Tuesday, July 30, 2013


 What is so elegant about Art is that the eyes of the beholder conjures up an imagination and creates and recreates a vision that violates the original. There are an unending stream of writers, philosophizing on what the author means or meant. Take a painting and it will “scream” millions and you look at it and you think, what am I missing? Take Jane Austen and scores of intellectuals have given their interpretation of what Ms. Austen actually meant when she wrote. The dubiousness of their claims are so cleverly assigned to metaphors in their craft that for the moment, one forgets what the original ever meant and you start to see it through the distorted lens of someone else’s view point.

Medicine is in the throes of such a predicament, where the primary purpose of patient care is being sharply denuded by the metaphors from some ancient and well-appointed voices. Some are slaying monsters because in their belief that is the correct way to a prosperous life, while others with their economic hats on, are more obtuse and sling from the side arm.

This model of prosperity in medicine is championed by stalwarts that maintain “we know best” because we have seen the promised-land and it is Shangri La!” Others use the oft-mentioned persuasion of “Big-Data.” Using comparative models with other countries, they cite that medical care in the US is worse-off than many other less-rich countries. They mostly compare apples and oranges but the production and display is so enormous that everyone with no time on their hands, to think, or those fed from the same persuasion of thought readily agree and become slaves to the promise.

Are we really that worse off? Think about it for a second. There is NO other country that has the prodigious innovation of health-related medicines, biologics and devices than the U.S. The whole world uses them, often challenging the patents as they go along, citing affordability, reaping benefits to peoples from the far and wide. Meanwhile the citizens of this country through their taxes and insurance premiums pay the astronomical prices to support such innovation. A prosperous country has the dual dilemma of not only playing with the best toys but a surfeit of them. It is in this excess that they also suffer the consequences of poor health through chronic illness. While the less innovative, tyranny-controlled, dictatorships usurp grants and subsidies from the wealthy nations and have their citizens languish and lose life through infectious diseases, the rich countries suffer from the obverse.  Even when age is the same, the excess-related and induced chronic illness from excess leads to a poor-functioning right tail.

Meanwhile the drumbeats against medical care, takes center stage and who is placed in the center, the doctor. Because all care is indeed rendered by the doctor, so he or she must take the blame. In so doing, the experts have started the art of manipulating, marginalizing and at times demonizing, akin to what they did to art itself. These busy-bodies manipulate, large data sets to create the best scenario to prove their point, similar to seeing a painting under sunlight and then under moonlight and extrapolating what the artist “actually meant.” But they don’t start and stop there with medicine, they make it personal, they invest emotions, passion and stand back to see how the rest of their crafty brethren will take the story and run and hope they give it faster and longer legs.

Medicine is in the throes of another predicament. Every thing is now patient-centric this and patient-centric that. One would believe that medicine before this enchanting terminology had nothing to do with patients. Bu these experts want to desperately get their lexicon to inhabit the brains of the people. Medical care once the thought-out process based on knowledge and experience is being relegated to the guidelines and mandates of “Do this for That.”. And here is the other monster that has to be slain, the doctor. Medicine they say can be adequately and proficiently be “practiced” by those with lesser education and experience. “Why, here is the subset of the Big-Data that supports our contention.” An isolated data set that is “Made to Stick” through reference to an anecdote makes for a game changer when everyone else who is considered a “journalist” hops on the bandwagon. As William James said, “Belief creates the actual fact.” But what is forgotten is his other statement, “The art of being wise is the art of knowing what to overlook.”

You begin to see the maladies that are inherent within a society that mis-frames the argument to educate its citizens with half-truths and a compilation of mumbo-jumbos. In the meantime, the patient is being denied services because they might be too old, too poor or too risky to need the services that should be rendered.

So the elegant art of anchoring and framing is what makes the society’s mind hum. Too bad that the “society” does not have the time, or the inclination to understand the edifice upon which the controlling argument stands. Too bad that the “Society” itself well-endowed with all the perks is too inured with their own self-interests. Too bad that the “Society” is inebriated with the promise of an entitled “right” fails to see the contours of the path laid out in its future.

