Friday, June 28, 2013


 Have you ever had a toothache? I am sure you have, if not maybe a backache or any one of the other maladies that make you want to wish for a quick relief? What happens to your mind?

In that question lies the germinal truth of societal distress, anxiety and frustration. Think about it for a minute. If you have a toothache what do you think about? Everyone will answer, “The toothache!” of course.

So what happens to all the best-laid plans in a suffering, well they are shunted into the background. That thought about the presentation before a committee, or the lecture about the biodiversity, jumping genes, proteomics, or whatever floats your boat, all that is transferred from the “panic room” to some obscure and hidden invisible shed. The primary thought is no longer that, but this, the ache. And this ache becomes all consuming! All else is forsaken.

Now play along with me for a while. In our daily schedule, we are tethered to the smart-phones constantly glancing at it to see what new treasure of information has been revealed. In the restaurants, in the bars, in the homes, in the cars or in the airplanes, anywhere and everywhere, even the grandma who couldn’t dial the rotary phone once is checking her text messages. Everyone wants to be smarter, more “in-touch,” or simply plain nosey.

You see, and here is the punch line: human capacity to interact with multiple competing arguments is great. That little prefrontal cortex in the brain where all decisions are made can deliver blow after blow, time after time for question after question through the efficiency of experiential reference in quick, reflexive response. This System One as Daniel Kahneman likes to call it, is the “quick and dirty” mode of response. We do it all the time and in dealing with all our daily smart-phone and personal interactions we stump our cause with a rapid-fire decision-making with “Yes go for it!” or “No don’t do that!”.

Ah and here then is the problem, and not a minor one at that. When we are busy carting around a myriad of informatics tailing us at every corner, in every bookstore, in every theater, we lose sight of the “methodical, carefully crafted and understandable” decisions borne out of real reason and thought and resort to those delivered in haste.

For that matter, what about, real pleasure. Enjoying an evening of pleasurable interactions with friends and family suffers the same fate of “quick and dirty” when both eyes are on the smart device and the ears are semi-tethered to the conversation. The nuance of the conversation may only be partially understood and faux pas come rolling out in spades when you ask irrelevant questions and give irrelevant opinions, to the horrors of your spouse.  And she or he quickly responds to protect with, “Oh he/she is under some stress over this new important job, decision etc.” The cavalry protects but cannot fortify the flanks when you keep blurting out inconsequential nonsense. It used to be, that people thought that only “important people” did that sort of thing and such social faux pas were considered the domain of the “rich and famous” but now that medium has been revealed to the masses, the medium of connectivity, and everyone seems to have gone into such unsocial and at times antisocial behavior.

The premise then is the human bandwidth. The information flow has to be narrowed down to a singular concept so that proper understanding is given to select information. When multiple flows of varied information are being funneled through the pipeline and challenging the bandwidth, the responses will also be superficial, inconsequential and varied to the disdain of the company.

So when people boast that they are able to parallel process multiple things at any one time, they are usually “Jacks of all trades!”

This brings us to the tougher question, where will the original thinkers be? Or will there be any? Original thinking requires concepts to develop, time for the thoughts to coagulate, silence away from distraction, patience to persevere through difficulties, logic and reasoning to understand. None of these variables are present in this society where technological ubiquity in the form of a fire hose of information is driving youngsters into a stream of constant linkage, and communication has shrunk to a LOL!

So in the end, it boils down to the basics… Think of life as a pleasant evening out for dinner with your friends and the social interactions as a gift.

Learn to live your life through the real lens of your eye than through the lens of someone else’s words being displayed on a screen. See the world as it is than as someone else wishes you to see it. There is a richer, more beautiful world out there in all its glory waiting to be rejoiced for its multitudes of bounty better than the photo-shopped picture on the screen. It is time to take a breath. It is time to live!

As Spock would say, “Live long and Prosper!”

Or as your grandmother used to say before the touch-tone thing came into being, “Take the time to smell the roses.”

Wednesday, June 26, 2013

Dinner at a Orthopedist Home

Dinner at a doctor friend’s house is always an interesting phenomenon. You learn the heartaches and the travails of another colleague and spend time commiserating the evening away. You also learn in the process of what has transpired in their field of medicine. Any and all new developments are bandied about and a roughly drafted thought of what helps and what doesn’t, seems to stick.

