Friday, August 30, 2013


The other day, I picked up a small item from a store. It was worth $20.04. I went to pay at the register and the guy rang it up for $204.00. I asked him to check. He did and said that is what the register said. No, I asked him, not the register, but the price on the item. He looked at it and then sheepishly he apologized and called the manager. The manager had to undo the sale and redo the right one. And it dawned upon me, how low we have sunk and are still sinking.

I won’t say, as other’s who are politically correct might, Oh he “just” made a mistake. Well that he did, but a colossal one at that. His education!

Forget the niceties, this is serious. We are finding excuses for illiteracy in all the wrong places. We have jargon-ed the education system with dumb-ed down, politically correct nonsense. Today we seem to be searching for the “soul of love” and spend countless hours on a semester that teach us “how to learn.” I mean what in the world is going on?  Does anyone know anything except “pop culture” nowadays? Does Winston Churchill or George Washington, Thomas Jefferson ring a bell? Or is it all about Ben Afflac being Batman? 

The immediacy of such a powered dive into the depths of ignorance is hard to conceive and yet the intellectuals who use “metrics” and “goals” can’t really understand their own metrics well enough to see the depths they have sunk to. Oh, they are tenured professors who have tied themselves to the coattails of others and reached the pinnacle of their careers through elevating nonsense. I wonder how many of these professors would pass the examination that the 8th graders took back in 1895? See here... 

I mean to be unkind, for kindness in elevating stupidity and ignorance makes a mockery of the very essence that made us as a people and as a society great. Alas, that gig is up with the current bunch of “wise men and women.”

How many would opine, when their political nerve is uncharged and dormant, that the U.S. Debt is one of the greatest challenges facing the US today? Not many, I bet. But consider this and I will point your attention to Japan, once the second largest economy in the world garnering 18% of the entire world assets is now the third largest economy with less than 10% command and rapidly declining. And it all happened to them in the wake of the “Lost Decade” when the debt was built up and the population aged from a large workforce to a smaller one and now the disenchanted youth cannot find a job, because there are few of those to go around. Sound familiar? It should! There are indeed evolved lifestyles of the consumers through these past  “decades of plentiful” and will take time to deleverage. But in the meantime, the time-bomb keeps ticking.  By the way at 6% interest to service the Debt, it costs the U.S. $1 Trillion a year or 6.25% of GDP... “And in this harsh world draw thy breath in pain.”

Forget Geography. Most people know only the streets they roam, whether in a car or by road. Asking them about the capital of a state or much less the national GDP is likely to invoke a wrinkle and a “You’re kidding, right!”

“The most unkindest cut of all” is in medicine, where there is another orphaned scenario in science through the arbitrariness of numbers. Seems to me that when the data-warehousing started and analytics became the vogue, everyone decided that epidemiology and public health is the way to solve the healthcare problem. Some even say, restrict food availability. Okay, then what? Unfortunately we cannot vaccinate our way to perfect health. All the medical intelligentsia, it seems, are enamored by the sights and sounds of the graphic/tables displays created from this data in the prestigious medical journals that fill their pages with (here it comes) junk (there I said it), massaged by the politics of correctness, the artifice of probability, the love of all things Bayesian and the lack of understanding of any of them. Amazing, how far we have come! Just amazing!

But through it all, a spark still exists and there are a few very young, who think for themselves. These few are being challenged in their quest to succeed by the warlords of mediocrity. Upon us lies the great and turbulent dark cloud of discontent that does not seem to want an outlier intellectual. Everyone of these sabre-rattlers believe, that all should be equal, “Really?” Upon the shoulders of these few wise and hardworking youth lies the future for all as yet unborn. 
We must allow them to prosper. 
We must allow them to live out their dreams. 
We simply must!

My impression, like others, has always been that diversity is good, not just the color of the skin but the content of the brain. That content is what makes the world better. It is not only in the “Art” in Art, or the “Science” in Science, but the philosophy, the humanities, the unbound and unvarnished subjects that deal with life and its many complexities, it is in those truths that life is meant to be lived and encouraged to the fullest potential. Life is not meant to be patted on the back with “that’s good, real good,” when it is real bad. Not excused to "prevent" the fragile break of a psyche. For an untested and always protected life, against the rigors of living, will forever look for protection against the rain and become defenseless once the storms hit. It is in the constant challenge, which strengthens the resolve that makes us better. Contrary to the Borg, “Failure is the right option!” Failure defines the success of the future. A fragile defenseless being is just that, a constant failure. (Now don’t get your hide up, napkins in a bunch and climb the pulpit as the “great supporter of the defenseless” for you would be committing the same sin of subjugating these formative minds into defenselessness). Nassim Taleb gives a wonderful account of how to become Antifragile, in his book "Antifragile". Essentially field the small losses yourself and by doing so that will make you strong. 

