement and attics for Radon. (Vacuuming the dust and submitting it under a Geiger counter will help determine).
  4. Eat vegetables and fruits
  5. If you have been a smoker go for annual examination and consider sputum cytology evaluation for DNA mutation if available. Otherwise consider the low dose spiral CT scan as a base-line after discussing with your physician.
  6. If you have been exposed to Asbestos in your life obtain a Chest X-Ray as a baseline, after discussing with your physician..
  7. Discuss all aspects of your past history, symptoms with your physician and the need for any evaluation.
Reference:

  1. STATEMENT CONCERNING THE NATIONAL LUNG SCREENING TRIAL
       October 28, 2010 http://www.cancer.gov/images/DSMB-NLST.pdf

  1. Facts about Radon. Facts about. Retrieved 2008-09-07

  1.  A Citizen's Guide to Radon. U.S. Environmental Protection Agency. January 2009. Retrieved 2008-06-26

  1. Roscoe, R. J.; Steenland, K.; Halperin, W. E.; Beaumont, J. J.; Waxweiler, R. J. (1989-08-04). "Lung cancer mortality among nonsmoking uranium miners exposed to radon daughters". Journal of the American Medical Association 262 (5): 629.

  1. Lamm, SH; Levine, MS; Starr, JA; Tirey, SL (1988). "Analysis of excess lung cancer risk in short-term employees.". American journal of epidemiology 127 (6): 1202–9

  1. Thomas Neumann, MD Premalignant and Malignant Cells in Sputum From Lung Cancer Patients. Cancer Cytopathology  2009 Published online in Wiley InterScience (www.interscience.wiley.com)

  1. Risch A, Plass C, Lung cancer epigenetics and genetics. CInt J Cancer. 2008 Jul 1;123(1):1-7.German Cancer Research Center, Division of Epigenomics and Cancer Risk Factors, Heidelberg, German

  1. How-Ran Guo et al Cell Type Specificity of Lung Cancer Associated with Arsenic Ingestion, Cancer Epidemiol Biomarkers Prev April 2004 13; 638

  1. Armstrong B, Hutchinson E, Unwin J, Fletcher T, Lung cancer risk after exposure to polycyclic aromatic hydrocarbons: a review and meta-analysis. Environ Health Perspect. 2004 Jun;112(9):970-8.

  1. Boffetta P, Jourenkova N, Gustavsson P, Cancer risk from occupational and environmental exposure to polycyclic aromatic hydrocarbons. Cancer Causes Control. 1997 May;8(3):444-72.

  1. Sven Perner EML4-ALK Fusion Lung Cancer: A Rare Acquired Event Neoplasia. 2008 March; 10(3): 298–302. Nature 448, 561-566 (2 August 2007) | doi:10.1038/nature05945;

  1. Malcolm V. Brock, M.D, et.al, DNA Methylation Markers and Early Recurrence in Stage I Lung Cancer. N Engl J Med 2008; 358:1118-1128

  1. Noguchi M. Stepwise progression of pulmonary adenocarcinoma–clinical and molecular implications. Cancer Metastasis Rev. 2010; 29: 15-21.

  1. Soda M, Choi YL, Enomoto M, et al. Identification of the transforming EML4-ALK fusion gene in non-small-cell lung cancer. Nature. 2007; 448: 561-566

  1. Soda M, Takada S, Takeuchi K, et al. A mouse model for EML4-ALK-positive lung cancer. Proc Natl Acad Sci U S A. 2008; 105: 19893-19897.

  1. Shaw AT, Yeap BY, Mino-Kenudson M, et al. Clinical features and outcome of patients with non-small-cell lung cancer who harbor EML4-ALK. J Clin Oncol. 2009; 27: 4247-4253.

  1. Palmisano WA, Divine KK, Saccomanno G, et al. Predicting lung cancer by detecting aberrant promoter methylation in sputum. Cancer Res. 2000; 60: 5954-5958.

  1. Brock MV, Hooker CM, Ota-Machida E, et al. DNA methylation markers and early recurrence in stage I lung cancer. N Engl J Med. 2008; 358: 1118-1128

  1. Belinsky SA, Nikula KJ, Palmisano WA, et al. Aberrant methylation of p16(INK4a) is an early event in lung cancer and a potential biomarker for early diagnosis. Proc Natl Acad Sci U S A. 1998; 95: 11891-11896

  1. Nuovo GJ, Plaia TW, Belinsky SA, Baylin SB, Herman JG. In situ detection of the hypermethylation-induced inactivation of the p16 gene as an early event in oncogenesis. Proc Natl Acad Sci U S A. 1999; 96: 12754-12759

  1. Meyerson M, Gabriel S, Getz G. Advances in understanding cancer genomes through second-generation sequencing. Nat Rev Genet. 2010; 11: 685-696

Monday, March 21, 2011

Decline of Thought

We’re in a giant car heading towards a brick wall and everyone’s arguing over where they’re going to sit. –David Suzuki

Can one person change the world? The answer might surprise you. The short answer is yes. But there are some details, intrinsic to that answer that need to be understood.
Details? You say. But I don’t want any details. And as it is you have just answered the question! Therein lies the conundrum that modern society faces. Today life is lived in the concision of words, frugality of thought and abbreviation of understanding.