The other night, it was orthopedics. You know, my friends who use buzz saws and staples, as they set broken bones straight. Yes, those wonderful human beings who spend an inordinate time washing their hands in the sink before they enter the theater. Oh I recognize their superiority in their art and the unsaid aplomb admixed with the tension of time constraints, sometime insufficient supplies or inadequate trainees gives it an air of a theatrical performance. All said and done, most perform admirably in setting things straight.

So I learnt that the orthopedic surgeons have seen a drop in their income. But not to despair, I said, it is happening in all specialties across the board. No he says, the NYT states that we are making more money than last year. Ah yes, that determination is based on one’s billing or revenues and not based on the Net Income. Yes, he says, that’s probably true. You know, he wonders out aloud, what will become of medicine? I ponder on the subject, staring intently at the glass behind the elegantly furnished bar in the basement of his house. I look up to answer and find that he is gone, shaking hands with another. Ah yes the art of company and being a host.

What will become of medicine? I wonder. But the wall in front of me is bare except for this tiny framed English painting of a foxhound hunt. And for a brief moment this painting clears the foggy view but then it is gone.

The dinner call comes and slowly we all fall in line to climb the stairs to his dinning room. Nothing ostentatious here, a table for 10 with place settings and in one corner a Roomba ready and “green” with desire to clean every dirty speck that came crawling in underneath every guest shoe.

The dinner is quiet with the clinking of stainless steel ware and the china and from across the room a friend of his shatters the quiet reverie. Hey, he says, did you notice what these PAs and NPs are doing? Boy! He sniffs, are they raking it in. What do you mean, my friend asks. Well, the other guy says, I operated on a arthritic hip the other day and I received my usual $1500 for the total hip from our bountiful masters. Meanwhile this non-par NP receives $2900 for assisting me and also has the temerity to balance-bill another $500 to my patient. I mean, what the hell? Really? My friend asks with incredulity. Yeah, so we started looking at all the surgeries done with these “providers” and in a 100% of the cases they were paid double if not triple of what I got paid for the surgery. Incredible! He gulps down his class of water trying to force the chicken he has swallowed, down the gullet. Oh, he exclaims after swallowing, the podiatrist who assisted me the other day got three times of what I got. I complained to him, and he smiled back at me. Well, he said, those are the chinks!

My friend now slightly agitated asks his wife, Honey! Could you check our explanation of benefits and see what is going on. Yes, she says she will.

Needless to say that the desert tasted a little out of sweet, to my friend and maybe all of us assembled, that night. The night ended with pleasantries as all dinners do and as I got back in the car the only thought ringing in my head was, what the hell is going on under the guise of Healthcare?

While the overhead costs for these surgeons has reached 70-80% their struggle to continue serving patients is making them run like hamsters. And hamsters can run but not think, you see! The programming is well in its final phases and you can run but cannot hide. 

Thursday, June 20, 2013


Once upon a time, there was a beautiful piece of land, high above the hill overlooking meadows and vistas of grand and wonderful delights. It was called, “The Land of Innocence.” In this land lived a peaceful people. They toiled by day and night and never complained. These were charitable, humble, and assiduous innovators. Blessed with the resources of the land, inbred with a dignity of labor and toughened by the demands of survival they conspired to create a haven for themselves and a showcase for the world.

Within these people there was a select group, called “Proofers.” The “Proofers” tended to the fears, emotions, pathos and any unwelcome trauma of the rest of the people. The “Goofers” on the other hand, created trails to various landmarks for all to see and enjoy, in the land of plenty. The “Goofers” were honorable people too. But as time moved on, one such special “Goofer” named “Roofer” who loved the control and purpose of the day to day lives of the people, decided that he would make a special effort to show his magnificence and benevolence. He decreed, that all “Oofers,” the elderly, would be given special privileges of help by the tax-collecting, “Goofers.” In return the “Roofer” had figured that the people would keep him in power for life. And that is what happened, until he died. Other “Goofers” successfully carried the mantle of the “Roofer’s” decree, all fearing the wrath from taking back the promise of easy comforts and freedom from costs of daily living. In keeping this “Goofers” promise fulfilled, Jeremy Bentham had won this contest against Immanuel Kant. Reason had taken a back seat to implied logic. There was no autonomously applied principle of Reasoning except for an ulterior motive of self-service via the expressed notion of common good.

