Thursday, June 21, 2018


I found it interesting having just arrived at the meeting from outside, where the grass was velvet green, flowers peeking over each other to get the rays, while the bees buzzed around with their nectar and the trees fully clothed witnessing the chirping birds building nests for a comfortable summer. Indeed, it was Louis Armstrong’s “Wonderful world” day out there.

But in the cramped darkened quarters of this large auditorium where almost all seats were occupied, the speaker was animated and challenging with questions to keep his audience from dozing. He seemed to paint a picture of a bleak world, no, not the one I had exited to enter his. It was a bleak world, devoid of color. Metaphorically he had dressed down the trees to their bare branches and painted the grass a drab patchy-brown color. And flowers? Forget them. Not a one in his dystopian viewpoint. Clearly this was a significant (not in a statistical sense) departure from my perceived neural substrate. The space-tie continuum was disrupted. The space where I was, the time just passed and what it is this talking head expert was proposing for the future, were at odds. Minsky would call this the collapse of his “Temporal Segmentation Boundary.”  The expected norm was violated and in its stead was a rude exposition of a single mind’s dilapidated shack in the air.

And yet, here I am trying to reconcile the beauty outside with this throw the darkest color on the brightest of canvas and call it a masterpiece sort of view. What was this speaker’s angle, besides the doleful drab and murky future? Another mechanism directly gathered from the Heath brothers book “Made to Stick.” Call up an anecdote and generalize it to all then make the claim of your personal ideal or ideology and push it in through the exercise of marketing and promotion. Soon the legions of the pseudo-journalists pick it up and claim their favorite Newspaper front-page column and all is well in this corner of the cubicles, except what is really out there, the… truth!

Ah yes, he claimed that physicians were responsible for 95,000 to 135,000 unforced errors that led to premature deaths. Of course, he brought up the “Jumbo Jet” analogy of “1 jumbo jet crashing every week of the year,” correlating mightily between imagined stuff and estimated stuff, thus making all sorts of “stuff.” He cautioned however, those were very conservative estimates. Implying there were more in the morgue than met his eye. From there he polished off some more “talking points” of the experts. “Too many tests,” he said, “was causing too many unneeded procedures.” Okay, I thought, where was he going next?

I didn’t have to wait too long, “Imagine,” he said, “the healthcare costs of $3.4 Trillion,” and he laid emphasis on the “Trill” of the trillion with a shrill that had everyone on the edge of their seat as if watching “Exorcist” for the first time. His sermon continued for what seemed an eternity, filled with graphs and statistical jargon only an illiterate would love. Struggling to keep my attention, my mind was back to the living world outside.

There is mercy in time. The whole darkness lasted a full 90 minutes and then everyone was allowed to mill around, stretch their legs and grab a coffee to awaken their senses or what was left of their temporo-parietal-frontal cortex.

I find this disjointed, poorly thought trough ode to disaster being played out at most medical meetings and in all the opera houses of the medical Academies and Associations. All of these “experts” seem bent on pointing the fingers at every one of their former colleagues as the cause of the plague that has beset the medical industry. And there is no question about the fact, that Medicine is now an Industry. It employs more MBAs and administrators than it does doctors. Perhaps you know that in the waning months of the 2015-2016 the fastest growing segment in employment to keep up with the regulatory burdens of yesterdays, was the medical office complex. So, clamoring about the rising costs and blaming the physicians has now become a “art du jour” an art-form perfected to a point where non-physicians are considered better in rendering patient care than physicians. To that effect the non-physician industry is booming at a 30%-90% growth rate per year as the overall physician numbers decline steadily from attrition, depression, suicide and other assortment of non-fun reasons. This is helping the bottom-line of the Insurer industry whose Topline and bottom-line continues to grow YOY. Payout less for mediocre services and call it topline care. Yet as history has taught us in the last 2 years the diagnostic workup has escalated dramatically due to indecision and lack of understanding of medicine. Cheaper labor, cheaper product and marginal healthcare is what the Medical Industry is glowing in the dark about these days.

Treating patients is a complex chore of understanding the malady and rendering an opinion for alleviating the rub. It comes naturally to those who have happily gone into the profession for the sake of healing, spending countless months and years in the process. Yet, if one were to listen to that “esteemed speaker,” the sky was falling with deaths and destruction everywhere and all around due mostly at the hands of the physicians’ follies.

Why such a disconnect? It appears there is more to the story than meets the eye. Experts and the wealthy lobbyists who have “NSITG” (No Skin In The Game) have determined that their future is safe and that they can pay their way to a healthy future by the world leading authorities in subspecialty medical care should they need it, but the rest should be limited in the use the resources. For the plebian, the non-physicians would serve as the gateway to average health, just shy of full recovery. After all Malcolm Gladwell’s 10,000 hours are now trimmed to an average of perhaps 2,000 hours. And I for one still think that 10,000 was the bare minimum in just comprehending the nuance of Anatomy and Physiology.