We demand answers in single words and better yet if it is in the form of a single syllabic form. The vast majority of us reside in the quiet desperation of a daily grind. Between the morning coffee and the nightly sandwich is lived the content of our time. What is left, are the small packages of fulfillment spent with the demands of the family and too little time for reflection, actually, too little time for anything. This daily grind is chewing away our lives and erasing our understanding.

Even more absurd for a supposedly enlightened society, but true, is the declining knowledge of the youth. When 1 out of 5 people (in 2009) believe that the sun revolves around the moon in the US, Galileo be damned, we have reverted back into the pre-Ptolemiac world.

Galileo

What has become of the inhabitants of the “shining city upon a hill?” Here the glistening tall monuments of “success” breed an ill wind of decadence and ignorance. Our educators cater to the “feelings” of the students rather then to their ability to understand. Here the passing grade is time spent in the classroom and not the gathered knowledge and understanding of science or mathematics. No student can be reprimanded for fear of alienation and causing the child depression. The education system has gone amuck with the decisions of the regulatory bodies that control education. And art is anything goes whether it is splotch of paint on a white canvas or even just a plain white canvas. (Broadway play “Art, by Yasmina Reza.”)
"Art" by Y. Reza


 Is it no wonder that the average number of adults reading books, newspaper or magazine has dropped 20% in the past two decades! A society that has achieved glories of being the first to fly a powered aircraft, to make the first mass-produced transportation automotive, to step on the moon, take a “walk in space”, create the most versatile military aircraft and assemble the smartest computer to beat humans in chess and the game of “jeopardy” cannot or will not see the decline of its intellectual prowess through inaction?

Space Walk


What happens when such a vacuum of intellect exists in society? What guiding light is there for the “rest of the people” as the “elite” are wont to calling the rest of us, the public.

As one can easily decipher, the once great nation and its people are fodder for a few “super-intellectuals.” These few, for what ever their personal motivation, be it personal greed, political ambition or delusion, create the environment and “feed” information to the “rest of us.”
Crusades


Lets us see where this might have all started. Going back to the fifteenth century the rules of control were already in place. Pursuit of knowledge although encouraged at the end of the Crusades and the end of the Dark Ages, nevertheless placed itself precariously next to the doctrine of the church. Any challenge to the Church was met with a cruel fate.
Giordano Bruno


Giordano Bruno was burned at the stake for crimes of heresy due to his belief in the infinity of the universe and that the sun was akin to the stars in the night sky. This was followed swiftly by the condemnation of Galileo for his experimental proof that the system of planets was heliocentric and not Copernican geocentric as proscribed by the church. Control of information has a ling history. Nowadays, most may agree that the era of opinionated radio-announcers followed by television “anchor-personalities” exploitation of the masses has made the populace into “zombies.”  These few successful people who have earned face-recognition by their daily presence on the TV screen are the puppets to the puppeteers, now turned “opinion-makers.” They incite, instigate and constantly barrage the public with their arsenal of words. They manipulate, articulate and stimulate meaningless discussions keeping the real world problems from “taxing the average mind.” They cajole, craft and color the view of the world to suit their intention. They denigrate, diminish and deny the facts to keep others from knowing the true reality. How have these people achieved such power?

I find television very educating. Every time somebody turns on the set, I go into the other room and read a book. –Groucho Marx
Groucho Marx


Given the vacuum of “intellects in the society” the few with the plenty of resources have created cabals that convene and reach a consensus on how to manipulate the “thinking.” Pejorative as it might seem, it is an unvarnished, albeit, hurtful truth. Their spokesperson after being carefully adorned with the right colored tie and jacket or dress, appear on the television screen to carefully craft an image of “truth and honesty” and with the forked tongue spew bite-sized lies to the unsuspecting audience. These “TV personalities” first chosen for their looks and speech have become “celebrities:” in an upward spiraling cycle feeding on it self and now speak their own version of the truth. These “celebrities” become experts in various fields of science, art, mathematics, physics and the rest and impart their version of reality. And the funny part of it is that a large segment of the population believes them!

On a larger scale of decision-making, where the intelligentsia gather to make decisions, these bodies are politely called “think-tanks”. There are thousands listed in the US, UK and Canada. These “think-tanks” belong to various political persuasions and are funded by individuals or groups through donations of undisclosed amounts measuring in millions of dollars. Thus the very essence of their words is tarnished with the color of money and subject to question. The list grows annually as new money is acquired and used to perpetuate newer aims and desires.

