"SIGNIFICANCE"

When significance had meaning

It was quite significant

Numbers meant something

Words held meaning.

History was history

Unconsoled and real

The past was magical

A teaching comfort.

But, no more

History needs tweaks

Statues need demolishing

Books rewritten and relearning.

Nothing is significant

Nothing has meaning

Only that which is implied

Repeated often, falsehood turns to legend.

The man of Statistics

Lives by manipulation

Reaching for Outcomes

That remain meaningless.

The man of Medicine

Lives by some numerical value

His patient dies

From that same numerical Value

A new Medicine is born

Filled with high praise

Lauded for its magical value

Tested in society, where it fails

No harm comes to the innovator

As she lives the dream

Beset with hubris

Concocting another miracle 

The man of Politics

Lives in his cagey bubble

Cajoling and promising

Tethered to the pols of similar “significance.”

The man of Science

Rewards himself with finery

Consenting to an aura of respect

Deeply rooted in statistical significance

The man of Cloth

Measures the winds of change

Is inspired by 

The men of Statistics and Politics

The average Working Man

Comes home to a cold meal

Living a diminished life

And is disdained by the lot

What has become of Society?

What has become of Society?

What has become of Society?

What happened to Society?

ABOVE ALL QUESTION!

We know that Iron does not turn to gold. We do, don’t we? And that Stone cannot be converted to plastic. No disrespect to either the stone or plastic. Both are held in equal regard. After all billions of pounds of stone is the fundamental foundation of the Pyramids and plastic is the modern-day ubiquity, hailed and maligned simultaneously.

But if you did believe in alchemy and magic then this is the right place for you to come and be exorcised. 

From John Ford’s movie, “The Man who shot Liberty Valance” comes the age-old quote “when the legend becomes fact, print the legend." There is so much truth oozing out in those words, especially in these modern days in this age of highly evolved civilization. Snarky as that might sound to some and others, it is the elemental truth of the day, these days.

Manipulating someone takes a calm shrewdness and calculated but persistent endeavor. It happens in everyday life, be it in science, politics or even and perhaps especially in medicine. We will deal with the two bookends around politics and you are free to draw your conclusions on the politics of today. I will not lurk there to ruin anyone’s day.

Science is real. It is based on empiricism. It is also based on trial by error. In that solemn enterprise it also is fleeting. The empirical methods change, and a more robust mechanism is realized. Take the Wright Brother Flyer for instance. A trial by error by ingenious bicycle makers that cost at least one life in the process of powering the first flight, today, we have arrived at behemoth aircraft weighing millions of pounds, capable of carrying hundreds of passengers far, far away from their homes and back. Each step of the way to here, there were errors and each error made for a more robust innovation. Learning from errors is how science advances. Science changes as new tools of empiricism emerge. Thus, emergence is nothing more than gaining a new solution to a tired old problem. In the case of the Wright Brothers, it was that man can fly on powered aircraft. But they also stood on the shoulders of Otto Lilienthal, the German aviator who soared several times on non-powered gliders. And innovation is nothing more than building on the past.

The alter ego of science is pseudoscience. Even joining the two words is blasphemous at best. Science is purported to be reality based on the current assessment of available information seen through the lens of expectation. The term pseudo is the forced evil twin who imposes restrictions on science by creating false legends and then printing them as science. Let me give you a few short examples;

1. The Food Plate was boasted as the nutritional equivalent harbinger for good health and endorsed by none other than the largest of the medical societies. Turns out that 60% carbohydrate base in that pyramid created an untold calamity of obesity and chronic illness such as diabetes, hypertension, stroke, heart attacks and cancer. So much for Nutritional guidelines. Given the green light, breakfast became a sugar haven for children via colorful sugary cereals and other delights. Adults meanwhile pursued the sugar through cans full of colas to meet their Average Daily Requirement. The Legend had been printed and it took many a year to realize the damage done.

2. Blood Letting was the manifest therapy of most maladies, when a doctor was faced with an insurmountable illness and no known therapeutic modality was available and few were other than poltices. Sometime the first and last resort of action was “blood-letting.” But let us not judge too harshly, “blood-letting” started by the Egyptians in 1000BC and continued on till the setting sun of the 19thcentury. A lot of harm there was done, except for those with undiagnosed and in those times possibly unknown, patints with polycythemia or those with Hemochromatosis, those few might have been helped. This treatment might also have been the proximate cause of death for some Presidents of the United States, including George Washington.

