Monday, January 4, 2016


Normatives need some understanding. These declarative (normative) statements over time and through constant rekindling efforts of the followers turn into factual statements. Widely shared statements in this day and age are; blanket the airwaves and digitally swarm the social media and you have a new Norm. It is like the use of the term "social responsibility" that is ubiquitous and bandied anytime when logic is in short supply. The very social structure morphs through the beating drums of the normative clan changes and small "n" numbered polls confirm the selected-biased answer through the tortured network of statistics. Entertainment becomes reality and the human misery index rises to new levels for most are buried in the sea of daily existence. "Oh the web we weave!" The illogic in this "Normative" logic is the fount of the current zeitgeist. Let me clue you in on a conversation that I had with one of these stalwarts.


“Normative”: You know physicians are destroying medicine!

Me: How so?”

“Normative”: Look at the costs, they are going sky-high. In fact healthcare is costing the US $3Trillion a year. almost 18% of the GDP.

Me: And you think all those costs are related to physicians?

“Normative”: Well yes. Who else controls medicine.

Me: Did you know that medicine has been subverted by the third party-goers?

“Normative”: Like whom?

Me: Lets see, for one, the middleman-businessman/woman managers who have grown 3000+% in the last 30 years compared to around 180% of the physician population. The cost rise is proportionate to the rise in these bean counting busy-bodies. For another the Insurance industry who keep raising the premiums and conflating the stockholder dividends and CEO bonus payouts and three, the pharmaceutical companies with a constant increase of the costs of drugs. 

“Normative”: What about the excess diagnostics and procedures?

Me: That is a two-part problem: One, The patient demands to know what is wrong when afflicted by a symptom and he or she will go to multiple doctors and facilities till they get the answer and two, The legal aristocracy is just waiting to pounce on the doctor for a missed diagnosis.

“Normative”: What about the CT scans causing cancer?

Me: Maybe if you read the study, you would realize that out of 81 million CT scans done a total of 15,000 MIGHT develop cancer. The “MIGHT” was based on a hypothetical risk extrapolated from the Hiroshima and Nagasaki related fallout.

“Normative” Maybe, but you know the doctor’s fiefdom is just about over, don’t you?

Me: How so?

“Normative”: Soon population medicine will clear the hurdle based on guidelines and mandates. And there will be little need for doctors. The Nurse Practitioners and Physician Assistants will be able to handle most of the problems.

Me: The educational basis of the NPs and PAs is not on par with physicians. Thus decision making skills are different. And besides, the NPs and PAs increase the diagnostic use because of their own insecurity in making judgement calls about diagnoses.

“Normative”: Yes, but if the guidelines tell you what to do based on population medicine then what good is all that knowledge for?

Me: Population medicine is based on sampling errors. Even taking the Bayesian rules and accounting for the statistical probability at 95% Confidence Intervals, we are left with information of about 50-60% of the population at best. The remaining 40-50% are not in the running for the appropriate therapy.

“Normative”: What do you mean?

Me: Say you have hospital conducting a trial and it draws most of its patients from a specific catchment area and the population of that area is mostly “X” type. Would treatment of the “X” population fit the “Y” population? The answer is no since phylogenetic variance are common in communities based on the growth and expansion of the community. Not every community is a “melting pot.” Even adding multiple institutional data fails to conquer this conundrum.

“Normative”: Even so, computers like IBM’s Watson will be able to differentiate between diseases and give a fairly robust diagnosis on an individual basis.

Me: It might but it will be based on percentage probabilities. For example a person with cough might have the following tape readout: 90% Allergy, 85% Bronchitis, 80% Pneumonia, 70% Cancer, 40% Drug effect etc. It will still take a physician to weed out the reality. And that is what physicians do today with their mental calculations, non-verbally.

“Normative”: What about the DIY laboratory tests. That should help empower the patients to make their own decisions. Right?

Me: Actually it will create a larger state of chaos when small abnormalities are noted in the lab tests. Who will interpret these abnormalities?

“Normative”: IBM’s Watson, for one.

Me: We are in a circular argument here, aren't we?

“Normative”: How about most medicine will be conducted via telemedicine based on wearable technology?

Me: Now you are getting somewhere. That is entirely possible one day. The data can be fed into the computers and analyzed for probabilities and then the physician becomes the decision maker on the computer screen. Unfortunately the need for surgical procedures will still be needed until we have Star Trek technology to cure diseases without intervention.

“Normative”: I think you are wrong. The change is coming and soon.

Me: Prove me wrong.

“Normative”: This time next year.

Progress in medicine has been steady. It is geared through trials and tribulations, tests and studies, drug “A” vs. drug “B” and rarely placebo nowadays. Medicine is changing. The Star Trek Hologram “Doctor” is still far away. We should continue on that quest, but not denigrate the current best medical system in the world methinks. Normatives, they will have their day of reckoning, one day…Maybe or maybe not and we will have advanced to a feckless, fact-less, opinion-anchored society. But, then I digress.

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