Friday, March 29, 2013

I THINK





I think,
In abstract,
In ways I cannot explain.
Mountains,
Valleys, Rocks and
Refrain.


I 

think,
About things
And how they come into being.
Paper,
Plastic, Lights and
Their meaning.


I 

think,
In substance
When form fails to train.
Will, wants
Desire, and snow into
Rain.


I 

think,
About days
And why are they all so different?
Mornings, Noon,
Sunshine, Poverty and
Reign!


I
 think,

About nights
And why they wash away time?
Dark, Moon
Blackness, Emotions and
Decline.


I 

think,
About people
Why they behave as they do.
Cry, Smile
Pretend, Laugh and
Renew.


I 

think,
Of creatures
And what are they to do.
Fight, Kill,
Eat, Hunt and
Zoo.


I 

think,
Of the sky
And why it is so blue.
Orange, Yellow
White, Grey and
Maroon.


I 

think,
Of the oceans
And how they reflect the hue.
Deep, Dark
Fluid, Angry differing
Milieu.


I 

think,
Of thoughts
And how they emerge from naught.
Sadness, Anger,
Serene, Laughter and
Forethought.


I 

think,
About thoughts
And how thinking merges them too.
Happiness, Love,
Sunshine, Warmth,
Anew.


I
 think,

Of reason
And how it changes thought.
No! But!
Listen! Understand or
Not.


I 

think,
Of Life
And why our time is short?
Moments, Memories
Laughter, Joy all in
Thought.


I 

think,
Of a thought
And how it plays in reason.
Hot, Cold,
Maybe, Sense or
Season.


I 

think,
Of Death
And think its nature’s treason?
Short, Quick,
Dark, Emptiness and
Milton.


I
 think,

Every moment
‘cause there is so much to life.
Smile, Wonder,
Laughter, Humor and some
Strife.


I 

think,
Of life
And that moment passes too.
Fleeting, Wispy,
Nebulous, Ether and
Something askew!


I 

think,
Of you
And me and you.
For in my thinking
There’s only anon
And me, and you
Till we are gone.



Thursday, March 21, 2013

PSEUDOSCIENCE


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


“Yep son, we have met the enemy and he is us!” ~ Pogo

Science is fairly simple and straight-forward, at least that is what I am told. One has a hypothesis and based on that axiom, one designs an experiment to prove or disprove the assumption. If proven, one verifies the experiments for posterity and voila a new concept is born. Well, and that is a deep well of doubt, it isn’t really like that anymore. It used to be once upon a time, when thoughts originated in the living flesh and knotted circuits while the heads were bent around the burning midnight oil to understand and reason.


Mastering the art of science is pretty straightforward.
  1. Develop a Hypothesis
  2. Research the background facts
  3. Develop a Methodology for Experimentation
  4. Experiment
  5. Review and Document the Results
  6. Repeat for verification
  7. Validation through other’s experimentation.

Right, so what is Pseudoscience?
  1. Have a premise
  2. Gather Big or Small Data from Warehouse or Data Marts
  3. Manipulate the data and the model
  4. Achieve Result
  5. Publish result
  6. Get Promoted.


But no more! Now we live in a sea of information derived from the digital warehouses of biggish data, where manipulation of one sequence leads to a new concept, enough to hang your hat on and plow towards the professorship or sell the least effective object or might I say, the least functional drug as a new concept. Hurtful, blatant, pure blasphemy, ignorance, Idiocy some would hurl such invectives, because they can and are wont to, if these words slice into their arguments.

"...man will occasionally stumble over the truth, but usually manages to pick himself up, walk over or around it, and carry on." 
-- Winston S. Churchill

The pseudo in Pseudoscience is the Falsifiability of Karl Popper or Robert Merton’s Detachment, Universality and Skepticism. What these gentlemen were alluding to was deriding the “norms” through violation of the basic tenet of science, validation. There is a growing if not dominant force that has captured the belief of laity and even some scientists that whatever is portrayed as science has got to be true. “Stuff,” like Astrology, Witchcraft, Pyramidology, Neurolinguistic programming, Reflexology, Reiki, Naturopathy, Graphology, Paranormal plant perception are all “disciplines” that use obscurantist language to purport theories without basis. None of these would survive the fine edge of Occam’s Razor.