As time went on the “Oofers” community grew bigger and bigger and they started to require a lot of time with the “Proofers.” The subsidies grew and threatened to destabilize the revenue stream of the “Goofers,” for their many and varied schemes. Since the “Goofers” could not blame it on the “Oofers,” because the “Oofers” had swelled in numbers across the land and represented a large base of power, they placed the blame on the “Proofers.” The “Proofers” meanwhile were a hard working bunch of single-minded, individualists, who paid seldom paid attention to the polity. Scrolls were published by the “Goofers” and nailed to the oak trees by the “Looters,” “Hooters” and “Suiters” where every one walking the country-mile could see. The posters decried the recalcitrance of the “Proofers” of their non-compliance. And there grew a groundswell of public distrust against the “Proofers.”

The “Goofers” finding a perfect target to assault, added insult to injury by creating a forced labor force of the “Proofers.” The “Goofers” initially enticed them into the fold with visions of freedom and appropriate fee for their services and then gradually tightened the vice on them, by adding an ever-increasing set of demands. The “Proofers” who served under a “volunteer” basis found themselves reimbursed based on some concocted formulas devised by some of the expert “Goofers.” The attempt was to create a controlled market system that denuded the freedom of individual contracts between the “Oofers” and the “Proofers.” The “Proofer” complaints fell on deaf ears, since the “Oofers” did not have to pay, they remained quiet, and the misery of the “Proofers” mounted. Frederick Hayek, Milton Friedman and even Aristotle would have been unnerved by the goings on in “The Land of Innocence.” Where once innocence thrived but since had died and now the fields were plagued by the shadows of corruptive influence. The lyrics of “common good,” “public trust” and “benefits of the many,” in sing-song fashion began to be broadcast across the land.

While the “Proofers” were busy hard at trying to make sense of the changes, they were slapped with another puzzle to solve. This “puzzle” was the specified need for the “Proofers” to constantly check their abilities to function at a 100% with one arm and a monocular vision. This puzzle testing was conspired by the “Play-along-self-enrichment Jeremy Benthem leaning crowd to extract monetary gains for themselves. They called this puzzle testing, “MOCP” or Maintenance of Credibility Puzzle. Each “Proofer” had to solve the puzzle to maintain his “Proofiness” abilities, all under the burning midnight oil.

Meanwhile the “Goofers” having found, a steady rock under their feet in the turbulent waters of misguided economic directives, against the “Proofers” continued the barrage with more and more restrictive covenants, devised unilaterally to the detriment of the “Proofers” and “Proofing.” No one paid attention. The turn of the screw was only harming the “Proofers” and they were the vilified group, so no one cared. “Yup, they deserve it,” was on every tongue.

There was a hue and cry across the land and every “Proofer” felt the sting of the outrage directed against him or her. There was a bully pulpit in every corner and a “Goofer” followed by a “Hooter” was always on it, seen yelling at the magnitude of the economic problem steadfastly pointing the finger at the “Proofers” as the root cause. Until one day an elegant and well-dressed “Proofer” from a prestigious school of volatile thought and an equally well dressed, “Goofer” from a prestigious school of contrary thought, got together and decided that there must be a way to level the playing field with a fairness doctrine. The “Goofers” decided to name the “Proofers” as “Free-riders.”

This was further adding insult to the “Proofers” many sustained injuries, to be called “Free-riders.” They made many an application to get the ear of the chief “Goofer” but no one would allow them near. With sullied reputation and an overburdened sense of despair, the “Proofers” at first acquiesced and then with added restrictions of being mandated to help the people with one hand tied behind their back and the right eye covered with a blindfold, they trudged along, complaining as they had all along, trying to figure out what to do.