Changing a paradigm, takes time. It is the slow process, directed by loud voices. The core constantly barrages, the mind-less followers bang the drum and the consciousness of the at-large is ultimately altered. Just to add more panache and weight to their argument, these experts start to take down the physicians in the process. They start criminalizing and posting banners of the corrupting influence in medicine and by that they add to their rhetoric of “This change is good for you.”

I admit change is a good thing. But when an expert tries to alter the landscape of art of which he has no personal knowledge or experience in and another expert tries to alter medicine when he or she has no knowledge of medicine then the future is up for grabs.

Life evolves through a series of experiments. The DNA itself undergoes modulations based on transposons, miRNA and through feedback loops from the proteome. But it is a slow and dedicated process. The DNA discards what is detrimental and accepts and retains what is beneficial to the soma. It is a slow and methodical process. Using externalist approach and taking pieces of DNA to fit together in a laboratory creates a Frankenstein. 

Are we ready for that?

Sunday, July 21, 2013

TETHER...of Life

The functional tether of each of our lives is based on two circuits. The first circuit is the experiential reference. Experience, you see is what gives you an anchor into the frame you wish to be placed in. This framing is both conscious and subconscious. It is both expressed and silent. It is visible in our behaviors or invisibly expressed in our actions. The old adage, “ we see one, we do one,” seems quite appropriate to fit in this monolog. Consciously or subconsciously, experience, becomes the tutor for all future actions.

Imagine yourself in a jungle, trying to pick up a stick to ward off any potential predators. And as you reach down to pick up the supposed stick, it curls itself, not in a Harry Potter sort of way, but as a stealthy snake pretending to be a stick. 

That experience will stay in your mind forever. You will, by my calculations be fearful of all sticks on the ground and if your fancy runs wild, you will consider every stick a snake and a poisonous one at that. Thus experience here has not been kind to you. It has led you onto a path that has culminated in a sheltered view of living, afraid of taking risks, afraid of taking the next step.

But what if you had picked up a stick that was a stick and continued on through the jungle, whacking away at any thing that moved and having encountered snakes or other venomous or non-venomous creatures, safely arrived on the other side.  You would have found a newfound courage and excitement to add to your repertoire, at each step, upping the ante. People around you would find you filled with the magnetism of courage and determination. This adulation would further your spirit into the vast unknown. Now marshaled with the armor of limited indestructibility you have moved on to shake the world to your needs. This path too has hidden dangers lurking within them, but if followed without any trepidation can have difficult consequences too. But a maturing mind that remains grounded in humility but daunting in spirit works his or her way through. And does so, by having a tincture of respect for the unknown and a dollop of reasoning to circumvent against such unwanted surprises.

The other circuit of this framing is a healthy fear. Fear drives many an emotion. It is innate to all animals. They protect themselves against predators, with color, with spikes, with ink, with feathers, with horns and thorns and poisons and might. These self-protecting abilities are borne of an evolutionary discourse between nature and being. The evolutionary concepts baked into our DNA have been fashioned over eons of experiential references. The “fight or flight” mechanism of adrenaline release, the flush of the face, the quickened heart-beat, the sudden surge of energy and the heightened senses are all carved out from the days of being “hunter-gatherers” and being hunted.

The tether between the experience and fear thus is the hallmark of our lives. It is strong and it pushes and pulls to the strength of each and makes us either timid souls awaiting the actions of others or makes us determined to face the fears and cast a wide net of action on this world of ambiguity to arrive at our fortunes.

How do we not become victims of one or the other is a question that needs to be addressed. I am no psychologist, nor a psychiatrist, but I do have a life experience that has taught me certain rules of the game and I will share those with you.

  1. Experience is an enterprise of history that we need to learn from. The stick in the forest that was a snake, well, if we were able to reason through that experience and use it as a means to “look” and “see” what we are about to do, we will learn that only certain snakes in certain areas look like that and can maintain that stealth. We can be cautious but not relegate that experience to a “be-all, end-all” life story to shape our lives. And if an experience such as that has shaped us to the present, we can spend some time in our minds to reason through the rationale of our current behavior. You see nothing is set in stone. As you might realize that a long bone like the femur in humans that is rigid enough to carry us walking, running, jumping and realizing many thousands of pounds per square inch of weigh on it with each propel also has the unique ability to mold and modify over time. Yes, indeed! Every bone that is shaped by pressures and forces modifies itself. So think of yourself as a modifiable, moldable being that changes to the pressures of the past experience in a positive way. Experience is not just to be relied upon for present and future action, but also to be utilized with reason to contemplate the next action. It should serve as a conduit to a rational, reasoned activity.
  2. Fear on the other hand that is derived from the potential that may or may not exist can be terrifying and limiting. It is terrifying in its unique but specific effect on the mind. Fear creates an environment of extreme self-preservation and it is limiting because it prevents us from taking risks and newer experience of the rest of what the world has to offer. Some will surrender to the fear, while others will continue on their own paths of self-discovery. The choice is always individual.