True Science is about questioning. It is about the wrong questions not about the right answers that knowledge is furthered. It is about skepticism. It is about advancing the knowledge and not about prostrate obedience. Today, some crafty individuals have taken the mantle of establishing organizations for the sake of minting large sums of money from various segments of society using the art of pseudoscience. These carpetbaggers have a unique mechanism of action. They create a product in vacuum and then become the arbiters of expertise. They decide another’s aptitude based on false empiricism. These few have grafted themselves into positions of power and have merged with larger powers, by convincing others that they alone hold the right and might to determine what’s right. In so doing they have amassed large sums of money for themselves and used that accumulated wealth to further their plans through lobbying for more control. They cite their false legends (self-created body of information lacking scrutiny or veracity) and print them as fast as they can to parade them as evidence. They are indeed a body of falsehood and evil. One such example in the medical field is the false promise of continuous certification and the maintenance of such certification. These organizations are folded under the umbrella of the American Board of Medical Specialties and they are under fire for falsehoods, coercion and other bad acts against physicians in general. The ugly truth of their large sums of monies held in places offshore and the large salaries commanded by the few that work in this organization to keep this false enterprise going, is the premise of the multiple legal actions against them.

Then there is the influence of statistics in medicine, which has been of equal harm in patient care. Medicine is practiced mostly under the best known and available evidence. That evidence is both of scientifically validated in nature, as well as intuitively known to those practicing the art and science of medicine in caring for the patients on a daily basis. Unfortunately, as the tools of statistical rigors were massaged over time, and means of means became the means to determine benefit of certain medicines, intuition has atrophied under guide of guidelines and wisdom has become a shell of its former self.

Many if not most, bowed to the gods of statistics as more and more massaging of a poor result in empiricism was heralded as the Second Coming against disease. But as all things are shaped by time, this one too has lost favor under tighter scrutiny. More physicians are trying to dig into the roots of the given answer and not just the colored leaf shown. Meanwhile the creators of this logic continue to march and berate those that defy their “Evidence.” Unfortunately, the emergence of truth is never timely, yet it always raises itself in the face of unseemly and irreverent acts.

Science is meant to be questioned at every step of the way, not swallowed as a pill of satisfaction. It is to be teased, pulled apart piece by piece to unearth that which will hold verification and can then be validated until newer tools and information emerge. We as humans advance by standing on the shoulders of giants to see that which cannot be seen. And each giant of the field learned his or her wisdom peering at what others were doing or had done. Watson and Crick advanced the DNA helix, not through the force of epiphany but on the crystallographic radiograph by Rosalind Franklin. Marie Curie had Antoine Henri Becquerel to rely upon as her muse. There is passion and persistence in remarkable discoveries as there is passion and persistence in great art too. It took Leonardo Da Vinci 13 years to finish the “Mona Lisa” painting and get the face to smile and smirk at the same time.

The quick fix methodology of the pseudoscientist, who are forever in a hurry, because charlatans do not want to be exposed nor do they want to lose the prize, do not care for the truth. Their aim is the financial prize.

Indeed, above all question! No one has said it better than this wonderful physicist Richard Feynman, “I would rather have questions that can't be answered than answers that can't be questioned.”

HUMANS TRAPPED BY AUTOMATION

Our minds 

resolve to adapt to our surroundings fairly quickly. Imagine my surprise when the Air Asiana jumbo jet came crashing down on San Francisco's Runway 28L in pieces strewing metal and bodies all over the runway. It was a shock of disbelief. In this day and age where Auto throttle and Autoland features are redundant in the airliners, why would this happen?

The answer was quite simple, horrific as it was; The Pilots had relied on automation to the point of dependency. They had been managers most of their pilot life in the airlines and given the redundancy of the equipment and it’s stellar history, well, the corporate offices of the airlines, figured it better for the aircraft to do its magic without the interference from the pilot. Sure enough the Instrument Landing System on the SF Runway was out for maintenance and the pilots were given instructions for a straight-in “Visual Approach” to the Runway 28L, that they were unable to manage.