But here is the interesting part in that 90-minute lecture that I failed to mention earlier, simply to keep you on the edge. At the end of the lecture, a wide eyed newly minted free thinker asked if the current state of medicine was more as a result of the administrative complex with its associated managerial brigades acting as middlemen and women collecting large sums as intermediaries, rather than the costs of the physician’s rendered care? The hush that followed was spell-binding. After a few ‘ums” and “ohs” the speaker countered with a question, “So your premise is contrary with the facts, I just mentioned?” Huh? What facts? He was merely pontificating without any facts in his more than 60 slide-deck of see this then do that. Slowly the rumble started and other hands shot up and an abrupt end came when the organizer had to usher everyone out to the beckoning fruit plates, croissants and coffee outside the auditorium. Another disastrous reality averted.

It appears, and you might have noticed it also, that when a question is asked against a set of conjured facts, the answerer can only be responded to with another question or with hyperbole of a prepared rhetoric. To confuse and obfuscate under the duress of falsified data is the name of the game. Get used to it, or fight it, I say. Kudos to the free thinkers amongst us.

Calls into question the malarkey that exists in medicine and the larger society as a whole.

Well back to the beauty outside where the sun still shines and the birds still sing and the children still at play. Enough with these Medusas and their serpentine “values” that turn one into a petrified urn of fear.

Tuesday, May 22, 2018


The stench of truth
Shaven off its husk
Fitted to a frame
Anchored in reality
Breathed into the air
Relieving the burden
Of bold and white lies.

The toll of that bell
for what it rings,
Its pitched dissonance
Rocking and rolling,
End over end,
Unceasing chaos calls
Of warring Liberty and
Her Sister; Imprisonment.

Factions in opposing camps
Vested to ideology
Buried in debts
Of human thought
Forever in deadly embrace.
To kill or be killed.

Winning is death
For both and neither.
While truth lives
And fiction dies
To be reborn
To die a thousand deaths.

Like hope from a fractured cry
Forever its piercing words
Drowned in the battle hymn
Reshaped anew;
Like time, recurring.

What is in man
That bends the truth
lies like a serpent
Cold hearted and
Weakened from the kill
Yet hungry for more.

What is it?

Life goes on
As lies proliferate
The Sun bakes
The breeze soothes
The leaves whisper
The petals fall
With regret.

Once again stench rises
To relieve the land
Of these untruths
As truth fills the air
To ease the burden.
The cycle renews,
The earth breathes.

Thursday, May 3, 2018

Defining VALUE

I went looking for a widget, only to find there were many kinds of the same widgets in the store. So, I asked which widget would work the best? The savvy salesperson answered with a question of his own, “What is it that you need it to do?” I listed some required needs and he ushered me to a stall with 3 different kinds of almost similar widgets. “Which one has more value for you?” he asked inquiringly. Hmm…after much finger, thumb Rodin-like expression, I picked up the shiny digital one over the battle-tested raw metallic one. Needless to say that 24 hours later, I was back asking for a replacement widget.

Based on Need

The term “Value” is a nebulous cloud of molecules that only collide to create an image based on the individual’s perception. You might consider the following thought experiment; Do you value Ford over than GM? The answer might surprise you. And there are many imputed variables there to bring about a rational and satisficing decision. Or better yet a decision between a Coupe and a SUV is based on need but between the many different kinds of SUV lies a choice and that is also fulfilled by desire and need. Or an even more extreme version of “Value” lies in a bottled water. At an airport you will find scores of cylindrical, squarish, small, medium and large, colored or plain bottles touting the freshest, most delicious water for your flight. Which one has value to you is based on your hierarchical metric of this amorphous thing called “value.”

Based on Armchair determination

By now you might have conjured up the concept that “value” probably lies in the eyes and mind of the beholder. While somethings might have “Value” to one person it might not for another. Since we all come with our own suitcases full of predestined baggage, acquiring loads and loads more as we move through time. Thus “Value” differs with different phases of life and time. In some cases, finances are involved, in others aesthetics, in still others pure function and lastly for some pure unadulterated desire and want.

But that is not what the “Experts” from the Elite School of “We are the Experts” like Slavitt, Gruber and Emanuel, have come to the conclusion. They have been screaming from the rooftops that in medicine, value is based on the outcome related to therapeutics offered. Hmm, okay, now let’s take a chill pill before we go answering to this loco-motivational self-righteous morality-signaling bunch’s point of view in medical care.