Interestingly I read a notice posted by the seashore, “Please do not feed the birds, it prevents them from foraging on their own and will hurt the species.” Go figure that one out! If it is good for the Geese, then it must be good also for the humans too. No?

The intellectual  recession, it seems, has a firm grasp on the youth today. When no child is being left behind to suffer the indignities of failure and all “well-meaning” educators have  learnt that herding the masses into a sea of mediocrity where everyone is just a bobbing head of similar size will earn them kudos from the powerful an mighty, critical thinking, reason and understanding are being damned.

Rant over!

But please do give a Damn!!!

"I must be cruel only to be kind. Thus bad begins and worse remains behind."  ~Shakespeare

Saturday, August 17, 2013

The Highs & Lows in MEDICINE

The art of medicine consists in amusing the patient while nature cures the disease ~ Voltaire
Often on quiet evenings, memories roll in the past and the forward motion of time is suspended for a while. These are mixed memories yet they are mine and define me to a certain extent, of who I have become. Nature disassembles and then assembles the nuances of what is called life through the web of her own making and we humans live through the lens of that web.

On a moonlit night, I remember walking in to see a 18 year old with low back pain. After the evaluation was complete, the diagnosis was that she was pregnant. She cried, I couldn’t tell whether it was joy or grief. Outside, her boyfriend confronted me and said, “You wrong doc, my GF ain’t pregnant. Now you go fix the record.” Taken aback, I answered that I was a resident on the case and walked across the courtyard to the resident quarters. I saw him from the corner of my eye pull out a gun. Nothing happened that night. But in the morning, after a 36 hour shift, my car stood on bricks with its tires gone and I without a ride.

Another morning I remember running besides a woman who was in semi-stupor with my gloved hand in her belly compressing the aorta that had been breached by a posterior penetrating ulcer. The anguish and pain, the joy and relief, the sweat of it all, still come pouring out at the thought.

One late afternoon, there was this beautiful young lady aged 16 in earth years, with wisdom beyond her age in her eyes, who battled leukemia and lost. The loss aged me overnight. The pain has never receded. Nature’s prize had been lost. A potential gone, vanished, disappeared and it still haunts me this many years later. Why? This simple question cannot and will not find an answer anytime soon.

As nightfall covered the twilight views, I remember the 78-year old undergoing CPR in his hospital room as the muted, anxious and heartbreaking cries of his family drowned all other sound. He was their rock. He was the repository of an aged wisdom. The team worked for over 45 minutes and then finally the aged atrio-ventricular node started its rhythmic electrical impulse again and the monitor went from a flat-line to a depicting a beating heart. Or was it? Relief was momentary, and clutched from the smiles of that relief, the ever looming grim design of nature held her sway. There was no pulse, no blood pressure and no other signs of life. There was a failure to communicate between the electrical supply and the mechanical stubbornness. An electromechanical dissociation had conspired to give us the momentary joy.

And then there are the wonderful joys of young patients who became fathers and mothers. Of impossible survivals that rearranged impossibilities into possibilities and others that should have couldn’t.

Practicing medicine is a tough art. The science is mushy, the art is not, because it is human. My twitter friend @jordangrumet writes eloquently about his coming into this sacred state of empathy after the haze and rituals between the agonies of defeats and the joys of victory in the practice of medicine. And so, I fear, it is for all who aspire to practice this craft of medicine. Another favorite @GregSmithMD sees through the turmoil of the human mind and dispatches equal wisdom. There is @Doctor_V whose concision in exploring the differing arts of medical education and current events is a true reader’s reward. Two others who I can ill afford not to mention are @DrJohnm who wraps his expertise and knowledge around the discontinuous and sometime disharmonious medical literature and makes it understandable and the voice of reason @medskep who delivers a wealth of information that dismantles the heart of most idiocy that derides medicine today.

Of those who have practiced medicine there are few who would give it up, because we love the art of medicine. But lately the quicksand of the scientism of medicine has evoked new outbursts from the many that have never touched a human heart, felt a human pulse or seen the untimely frost lay its cold claws on a beautiful flower of nature. No, they have instead marshaled the spirits from the catacombs of statistics and gathered their armies of propellants to vouch for, in their minds and those of likeminded others, a better version of  medicine, one that is guided by guidelines and mandates, software codes and hardware interfaces, sprawling digits of useless and meaningless words repeated over and over to fill in the gaps on paper while the human touch lies withered and atrophied.

In the name of better care, there is an electromechanical dissociation between what is and what should be.

Maybe it is time. Maybe these new holograms of medicine who perceive disease through the vigor of digitally inspired words, the rigor of scans and the knowledge of various chemicals in the blood will create a better life for all of us, or maybe, just maybe, they might not.