The excerpts below on Air Asiana flight #214 are from the NTSB: https://youtu.be/zTXDalv7kNQ

“The flight was vectored for a visual approach to runway 28L and intercepted the final approach course about 14 nautical miles (nm) from the threshold at an altitude slightly above the desired 3° glidepath. This set the flight crew up for a straight-in visual approach; however, after the flight crew accepted an air traffic control instruction to maintain 180 knots to 5 nm from the runway, the flight crew mismanaged the airplane’s descent, which resulted in the airplane being well above the desired 3° glidepath when it reached the 5 nm point. The flight crew’s difficulty in managing the airplane’s descent continued as the approach continued. In an attempt to increase the airplane’s descent rate and capture the desired glidepath, the pilot flying (PF) selected an autopilot (A/P) mode (flight level change speed [FLCH SPD]) that instead resulted in the autoflight system initiating a climb because the airplane was below the selected altitude. The PF disconnected the A/P and moved the thrust levers to idle, which caused the autothrottle (A/T) to change to the HOLD mode, a mode in which the A/T does not control airspeed. The PF then pitched the airplane down and increased the descent rate. Neither the PF, the pilot monitoring (PM), nor the observer noted the change in A/T mode to HOLD.

As the airplane reached 500 ft above airport elevation, the point at which Asiana’s procedures dictated that the approach must be stabilized, the precision approach path indicator (PAPI) would have shown the flight crew that the airplane was slightly above the desired glidepath. Also, the airspeed, which had been decreasing rapidly, had just reached the proper approach speed of 137 knots. However, the thrust levers were still at idle, and the descent rate was about 1,200 ft per minute, well above the descent rate of about 700 fpm needed to maintain the desired glidepath; these were two indications that the approach was not stabilized. Based on these two indications, the flight crew should have determined that the approach was unstabilized and initiated a go-around, but they did not do so. As the approach continued, it became increasingly unstabilized as the airplane descended below the desired glidepath; the PAPI displayed three and then four red lights, indicating the continuing descent below the glidepath. The decreasing trend in airspeed continued, and about 200 ft, the flight crew became aware of the low airspeed and low path conditions but did not initiate a go-around until the airplane was below 100 ft, at which point the airplane did not have the performance capability to accomplish a go-around. The flight crew’s insufficient monitoring of airspeed indications during the approach resulted from expectancy, increased workload, fatigue, and automation reliance.”

On the other side are the Lion Air and the more recent Ethiopian Airliners that were both struck with tragedy. Both seemed to be the result of a new automated system: The Maneuvering Characteristics Augmentation System (MCAS) is an automated safety feature on the 737 Max 8 designed to prevent the plane from entering into a stall, or losing lift.
https://phys.org/news/2019-03-ethiopian-airlines-mcas-boeing-max.html

The potential of the new automation seems to have played a part, at least in the Lion Air information and the flight paths and behavior of both aircraft, on Radar seem to be identical, indicating the ghost of the MCAS automation within the silicon chips may have created the maladies that either crew of the two airliners were untrained or unable to handle. Important to note, a flight crew had successfully interrupted the automation from the MCAS system in a previous flight prior to the Lion Air tragedy.

Lion Air:  
https://www.bbc.com/news/world-asia-46373125

Ethiopian Airline: 
https://www.cnn.com/2019/03/10/africa/ethiopian-airlines-crash-boeing-max-8-intl/index.html

“Click, Click and Click, Click” is what the Chief Pilot of the American Airlines stated in this great video, “The children of the Magenta Line.” It is worth a watch and explanatory of our continuous dependence to a greater degree on automation.

https://vimeo.com/159496346?ref=tw-share

or click on the Blue icon "Watch on Vimeo"

Children Of The Magenta Line from SKYbrary on Vimeo.

Tesla on the ground seems to be having some trouble on the roadways as well. It seems that the cohabitation of robotics and humans has to be synchronized to the degree that both sides; the silicon chips and the Grey Matter, have defective understanding and that the Grey Matter side better be better prepared to reconcile any anomalies that might arise in the chip algorithm command. “Click, Click and Click, Click” to disconnect the Autopilot and fly by hand while resolving the anomaly.