Based on Marketing and Promotion

The bluntness is partly a function of the historical mess these “experts” have created and partly because they have made a mockery of the philosophical integrity of the Value Theory. This theory states that Value is divisible into “Moral Value” as in those belonging to the character of an individual and “Natural Value” as those belonging to an object. A “good person” versus a “Good thing.”  Ok, I admit it is just a theory, nonetheless it has some gravitas. These “experts” have cunningly crafted a meme that seals both those disparate values into a combined whole where attempts to void inseparability, destroys both. Let me give you an example… The term “Public Good” is designed to make you think that some virtue is at stake, if whatever is recommended is not done, but look deeper and you realize that it is manifestly only good for the “Public employee” their promotion and pay check and potentially a disaster for the private person or his/her ruin. Merging the two “Values” has come to claim at least one life recently, i.e. Alfie Evans in the UK under the aegis of the National Health Services (NHS). These memes crafted as they are, are designed to assuage the softer minds in all of us; words to comfort but deeds to actually destroy is their credo. (Read Here)

These minions serving bigger minions have combined the Business lexicon into their empathic virtuosity vocabulary. They have merged Value with Metrics. Please do not snark at this. Look up the two words individually or collectively and you will understand the goal of the oft repeated and revered term “Value Metrics.” Look deeper and you will find it embedded in all forms of Healthcare discussions. Why? Because, starting a conversation from that baseline leads to the merger of the “Moral Values” and “Natural Values.” If you start there, then the merged premise becomes the anchor and the frame of reference. (Definition:A value metric (also called a pricing dimension or a pricing axis) is basically the foundation of your pricing model).

Medicine is both an art and a science. Do you agree? If you don’t, perhaps you might consider reading something else, since your mind is already made up. But if, if you do agree that there is Art in medicine, then stay with me, friend and we shall explore this a bit further.

Assume two patients, both diagnosed with the same bacterial pneumonia are admitted to the hospital for their care. Both of equal age, one with more vigor than the other. Both treated with similar and appropriate antibiotics. The less vigorous one responds while the other requires additional resources to circumvent this rapidly multiplying micro-monster in her blood stream that has established a beachhead and breached the immune surveillance defense. In the eyes of the “Experts”, especially those that sit in cubicles and do some patchwork of “billing denials” (to the order of 12% of all medical bills) in order to thwart the requesting physician from receiving a timely payment for services rendered.  The complex world of the medical industrial complex, has now become the norm. That denial keeps the “Time Value of Money” squarely for the agency (Insurer) and creates 6-12 weeks of Medical Revenue Cycle (wait period) for the Physicians who struggle to meet the payroll. Permanent denials are also handed out because “Value” in the eyes of the “experts” has not been met by the requesting billing physician and if you fail to challenge, you don’t get anything period. Failing to challenge is easy when you are a hamster in the wheel, working 12 hour days and managing this complex medical arcade.  In actuality, given the above scenario, both patients survive the onslaught of their malady, one’s stay was less expensive than the other. The authorities deem the longer stay as the physician’s lack of good care and absence of average skills to manage the condition appropriately. After all, how can the frail person recover quickly while the robust one had 3-4 extra hospital day stay? It must be the physician’s fault.

You might think the same, if you were not well versed in the nuance of each patient’s biology. But reflect on the fact that a minor mutation of one’s gene might have trifled with the protective white cells functional ability to defend against the onslaught. And therefore, the response of one exceeded that of the other. The “Value” as determined by the person in the cubicle was expense based on “Value-Metric” and not the breach in the immune surveillance. Not being educated, how would he or she ever know such a nuance? This faceless person is doing the bidding of the customized checklist manifesto. A manifesto granted him/her by the hierarchy, designed algorithm from a set of other algorithms, strictly based on the IFTTT (IF This Then That) and cost the department, division and the Insurer (Government/Private) oodles of money had to be accurate. Ah, and here these agencies tout, “no emotional Homo Sapien element was involved in the denial process.” What utter malarkey! 

Based on Mandates & Regulations

“Value” as breathed by the “experts” is a relative term and the relativity is based on the hard and finite resource of money, read “Value Metrics.” It has very little to do with the rendered care or the nuance of individuality dealt expertly by the physicians rendering the care.  But alas legion of Twitterati, Facebook and Instagram followers are already sending reams and reams of digital information touting the benefits of such “Value Metrics.” After all they ask themselves, resplendent in their googled knowledge and fully vested with the simple concept of “Less is More” therefore “More is necessarily Less” and therefore should not be “gifted”/reimbursed in any way. They forget that “Less is More” applies to a knowledgeably determined need of an individual and not a capriciously based algorithm combined with a useful idiot punching keys. Less diagnostics have a place in medical care, but less needed therapy has no place in society. Life cannot and should not be equated to money. Equating the two is a slippery slope and leads to life-long trauma on the well-being of an entire society. There is definite need to circumvent frivolous care. But there is no need to reject appropriate care on the bases of cost.