Diane Stone

According to Diane Stone a Professor of Public Policy in PAIS and at the Central European University in Budapest, there are over 4000 “think-tanks? operating across the globe in various ventures. These ventures vary with the bias inherent to each entity. Invoking such statements might lead some to relegate the premise of this conversation to the “Conspiracy theorist” camp, but when has self-education to gain an understanding been a poor substitute in any personal enterprise. One might argue that companies that produce products also motivate and manipulate the public to sell their products. This is true, but the difference is that the consumer is free to have the will to resist or the desire to purchase. It is not a policy mandate of “Thou shalt not…”

Donald Abelson

Donald Abelson, professor and director of The Canada-U.S. Institute and Director, Centre for American Studies has written a balanced treatise about the inception, organization and development of “think-tanks.” He cites the rise of such thought through the philanthropic measures of Carnegie and Rockefellers. Both foundations later converted into policy-making Institutes. Similarly, other groups have created American Enterprise Institute, the Heritage Foundation and Cato Institute to name a few who live by the credo of their philosophy and their like-minded donors. The government also has its own “Think-Tanks” euphemistically called “Advisory-Boards.” The government funds, in part or whole, activities at approximately 30 Federally Funded Research and Development Centers (FFRDCs). These FFRDCs include the RAND Corporation, the MITRE orporation, the Institute for Defense Analyses, the Aerospace Corporation, the MIT Lincoln Laboratory, and other organizations supporting various departments within the U.S. Government. The purpose of these Centers is to advise the government on a course of action. Since the government pays these institutes for its activities, their research decisions, by virtue of that fact, will be tainted in favor of desire of the paying entity.

Today medicine is besieged with guidelines for the physicians on how to practice. Guidelines created by the same mind-set. They call it guidelines based on “evidence.” The one thing that we can be sure of in the field of medicine is change. The problem is that revisions of the guidelines take time. The art of medicine is in the recognition of a specific treatment that would benefit a specific patient based on disease, circumstances and patient’s condition, not on some algorithm modeled after old and slow-to-change data. The currency of the situation requires a currency of understanding and not regurgitated old information. Unfortunately the “guidelines” are being considered as gospel and thus through mental fiat have become mandates. Not only does this hamper the ability of a “thinking and educated physician” but it also results in sub-par patient care. Guidelines are an essential part of the larger process of governance.

Let us look at a fiscal case in point coming out of such an entity in regards to physician reimbursements. A few elite like-minded individuals concerned with the cost of medical care decided on a concept of P4P project. The P4P project is an acronym for “Pay-for-Performance.” A concept bereft of actual common sense and understanding of illness or patient-care. “Money” being the root of most evil is at the bottom of this decision-making.

Let me expound on this argument a bit further. Say a patient comes in with a diagnosis of cancer and undergoes treatment for the same. In doing so he contracts an infection, because of suppressed immunity form his cancer or the treatment and ultimately succumbs to his illness, this patient would be considered a “bad-outcome” on the P4P scale. A few cases like these and that physician would not only be considered an “outlier” but subject to reprimand from all governmental agencies. Yet if he is crafty enough and knows hw to “game-the-system” by taking only the best outcome patients with good nutritional and immune competent early-staged cancer patients where the risk of co-morbidity is limited, then that physician would be “hailed” by the system as a wonderful physician and paid handsomely. You might say so what? Well thinking through this prospect then brings us to those unfortunate multitudes of poor-performance individuals who may have difficulty finding a physician to take care of them. Unintended consequences have sharp teeth and bite indiscriminately. The “think-tankers” while munching on “finger-food” in their ivory towers, apparently have not had any insight into this thinking. Even some who might have thought of this consequence failed to raise their minority opinion for fear of the extortions by the majority. Unfortunately one can take the example and apply in every specialty of medicine and the consequence would be the same. Michael Cannon has written a comprehensive piece on this matter and the trade-offs that it brings with it.

Another “think-tank” move by the health insurance companies was to bundle payments (its money, always money, I tell you) to primary physicians, If the patients remained in the primary care physician’s care without referral to a specialist (since specialist care adds cost to the insurance carrier) he or she would get the entire bundled payment at the end of the fiscal year otherwise monies would be trimmed based on referrals to specialists. Unintended consequence to the patient of this action is obvious if medicine was a job and not a “calling” to the physician. What do you think was the result of this boondoggle? You guessed it, several primary care physicians found themselves in the hot seat facing legal action.

Unintended consequences occur daily by actions of a few individuals or groups who think they know best or are motivated by greed, personal gain, political aspirations and the like in every field of enterprise. How then can an “average American” know the difference between what is right and true and what is rhetoric of a “game?”

The answer would seem obvious, “Knowledge!” If you take the time to learn, educate yourself and make decisions based on that knowledge, right or wrong you can take responsibility for such an action. But to be led by the wooing and deceivingly soft tune of this “super-intellectual” authority that “knows” everything makes you believe in it, is akin to self-immolation and subjugation to someone’s dictates.

Mobilizing and motivating masses is not just relegated to medicine and government agencies, it is also in the purview of other industries for instance, the fashion industry where a select few decide the coming “craze” by walking a few lithe and tall women and men parade the wares. Soon the mindless herd follows suit and fashion magazines adorn their covers with the “trend of the season.”


I think we as celebrities have a lot more control. – Annette Bening

Again the celebrity-crazed youth is the victim of its desires for similar notoriety. They act-out and live through vicarious and suggestible means always viewing their world through the colored lens of their “informed-choices,” lending covertly to the strength of the “celebrities.”