I will share a short story from my childhood…

In a swimming pool, one late afternoon when the storms were close at hand and lightening strikes were too numerous to count, my friends and I in our early teens set out to experience jumping from the highest platforms. Unbeknownst to the other three, I did not know how to swim. Well we all jumped one after another as each cleared the space. I was the last to jump. Everyone was on the edge of the pool looking up at me. 

I hesitated a moment too long and catcalls came tearing into my head. Just then, a loud crack of thunder and that huge expansive 5 mm lightening bolt hit nearby. I lost my step and tumbled over. I hit the water hard and into the deep end of the pool. End over end with frothy bubbles all around me. Finally the physics of buoyancy took me to the surface. As my head surfaced, the small ice pellets and hail hit my head. I caught a glimpse of my friends running for shelter. And the weight of my scrawny legs, it seemed, pulled me below the surface of water, I swallowed large parcels of chlorinated water, coughing and choking. The words did not form as the frenzy of fear took hold. I thrashed and thrashed and knew that that was the end. Too young to contemplate the newspaper headlines of the next day, I do remember thinking, “Is this it, of my life, - no meaning!” As the frothy bubbles grew more violent, I felt a hand grab my arm and I am here to tell this tale.

For years, I did not swim. But one day, on a quiet introspective hour, I rationalized my way out of it. I am now a swimmer, no Phelps, but I can make my way around the pool with any stroke you can imagine.

We all have fears. What will happen to me? What will my future be? What will my friends say? What will everybody think? These are unfounded fears of inaction. Bold actions undertaken out of good reasoning makes for a better and fulfilled life.

Take for example the entrepreneurs like Bill Gates, Steve Jobs or even Mark Zuckerbergs of the world; they gave up a life of education for a dream. They did not fear the future due to expectations, but welcomed the adversity to face it with determination.

So chalk experience to experience and learn from it. Relegate fear to risk and learn to mitigate it. Propel yourself forward. It is the bold action that thrives and survives and those hampered by they’re past or by the future, live with an expectation of help from others, as life dribbles by.

"A fulfilling life is different to each person. You have to acknowledge your dreams, and not just wait for life to happen, and opportunities to come knocking at your door." - Joan Lunden

Monday, July 15, 2013


There is a push and a pull in the society that might not have existed a few decades ago. We live in the ease of euphemisms and under the banal shade of blaspheme. Nothing can be said that might harm the fragile psyche of anyone. Heavens forbid! Every word, nuance, implication is seated in the well-endowed virtuous crucible of euphemism. And in the latter we can commit the most heinous acts against humanity and chalk them over to the messages from our DNA. It’s a perfect world of Irresponsibility!

Eupheme: the ancient Greek female spirit of words of good omen, praise, acclaims, shouts of triumph, and applause. 

From the yesteryear of “this is not good” we  have moved to the present day of “its okay.” And not forgetting that any reference afforded to a former employee must never have any negative comments in them. So today’s “He or she is an Okay employee” actually means, “He or she is terrible. Don’t hire this one.” As we go about writing these false love-songs, with the nasty invisible rap mixed into it, we all know the implied meanings. We ignore the euphemisms and make the necessary adjustments. Is this the new order of a conscious mental hypocrisy?

The converse epistemological world to euphemism is the well known “blaspheme.” Ah yes and you know what, if you take a global view of the world today, our actions are more blasphemous and our language is a tad too euphemistic. We do others harm but sugar coat it with the niceties to deflect our intentions. The analogous iron fist in a velvet glove fits the image, perfectly.