The other side of this automation in keeping personal data safe is also wreaking havoc; routinely we hear of data breaches in the digital medical record keeping business. Millions have their personal data exposed those who will sell it for nefarious reasons. Increasingly the younger generation by a 55% margin seems to think that allowing giant digital corporations to know everything about their personal life is ok, since, they do “nothing wrong.” The fallacy of this thinking is blatant if one is to reason through. Innocence is determined by the current vogue in thinking. What is acceptable in the 2010s may be considered lunacy in the 2020s. So imagine your chagrin when all the “clouds” are combed over and voila, your innocent mischief is now considered a crime against humanity. The #Metoo scenario with the advent of past and present digital records is playing out even against those who initiated this form of societal justice. Real-Time video manipulations and other assorted nefarious tricks are creating animosity amongst the best of friends. Sad reality from such nefarious actions abound in the world today.

1. It is perhaps not necessarily being a luddite that one gains some protection, but from common sense usage of the grand scale digital universe. Keep your personal information to yourself. (FYI)

2. Personal Information in today’s world is equivalent to your life’s work and acquired assets.

3. Monitor Automation but don’t let it rule you.

4. Keep a healthy respect for all automation. Be it in aircraft, cars or even medical devices.

5. Remember the Software was written by humans.

6. When in doubt, OVERRIDE the automation.

7. A single nucleotide misplaced/inserted/ deleted can cause a calamity of cancerous proportions, so can a single digit inserted/deleted/misapplied can cause the algorithm to cause the robotic maneuver to stop dead in its tracks.

Above all learn the discipline of Reason and Critical Thinking. Life is short and Learning is fun. Read, write and spread that honest joy around.

SILVER SPOONS & ILLNESSES

Silver spoon feedings have an allure of wisdom, intelligence and success conferred upon the parents because of their diligence and hard work in paying for them without regret. With silver spoons come some very surreptitious little gremlins that I plan to explore today with you. You may not like what you read, but then I wasn’t one to walk behind the piper either. So here it goes.

THOUGHT # 1

My first thought was, why are younger adults being diagnosed with Colon cancer? Provocative as it is, it is also very true. About 140,000 cases of Colon Cancer are diagnosed every year in the United States and of those 90% are in the older adults, here defined as over the age of 55 years. However, the 10% of the younger adult their incidence seems to have escalated. 

 "The 2017 ACS study found that for adults ages 20 to 39, colon cancer incidence rates increased by one percent to two percent per year through 2013. In adults 40 to 54, rates increased by 0.5 percent to one percent per year from the mid-1990s through 2013. The death rate among young adults ages 20 to 54 has been increasing since the mid-2000s"

This is not only alarming but also gaining attention as a serious health risk for the entire nation. So, what gives? Why did the rate of colon cancer in the young ones suddenly jump? Although many explanations were advanced, such as genetics; a common one when all else fails, perhaps alcohol and cigarettes; a catchall in almost any cancer. There seems more to this conundrum than meets the eye. To my simplistic thought it is the increased “colonic transit time.” What that means is that there is a slower transport of digested and undigested food through the colon that causes the colonic crypt Stem cells to come in contact with the foods for a longer time and the altered microbiota because of the modern “open the box, filled with carbohydrates and other wonderful processed chemicals" diet. The stem cells have unlimited growth potential and create a fast growing difficult cancer to treat, on the other hand the cells higher up on the crypts have the growth potential limited and thus can create large polyps without turning into cancer through similar contact. In addition to that little change there is also the fact that the younger adults sit for longer time gazing fondly at their latest tech marvels that delivers oodles and oodles of useless information and after their eyes have become accustomed to thicker reading glasses thrust upon them, they add more misery by spending the rest of the time playing video games in their armchairs. So not only the poor diet, the changed microbiome in their gut (that’s a few trillion bacteria in the intestines) and then to add insult to injury a slow transit of this fecal mass through their colons because of sedentary status.

You might be saying, he can’t be right? It cannot be so simple? But as I said before it is my thought and you are reading it. There might be some fallacy in this simplistic logic but new data seems to corroborate what I just said and here it is… (READ) https://academic.oup.com/jncics/article/2/4/pky073/5301781

A very simple and easy cure is to add some healthy fresh food to the diet, reduce the caloric amount to 2000 or less a day, unless you are a body builder or training athlete and learn the art of daily walks, runs and a trifle bit of weight training. Stop eating the carbohydrates rich foods period. Our bodies were designed for feast or famine because that is how hunter gatherer social contracts came to be. Now there is a constant state of feast and the body has not had its equal measure of protection from the famine as in involuntary famine. So, here is another tiny bit of a pearl; Fast for short periods, it keeps the microbiota stress levels low and the colon doesn’t have all this junk flowing through like flood waters every day.