Based on Mandated Outcomes

Another case in point is the Hospital Readmission Rate used to redefine “Quality,” a primary metric (or as previously mentioned of “Moral Value” implying, lesser the rate of readmission means better care apportioned) and then as “Natural Value” (less cost to the insurer and the government) as a secondary metric. It turns out, after this mandate was enforced on Hospitals, the heart failure death rate rocketed up. More people were left to die without care because readmission was frowned upon and the patients if they did attempt to go to the hospitals in distress, were discharged before 24 hours (not considered an admission) or simply turned away from the Emergency Department of the Hospitals. After careful analysis, not a whole lot of “Natural Value” was saved from this “expert’ meme, because legions of more administrative staff were needed to oversee the mandate, but a lot of “Moral Value” was lost. (Read Here)

Based on Minions

And as I have often hollered through my words. The “Cost of Medical Care” in these the United States is not based on the care rendered. It is mostly from the administrative minion costs, be that at the insurer level, government level or at the medical practitioner level. All contribute to the $3.4 Trillion annually. Here again the “Natural Value” of blaming the physicians for the high cost of care is hidden behind the “Moral Value” of virtue signaling by the Insurers and the public policy managers who do not want the attention focused on their paychecks and their “paper pushing techniques.” And by the way, seriously, if one wanted to get all these fat cats and their administrators out of healthcare, the cost of healthcare in the US would drop by at least 1/3rdif not ½. (Read Here)

For now, like the salesman that I met, “Value” lies in the eyes and the pockets of the moneybag “Holder.” 

Monday, April 30, 2018


At the heart of medicine is the expansion of knowledge and its governance. Let us explore that a bit as we go along on this journey together…

First imagine forcing a cotton thread through the eye of the needle; the fibers catch the sides of the eye and the thread twists and turns making the progress difficult. Science too works through fits and starts, from moments of eureka to utter despair. One cannot force a braided thread through an eye of the needle that does not cater to those dimensions. It is akin to forcing a square peg through a round hole. Dimensionally, that is a challenge. So, first some elation; these are some of the tales of human ingenuity forged through diligence and perseverance …

The first part of knowledge is an old streaming phantasmagoria of the past; an acquired information that is understood and then verified. Take Marie Skłodowska (Marie Curie) for example; only one of two people in history to have received the Nobel Prize in disparate fields of physics and chemistry. One has to look at two other greats in science who paved the way for her discoveries; Wilhelm Roentgen discovery of X-Rays in 1895 and Henri Becquerel discovery of the penetrating powerful rays from Uranium salts. From those humble beginnings and pitchblende arose Radium and Polonium via differential crystallization. All in all, a magnificent feat of human endeavor!

Marie Sklodowska

Another simpler time brings back a past shared by a certain Edward Jenner, who through keen observation had determined that milkmaids were somehow immune to Smallpox. His assumption was that the pus from the blisters on the milkmaids’ hands were rendering them immune. Harkening to his mentor Sir William Osler’s advice, “Don’t think, try!” he inoculated an 8-year old James Phippes, the son of his gardener with cowpox and rendered him immune to Smallpox. During the 18th century Smallpox had decimated 20% of the population. In 2015 through vaccination, we have extinguished the disease.

Edward Jenner

Now a couple of tales that don’t get out of the bathtub and make you run naked through the streets…
Top among such human foibles is the Tuskagee Syphilis experiment. Between 1932 and 1972, 399 impoverished individuals with known diagnosis of Syphilis were observed without available treatment to determine the disease progression and timeline. ( Here)  Or another in the name of science was the Japanese experiments during WWII on native Chinese inducing vivisection without anesthesia, induced gangrene, live weapons testing, germ warfare infections, and other such macabre testing in the name of science.  While the story of Thalidomide and children born with phocomilia is well known, ( Here ) there is little heard about a 2007, drug trial with THN1412, a leukemia treatment that caused significant harm and death to the participants.( Here ) Josef Mengele’s experiment on eugenics and twins is another lasting memory of despair.

Tuskagee victims

What would make humans conduct such experiments? It boggles the mind. Yet as the Stanford psychology Professor Philip Zimbardo’s prisoner experiment clearly shows humans when given the power use it without discretion. And to further the damage the ones treated as prisoners develop varied forms of the Stockholm syndrome; acceptance! ( Here )

Today most of the “science guys” are happily running with the banner of “Optogenetics” (modifying the cerebral genes into being switched on and off, on demand. ( Here ) We think of the Large Hadron Collider as a means to discover the “Big Bang” and in doing we as yet have not mathematically or through physics determined whether we might create an abyss that has its own virtual event horizon.
In medicine (you knew I was going to go there, weren't you?) there is the newest version of experimentation that seems to have ignited the mind of the scientific world. This experimentation arrives at us through the aegis of the Economists. To boot they seem to have a predilection to the Keynesian world of thought…It starts and ends with costs!

The driver of today’s experiments is money, period! There is little in the name of patient care and benefit and more in the purpose of costs. Our focus has shifted from one of curing the maladies of yesteryear and today, to the potential only of saving dollars. The louder the cry, the more the economists and their agents seem to be benefiting from such diatribes. They seem to point fingers as they gather large reals estates and flashy, fancy cars, all in the name of public good. The scientific journals are filed with jargon and meaningless pseudo-intellectualism.