At a board room meeting where all the mean and mighty power-grabbing hungry step-on-your-face crowd sat in full clothed civility sipping at their half filled glass of orange juice or cranberry juice, the icy, nice spoken words like “wonderful” and “good” were encased in raw acid, that one had to shield against with a lead-encased covering. These words were always followed with, “we shall see,” or one better, “the built-in triggers will prevent any missteps.” Meaning- we have no idea. But if you pointed out that the emperor had no clothes the wrath of the bitter-sweet professionally denuding deluge came roaring onto you. So you learnt to be careful, cautious, impeccable with euphemisms all the while holding on to the Cheshire Cat smile.

On the flip side amongst my colleagues in medicine, where we are always at the cutting edge of medical revolution, but never make it over, the other shoe has dropped. Some outright blaspheme pervades here. In this context, the feelings are quite the inverse. Here, “I am better than thou” is the prevailing sentiment. No ands, ifs or buts about it. “I am self-serving” and that is it.  Deal with it! 

Refreshing as that might be in this world of the hoity-toity with nothing but a Swiss-cheesy smile of distemper, somewhere in this societal upheaval the humanity train has left the station to whereabouts unknown. The medical world is rapidly transforming itself to the financial world, where a few giants riding the coattails of even fewer quants are constantly quantifying the “IF-THEN” scenarios to line their Armani suits. A recent New York Times article http://well.blogs.nytimes.com/2013/07/11/doctors-badmouthing-other-doctors/

An unmitigated self-serving derogatory comment against a physician colleague for his or her management, disparages the profession as a whole. It takes the patient out of his or her comfort zone. It makes them think that there are a lot of bad actors out in the universe, that no one is to be trusted and worse yet, creates an environment for the patient to consider frivolous litigation over a fickle conscious or subconscious thought. And all it takes is an unguarded deleterious word or a comment or even a disparaging look from one doctor. As humans, doctors also are wrapped in the “dog-eat-dog” world using sham peer reviews, acting as “experts” against one another in legal cases where facts contradict. Some are perpetually involved in the deceptive tenet of “this is best for you,” while the best it seems is the all mighty dollar sign that gleams in their eyes. And these too are doctors of repute! Some even have the audacity to write consultation letters that are merit less but full of self-fulfilling and self-serving monologue of superiority in medical malpractice civil cases. What gives? Well, for one, it is the old human tradition of climb to the top, step on a face, and then find another face, to gain the power foot-hold, then rinse and repeat. The old sociopath next door is found living large in most intellectual bounds and being a physician is not an exempt society.

This tale of two cities where “the best of times and the worst of times” are joined together on the same stage for the world to see, the dichotomy of thought and action in this schizophrenically motivated culture, is slowly destroying the basic goodness of being a human.

Meanwhile, the world moves on tick by momentary tick, oblivious to the lives and times of mere humans. One only has to see the newspaper headlines, where it clearly shows how this modern society is in love with disasters, train-wrecks, plan-crashes, car-accidents, suicides, homicides, genocides, anything that will invoke a verbal empathic comment on the social media to make themselves look and feel better. It is as if they do not have the capacity for real emotions and that only the worst of the disasters are needed for them to feel “something,” and then to display these emotions through words for others to “see” them in the projected light. This might seem harsh, but I have seen both sides of coin - the real and the fake. It is quite easy to tell them apart.

What do we do about this?

Learn to live again, or as Pink would say, “Learn to Love again.”

Or go back to the age old wisdom from Louis Armstrong in "Its a wonderful World."

Wednesday, July 3, 2013


 Two quite opposite qualities equally bias our minds - habits and novelty. - Jean de La Bruyere
You might ask yourself this question, “Why am I reading this?” Well the answer and the only one I can give you is “Only you know the real answer to that.” That is the truth. It is possible you are reading this because of a multitude of reasons. You might have come across this post searching for other more enlightening subjects. You might have been one of the faithful stalwarts that reads my ramblings periodically and blushes with an embarrassment that turns your face red from ear to ear, or you might simply be interested in where I am going to go with this line of thought, today. But there are many others that I am not privy to.

So after all what is “Intention?” Is it a motivation, a thought, a concept, or an idea? Whatever it is, it has the profound effect in every thing we do to achieve a goal. It makes us do things, create objects, mold psychologies, change ecologies, grasp the epistemology of phrenology and so forth. (I told you to stay close on this one).