THOUGHT  # 2

Switching gears, I came across another thought. Why are children getting more and more allergies every year? The experts have all sorts of explanations about the air and the water and the foods and the allergists have a field day, fielding hundreds of younger patients walking through their doors sneezing bucket full of their inhales. So, one SHOULD wonder why?

Applying the Occam’s Razor to this whole thing, I find an easy and simple understanding behind this scourge. There is 1 in 13 children who has allergy to one or more foods. Centers for Disease Control & Prevention reports that the prevalence of food allergy in children increased by 50 percent between 1997 and 2011. Between 1997 and 2008, the prevalence of peanut or tree nut allergy appears to have more than tripled in U.S. children. Alarming to say the least. Again, one has to ask the question, WHY?

The Silver spoon comes to mind. The society is so fearful of infections that parents treat their children as bubble children. “Don’t touch that, don’t eat this!” A common refrain. Children are kept away from peanuts and other foods because of the risk of allergies. Airlines don’t even hand them out, in case someone might touch the feared hypersensitizing monster out of the shell. But it appears that, that might be the very cause of the allergies later. The young child never having being exposed to the offending agent, when he or she finally comes in contact with it, the antibodies come out in droves. The B cells having ever tasted the offending epitope realize the body is under attack, liberate tons of immunoglobulins, and the battle ensues within as the T cells arrive to partake in the battle royal.

Why would the Immune cells be so primed, you might ask?  Easy Watson! We as a society are correctly concerned with viruses and their wrath. The FED and the States have mandated various and sundry vaccination schedules on the children. These vaccination schedules incorporate multiple doses of vaccines starting from the age of zero to 9 years. The immune system is jazzed to protect against these viruses but anamnestic responses to other antigens because of minor mismatch between the viral shell and the say the peanut epitope can cause a horrendous hypersensitivity reaction (or anaphylaxis) landing a child in the hospital needing emergency epinephrine. Parents with children with allergies carry expensive Epipens (There is story of financial fraud upon patients here that has been reported through the years) as a safeguard against such an event to save their child’s life.

How do we fix this problem? Perhaps let children be children and let them play outdoors, breathe fresh air, feel the earth and experience the antigens in small doses to be resistant to such maladies when they grow up. A study about exposure to cow’s milk at an early age 2-4 months reduced the risk of cow’s milk allergy later in life, sets the stage well. Ruchi Gupta, MD wrote an editorial suggesting exactly this, that early exposure even during pregnancy if a mother consumes peanuts the child will grow to have no risk of developing the allergy to the peanuts later due to the antibodies exposed to the infant and their immune system's recognition of the same through the placenta. (READ)
https://www.ncbi.nlm.nih.gov/pubmed/20541249 

Perhaps the Austrian doctor was right when he wrote that children who eat their boogers have stronger immune systems. It was further corroborated by the American Society of Microbiology and reported in this study by the NIH paper (READ). https://www.ncbi.nlm.nih.gov/pubmed/25344244

We are well past the time of the wisdom of the Azande people of Central Africa who believed that the burnt skull of the red bush monkey was an effective treatment of epilepsy as equally we are well past the pronouncement that early through late life avoidance of peanuts (for instance) prevents hypersensitivities. Quite the contrary, small exposures strengthen the immune system against the potential allergen and the immune system recognizes the allergen and accepts it rather than rejects it. The current treatment after acquiring an allergy to a food substance is to desensitize it by slow incremental addition to the food product in the diet. There that should tell it all!

Silver Spoons have their unintended consequences and we need to be aware of them. Let the children be children and go explore the world in more than a thousand different ways. As far as experts go, Chekov said it best,“When the ground beneath shifts, the first it fells are those that stand tallest in it.”

As Spock said, “ Live long and Prosper.”

The Warp and Woof of our FIRST CONSCIOUSNESS

"A cache of a thousand Obligations"

I did not invite it, but the thought occurred to me the other day; How linearity has changed human society. Simply put applications of linearity have increased our productivity and assets, in mechanical things.