The “Goofers” with the help of the “Hooters” published new and far-reaching guidelines of how the “Proofers” were to carry out the specialized “Oofers” mandated programs. There were compensatory incentives for those that played along and forsook their oath while those who stuck to their principles were placed under more restrictive covenants. The latter suffered the wrath of the “Goofers” by being burnt at the proverbial stake. Their oaths were torn up and shredded in public, their abilities chained and names sullied. Meanwhile the play-along “Proofers” had a larger and forceful voice with passionate articulation of the “Goofer’s” new paradigmatic mechanisms of “Proofing.” This new paradigm according to the turn coats, was the greatest thing since sliced bread. These “Proofers” taunted the true-to-spirit ones that resisted and who had stayed true to their oaths, at every step and at every corner. The spoils had gone to the play-along crowd or so it seemed.

Given the clamor, restrictions and the vilification, the “Proofers” finally decided that they had, had enough. They had to work four times as hard and earn quarter as much and even then they had to face the wrath of the “Goofers,” “Hooters” “Suiters” and “Looters.” Many stopped working, others were disillusioned and others still contemplated their exits from the field of “Proofing.” One day the “Proofers” decided to stop meeting the demands of the “Goofers,” “Hooters” and “Looters” altogether. “No more!” they said. “No more!”

They made it known that they were first and foremost “Proofers” and not “Free-Riders” and that they would have nothing to do with the “Goofers” plans. If any of the people wished to bring their grief to their doorstep, they would assuage it as best as they could, but they would not be a party to the “Goofers” self-serving plans. They would serve the people and “Oofers” with both arms and eyes and to the best of their abilities as they had in the yesteryears. They would give them the full benefit of their expertise and knowledge. They would remain loyal to the oath of honor they had undertaken. They, the “Proofers” would be “Proofers once again!”

There were “Goofers” sponsored demonstrations and large-scale posters demeaning the “Proofers.” But there was no turning back. The backbone had been firmed up, finally. The die had been cast in stone and the paradigm was about to change. The exodus from beneath the heavy hand of the Goofers was in progress. The supreme principle of morality was in play, welcoming the Autonomous reason and the sense of duty.

Crushed by this change the “Goofers” were back in their big-little grey and white buildings, with the  “Looters” and “Hooters” conspiring their next move…

“What to do? What to do?...

Sunday, June 16, 2013

Happy Father's Day Dad!

He tousled my hair. I was 8 years old then. I looked up to a broad smile and caring eyes. Nothing was said. All I saw was the smile and kindness spread cross his face.

His uniform was always starch with ribbons across his chest. There was an authority in his gait, a deliberation at every step. It was a measured gait of contemplation. I never knew what he was thinking but when he picked his eyes up from the reams of tangled thoughts and cast them towards me, the ends of his mouth swept wider and the eyes narrowed into pure love.

He tousled my hair when I was 9 years old on my birthday, holding a ribbon-bound white box for a birthday present. It was a helicopter that he had bought from some far away land. His eyes watched me with delight as I opened the box carefully, to peer inside it. The smile grew to a laugh when I held the toy, a scream must have emanated, I do not recall. Yes he was all there, present at every moment of my delight.

He tousled my hair and his large hands cupped my face. Tears were rolling down my face in streams, I remember, and the toothache had paralyzed me into sobbing fits. I don’t remember the dentist visit or much else, except the calm and comfort of that warmth on my cheeks. I was a 10 years old gangly awkward child of man then.

He never tousled my hair again. His fingers never brushed the tears off my face again.

Now many years later, that I am well passed his age, he was on my tenth birthday, I miss him still.

I remember that age of innocence and of deep love.

It was great while it lasted. I didn’t know then, what I know now. Time’s arrow has a prick to it and points in the direction where memories grow. He was and always will be my hero.

Happy Father’s Day Dad! I know you are up there smiling down at me as you always have for all these years.

Thursday, June 13, 2013


One would think that sliding into one’s mind through the various foramina in the base of the skull, one could figure out the domain of the mind; its conjectures, thoughts, rationale, opinions, ideas and all the rest that make us who we are. Even peering from the outside with the likes of fMRI (functional Magnetic Resonance Imaging) we aim to reveal he inner secrets of the various parts of the brain as they tie into a thought or action. But do they? At a moment in time, in a snapshot of one's life, maybe. But that is all. This is not a judgment about the various pronouncements and discoveries related to the fMRI or the manifestation of the BOLD data that is utilized in such experiments, but a careful cognizance of the true and unblemished reality of life...

