## Sunday, April 6, 2014

### The function of x ~ f(x)

f(x)

It is a beautiful morning.  The sun is bright and warm and the sky is azure blue. The breeze lifts the veil of life’s opacity and shows her assets. Ah it is good to be alive. What should one do today? Maybe work in the yard, maybe go for a bike ride, maybe roller-blade on the side-walks and worry new moms cuddle their minors closer to them, or maybe just sit on the grass and read a book. So the “x” in the equation is the beautiful morning and the “f” is the function that I am willing to perform as a result of the “x.”
Now that we have it, let us explore how the science world has mutated the norms of their and our thinking. The function of “x” has become over time “x” itself!

Let me explain:

1.       Take for example the hammer. It is always looking for a nail, otherwise it is mostly useless, wouldn't you say? So if we have this new hammer that we bought for \$10 we want to pound some nail somewhere to find utility in it. A similar corollary would be discovering a drug and finding a disease to apply it against to find relief. The problem with both is that we have not really seen a problem but through acquisition of an “x” we want the “f “-related to it. So now we have to throw this drug in meaningful ways at different diseases and through the art of statistical manipulation come up with a tightly bound Gaussian metric and negate the null hypothesis, or simply find proof (you know like the one that proves that the absence of your friend is due to alien abduction and the Alternate true Hypothesis is the absence of your friend is due to the fact that he is on vacation)!  Ah, Ha! We exclaim, lo and behold we have found the cure for disease “y!” But did we? Or is it just the manipulation of the hammer to pound down further something that looks like a nail buried in the wood? The example here would be the “Statins:” Once the charmer that was to cure/prevent all of coronary artery (atherosclerotic) heart disease, Pravachol seems to have morphed into its various iterations and now seems poised to find some inkling in curing or at least besting cancer by improving survival rates. Well, and this is only a minor well, the Patent on the powerful statins in cardiovascular care seem to be coming to a close, so it might be time to find another "f". The “x” looking for an “f” then looking for another "x"?  Other beautifully rendered scientific articles with appropriate graphs and tables seem to pop up every now and then on the unbelievable benefits of Vitamin D. It can cure almost everything or can it? But here is the lasting memory of a fond desire to everyone or anyone who loves chocolate. Chocolate is great for your heart! Okay, I’ll buy that, even if it tastes good! So the current science or pseudo-ness of it is to prove whatever you set out to prove and with probability manipulation of a few numbers and voila, there’s the proof!

2.
The same experts that prattle on about the symbolic “f” of a certain “x” now bring the two together in another well-advertised episode of “f(x)” by using the self-enriching models of creating such endless hardships of NO utility as the Maintenance Of Certification (MOC) for doctors. The “x” here is the biannual expense of \$5000 cash outflow for the doctors to the inflows for the American Board of Medical Specialties and the “f” in this examination is deemed as means for the doctors to be tested for their knowledge and abilities. Huh? Knowledge and abilities tested every 2 years? The makers of this MOC test (x) propound that the public deserves to know that their doctors are knowledgeable. Indeed the doctors have to fulfill the Continuing Medical Education credits of 50 hours per year to maintain their license in the states they practice and that is the “f” of the test of practicing medicine “x.” But these self-serving agencies have now put themselves right in the middle to promote themselves as the arbiters of physician knowledge. What is most interesting is that there is not a single shred of real “EVIDENCE” that the tests that they profess to be the greatest thing since sliced bread for detecting “unknowledgeable” doctors have any proof. But they carefully craft the queries to the willing about how they “felt” the examination helped their knowledge base. So the “x” here is in place in the form of MOC and the revenue stream to the agency and the “f” is grinding out the template of acceptance and acquiescence through enabled doctors (selection bias) who will affirm the “x.” What is not mentioned that the ABIM a branch of ABMS brings in more than \$49 million/year and the President of ABIM makes about \$750,000/year. The “f” of this “x” is plain to see, isn’t it?