For the past decade however, there is a new paradigm that is crossing the “old-boys-network.” It is the Internet! Even though it still remains free (although pressures to control are mounting) the information available is diverse and to assimilate and digest the real from nonsense one has to have gathered a fair amount of knowledge though personal research. Knowing right from wrong and acting on it is the name of the game. A simple example to reiterate this truth is a “stock-pick” from a broker. Why would you believe that? The broker will get his commission both from you and from the company sponsoring his action of selling. You would do better to do your own research. If you do not have the Know-how then GET IT! Accessing information is easy but analyzing and reasoning through that information requires personal knowledge and experience.

Life is lived in the confluence of ideas. It is for us to separate the truth. One cannot and must not rely on “others” no matter how well meaning they seem to be, they are not. Reliance on the self pays far bigger dividends over time then the short-term gains so exploited by a few. It is in the “ordinariness” of the commonsense that life has great value. Dependence on any other, be it a person, group or government creates the foundational cracks of a fractured future.

A lie repeated often enough becomes the truth. 
-- G. Goebbles

The divide between Science and Pseudoscience and Reality and fiction is the same. The gash is both great and small. The relativity is based on the knowledge or ignorance of the individual. It is not what is told to us but the “B-S meter” that we employ based on our own knowledge and experience that determines the validity of any such presentation. For instance, if the woman on television states, “the world is in chaos!” What is she implying? Whose world? Hers? Yours? Or does she mean the world in general? And if the latter is true then does that affect you and if it does what are you going to do about it? And if it doesn’t then is her statement credible or is she just fear mongering? Is there a cause behind her statement? Is she the talking head for an individual, a group or a ”think-tank?” Or is she simply giving her “opinion?” And if she is what are her credentials? Is she a newscaster or a self-appointed opinion-maker? The questions abound and only knowledge and experience can differentiate between what is real and what isn’t.

So what have we here? The remains of a dying public intellect co-opted by a select few that determine the state of the ship and motivate, manipulate and subsequently direct the movement towards their own version of the future? Or is it that we the public have succumbed to the sedation of laziness and sedition of personal desire and have decided that “they” know best about the direction and continuity of human affairs, whoever “they” might be? Or is it that we have let ourselves slide down the intellectual scale into such an abyss that climbing back up would require such an effort in our daily lives which are already filled with toil and trouble, fear-mongering and ridicule, that daily survival is the only thought in our minds? What in all this is our role? Where in all this is our future? Where do we see our children and grandchildren’s future? Are they to be condemned to a future that we allow to happen because of our inaction? These are questions of magnitude. They must be answered to allow us creditability to be considered humans with knowledge and sense.



Just as iron rusts from disuse, even so does inaction spoil the intellect. --Leonardo da Vinci

So to reiterate the question, Can one person change the world? The answer is an unqualified “yes.”  If each of us is armed with the individualized knowledge of whatever depth and understanding we choose, not just a parroted version from the “anointed ones” on the media and we analyze each fragment for its totality to expose reality then we can speak our minds and be involved in the decisions to shape our lives and our future!


Reference:

The Institute of Medicine (2006). Rewarding Provider Performance Aligning Incentives in Medicine”, The National Academies Press. Retrieved 2007-04-15.

Cannon, Michael F. (2006) (PDF). Pay for Performance: is Medicare a Good Candidate?. The Cato Institute. Retrieved 2008-04-02..

Abelson, Donald, E. Do Think Tanks Matter? Assessing the Impact of the Public Policy Institutes. Translated into Simplified Chinese By the Shanghai Academy of Social Sciences Press, 2010

Hellebust, Lynn and Kristen Hellebust, editors. Think Tank Directory. A Guide to Independent
Nonprofit Public Policy Research Organizations. Topeka, Kansas: Government Research Service, 2006 (2nd edition).

Stone, Diane. Think Tank Traditions: Policy Research and the Politics of Ideas (Manchester, Manchester University Press, 2004)

Diane Stone 'Think Tanks and Policy Analysis', in Frank Fischer, Gerald J. Miller. & Mara S. Sidney (eds.) Handbook of Public Policy Analysis: Theory, Methods, and Politics, New York, Marcel Dekker Inc. 2006: 149-157

http://en.wikipedia.org/wiki/List_of_think_tanks






Sunday, March 13, 2011

St. Patrick's Day and the Pi

He was 16 years old. In the dark of the night when silence reigns and the limits of the world disappear into the unbound vistas of the subconscious, he heard the faint sound of muted footsteps. He lay quietly contemplating the lone star visible through the small window. He heard the creek of the door and from then on a coarse hood over his head smothered his view. His one and only protest had been silenced with the glint of the dagger that pressed against his neck.
Saint Patrick


He was born to Calphurnius and Conchessa. Calphurnius was high-ranking official Roman and a deacon -son of a priest, while Conchessa his mother was a relative to the great patron of a Gaul, St. Martin of Tours. In their house religion was the foundation of life. Now at a tender age, he was a captive.