Plutarch back in the 1st century wrote about the Life of Theseus, in which he wondered, if a ship whose planks and oars from stem to stern are replaced, does that constitute the same ship or one completely different? Others like Thomas Hobbes asked if the planks and oars were replaced with another ship’s would that ship become that from which the planks and oars were replaced? These philosophical debates have much in common with us as who we are.

Think about our bodies for instance, they undergo a constant remodeling from the forces of nature. We are born, we grow into adulthood and then through aging and decay we grey and ultimately reach the undiscovered country. But during the process of those 80+ years of life the multi-trillion cells we were born with have long been replaced. Each organ is in a phase of replenishment as the old cells undergo decay, apoptosis and are metabolized to create new cells to continue the process of renewal and life. 

Ultimately this renewal hits the firewall of the Hayflik limit predicated by the Telomeric loss and cells void of the last bit of that tandem repeat in the DNA goes into a chaotic frenzy of uncontrolled growth and dysfunction. 

The red cells in our blood stream have a120 day limit of survival and the white cells depending on what type can survive from a few hours to over 10 years. There in lies the vision of the macabre hood and sickle of the grim reaper.

That brings me to those of us who get transfused with others blood, Stem cell or organ transplanted, how indeed is the matrix of their Morpheus? Is the metamorphosis a blindingly slow and imperceptible conclusion at a later time. And one wonders, “Wow, he/she is a shell of who he/she used to be. He/she has changed!” Or not?

So we are who we are, when we are in any state of being. We flourish through the nurture of time. We change and evolve, both in physique and in thought, in ideas and execution, in love and hate, in cognizance and in contemplation, in virtually any argument and in every mode of expression, we change for the better or worse. But we change!

So Plutarch and before him Plato, Socrates Heraclitus were correct in their philosophizing about the Ship of Theseus. Yes indeed as the planks and the oars change so does the foundational basis of the ship. It may look the same, a little different or a lot different, but at the base level it is altogether different.

I wonder…

Friday, June 7, 2013


At tea parties, if they still have them, but most especially at cocktail parties, which I know are the present craze, you will hear the word, “significance.”

A guy dressed in faded jeans and a cotton shirt poised in deep thought with his chin carefully, but gently cradled between the forefinger and the thumb, as the forefinger carefully caresses the side of the face. He mutters to the throng of well-dressed beautiful people each carrying their share of the bubbly or the sanguine color of thought in their glasses, as they hang on his every syllable. “Significant… I would say.” And the crowd utters a sigh of relief. You can feel them shiver disquietingly as if the sage might have gone the other way. What then of their future fortunes? What would have happened to their parties? What about their stockholdings, their mansions on the Greek isle or the French Riviera? Why that would have never worked. We would have to find a better statistician, then wouldn’t we? The pretty lady in the red gown wonders.

And so in the dark art of probability, there resides the goose that periodically lays the golden egg of significance. But no one has cracked open the egg yet; to see what is inside and that is where we lay our scene…

What does significance mean? This is significant compared to that? Or this has more significance than that? The veritable definition of statistical significance is “the extent to which a result is unlikely to be due to chance alone.” Pay careful attention to the word “extent,” here. After all, the pride and joy of every scientist-author is to determine that the value of his or her hypothesis generated experimental model has relevance. That, using the information from the experiment, will yield benefits to the consumer, be it in engineering, mathematics, economics, social sciences and especially in medicine. We will restrict ourselves to medicine, because that is where everyday lives are being helped or hurt in such reliance.

The concept of significance is numerically advanced by the p-value. And p-value, is the fire that heats the water and makes the steam that turns the engine, is defined as the probability that the observed data would occur by chance in a given single null hypothesis, or the probability of incorrectly rejecting a given null hypothesis in favor of a second alternate hypothesis.” In an experiment, the lower the p-value below 0.5 the better the chance that the experiment is not a fluke. And the levels of significance are 10% (0.1), 5% (0.05), 1% (0.01), 0.5% (0.005), and 0.1% (0.001). What? What did I just say? “FLUKE?” Well actually, to be quite truthful the “p” in the “p-value” stands for none other than “probability!” Yes you read that right, “PROBABILITY.” So a p-value of 0.05 means that there is a 5% chance that the expressed difference is a “FLUKE.”  The “p” is determined in this formula {p = 2(1- cumulative distribution function x sample size)}

In a coin toss experiment, where the coin toss would yield “heads” or “tails” The probability of two successive “heads” in two flips = (1/2)^2 = 0.25 and that is certainly possible and happens all the time that you get two “heads” or two “tails” with two flips. Now doing ten flips in a row the probability becomes much smaller 1(1/2)^9 = 0.002 which means a 0.2% chance. That is how probabilities are ascertained through straightforward arithmetic.