The Statin era that created a 20-year enrichment cycle for companies is now falling by the wayside as patents expire and eggs and cheese are no longer considered the bad foods. The “Food Pyramid” once touted by the USDA, the American Heart Association and by the experts in various scientific literature is now flattened into the “Food Plate.” The “Food Pyramid” probably has to share some responsibility in the Obesity epidemic of the 20th and 21st century- if you were inclined to think about it further. ( Here )


As we mightily profess the wonders of End of Life discussions in a myriad of ways that exposes all the virtues of Tantalis, we seem to forget in those many ways how it is to Live our Lives; to take care of ourselves rather than be dependent on the most mundane of newest "studies" that this potion extends survival and that pill rips your rectus abdominus. That, there is fear boiled into every moment of our living by the many informants, is the curse of  this information age! The asymmetry of information is forced upon us as reality. The Orwellian doublespeak is over-polished and rules our days and nights.

1. Learning from history is good if you are not blinded to repeat the past. The answers lie in front of us.

1.     2.  If you experiment use basic science, not the fiat of correlational junk science. Use the correlational data to go further through verification from basic science.

2.     3.  Use the p-values more for the next step in validation rather than as an incontrovertible truth.

3.    4. Expose the economists at their own game…follow the money trails. Fiat (not the car) by any other name is fiat!

4.      5. Always have the goodness for the human, in human experiments, in your thoughts.

5.      6.  Refrain from using experiments as a means of self-enrichment. They eventually get found out and fame is replaced by infamy. Good science will bring its own rewards.

6.       7. Think how to advance the knowledge without harm when you conduct experiments.

And as one very smart person once said, “Trust, but verify” both in human affairs and in science!

Wednesday, March 7, 2018

Finding our SOUL

The other day, I read an article written by a Dr. Robert Baker on “Medicine needs its soul back."  And it got me thinking about the “soul.” After all what is soul? Like the mind, soul has no form or structure, but as humans we believe there is such a thing as soul. After all a former president seemed to have seen the “soul” of a former KGB agent. What he deciphered was only the front of the great red curtain. The stuff behind remained hidden. Yet we as humans are aware of this “essence” called the “soul.” The definition in the dictionary is no better in defining the soul: “the spiritual or immaterial part of a human being or animal, regarded as immortal” or “the essence or embodiment of a specified quality.” We are again tempted into the world of ether. Yet we all feel and think there is such a thing, for all of us in one way or another has seen it. Mostly in the form of another human being. The Hebrew word neʹphesh or the Greek word psy·kheʹ are mentioned widely in the older testament. The term soul has been around since Socrates, Thomas Aquinas and Aristotle, who all battled with the essence of human life. A pause is required to gather the moment into the basket of understanding, perhaps. Marcus Aurelius asked us to listen to our goodness within,’ “the very god that is seated in you, bringing your impulses under its control, scrutinizing your thoughts.’’ Perhaps he meant our “soul?”

It does in the final analysis mean being human. The soul of a human is what drives the desire of that human. But sometime the term is also taken literally as well. For instance, in Air traffic Control (ATC) lingo when one files a flight plan the question posed by the ATC in asking for the number of occupants in the aircraft is, “how many souls on board.” So the FAA takes the term quite literally as materiality.

But getting back to Dr. Baker’s question there is a larger point that he makes; “Searching for the Soul of Medicine” is like searching for the soul of all human beings. At least in the case of medicine, one might look at the physicians and their interaction with the patients. Unfortunately, as the current environment is dictating, a thick and almost impenetrable barrier has been created between the physician and the patient. The physician does not “see” the patient because his eyes are glued to the computer screen that is dictated by the Insurer mandates and the patient cannot in reality “see” the physician because of the insurer wants. Where once insuring was actuarial-based risk pools, now those have devolved into “stake-holder” and “share-holder” benefits all to the detriment of the patient. But that is another story for another day. Adam Smith remarked, “morality could be understood through the medium of sympathy,” but today the whole meaning is wrapped under the influence of peddling sympathy to deceive and obfuscate. The preaching of ‘do as I say’ has nothing to do with ‘do as I do.’

Meanwhile the society continues to creek and moan as the gears are greased by the soulless Victor Hugo’s Morlocks. There is a pause in the state of humanity these days. One can see it on the streets with “road rage” and “anger” belched out in large doses of expletives. It is rampant in the business world, where cronyism caters to wealth, in the scientific world where “studies” are done more for the self and not for the sake of enhancing science but for the sake of tenure and popularity, in law where the client is a means to an hourly pay and in the government where the individual is dragged for the sole purpose of extracting their earned livelihood and pursuing a higher salary and promotion. Many examples abound on all these events that unfold on a daily basis, but the best one is a judge who on presiding over a poor couple’s divorce simply said, “here sign this, the both of you. It’s a simple matter, you don’t have any assets, so no lawyers are involved.”