Okay, most like-minded people will easily agree with that premise, but now the hard part, and there is a hard part coming, there is a growing volume of discourse that enables a different kind of rigor.



What is different about this rigor is that it states and touts willingly that it has a very rigid one, but when you dig deep, you find there is nothing. It boasts about various mathematical models and probabilities, but when you look at reason, you find gaping holes of indiscretions, exploiting the Confidence Intervals and building Forest Plots to hide the burnt out trees within. Let me take you through the prism of today’s scientific rigor. We are mired in the Observational Pseudoscience. Most data is being compiled through data harvested via varying inputs obtained from irrelevant streams. This data is being warehoused and then put through the “wood-chipper” to get to the chips and bits. From those chips and bits, depending on one’s selective nuance, a premise is arrived at and the computer spits out a series of data. These data are then paraded into a mathematical modeling through the grinders of Probability functions, at times even using the Baysean Rules, to then arrive at a finality. If the final answer fits the original premise, it is heralded as the latest version of the medical/scientific gospel. If it does not, then two avenues remain, one, to use different mathematical models and rules or, two, to use more graphs and plots to "shoehorn" in the bias. The third version of discounting and trashing the entire exercise as futile, is never entertained, because time has been spent. Further more, although some good can come out of this search by outlining the negative in it, but No! that cannot be, for we live in an optimistic society and everything must be a positive endeavor.



The fuel that fuels this drive is the non-science of epidemiology. Now Epidemiology has a good part to play to enrich society by unearthing information from large population clusters about certain disease manifestations, probable associations with other etiological possibilities and even highlight the potentialities of water-borne, tick-borne, air-borne illnesses after basic science has revealed such as causal inference. But today, there is no rigor of basic science, once the numbers have been collated, tables and graphs have been populated and the forest-plots have been drawn, there is little left to do for these new “scientists” but to claim their fame. In some cases the ticks never bore the disease, and the water never was contaminated and the air was not the vector for the illness. Ah but those are such trivialities, that they can be discarded for the overall beauty, artistry and conclusion derived at by the authors.



"I love fools' experiments, I am always making them." 
-- Charles Darwin

I came across a college graduate who had finished his four years in Arts decided to go into Public Health. He finished his degree in MPH (Master of Public Health) and upon graduation he comfortably found a position within a public healthcare firm. Life was good for him, he continued to climb the ladder of success as he added his name to the large roster of co-authorship in various and sundry articles written in various journals. In fact he got so famous that he became the head of a large agency. His word became gospel. He made various arbitrary statements and using irrelevant and obscurantist language that he had compiled in his repertoire continued to master the art of forceful expression. Everyone looked to him for answers to questions that never had any underlying reason. The charade went on and on and then one day the entire fa├žade of the pseudoscience fell on him. He had traveled too far on the path of no return. He had made the fatal error of tackling basic science in his hubris. Uh no, you never use the dictionary of pseudoscience or junk science to lay a finger on verifiable, validated and true basic science.

"When even the brightest mind in our world has been trained up from childhood in a superstition of any kind, it will never be possible for that mind, in its maturity, to examine sincerely, dispassionately, and conscientiously any evidence or any circumstance which shall seem to cast a doubt upon the validity of that superstition. I doubt if I could do it myself." 
-- Mark Twain



You see, Basic science is tedious work, which requires diligence, hard work, a constant battle of wits, and a real search for the truth. Pseudoscience skims over the vast seas and flies in ether of scattered streams of data, collecting information to force-implant an ideology of thought. It is never verifiable and almost never repeated and if it is, it never arrives at similar conclusions. Case in point would be the nebulous virtues of Blood-Lettings, Amputations for Vitamin B12 deficiencies, High carbohydrate Diet, Smoking as a treatment for bronchitis, Cholesterol and Heart disease, Vitamin D, Coffee Enemas and a whole host of other holistic-nuanced feel-good approaches.



