Saturday, April 11, 2015


Now you might have heard about the Dark Pools. No they are not found near the Dead Sea, umm maybe metaphorically one might say they lurk there.

Let me give a very novice kind of a take on these things called “Dark Pools.”

First they are not pools of water. Nothing can swim in them but things can be dunked in them. People can get wet in them and come out “dried out like a prune.” They are dark, because the only light is from the “one who shines it.” Everything is quiet, nary a ripple, just the chaotic, whirlpool like or tsunami-like mixing and churning goings on below the surface. Thus the “oxy” in the “moron” is the light shiner and the others are well, dare I say, “morons.”

To get a real grip on “Dark Pools” it is best to Google the term and you will get the gist. For the more inclined there are several books about the subject and has been captured nicely in “The Flash Boys.”
So there in the dark pools as estimated by some, is almost 20%-40% of the wealth that never sees the light of day, but transacts as if the sun never sets. Stocks trade between well-known large entities like the Morgans, the Stanleys, the BlackRock, the Barclays, the Citadels, the Millennium, the Renaissance, the Two Sigmas and others of the world. In the darkness of daylight they trade large portfolios with no stock price movements for each transaction, while outside in the cold street outside on the ticker tape the stock price shows large gyrations to the uninitiated.

 Most days the dark pools win, unless of course the Algos are at it (aka High Frequency Trading or 70% of Market trading). These wily Quant-satisfied, mathematically aligned codes of IFTTT are always on the lookout for micro-asymmetries in data availability and gain from select information a micro-second makes.

 "So you see, you poor soul, you have no way to win, just plenty of ways to lose!"

There is another “Dark Pool” cluster in DC, where "the dodgy air of opportunism and profiteering" is always in full swing.. This one controls all the other Dark Pools. This one is well-connected and trades favors between competing lobbyists. The colors might be blinding but the intent is there to trade and win for the self. Pinstripes move in and out of these large cavernous halls, slipping favors that only come to light if the powerful on the top are slighted in any small way. You want to fly to the Bahamas, or a Getaway Island where other measly human creatures cannot step foot, there is a flight for you in Champagne-bubbling first class lounge. Oh and yes, lest I forget, if you happen to be in this class of classes, you can participate in a soon-to-be-sky-rocketing-stock that will make you fortunes so you don’t have to read anything you undertake now or in the future. Just take the bicoastal flight in pure luxurious comfort.

And speaking of Algo codes, unlike the Mid-town Manhattan transfers where milliseconds matter, here the Algos churn at a breathtaking snail’s pace. The Zeno’s paradox is fully in play and the closer you get embalmed in your pinstriped, well-coiffed hairdo, the wealthier you feel.  The trouble with these Algos is that the old code much like the Microsoft’s Windows Program only gets overwritten and the old code is never deleted and likewise needs layers upon layers for corrective actions, which only exacerbate the underlying premise. Eventually in this morass, no one knows what is going on and the Red Queen can at will haul off with, “Off with their heads!” and be heralded as the great monarch.

Medicine, you knew this was a-coming, has large clusters of dark pools and Algos committed to serving it. The clusters reside in Universities and the Halls of Congress. They are called the experts who partake in the walking-in-and-out of the singularly well-known address in the world. They rejoice in lengthy monologues at other universities or places where anyone will listen to them or at the seats of government, where everyone pretends to listen but dreams of the first-class promised vacation. These clever brutes employ their wicked intellect to douse the flames of thought and create complex Algos under the guise of “Public Good,” and “Choosing Wisely” to manifest the meaning in their "lord’s" prayer. Their "lord" is whomever has the throne and control of their actions. To wit, the EMRs so proclaimed to change medicine are nothing more than a form of Algo duping in the reverse. They collect data for insurers and policy makers for control and command and not for the benefit of the patients. This kind of Brownian movement within the small enclave of self-service in these ivory-dripping tower inhabitants is often considered progress. Meanwhile pressed by such nonsense, the obedient, fearful minds lose all color, their eyes turn joyless and bland, and everything about them turns robotic as they hurry their way onto an early date with the Reaper.

"The seeming truth which cunning times put on
To entrap the wisest." - Shakespeare, "The Merchant of Venice"

Like the HR2 Bill passed by Congress, considered as an SGR fix for the “poor docs who have suffered such interminable uncertainty,” they weigh in with a hammer of more provisions to indenture the servitude of the physicians. In legal jargon printed over 263 pages there are interesting roadblocks; HHS Secretary’s control of who can write prescriptions based on the “recognized” NPI number ( If you do not participate in Medicare, your NPI will not be recognized and neither will your prescriptions-so essentially you cannot treat patients), the lobbied MOC need for “Physician Quality Reporting” when MOC has not to this date shown any benefit for the patients or their physicians, but it makes good money for the ABIM/ABMS, A soon to exist, colossal change in reimbursement through the ACO (Accreditable Care Organization), P4P (Pay for Performance) and APM (Alternate Payment Model) and penalties and bonuses to be determined at a later date by a single person-the HHS Secretary is being promulgated. Monarchy has a new name. Sure, the 21% SGR is being removed but it is being replaced by an even more onerous and medicine-destroying, guideline-mandated, population-based non-individual management of a patient’s illness based on cost and resource consumption-the Hippocratic Oath and the ethical standards-be-damned version!

Horrific, you say? Where have you been ol’ chap?

A friendly colleague @RogueRad asked this question, “Do you think this is how the Eloi will have developed?”
My reply:  “If Morlock pathos is to Eloi physiology, then Eloi pathos is to utopian fantasy?”

@RogueRad reply: “Progenitors of Well's utopia didn't believe in utopia. They were lazy. That's the real problem - laziness. Intellectual laziness”

My reply: “Granted Intellect is cake's foundation & laziness is the oozed icing. What if there is no foundation? Then… "Pass it then read it?"

@RogueRad reply:  “You're correct. If the foundation, higher education, is shaky then the icing will topple.”

For those needing info about the H.G.Wells "Morlock and Eloi" species:
The Eloi are pretty and the Morlocks are not
The Eloi are dumb and the Morlocks are not (or, at least, not as dumb)
The Eloi wear clothes, the Morlocks do not
The Eloi eat fruit, the Morlocks seriously seriously do not.
Perhaps most important, the Morlocks work and the Eloi do not.

The foundation crumbles under the weight of pseudo-intellectualism to guide the weary populace as these self-proclaimed intellectuals slurp the icing and fall into a diabetic coma of oblivion.

PS: The term "Algo Duping" borrowed from @MedicalQuack

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