It appears that the world has also divided itself into camps of sorts. The battles are being fought not for survival but by the survival of a dying or dead ideology; socialism. Those not versed in history are indoctrinated and lulled into the virtues of “free things” and “free time” and “life of leisure” without effort. What they have failed to realize that history is full of such promises of the past that ended poorly. Even today there are examples in the South American continent of a failed state, milked on the potential future of freebies. In 3rd century BC, Zeno of Citium’s “Stoics” held ‘four cardinal virtues;’ wisdom, justice, courage and temperance. None of them seem to apply today to the governors or the governed. Today’s “wisdom” is a panoply of whispers, “justice” is in the eye of the beholder or case law, “courage” is a mass riot and destruction of other’s property and “temperance” is guilty of absence.

About the soul, we turn to dissecting it again. Those ideologues of yesteryears and some today are the soulless monsters that promise the world to the masses and amass power to control the future for their own benefit. Hitler, Lenin, Marx, Mao, Castro, Chavez all come to mind as ideologues with the soulless trait of mind.

Losing one’s soul is the last vestige of reason in our current state of our humanity. If one loses that, which having makes us a species of benevolence and kindness, not having that makes us monsters.  Remember Kermit Gosnell, MD a Philadelphia physician who was charged with multiple counts of murder. ( )
This man seems to embody a soulless human shell with a mind writ large with banal ideations. Unfortunately, there are too many more to count.

Why does our society seem to appear directionless and filled with anger so suddenly? Perhaps it is the lack of human contact? Perhaps it is the plethora of digital things that govern our daily lives? Perhaps the parents are equally interested about the next “like” as the child is and neither knows the travails of the other. Soon the “likes” don’t carry the day and depression sets in. Among physicians, depression is an epidemic. The doctors who have governed and honed their lives in the art of healing are now being told to spend 40-50% of their time answering meaningless questions on computer screens so they can get paid for services rendered rather than tend to their patients. The artful managers have positioned themselves right in the middle to control the flow of capital between the patient and physician. The third-party insurers now control the conduit via the managers and what costs $50 for an evaluation is now $200. And interestingly, $170 of that goes to the intermediaries. This has forced physicians to leave medicine in early retirement, others to seek help to fend off depression and still others to commit suicides. An analogy of the numbers of physician suicides suggest one year’s worth of a medical school graduates a year are lost to suicide. The patients too, walk like zombies from office to office and hospital to hospital in search of a meaning for their suffering, all the while the levers and gears of injudicious commerce move effortlessly, greased for full efficiency.

Where has the soul gone?

It still exists but in small pockets. The larger domain is riddled with soulless deformities. The soulless beings are anchored by their virtue-signaling and holier-than-thou proclamations, yet in that verbosity and displayed anger is the insecurity of one and the desire to be recognized. The fleeting 15-minute of fame, is fleeting. And once that fame evaporates depression sets in. The society as a whole continues to be harmed through the puppeteering by a few hypocrites. Strong words, these, but believe me the monsters exist in our midst. They will take from you what is most precious to you without a blink of an eye without remorse.

So where is the soul?

Find it within yourself. Nurture it. Feed it with goodness and kindness. Find that medium of sympathy and morality and you will find the peace and harmony that accompany them. In there you will find your soul. Live out virtuous lives worthy of a tale told by your progeny by a campfire of the future.

“You have power over your mind — not outside events. Realize this, and you will find strength.” – Marcus Aurelius

Sunday, February 25, 2018

The CADEUSES Serpents

Expressed or implied weakness creates the predator. You see when the unicellular organism, many eons ago, wrapped itself with another unicellular being and created the mitochondrial factory of energy production, a multicellular being was born. Soon the many varied species would emerge as they floated past the waters onto lands and developed pedal motion. The smaller animals evolved into bigger ones and the food fight began for survival. That food fight amongst animals in the wild continues till this day. Man came along and changed the entire paradigm. He developed a little swelling on the left side of his brain called the Broca’s area and soon heralded the “hunter-gatherer” form. His evolving intellect grasped the flint as a mechanism to bring the animals, many times his size, down to their knees that he would need to feed his lot. Soon the flint heads turned into arrows and spears and then into high velocity projectiles. Similarly, as the brain evolved so did the means of transportation. Inventing the wheel created a booming commerce. Soon the beast of burden morphed into a Mack truck capable of carrying a farm load of food and other needed products. Meanwhile man wondered about the wings of the birds and dreamed to fly. The feathered wings turned into wooden slats covered with double layered fabric of the Wright Brothers, turned into aluminum and then into composite material; harder, stronger and more resilient than steel. Today the aircraft are capable of being in the air with hundreds of travelers.

Innovators innovated and everyone else gained from the fruits of their successes, they stood on the shoulders of the giants and built better products. However, today the less intellectually endowed versions of humans have crafted mechanisms for controlling the innovators by placing hurdles, which soon become so large as to quash the flame of innovation. These few middling managers grow in numbers and multiply like rabbits, finding places wherever there is wealth to be made on the shoulders of others. For in the far reaches of the psyche of these people on whom everything is lost, you will find emptiness.