After days of fear, anger, resentment and subsequent acceptance, he found himself in the hands of Irish raiders who then traded him for their needs. His mutinous thoughts were long forgotten after the short but tumultuous journey by boat onto a land far away from his birthplace in Roman Britain. For six long years he tended to the flock of his captive chieftain named Milchu in Dalrida and during those days and nights his faith in God increased, as did his knowledge of the Celtic tongue. He realized his master Milchu was a high druid and so he immersed himself to understanding that culture. He became accustomed to the Celtic pagan pantheism. One night wistful under the canopy of stars, he heard the voice that bade him to return to his home. With the strength of that conviction he fled from the cruelty and traveled some two hundred miles by foot to the seashore where he boarded a ship back to Britain. He was 22 years old, wiser of the ways of his captors and deeply religious when he came ashore.

The Bishop of Auxerre commended the young Roman-Briton lad to Celestine, Pope of Rome. Knowing of his understanding of the culture in Ireland, the Pope decreed him to return to Ireland on a mission to Ireland’s apostle and gave him the name “Patercius.”
"Vercingetorix Throws Down His Arms at the Feet of Julius Caesar", 1899, by Lionel Noel Royer


The Gallic wars of 58-51BC had laid Gaul under the mercy of the Roman Empire. Julius Caesar had annexed all the conquered lands to the Roman Empire. Caesar’s written account “Commentarii de Bello Gallico” gives a limited but cautious account of the culture of the druids.
Julius Caesar


"These men predict the future by observing the flight and calls of birds and by the sacrifice of holy animals: all orders of society are in their power... and in very important matters they prepare a human victim, plunging a dagger into his chest; by observing the way his limbs convulse as he falls and the gushing of his blood, they are able to read the future.”
Wickerman (reenactment)


This culture was steeped in paganism that allowed human sacrifice to please the Celtic deities. The sacrificial humans were burnt in a large wooden effigy that later assumed the name of “wicker man.”

When “Patercius” returned to the shores of the druid-Ireland in 433, he immediately faced their wrath, yet, undeterred he persisted in his preaching to the assembled chieftains who showed him some deference. It is said that during that discourse, he plucked a shamrock and explained the doctrine of the Holy Trinity to the pagans who were Christianized.
Shamrock


Patercius died on (3.17) March 17 in 493.
St. Patrick's burial


Saint Patrick, as he is now known banished paganism and human sacrifice through the conviction of his religion from Ireland. His intimacy with the Celtic traditions and those of his ancestry set the stage of bringing enlightenment to the country and people of Ireland.

Pi


Just as significant as 3.17, 3.14 is a curious string of numbers also. They seem to have some implication in the field of mathematics. Archimedes was the first scientist to try to come to an approximate value Pi.


The measurement of the area of the circle is determined by dividing its circumference by the diameter.


What is curious is that Pi is an irrational number, in that it does not have a finite integer and a transcendental number, which means, it is non-repetitive. Great minds like, Archimedes, Leonard Euler including Albert Einstein and others has studied Pi at great length. So much so, with the advent of computers, what was once considered difficult to calculate past hundred digits, now through dense computational power, the current value of Pi is calculated at 5 trillion digits past the decimal in a non-repeating string! Curiously Pi is used throughout all disciplines of sciences. It appears in formulas of area and volume and is extensively used in architecture. In fact The Great Pyramid at Giza, constructed c.2589–2566 BC, was built with a perimeter of 1760 cubits and a height of 280 cubits; the ratio 1760/280 ≈ 2π

More interesting is the slope of the Great Pyramid is calculated to a value of 4/Pi. If not for this precision, the Pyramids would not with stand the vicissitudes of time.
The Great Pyramid at Giza


Leonard Euler described a formula correlating the behavior of the exponential function of a complex variable.


Pi also appears in equations dealing with the principles of the Universe, in probability and statistics. Interestingly from the known values of the Pi in calculation any deviation translates to an error in measurement and performance over time. The precision can be quantified, as a difference of a single atom in a 10-centimeter needle would display itself in the 9th digit of the result. Essentially, deviation from the known value becomes the Lorenz's  “Strange attractor” for the beginnings of a chaotic model.

Nature has a tendency to follow the Pi rule:
“Under ideal conditions (uniform gentle slope on an homogeneously erodible substrate), the ratio between the actual length of a river and its straight-line from source to mouth length tends to approach π.
Albert Einstein was the first to suggest that rivers have a tendency towards an ever more loopy path because the slightest curve will lead to faster currents on the outer side, which in turn will result in more erosion and a sharper bend. The sharper the bend, the faster the currents on the outer edge, the more the erosion, the more the river will twist and so on. However, increasing loopiness will result in rivers doubling back on themselves and effectively short-circuiting, creating an ox-bow Lake. The balance between these two opposing factors leads to an average ratio of π between the actual length and the direct distance between source and mouth.”