"I know a lot of people without brains who do an awful lot of talking." 
--The Scarecrow -From the Wizard of Oz

With fiscal uncertainties we are falling into the trap of such pseudoscience, where once early diagnoses lead to more cures, now early diagnoses leads to harm with purported “lead-time-bias.” Where once early stage disease-capture was tantamount to survival, now it is considered an expensive and greed riddled proposition without value. The funny thing is, that many intelligent folk are feeding on these paradigmatic, acquired so-called “virtues” and regurgitating them as gospel.

"The great enemy of the truth is very often not the lie - deliberate, contrived, and dishonest - but the myth - persistent, persuasive, and unrealistic." 
-- John F. Kennedy


So what is the answer? It is quite simple, if you have followed the train of thought here. An observational, epidemiological study done using ODD-Ratios and with all the beauty of graphs, plots and tables, can still ONLY suggest correlation at best and must be confirmed with basic science to arrive at causality. This, basic scientific rigor then must be validated and verified before the concept becomes the hard evidence of the day. Otherwise, I fear medicine and science are doomed to a “he-said, she-said” shouting match of idiocy! 

"I maintain there is much more wonder in science than in pseudoscience. And in addition, to whatever measure this term has any meaning, science has the additional virtue, and it is not an inconsiderable one, of being true." 
--Carl Sagan

There will be a cohort who will chortle, "He is a lunatic, satan, how dare he question us, Who is he, He has no understanding of the universe..." I accept that they will be angry and that  makes me happy!

Just a thought…

Wednesday, March 13, 2013

EMR #2 ~ Solutions?


"Simplicity is the ultimate Sophistication." ~ Leonardo Da Vinci

Sophistication or Success?

Sophistication unlike success arises out of need, while success is borne of a difficulty.
The vagrant causal arrow seems to arrive from everywhere nowadays. Any “expert” who arrives at the mindfulness of a deeply flawed conjured idea, he or she becomes the author of the new cause celebre. This top-down, one-way dictates are flawed in execution even though the concept might have been sound at inception.

So let us go through a thought experiment.

What if?

What if we decided that sharing data between physicians, the hospitals and other healthcare facilities would be a boon to proper caring for a patient?

Ah yes. The logic in this is sound.



There is some potential for failure, especially if all the parties do not cooperate or the hospitals refuse to transmit their information, but then those are the inconsistencies of the human condition. Given enough time and little by little as the early adopters through their own trials and tribulations show success in regaling the virtues of this new form of a quicker communication, others might do some shoulder surfing and try their hand at it. In these early days, just like Lewis and Clark, the adopters would go through a sea of troubles, fits and starts, fortunes made and fortunes lost, before isolating all the potential pitfalls that might need remedy. The adapters, on the other hand, would get the benefit of usage while the early adopters would reap the rewards of their tribulations.

Lewis and Clark Trail


Now that makes perfect sense. Doesn’t it? It is after all the underlying principle of supply and demand. 


Like Apple’s iPad, no one needs one, but given its capabilities, everyone wants one. It arguably brings the world closer, integrates information faster and does not need a tether or a lot of weight to go with it. An innovation worth its tiny weight, a lot of bang for the buck! Now, Apple did not go to the Central Planners and through lobbying, ask that an iPad be mandated for every child, student, doctor or businessman, because the argument would go, “this would help in education and help humanity as a whole.” No they did not! They produced a product that needed little assist. It had value in it, all by its lonesome and today resides in millions of homes. Thank you very much!



So that brings me to the 50 some billion dollars that the central planners used as inducement for EMR, and created empires of software/hardware industries, “to create and sell the right widget to the hospitals and the doctors.” But their motive although explicitly expressed as being patient-centered turned out to be more for the benefit of the makers of the software and the industry that governs payments. The patient care itself was relegated to the sidelines because, “Oh the beauty of this is that predigested-Medicare-Approved-Verbiage for the appropriate level of care is already built into the glossary to populate the data, to reduce your interactive time (they did not say, “fills reams of digital data, all with one click”).