Cadeuses...Notice the Serpents

Medicine in the yesteryears was a simple mechanism of doctor and patient relationship. One called, the Other answered and to the best of his or her abilities fixed the malady that had struck the former. Soon evolutionary products took over and in came the carpetbaggers that had hogged and slowly destroyed the innovator spirit in other fields by feeding their unrestricted desires of gaining wealth in the health care field. These few realized that a whole industry had been created by a stroke of a pen in 1965 with the advent of the Medicare Act. The Government in the United States would be involved in using tax payer funds and placing a safety net for the elderly and the misfortunates. Tax payer funded healthcare was the “Manna” for the Middling Managers. They gobbled it up by creating serpentine paths, as hurdles, between the simple doctor-patient relationship. Their demand was simple, really, to get paid, one must have to do this and that before the check was cut, they said. In 1973 when President Nixon unilaterally eliminated the dollar to gold convertibility, a large number of paper money became available and resulted in the loss of value for the dollar, which now relied on the “full faith of the government of the United States.” The "manna" however, grew exponentially.

While Emerson wanted us to "live amid surfaces, and the true art of life is to skate well on them." He also warned that, "The coarse and frivolous have instinct of superiority." Unfortunately the evil exists below the surface and thrives and grows to ruin those "surfaces." So he went on to suggest, "Let us be poised and wise, and our own, today." Or think for ourselves! For the stem of knowledge to reach the light above, the roots have to drill deep the dark below. 

The cost of healthcare increased exponentially from multimillions of dollars per year and single digit percent of the Gross Domestic Product (GDP) to double digits rapidly. In 2008 the cost was $2.3 Trillion a year at 16.6% of the GDP and not a decade later it is 18.2% of the GDP today circling the $3.5 Trillion mark. A 30% increase!

So one asks a simple question…where does the money go?
To the Patient Care? Answer a little…perhaps 8-10%
To the Doctor Services? Answer about 6% or $180 billion of the $3.5 Trillion. Then, where does the rest go? To answer that, perhaps one should look at the Administration and the Middling Managers that have warmed millions of seats and sit cozy behind desks looking at the screens as their pensions pile up. And some of it never gets past the Insurer enclave.

In 2012 alone that segment garnered around $385 Billion of the $1.2 Trillion of the CMS expenses based on some estimates. One can only wonder what the tally is today, that is, if real GAAP measures of financial practices were used and not some other measures that use “goodwill hunting” in financial sheets. And here is the ultimate rub, everything the experts do is largely based on estimates and probability. Nothing is concrete!

The costs of healthcare increases steadily and the carpetbagger fat fingers of instability keep pointing to the cost of patient care, doctor charges, drug costs etc. But those are false dichotomies mostly. Yes, drug costs have gone up in cancer but only to the tune of $38 Billion and that represents 0.01% of the $3.5 Trillion. You wonder why Amazon, Buffet’s Berkshire Hathaway and J.P. Morgan are running after this train? Think again! They want to be the "intermediaries" between the patients and their physician too.

"In Medicine what has happened is even a worse travesty for all our patients."

The Predators here are like serpents, they continue to raise the bar of how much something costs in isolation but never really look at the whole ensemble. Serpentine paths by these serpents is to delude the easy mind and obfuscate the busy mind. And then to boot, they advocate groupthink, collaboration as the only means of progress. Hmm…Apparently, critical thinking is for the conspiracy creators and that needs to be vilified.

In Medicine what has happened is even a worse travesty for all our patients. They are lead to a primrose path of insurability as equating to care, with high annual premiums ($14,500 per family of four) a CoPay of $50.00 for each “encounter” and one has to reach the threshold of “$6,500.00” deductible (or $21,000.00 spent) before a single insurance cent is paid out. All the while the Health Care Insurance Companies are sitting on Market Caps in the many hundreds of Billions (below). And the CEOs are earning handsomely in the Millions.

Company 2018 in
2016 CEO Salary    Million$
United Healthcare  $         222.71  $                 17.80
Aetna  $           57.39  $                 18.70
Humana  $           38.74  $                 17.00
Well Point  $           60.40  $                 17.00
CVS  $           69.05  $                 15.07

But that is not where I am going with this. You already know this. There is another path that often eludes the eye. The cost-controlling managers realize that the only way they can make more money is by reducing costs even more. So they take the next step…

" some cases, has now been equated to 10 years of education and many more of experience with the stroke of a pen!"