3.
Healthcare cost has been the topic of conversation for several years now. Yes, it is spiraling and you know why? Because it is an incentivized system of care. The misplaced responsibility onto the middle man (the Insurers, Medicare, Medicaid) to pay for any and all ailments of the elderly and the indigent. This incentive creates a sense of entitlement. The doctor’s offices and the Emergency Rooms across the country are bursting at the seams with patients who have arrived there with every minor ailment that time can heal. But what is lost in the jungle of honking noses, dried out coughs, red cheeks and low grade fevers are the real medical horrors that have difficulty being seen by the physician. So cost containment is a need. If responsibility is shifted to the patient for a larger portion of payment and the rush to the emergency room will most likely be reduced. But no, the experts have taken a different tack.
They are refusing to reimburse the entity that cares for the sick by denying reimbursements for re-admissions, for infections that become evident during hospitalization claiming them as a result of hospital error and the like. The votes seem to propel the politicians into this circuitous thinking of find the wrong “f” for the “x” all the time. Find the fault with the physicians or providers as the doctors have been demoted to nowadays. These same experts burying their heads in the sand find arcane and clever ways to arrive at reasoning  that we should not be trying to diagnose an illness too soon as it causes unnecessary tests and potential harm. They go against mammography (breast cancer screening and PSA test for prostate cancer suggesting “lead time bias” as the root cause of too many diagnostic errors. They also have determined colonoscopy is an over utilized screening tool. But then studies recently have shown an overall dramatic reduction in colon cancer as a consequence of the screening colonoscopy. They flood the digital and printed ink universe with their version of the “f” (harm) for the “x” (costs). Who is the general populace to believe? The current vogue answer to that question is; the adoring media and its “Made to Stick” format and their "Buy-in." A travesty upon travesty!

EMRs. Now here is an “x” that was contemplated at the political level through the arbitrage of the experts willing to create the hardware and software for self-aggrandizement at a large scale. So they duped the consciousness of the physicians and the general populace into thinking that the Electronic Medical Records would reduce errors and give a better handle over the disease to the doctors. Did it? Simple answer: No! Did it create a gulf between the physician and the patient? Answer: Yes! But for the “f” in this “x” which was done for monetary gains of the companies that got the contracts, it seems that the physician practices are in disarray due to complexities of the EMR and its meaningless use after spending thousands of dollars that they have been refused reimbursements for by the agency. It has created a mound of useless verbiage through “cut and paste” in the medical records that are done to satisfy some arcane rule of the insurer for documentation and the most devastating of all, it has taken the eyes off the “Ball” -the patient. The eye to eye communication no longer exists and the patient drones on about his or her ailment while the doctor is busy trying to fit round pegs in square holes in the arcane digital universe. This paradigm shift in patient-care is uniformly destructive to the field of medicine. The holistic view however of human care is in the understanding of another’s dilemma and then to solve it through knowledge, experiential reference and a pulse on the frailty of the other. It is not as some experts will have you believe that medicine is but a ceramic/silicon away from being dehumanized and perfected.

Kahneman and Tversky famously discovered the utility of the “f” of “x” and not “x” itself. In other words, the relative rise in the utility of one’s wealth as measured by the benefits had a far more meaningful nuance than sitting atop a mound of coins as Uncle Scrooge. You see, the small incremental “f” of “x” have a larger core of happiness in it then a large “x” sitting in a vault that these experts are accumulating on everyone’s dime.
The “f” today is manufactured, sometimes created out of thin air similar to printing money by the FED. The artificiality of this “Goldilocks soft-landing” will have a price to pay in the end. The “x” here unbeknownst to most is the lost asset of many trillions by the middle-class, and the ÿ" here is the white-wash, but that is another story…

Know your “f” of “x” that is...

Live only to accumulate the “x” off of others by a false “f’ prophet and one day not too distant in the future the Lorentz Strange Attractor will have your head for the false "f."

THINK!