Opining from the cloudy realm of the ivory towers where everything is an evolving nebulous stream of dictum. And, without the benefit of success or failure from hardships and difficulties, is tantamount to the marginalizing of real intellect or need. Might I suggest that if the system had allowed for and indeed now shifts its gear into neutral, the intellectuals on the ground would create such a process to really incorporate excellence of patient care into this proposed paradigm. The contextual basis for this evolving paradigm would be a ground-up means and not the central planning top-down mentality of forced pseudo-intellectualism.



Hey give it a try! What have you got to lose? Except, maybe control. You Top dudes have failed in all aspects of managing this concept, except maybe in determining who is doing what in medicine, but that is a far cry from patient care, now isn’t it? Let the boots on the ground come up with their pride and joy. They will make sure when they have done their tinkering of trial and error, the product would be seamless and exist in the background without the prejudice of an intermediary obstruction between the physician and patient. All such electronic data would be hum-less, noiseless software, an invisible, recording of the physician-patient interaction and generating good and solid data for the benefit of the patients!

Thought experiment over!

Now lets dream…

The spirit's foe in man has not been simplicity, but sophistication." ~George Santayana





Thursday, March 7, 2013

I AM A BRAIN WATSON,


“I am a brain Watson, the rest of me is a mere appendix.” ~Sherlock Holmes

And there in lies a story…



Some time a ago, I was licking my wounds after being chastised by a kind old lady, who without mincing her words, as they are wont to at that age, said in a brief statement, “If I wanted that kind of advice, I could get my grandson to look it up in his computer.” Stunned and embarrassed and concerned and red-faced, all I could stammer out of my pursed mouth was, “Yes, but…”

Time has a habit of healing the deep penetrating gashes, only this one remains, open, hideous and painful.

“Meaningful use,” is an ugly term, ugly, because it is smothered between pages of ink that are populated by meaningless words. My head is behind the glow of a screen and yours dear kind old lady behind the back of that screen.

You are looking for answers in my eyes, whether the verdict from my experience and knowledge will carry you through to see your grandson’s wedding and maybe if you are lucky to see your next great-grand child. And all I can see are boxes to click and glossaries to populate. My intent is to make the two pages into three pages so that some central planning unit hidden inside the collective “Borg” interprets “meaningful use” correctly, belted in some faraway place. 



And your intent, well dear old lady, is quite plain to see. And as I have continued to spy on your eyes from behind the screen, I can see they are being filled with disgust and loathing. The rise of the frustration is evident as it rises like mercury in the glass container at the touch of heat.

“What happened to your skills boy?” she asks, her words full of pith.

“But…but…” I stammer again.

“Don’t but me. I’ve seen enough. I’ll find myself a real doctor!” She picks up her little green handbag, gathers her wooden shillelagh and without further ado walks out.



Sitting besides the miniature version of Watson, that hums away without a wink or a smile, detached and oblivious, and occasionally lets out a rapid clatter, as the reading arm of its hard drive collects the data, I realize what has happened.

We are no longer the intellectuals, pondering over the complexities of human ills. We are no longer looking into their souls and baring our own weaknesses. We are no longer excited with a brilliant flash of thought that inspires and elevates another. We are no longer the hope of a remarkable innovative change to spur humanity into prodigious health and long life of well being. No! We are no longer…anything but a man or a woman behind the screen punching a keyboard, minimized into triviality. We are no longer the essence of bringing health and joy to humanity. We are losing the “touch” and the hand on the shoulder with a smile of empathy that by in it self confers a 14% placebo effect. No! We are now subject to the impressive guidelines from whence issue the results from the 1 and 0 stored deep inside the tiny light blue box with a glowing bulb impression on it’s shiny lit surface.

Oh what a shame! Yes we are all the same, lest we forget, except for that quintessence of difference of thought, emanating from that tiny speck of humanness called the DNA, inspired by the varied signal from “jumps” caused by the miRNA creating that evolving evolutionary revolution of advancing thought. But for that, we are the same, drab and colorless elements of humanity. And as someone just pointed out to me recently, we are a collection of 10^28 atoms each with its own story to tell, a virtual cavern of mysterious shadowy characters, excitable, emotional, fearful, thoughtful, diligent, intelligent, evaluators, and contemplative with reason. But alas, we are reduced to one. The drab and the mundane. The encoded line!