So what does Pi have to do with St. Patrick is the obvious question. Well it turns out that the value of Pi is 3.14152965 or 3.14 or March 14 which is three days before St. Patrick’s Day (celebrated for St. Patrick’s death) and 3.17 is exactly 3.14 days after the value of Pi, or St. Patrick’s Day-Pi=Pi (saw that on a tee-shirt) translation: 3.17 St. Patty’s day -3.14 (Pi =3.141) =3.14 (days left between the two). So there is a mingling of science and the Great Saint of Ireland. Both true in their transcendental nature, both perfect in their precision, both related in time and both immersed in the rigors of knowledge and both remembered eons after their time.
So let the rivers turn green in honor of a great Saint and as they do remember nature that ultimately controls the flow of those rivers uses a Constant that is precise and transcendental as nature herself.
St. Patrick's Cathedral in NYC


The caravan of digits that is pi
does not stop at the edge of the page,
but runs off the table and into the air,
over the wall, a leaf, a bird's nest,
the clouds, straight into the sky,
through all the bloatedness and bottomlessness.
Oh how short, all but mouse-like is the comet's tail
----- Wistawa Szymberska

Friday, March 11, 2011

Critical Thinking


The word critical makes you stand up and take notice. Doesn’t it blow your mind whenever this word crosses your field of vision? Yet, I notice that lately there is a lag in that standing up and equally longer a period of time of taking notice. I wonder why? Why is it different now? I mean, the meaning of the word has not changed; yet the impact seems to have dried out like a stone in the Sahara Desert. Just as the word critical has been misused and overused and inversely, thinking has been underused and its totality has fallen into disrepair.

We live in an environment soaked with “Breaking News” and titillating bits and pieces of information that cross our path hourly, if not minute by minute and somewhere in this mud, a new “norm” of fatigue has set in. Fatigue is a mechanism of drawn-down reserves through excess use.  So maybe seeing the scrolling news data below every television broadcast has finally depleted everyone’s reserves. Too much! Too much!

Illustration by Matt Mahurin for Newsweek

Critical thinking in its purest sense indicates the value of assumptions used to render a hypothesis, followed by clear concise interpretation of the gathered data -both hidden and visible -to prove or disprove that hypothesis and subsequently draw a reasoned conclusion. It is not accumulation of information but the derived reasoning from it and the changing sets of facts that determine critical thinking. Things change, so, rationally must the thinking. Critical thinking involves reasoning based on some assumptions and deductive rationalization before a conclusion is drawn. If the mind is capitalized with ancillary, irrelevant streaming data, thinking will be impaired. And that is where we spot our Little Red Riding Hood scamper through the forest in search of fruit only to find the Big Bad Wolf.

The algorithm of Critical thinking:

Assumptions -------> Hypothesis ------> Evidence ------> Proof -------> Conclusion

Extorting Emotions that deny Critical Thinking:

Angelika Dimoka, director of the Center of Neural Decision Making at Temple University has revealed through experimentation that information overload causes us humans to make stupid mistakes. The dorso-lateral part of the Prefrontal Cortex which is the key zone in the brain that makes smart decisions, when inundated with data overload gives up the ghost allowing less analytical parts of the frontal cortex to make stupid and arbitrary decisions.


 In spite of claims to the contrary, by people addicted to a surfeit of information, most of them lose the pitch and moment of creative decision-making and resort to just making a decision! Experiments done with MBA graduates working in financial quarters when given every hiccup on wall street lost significant monies as compared with those that were not subjected to each tick by tick, yawn and smirk of the Dow Jones Industrial Average. The latter group made out handsomely on carefully crafted stock purchase decisions.

Ambiguous as it might seem and as anecdotal as it might appear, the phenomenon of fatigue is overtaking the society in a surreptitious incipience that we cannot deny.
Imagine a pilot in the cockpit of an airplane whose mind is overloaded with information and the gentle sirens of  “out of tolerance” warnings of non-critical systems are periodically sounding, fatiguing his sense of calm. This distraction keeps him from addressing the minor incongruities in the critical systems. All it takes is a conspiracy of the electronics and the hydro-electrical systems to create a perfect storm and disaster to strike the unsuspecting pilot and his passengers. As Eric Kessler points out, “we are fooled by immediacy and quantity and think it’s quality.” The brain integrates recency of information and makes it available for review towards decision-making and that preference of “quick” over “right,” causes problems. The conscious brain with an ambush of data resorts to the conscious system where it integrates both useless and useful information to eventuate an incomplete solution. This leads to poor choices. The decision system breaks down and as one person put, “it is as ineffectual as eunuchs in an orgy.”

A bleeping horn of an un-extended gear during the approach to landing phase of the flight may be overlooked due to distractions; such as a deer on the airfield, or a passenger with a minor but irritating complaint, or even the nerves of pilot’s own sanity frayed by personal and global issues. These events occur not too infrequently in aviation and in every day life. Distractions are natural phenomena that limit focus. However it is, the constancy of these distractions and over abundance of related information that causes unmitigated disaster.