Fluke in this argument, based on new drug evaluation against a standard drug, is rendered as such: If two drugs for instance are being compared and the experimental drug shows benefit against the standard drug by a certain margin that the probability of that benefit is outside the realm of chance, then the experimental drug is considered significant in its benefits compared to the standard drug. And that is why after the clinical trials are over and a lot of money has been spent over the “new great miracle drug” the reality in the doctor's clinic is, shall we say, different!

But, and here is the devil in this minor detail. In most medical studies, the experts use the cautionary brackets of Confidence Interval (CI). And Confidence Interval is none other than the limits of the significance based on the number of the sample (n) that expresses fairly confidently, within two standard deviations, that the observed benefits of the experimental drug were within the confines of 95% probability. In other words, the experimental drug induced benefits are true given the probable accuracy of the experiment 95% of the times, and by extension, a failure to uphold that possibility in the other 5% of the times. CI is determined: Confidence = Signal/Noise x square root (Sample size). And this is all predicated on the assumption that the model follows the Normal Distribution or as it is called the “Bell Curve,” or Gaussian Curve.”

You might ask if you are inquisitive, what happens in the 5%? Well those are the outliers. And these outliers are considered so far out of the dome of certainty that they need not be counted against. What?

Yes! Its true!

The outliers of 2.5 % on either side of the normal curve (that is if the curve is not skewed to either side), the grand old dame called “Bell Curve” rarely considers those little tails on either side. For you see, if we were to start considering those outliers in the studies, we would have to increase the number of people who would have to take the experimental drug and compare them to an equal number of those taking the standard drugs greatly. So the little (n) would become the big (N) if we were to test the drug in all of the 7 billion people on the planet.

A word on skew ness: The two 2.5% tails can be minimal on one side of the bell or the other or fat on both sides if the outliers are more than 5%. These so-called fat tails can out-maneuver and out-distance any fast running p-value.

Ultimately rationalizing ourselves into this form of accuracy is the best defense against any argument. Incidentally, most of the times a smaller “n” shows a flattened “curve” or platykurtosis, while a bigger “N” gives us a more tenting curve called leptokurtosis. The difference being that the standard deviations become smaller with a leptokurtotic curve and the tails get thinner and smaller with a bigger “n.”.

And that dear reader is the problem. Since the significant p-value is based on a probability of 95% accuracy, most of the times, which says that there is that possibility that the entire experiment could be a potential failure? With the outliers, left alone, wearing the dunce hat in the corner, the 5%, or 4% or 3% or 2% or even 1%, no matter how significant the value it is, it will never be 100% accurate.

In the end significance is a probability expression with the caveat that there may be a likelihood that the whole experiment is a failure, the drug is a failure and the author’s scientific treatise is as useless as the 1s and 0s it has accumulated. I am harsh, am I? Not when some experts sit on their elbows peering over there coke bottle lens eyeglasses and with their hands clasped, their spine hunched in ominous fashion like the bird of prey, pronouncing in exactitude the certainty of their findings. And in the future when proven wrong, they search to identify other targets within the failure to prove their point. For failure is not an oprion! The parties must go on and the Rodin stance must not be trifled with, for therein in that perfect thoughtful, intellectually nuanced moment lies the mystery of what hides behind the real scientist’s eyeglasses.

(from art5play)

The ideas that prevail in science are unique and some experiments do end up with the future love and fanfare by delivering what they promise, but in these heady days where publish or perish has taken on a whole new meaning of selling nonsense as sensible science and plotting a forest of data and curves made of famous names, tables that defy logistics and graphs that would make Excel blush, life is being lived in the fast and furious lane.

So next time, you say this is “significant” or you exercise the intellect of p-value because there are a couple of zeros after the decimal, please understand, it is tailored to the eye of the beholder.