And therein lies the tale of woe. Everyone, no matter what the diversity or the disparity of the genes, is addressed with the same common broad brush dipped in a dull grey color. The biopsy from this pathology of thought reveals a decadence imposed by the will of force, championed by the many who serve to game and gain. Why not, let this innovation of digitization, which I believe has a great potential, naturally flow, inspire and in so doing become a rites of passage to a better future, rather than a vengeful drumbeat of "meaningful use."

Dear kind old lady,

I am so sorry.

Yours sincerely,

Me of thousands!

Friday, March 1, 2013

Breast Cancer in Younger Women


The JAMA article suggested that there was significant increase in the number of breast cancer cases between 1976 at 1.53 to 2.8 per 100,000 in the 18-34 year old female population. And to boot the cancers were more aggressive and fatal!

That got me thinking…

This entire DNA enterprise is a remarkable creation! From the rudimentary beginnings with just four Nucleic acid molecules to this giant skyscraping intelligence called human. What a concept?


It is well know that older women who gat breast cancer have the slower tumor growth rates. These cancers are universally limited in their scope of aggression. The disease is mostly discovered in the breast  (Stage I or II) with some cases spreading to the lymph nodes in the axillary region (Stage II or III) and fewer still traversing through the blood vessels and finding haven in distant organs (Stage IV). (you can read some more here: http://jedismedicine.blogspot.com/search?q=breast+cancer+energetics )

 STAGES of Breast Cancer:






Why the slow pace in the elderly?

For that answer we have to go into the evolutionary dynamics of cancer in the elderly. As humans we are subject to about 10,000 hits on our DNA per day. These hits come from the atmosphere in the form of errant gamma rays or even neutrinos (although some claim they just pass through). 



The damage done to the DNA causes a disrupted DNA code in the form of an error, a “missense” or “nonsense.” The mismatch repair gene is, by virtue of its great “proof-reading” abilities, able to repair the damage as if no damage had ever occurred, like sifting “squares” through round holes. The hits however keep coming and most time the DNA damage is in non-critical area where the change just exists without repair as a SNP (Single Nucleotide Polymorphism) or as a “snippet.” Other times the degraded gene is optimized by epigenetic phenomena that can modulate the behavior into compliance, even though the mutated gene persists and still other times through the evolutionary leap of the Transposons; Barbara McClintock’s “jumping genes” the DNA itself in self preservation wants to thwart a potential risk to it, like the sickle cell gene as an affront to Malaria. But let me stay on message here… (you can read some more here: http://jedismedicine.blogspot.com/2011/02/human-diversity-in-genes.html )

Aging


The problem as we age is one of capabilities. Just like at 70 you cannot jump like you used to, or quickly pick up an object on the ground, as you did when you were 20 years old. The Mismatch repair gene cannot keep up with the accumulating DNA damage either. Thus the damaged erroneous gene through a mistimed event when the mismatch repair gene is not looking or able, gets transcribed into the dividing cell and that cell through the transcriptional powers of an unleashed cancer promoter gene or by virtue of damage to the tumor suppressor gene, leads to cancer. The process is slow; the aging process retards the cellular division, hence the growth rate is also slow. However over time as more and more unwanted genetic mutations gather forces within the cell, an explosive all out head for the hills growth spurt occurs culminating in the somatic death. Then there is also the Telomere issue. 



A finite number of these CAG units exist in the cellular DNA; tiny fragment repeats at the 5-prime ends of the DNA. Each repeat unit is discarded with each division and after the last one is used up the cell division fidelity is no longer guaranteed. Remember the Hayflick Limit? (1) A fibroblast in culture medium will only grow for a certain number of divisions and then no more. Well same here in the human body! With no further division the cells eventually die. Unless of course you happen to sprinkle a little Telomerase enzyme and the cells happily continue to divide. Now guess who has a boatload of Telomerase? 