But however this age of information turns out, somewhere in this newness, humanity must preserve its humanity!

It has become appallingly obvious that our technology has exceeded our humanity ~ Albert Einstein

Thursday, August 8, 2013


On the eve of the new day, a thought occurred to me. Why is our thinking different now?

"Reason is the natural order of truth; but imagination is the order of meaning." ~ C.S. Lewis

Think about the past, as it is chronicled. Historians have packaged the past in tidy volumes of words that show meaning and offer a vision of what was. Reading different versions you get the nuances of the different state of man and his society. Historical references are peppered with the author’s opinions, some groundless, others axiomatic and others still enriched with fluent facts. The fuse that lit the thought in the early centuries were confined to wonder. Wonder as Aristotle had aptly said, "is the beginning of philosophy." As time passed, William James’s thought progressed into deconstructing “wonder” through the lens of empiricism and leaving no “dust cloud of exceptional observation” hanging at the doorstep of wonder. So there exists a veritable library of what life and thought has been all about. If one were to reduce that to one word, no word would fit better in describing our current understanding than, “Reason.” We have arrived, I hope, at the age of reason.

Men have long since tried to figure out “the meaning of life.” And from that there followed the birth of a morally rich society. The reasoning being, that if there was no meaning to life and all was a random chance, then plunder, pillage and maximize power over others would be of consequence. Some “monsters” of society like Genghis Khan, Hitler did just that. From there the “Consequentialists’ were born, deriving reason. These few stalwarts who ventured into this state of quiet “grace” gave philosophical constructs to “the meaning of life.” Not only were they defining the statutes that should govern a human behavior but associated rewards and punishments were predicated on good and bad actions. Men like, Hobbes, Locke, Mills, Kant and Rawls explored the territory of human behavior and reasoning, to reason their construct. They did not have any empirical information, no streams of warehoused data, nor did they have predictive analytics to come to a cohesive ideation that still stands today, favored by society through enactment of laws.

But today we are seduced by the canard of “Big Data,” “Bayesian Probability,” “Significance” and such to drive the author’s purposed intent. Mathematics, which remains the language of life is being ordered to find the relativism between what is and what should be? The defining principle is to use numbers to ascertain the value of “x.”  What is measured in the recipe maybe from A to M and nothing beyond. The answer that is derived from such a limited cluster of variable mathematical intuition is posited as the “truth.” As C.S Lewis states, "An explanation of cause is not a justification by reason."

The fundamental offspring of this curious but persistent thinking and articulation is an abomination of the real merger between science, philosophy and reason. Science alone cannot withstand the attacks from reason, unless reason is embedded in that science and neither can philosophy stand on its own without the “radical empiricism” of William James or the validity and repeatability of experimentation. All three disciplines require the unvarnished truths in their own respective disciplines for connectivity. Humans have an innate sense of right and wrong. We may not know why, or what for that matter, but internally we know when something is fundamentally flawed.

Intelligence is not the sin here when pure mathematics is applied to life, it is but the isolation of such an action that conjures up the word, “wrong.” We can be seduced by the many illusions, fallacies and time-honored false beliefs compiled and condensed through false education, propaganda and idealized versions of reality. These false prophets plague our minds on a momentary basis against the hard constructs of mathematics. Unless braced by the philosophical spine of reason, which give us the propellant for progress, we would be confined to the “caves of ignorance.”

Once we begin to examine the premise of the argument with the clear lens, the unraveling begins to take place. The light emerges from the crevices and the cracks where once the dictum was enclosed in the darkness of it’s confining chamber.

One can think of  the ‘greats” like Galleleo, Kepler, Newton, Einstein, Heisenberg, and the likes who made it their life to understand nature through reason and experimentation. 

"The important thing is to not stop questioning. Curiosity has its own reason for existing." ~ Albert Einstein

Their view of reality was a composite of philosophy, science and reason. Absent any from the equation and the entire fundamental scaffolding of the world falls apart and causes confusion.

There are many distractions in this coupled world and more and more are being added daily. As one digests the distortions and distractions and reality, incorporating the latter in an aggregate form, the whole image is blurred.

Then there is the “pseudo-scientific” patina in use to vilify and demonize the opponents for personal gains. Many cases of ad-hominem attacks against a person or companies abound the literature of sociology today. This form furthers our motives away from reason and continues to add ignorance in our understanding of human nature and his environs. Our tendency when leading the notion of implied reality is to continue and not realize that negative returns are just ahead. Force of thought absent reason is unjustified under any social philosophy.

The daily retractions and reversals in the scientific literature is also a testament to some who view the world through the lens of reason. A review of the neuro-scientific studies written in journals finds that only 20% are accurate. And this is not some met-analytic view either, but hard and soft evidence of bias and intent that permeated through these “scientific articles.”