Two real world scenarios in the aviation community that best exemplify critical thinkers not given into informational overload are Chesley Burnett Sullenberger III and Captain Alfred E. Haynes.
Miracle on the Hudson

Captain Sullenberger or “Sully” as he is known successfully ditched a disabled Airbus 320 on January 15, 2009, into the Hudson River, saving all 155 lives. 
Chesley Burnett Sullenberger II


The event was played out in real time on US national television and many consider him a hero, but his most endearing legacy will be his ability to decide to ditch in the water when three airports within the 15-mile vicinity were tantalizing him. The US Airways flight #1549 outbound from LGA (La Guardia airport) lost its engine thrust due to ingestion of a flock of geese. Calmly his mind reasoned the probability of survival. The result was a spectacular success.
Captain Alfred E. Haynes

UAL 232
Captain Al Haynes had an equally challenging but more difficult issue for the United Airlines flight #232 bound for Chicago’s O’Hare International Airport on July 19, 1989. The incapacitated number two engine of the DC-10 aircraft had sent shrapnel into the vertical empennage severing hydraulic lines. 
Flight path flight UAL 232


Working without ailerons and elevator control and the two remaining engines he used asymmetric thrust vectors to land at Sioux City Iowa airport. 
UAl 232 Sioux City, Iowa


184 of 296 passengers and crewmembers survived the controlled crash. 
UAl 232 post crash image


55 attempts with identically simulated conditions on a simulator by different test pilots failed to accomplish what Haynes had done. What he had managed to do was extricate all extraneous information and relied on his basic piloting and common sense to save lives. If worries of life and death had entered in his mind, the results would have been much different.


The answer to erroneous decision-making lies in the multiple competing arguments in a multi-tasking world. Here in this existence, life is on the run, time is in retreat and days merge into nights without distinction. We as humans live in a world that demands constant attention, failing which it invokes various mechanisms of reproach to acquire it. For instance you did not post the letter today that was supposed to be received by the addressee yesterday and you end up with the dreaded fine. In this pressure-filled life, our rush to belong truncates life itself. In so doing, the essence is lost. Remember the paper boat that you watched as it rode the stream of water, hitting every pebble and changing course to your delight, now you wish a quick arrival at the personally specified destination. The journey no longer has the same “kick.” The point “a” to “b” is a nuisance and the destination, what we have instilled into our thinking, is what holds the key to progress. Life is being lost in the blur of “getting there.” Thus decisions are being made not on the whole but part of the reality.

To that preamble let me add another real world aviation disaster to illustrate the point that all arguments must be heard; a minority opinion can weigh heavily on a decision and predetermination without full knowledge can lead to a catastrophe.

Tenerife Disaster portrayed

On March 27, 1977 a Pan Am flight 1738 and KLM flight 4805 crashed on the single runway at the Tenerife North Airport. 
Tenerife North Airport (One runway)


Captain Jacob Veldhuyzen van Zanten piloting the KLM decided in his hurry to takeoff without receiving proper (ATC) Air traffic controller clearance and acknowledging a statement from his first officer who told him that they did not have clearance to takeoff. In an airport bogged down with fog and 1000 feet visibility the “back taxiing” Pan Am aircraft was not visible to the KLM aircraft that had commenced the takeoff roll. The collision resulted in the largest aviation disaster in history.
What went wrong was a premeditated thought process, an inducement to hurry (flight prior to mandatory 8-hour pilot rest period) and a mental framework of disregarding contrary opinion. The decision to override all fail-safe mechanisms by a single individual resulted in 583 fatalities.
Tenerife Disaster actual image


So how do we extricate ourselves from beneath this egregious cloak of risk that shields our mental vista? How do we make ourselves less pervious to this reptilian shadow that slithers, within the tall grass of life?
Rodin's Thinker


It appears our brains are gifted with a decision making apparatus that views, reviews and then based on experiential knowledge and Bayesian probability comes up with a determination of how and when to act. This mechanism is relatively fail-safe, but it is dependent on the quality of information provided. Consider then the constant feed of misinformation of limited relevance through all the portals accessible to the average Joe. These bits of information (twitter, facebook, myspace) constantly demand a contract with Joe’s emotions, to which he succumbs and drops into his chair of “oh heck,” and blanks out.  Meanwhile the TV, competing for the same neurons in his brain, is showing images in 10-second segments; of some poor soul caught in a deluge, drifting in the wild flood waters, in a far-away land, abruptly switching the scene to a homicidal maniac with his wrists in cuffs behind his back awaiting justice followed by the economic data of jobs, GDP and national debt leading to the plunge in the financial markets. So Joe’s mental frame has hung itself onto another wall of misery. And right on cue admixed with this torture are the advertisers paying huge amounts for 30-second of contracted time, vying for Joe’s hard earned money, to regale their version of their revenue enhancing snake oils; the cure for athletes-feet, a nasal-spray for congestion and a pill for a robbed sex-life. Extraneous information robs us of our thinking. Adding complexity leads to mental chaos, quick decisions, confusion or even inaction. Oh what a web we weave in an attempt to deceive the unsuspecting, unthinking souls.