Enter the artificially created “Physician Shortage.” This shortage is accrued as the population of the United States grows. The total number of Medical Students remains the same or even dwindles. Additionally, when two new Medical Schools came online a few years ago, the Residency spots to help the physicians hone their skills under a mentor’s tutelage remained the same so some of the newly minted Medical graduates could not find residency slots and had to waste a year of their lives waiting to be “matched.” Meanwhile most of the graduates were indebted with at least $300,000.00 of school debt. So, the “Market-Makers” of Medicine decided in their supreme intellect, again “for the public good,” to allow a larger portion of Nurse Practitioners, Physician Associates and the like to practice medicine. Initially this was under the supervision of the physicians, now, not so. Under pressure from the media, the States are clamoring for action and their legislators are signing bills upon bills to let these paramedical staff enjoy the “privilege” of independent practice of medicine. 2-year of schooling, in some cases, has now been equated to 10 years of education and many more of experience with the stroke of a pen!

"Remember the artful, fear-mongering media mavens talking about “medical errors were equal to a jumbo jet crash every week?” Well get ready for the metaphorical 2 or 3 Airbus 380s going down a day!"

Yet all actions have consequences, don’t they? In this case it appears that the very costs the Managers were trying to reduce has skyrocketed. The Diagnostics under the paramedical staff has spiraled upwards because decision making is based on knowledge and experience and lacking both, one flails with irrational ideas and keeps the patient locked up in a mind game of being "ill,” with more and more tests. The differential diagnosis goes on and on in perpetuity…
Remember the artful, fear-mongering media mavens talking about “medical errors were equal to a jumbo jet crash every week?” Well get ready for the metaphorical 2 or 3 Airbus 380s going down a day!

Meanwhile pouncing on the costs, their fingers are ossified in place against the physicians. A bevy of acronyms plague the scene such as; PCORI, MIPS, MACRA, EHRs etc. The Physician is practicing today with both his hands tied behind his back, one eye on the computer screen and the other looking over his shoulders at what is coming next and where he might not step into and be fodder for the army of finger-pointers. O’ woe to him or her that does not understand the folly within these actions.

So what of the serpents?

They are everywhere; in pinstripes, flannel, skirts and flowery dresses. These serpents crawl in the halls of power, dismantling a life-long work to the community with the stroke of a pen or press of a computer key, ending a professional life.

Within the medical profession as well there are many serpents feeding and growing in size. These clever ones or so they think, hide behind the façade of sniffing out the “public good.” They create hurdles upon hurdles which can only be surmounted by paying them a grandiose fee of a few thousand dollars periodically to allow the physician to stay within the confines of their medical practice. You see, these corrupt intransigents have created a wall of good will through lobbyists and gained the well wishes of the policy-makers to make physicians subservient to this shell game of “Certification.” The American Board of Medical Specialties and the American Board of Internal Medicine in cahoots with American College of Physicians and the American Medical Association have decided that constant testing has to be done every year of the physician to maintain their medical edge and the certification. To pass these tests, one has to go and spend time and pay monies to learn the answers to the potential questions being posed in the tests. The gig has garnered a mere $134 million in less than 10 years for the ABMS/ABIM and untold revenue for the ACP in their “Exam Preps.” Experts cannot be refuted because they use complex rationalizations to thwart any opposition. They do so in unison, because power lies in their collectivism. As Theodore Darylimple (Anthony Daniels, MD) a retired UK prison psychiatrist states, They (intellectuals) use the “dark art of suggestio falsi and suppressio veri," to advance their agenda.

You see dear reader, tyranny is enacted in many ways, and not only by material force. Any irrational absurdity imposed upon the governed without their consent is still tyranny. This form of tyranny prevents the symphonies being played out in a blank slate of silence in the human mind. The mind is cluttered with nuances of useless thoughts. Innovation and desire become subservient to fatigue and chaos in the mind and physicians leave their vocation and get “burnt-out” from tyrannically imposed untested theoretical regulatory fiats, or they commit suicide. The Angel's feathers are fraying as the serpents grow in size. A reckoning is coming, if it is not already here.

Interestingly, while these self-imposed experts keep talking that physicians should not be paternalistic with patients in their care, they force their own paternalism upon their own peers.

"Innovation and desire become subservient to fatigue and chaos in the mind and physicians leave their vocation and get “burnt-out” from tyrannically imposed untested theoretical regulatory fiats, or they commit suicide."

Medicine has become a place of groupthink and Mediocrity instead of a place of Meritocracy and excellence. The Organizers have command over the Organized. The insurers and their Managers have scrubbed off Adam Smith’s Invisible Hand. They have imposed price controls and created shortages only to allow their own egotism to flourish and gather stream as they pocket wealth in their deep pockets. They forget that for a concept to endure, it must have discrimination value, absent such value, the concept should wither. But they pile on and on their failing concepts, because a lot of future earnings are relying on their deceipt.

A nation of innovators and Risk-takers have turned into a nation of poll-takers bending to the whims of their personal self-serving needs.

Dissecting the anatomy of this terrible cancer reveals a plethora of bleeding blood vessels supplying the wayward cabal of individuals, that grow in size and number and ultimate power to usurp the rights of every patient and their physician in these, The United States of America. To make medicine what it was meant to be, one has to use ligatures and cut off the blood supply to this cancer!