You guessed it, the cancer cell! (You can read some more here: http://jedismedicine.blogspot.com/2012/06/aging.html?spref=tw )

The normal cellular division rate in the young however is robust. Their mis-match repair is in great shape, they have plenty of the CAG repeats on their DNA and life is humming along. New cellular structures are needed to add to the existing ones as the genetic structure commands the proteins to build and strengthen the scaffolding and the organ function for the present and the future life span. This growth rate is noticeable in the height, weight, body structure, physical and mental reserves and all the fine things that adolescent and young adults are heir to, albeit without knowing or caring about it. Since billions of cells in this multi-trillion-cell economy are in a state of division, so also is the mismatch repair gene mechanism in full dress rehearsal. The functionality of the repair mechanism and the governance of the p53 guardian both keep the harmonious fidelity of normal information transfer from the mother cell to the two daughter cells. Growth is a natural byproduct in youth.

p53 Guardian of the Genome


Now stay with me on this one.

The Disposable Soma theory states that the human body is just a vessel to transfer and propagate information to the progeny. In other words, the DNA is the real information and the body is just a glorified medium for the transport and transfer mechanism. So if that premise is correct and it seems to be relevant, then maximum fidelity is needed at a young age, which is true. After the 60 years have walked the road of life, is where cancer starts to raise its ugly head at a faster incident rate, doesn’t it?  



If cancer was affecting the youth at the same rate as it does the elderly, then the human population would be stifled and ultimately go extinct. Now wouldn’t it? The self preserving abilities keep the youth from being endangered so that the propagation of life may continue unabated. Each progeny is therefore blessed with an evolutionary benefit based on the attached Lamarckian nurturing benefit.

Disposable Soma Theory

So you might think that this is counter to the premise stated above. But bear with me, on this burden of reason. Imagine that the most important mechanism is for the DNA to transcribe its information with the utmost of fidelity and then an erroneous gene (mutated) escapes the mis-match repair mechanism and the p53 governance, what is the soma to do? What is the DNA to do? If the DNA continues to propagate the bad genetic structure it will perpetuate a somatic vessel that is ill-equipped to propagate it’s progeny and the population will die. In other words a faulty gene that forces the soma into extinction, is also forcing itself to the same fate. So what mechanism does the DNA have in its quiver?

That is where the dilemma exists.

The only mechanism for the DNA is to allow the propagation of the mis-wired genetic complex to complete its task of allowing the cancer to grow unchecked and unabated, quickly and efficiently, so that future damaged genes are not created in the process through mating and to therefore keep the fidelity of the ancient DNA structure in place that has allowed humanity (from Homoerectus to now) to survive for millions of years.
From ~~~~~> 
to


Equally in men with testicular cancer who have borne children there is a high propensity for their wives to miscarry. The primary directive of fidelity is at stake and the DNA does not wish to have a progeny that will be unable to propagate fully with purpose.

So the basic premise is that in younger women given such a DNA damage (from random DNA hits and lifestyle choices etc.) of the mismatch repair gene efforts and the p53 governance, once the data is error prone the quick, expansive growth rate and the rapid doubling time of the cells leads to an aggressive metastasizing cancer.

So, why the fast spread? That too, is as a result of the accumulating gene mutations. Once the bad cell has transgressed the imposed, self-governing limits, it is free to churn and burn any and all encoded messages within (acquiring the H-ras gene for instance) . Having this lack of governance and ability, predisposes it to acquire mechanisms that thwart the immune surveillance and the spread comes fast and furious. The cancer cell now is on a quest for its own short-lived dominance!

Thought experiment is over.

I know, I know, there will be vilification, demonization and all the rest because these are not politically correct, soothsaying words. Rest assured, if another mind catches the drift of this reasoning, solutions to this problem might come in the future. If you reached here and stuck with my monolog, I thank you.

References:

Hayflick L, Moorhead PS (1961). "The serial cultivation of human diploid cell strains". Exp Cell Res 25 (3): 585–621.

Rebecca H. Johnson, MD; Franklin L. Chien, BA; Archie Bleyer, MD. Incidence of Breast Cancer With Distant Involvement Among Women in the United States, 1976 to 2009. JAMA. 2013;309(8):800-805. doi:10.1001/jama.2013.776.

EDITORIAL: Testicular cancer and infertility
BMJ 2000; 321 doi: http://dx.doi.org/10.1136/bmj.321.7264.781