The parody that plays itself in our daily lives is overtaking the gravity of the reason for living. We aspire to compete and that is not a bad thing, but constantly being ushered into the domain of negativity, despondency and imprecision, which has little relevance to our lives, makes us wistful and fearful even for what we have. The brain needs to incubate new information and integrate it with existing knowledge to strengthen its synaptic connections to be able to see hidden and elusive patterns in this complex world. Life is not lived in the fringes but within the core. It is not a game of Jeopardy -a push of a button away from success. It is a thoughtful exercise in restraint and understanding.

Exploiting Falsehoods that affirm poor conclusions:

"Too often we... enjoy the comfort of opinion without the discomfort of thought." – John F. Kennedy

Shoehorning into this negativity I would be remiss if I don’t point out the even more perfunctory, illusive and egregious behavior exhibited by the ill-gotten celebrity status of actors and journalists who pose as scientists and scientists who pose as actors in helping disseminate nonsense, mis-sense and pure bull. These stalwarts, with their televised imprecision, armed with 15 minute of fame, exploit and force-trend the people’s thinking for their own gains. This is the tragedy of pseudoscientific ideas buried in troughs of conceit. The world is awash in the rigors of this blur. The truth is hidden from the gullible public under the nuances of deceptive and unproven “facts.”  Here “motivated reasoning” of these pretentious journalists falls in line with confirmation bias, denying any existence of counter-arguments and even turning a blind eye to Cartesian logic just so to effectuate and win the argument. To overcome this skullduggery, not only do we need critical thinking for our own sanity into not believing that “snake oil” works wonders for optimal health, contrary to some “Cinderella-like” epidemiological conjecture and correlative fiat, but also to relate to the true scientific information that requires verifiability, validity, legitimacy and purpose. Negative exploitation of human emotions and falsification of real world issues have similar impact; they make non-critical thinkers into believers -slaves to the over-ripened falsehoods of charlatans and by virtue of the opinionated and misinformed media label the true critical thinker, a naysayer.



Living Well:

There must be something we can do to rid ourselves of this agency of fatigued self-doubt. Ah! I see a hint of a smile precariously perched at the edges, hoping for some help. I begin with a few caveats, since fulfilling each and every vocation and desire is not the purview of this brief-reasoned exercise.

Pilots:

So if you are a pilot in general aviation or for a commercial airlines, you may consider a daily jog out in the fields where the air is clear and the grass, weed, bushes and trees are visible for your pleasure. Limit exposure to the television newscaster and radio-heads especially the “news-makers.” The real news, I guarantee will find you, but without the noise that deadens our resolve to function as human beings. Expand your knowledge of the aircraft-systems employed for your safety and that of your passengers. Explore relevant data in various circumstances within your mind to evaluate your thought process. Practice emergent events in a safe simulated environment at least every six months to keep yourself proficient. 
Garmin's Glass Cockpit in a GA aircraft


The “Glass-Cockpit” equipped newer generation of aircraft pose similar risks of “head in the cockpit” and “too much information” syndrome rather then the “see-and-avoid” that has saved many an aircraft from in-air collisions. The “Glass-cockpit” is replete with tremendous amount of information and although relevant, the pilot must always remember the six basic pieces of information that keep him flying. Exercise your mind and your body for optimum functionality and resolve. It is better to imagine an emergency and how to escape it rather then have one in real life in flight and devise mechanisms on the fly to save yours and other’s lives. (Sounds pseudoscientific thinking, but it isn’t).

Physicians:

If you are a physician, consider ignoring the television completely. You live in a “live and die,” universe where people’s lives are at stake. Consider options of positive energy constantly flowing to you and away from you. Yours is a universe bedeviled by nature’s wrath. Help others to help yourself. Expand your knowledge and art. You need the constant flow of verified information that determines outcome related to patient care. The wealth of love and respect come back many fold for a well-thought and executed patient managed process. (Sounds like mysticism, but it isn’t).

Housewives:

If you are a housewife consider joining a book club and discuss simple and complex matters of life and living with others. Read more and help your children to understand the reasoning behind facts rather then fill their heads with known facts. Teach them to reason. Keep the home fires burning, learn verifiable knowledge and teach your children the same with respect and love and focus your family on developing a stronger bond with your neighbors to enhance your lives. (Sounds corny, but it isn’t).

Unemployed:

If you are unemployed, imagine a better life. No reason to revel in other’s miseries just to make yourself feel better. What you employ in your imagined universe has a better prospect of accomplishment then otherwise. Think and your universe will find means to fill your life with that reality. (Sounds new age, but it isn’t).

Employed:

If you are working, enjoy the work and use your creativity to advance the environment and yourself. Think of ways to make your job more productive. (Sounds like more effort for same pay, but it isn’t).

In a world bent on exploiting the raw human emotions, it is time to look the other way and smile.

Please do strive,

Please do compete,

Please do achieve,

Please do elevate your knowledge and understanding but above all if you are a person reading this,

Please be a fellow human and consider all arguments, even the contrary ones with your own lens of critical thinking.

Think for yourself yet give credence to others for their opinion.

Question the legitimacy of any argument with factual and reasoned knowledge.

Perpetuate a desire to learn and your world will be a better place for it.

"It is the mark of an educated mind to be able to entertain a thought without accepting it." - Aristotle