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?

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