But then, you might ask the question, “My intention might be different than yours.” Of course it will be, because the base of our intentions is shaped by something else. Something, deep and dark, something quite surreptitiously lurid, something more like ether than stone. Something that is not quite quantifiable. Something that is without a measure of metrics.

What of this ether? This nebulous vapor that so motivates us into creating this enigma, we call intention?

To answer that, let me trail this idea further with a short question posed by a youth…

There was a young man, whom I met several years ago. He told me about the nature of nature. He described his thinking in detail. He explained to me the consequence of the haphazard flow of evolving concepts, the drivers, the resistors, the mechanics and the constantly changing scaffolding that housed all those changes. He likened the present to a series of events between the occurrences in the past and the hazy, smoky, cut-with-a-knife foggy, future. He said we are where we are, because we are. He was wise beyond his years. I never met him again, but there was something from Rene Descartes, “Cogito ergo Sum,” in his dialog. He had posited, where does the Intentional thinking emanate and why does it change so over time? A valid question one might ask. Indeed, where does that come from? And does it change and if so why?

And we are back to the same question? What makes the change that makes the change? Ah! Now that gets us into the real conundrum of “Why?”

If change is going to happen, then what makes the change? If that is the intent then that must come from somewhere.

So we must launch into another short tale…

This middle-aged salesman, sharply dressed, eloquent in speech and quiet in demeanor asked me one day, to use his product. He hammered about the benefits of the products and that how it would bestow such wonderful benefits to everyone who came in contact with. It was a moving impassioned presentation. It was a classic act of promoting a marketable item. Having been moved by his pitch and rhythm, I asked him what made him so passionate about the product? Had he tried it himself, or knew of someone in his family that had done so? He answered, “No” to both the questions. Taken aback momentarily, he stammered a bit searching for words that failed to arrive, leaving the blankness of surprise firmly planted on his face. But never to be outdone in the field that he had mastered, he mumbled something like, “Well, to tell you the truth, If I sell this product to four more people, I will get a 20% bonus increase in my salary at the end of this quarter.” Now that was refreshing honesty, I was unaccustomed to, but having been pleasantly surprised by the facts and no further marshmallows to hide the bad tasting cereal, I shook his hands and promised to look at the product.

So here by now you might have arrived with your own concept of what is intention!

Intention is based on the fundamentals of bias!

Heresy! You say. This is a travesty put in words! “Off with your head,” as the Red Queen would say, but, but, hold on one moment, let us think this one out, shall we…

If you intend to do something, there always is a prerequisite to that action. If you desire to get another smart-phone, it is because…

If you want to go out with your friends, or shun their company, it is because of…

If you want to buy the latest model car, or for that matter a jalopy, it is because of…

If you want to wear your jeans below the butt…

Okay, that might be going to far.

But you do get the message. It is loud and clear. All our actions, motivations, concepts, ideas are based on a certain bias. What that bias is, is not a matter of terminology but the experiential reference of our past actions and future desires, based on birth, environment, culture, upbringing etc.

Uncovering the bias is not up to a litigator, a grand jury or a judge for that matter, but what is within us. It is the truth that hides in every living soul-bound artifice called human. This truth is hidden because it is biased. It is hidden because, sharing it would mean divulging a part of oneself. It is hidden because that is what makes us human

Am I biased to certain things? You bet, I am… 

Are you?

So you see, our intentions are what we make them and base them to conform to our ever-changing ideas and thoughts. These thoughts are further powered by a self-generated strategy or overpowered by others’ passion. The unexpressed view of the world, we hold, comes out through our intentions and is constantly masked over by that certain pale cast of thought, of which we may or may not be consciously aware, called bias.

This bias can be in the form of:
Illusory correlation
Primacy effect in memory
Availability heuristic
Pollyanna Principle of wishful thinking
Attitude polarization through cognitive dissonance
Risk aversion
...or other not mentioned forms of self-delusional, self-serving means of self promotion.

Moving bias from a noun to a verb…
To bias is human.
To bias is universal.
To bias is inevitable.
But to bias is not an error. It may create one, mask one, enhance or suppress one, but it is not one by in itself.