The lesson we learn is quite simple, even under the most arcane of all scientific literature that has been assembled with the largest of data and aggregated with the embellishment of graphs and tables for its “genuine-ness,” the objectivity of reason must follow in creating and considering it. Remember Einstein Theory of Relativity was a single page. A theory or hypothesis needs a simplified clarity of concept. The proof requires a similar display. The repeatability of the night following the day is the proof of the solar system and the shortest distance from point A to B is a straight line. Go ahead, prove those wrong.

It is or it isn’t, period.

Our operating impulses in deciphering such claims have been assuaged with the needs of complexity. There must be this and that before people will buy it. But then, if you have to sell it hard, maybe it is not worth buying. Consumers demand a product with inherent value, until a better product comes along. You can and will win some with good promotional marketing in the short term, but the long-term value proposition in the minds of the consumer will make them stray and yearn for what they need. Scientist, artists are no different. We are all consumers in the end.

A forced intent is as bad and is one filled with bias. Both have a lit fuse of a Boolean logic, devoid of “radical empiricism,” repeatability of results and reason.

Let me then get to two short but telling specifics in medicine. Medicare just cut $227 million from hospital reimbursement for readmissions. What potential ramification would this policy have? It does not take a large set of Betz cells to figure this one out. Hospitals will engage in policing the patient admissions and denials for admissions will soar amongst the weak, infirm and the elderly, because they have multiple co-morbid states where different organs are constantly taxed and fail at different hour. Similarly Pay for Performance, another concept was met with a change in physician behavior of not undertaking care for the weak, the infirm and the most vulnerable, who were turf-ed to tertiary institutions. Consequently these institutions suffered the high readmission symptom-complex. The arm of mandates in the social order of things is counterfactual to the orderly discipline in society. The society by and large lives with principles. Creating a system of principles and monitoring is the fundamental freedom that every philosopher has ever dreamed of. Even in their most utilitarian ideation the objectivity of fundamental freedom and liberty of each individual was the Rosetta Stone  at its core. Orderly discipline is a reasoned discipline.

Reasoning beyond the now and the obvious is a gift of a stable future, failing, which the entire complex of society disintegrates. Reason is the steel beam inside the skyscraper that gives strength to it, just as single spar does for the airfoil in an aircraft.

Monday, August 5, 2013


I love rainy days as much as I love sunny days. There is something about rain however that is so unique. There is stillness with the hushed sound of rain on the leaves. The sound surrounds you. The leaves move to the rain drops, tap, tap, tap. The puddles grow ever so slowly as the raindrops fall and the expanding rings of water collide on the surface with each other. The breeze blows gently forcing the raindrops sideways, Except for raindrops and the breeze, there is very little movement from nature.

My fascination with rain, stems back to my childhood. When I was little, my family and I along with three other families went on a vacation to this remote destination where an old mansion stood. We were in three separate vehicles, ours was third in the caravan. The hundred mile journey that started late in the evening marched into the night as we came to the last five miles of road that was all dirt. Steady rain had been falling most of the drive as I kept counting the rivulets on the windshield. 

The road became treacherous with deep puddles filled with earthy brown water that splashed sideways as the tires traversed through them. On and on the bumpy ride continued making me nauseous. We suddenly hit a large puddle that was deeper than anticipated and I heard my father groan.

He was out immediately looking at the problem and I saw him carry the spare from the trunk and in the driving rain with the wind blowing the trees on to their sides, carry on the necessary work to get us back into a mobile state. My mother kept telling him to come in the car. He finished the job and got back in soaked to the bone. “you’re gonna catch a cold! She said. He smiled back at her and looked over at me and said, “Its just a little rain.”

Many years later, I was awakened by the phone and was asked to go to the hospital for a sick patient. Upon arriving, I was asked to scrub and go into the operating room. My surgeon friend was there with a grim look on his eyes. About all I could see between the mask and his head cover was his concern. The dilemma was pretty obvious too. The patient was bleeding from small blood vessels everywhere. He was in a full blown DIC (If you know what that is good for you, otherwise, just know, it’s a real bad thing) From one o’clock that morning till the dawn broke, both of us did everything we could. I, with my monitoring and recommending blood products and medications and he with his cauterizing abilities. Finally the storm broke. The pressures stabilized, the blood thickened and the bleeding stopped.

Exhausted we sat in the recovery room sweat poring out and little to say to each other. After a while as the outside hum of the morning grew louder, he looked up and still no words came. I looked at him patted him on his shoulder and said, “Its just a little rain.”

The next day as I was passing by that patient’s ICU room door, I heard my friend speaking to the patient who was awake with his family by the side. I slowed my pace and distinctly heard him chuckle, “Its was just a little rain.”