Take for example the automobile industry, from the Ford Model T to the Porsche Panamera is a series of incremental improvements. The Model T had a 177 cu in (2.90 L) inline 4-cylinder gasoline engine, producing 20 horsepower. The Porsche Panamera twin turbo V8 engine (8-cylinder engine) produces 500 horsepower. Quite the change! Of course, there were a host of improvements in safety and ride comforts that evolved during the ensuing 110 years, not forgetting the 0 to 60mph in 4 seconds.

Another example of linear increments in design and efficiency is the aircraft industry. From the Wright Brother Flyer (WBF) to the modern-day Lockheed Martin YF22 (Raptor) or YF35 (Lightning) are examples of advancement.

In both these cases humans experimented and learned from their mistakes, and there were many. Aerodynamics is played out in 3 dimensions and minor mistakes are magnified manifold. 

Humans have discovered through time all different ways to crash an airplane. But each accident is studied for the benefit of the future pilots and passengers. Issues related to metallurgy, how much a metal is able to withstand the heat and internal pressures of generating thousands of pounds of thrust in a self-contained power plant? From a 180-pound weight engine in the WBF aircraft 

to the modern GE CF90 high bypass jet engine that produces 127,000 pounds of thrust, or in simplistic terms, has a whole lot of horses in it. 

Artificial Intelligent models based on a small set of variables are wonderful in aircraft control, take the Autopilot capabilities that can manage to keep an aircraft on a decided flight path from 200 feet above the runway and back to the runway in zero, zero visibility in Category III ILS approach. Add that to the Autoland feature and the aircraft will also come to a stop on the runway.  That was a giant leap in engineering. The mechanics in the mechanism are written codes based on linear behavior of IFTTT. These are obligations easily met and validated. They are based on mechanics and artificial mechanisms. There is no blood coursing through the veins or electrical spark weaving its way jumping across neural sheaths via the axons. No these are gyros and actuators and bearings and valves that have strict specified instructions and modes of action.

Linearity then is the hallmark of advancement in mechanical things. You have a hypothesis, develop the proof of concept (POC), experiment with it in different conditions and environment until all the boxes have been checked and then let the public partake in the new shiny asset. Things fail and as they do, more studies from the loss are determined and modifications ensue for an incrementally better product. Simple, QED.

Humans being humans, will interpret from one industry and try to lay claim on another. The classic example being economics. There are a boat-load of economists sailing in the vastness of this ocean, who determine the future of the monetary and fiscal policies. They use “data” from the markets and human behavior (called behavioral psychology) and determine what lies in the future. Market actions are tied to human behavior therefore study one and the other shows itself easily. Or so it seems. And just like a coin flip, these experts are lords for a quarter basking in the sparkle of the moment, having guessed correctly. And, in the toilet, the next when they fumble. The reason they flub is to correlate the linear mathematical models that have helped create machines that live by the rules of metallurgy, mechanics and run time, to the waffle-zone of human behavior. As any investor or trader in the markets knows, past performance does not guarantee future results. Yet these intellectuals don’t learn well. They just keep upping the ante with new books and promises all based on a single good call, basking in the sunshine of the survivorship bias. But then who am I to contradict the messages from up on high. Some books claim their author made millions from $2000 while others keep upping their net asset values for the blaze and glory of one up-man-ship. What matters if a homeless goes hungry for the night.  Here is the link again... https://www.theguardian.com/money/us-money-blog/2014/jun/29/economists-wrong-fed-report-flaws-meaning

As if that was not enough, there is a large cohort of individuals some schooled in medicine and others in business and others in high places of finance who have deemed it necessary to apply the same science to our health. Imagine the hubris in that. And, you know what they have come up with? A more formal idiocy of juxtaposing caring with cost containment. They have tied the mechanics of machines into the workings of humans. What could go wrong with that assumption? One wonders? Their continued gambit as mentioned, is based on cost containment and their first salvo is …

The Depart of Population Medicine at the Harvard Medical institute

Population Medicine, in other words “One size fits all.” Or, given a set of studies in a small number of people, why not scale it to the general population of 7.2 billion people (strictly speaking in the U.S. but spreading globally at the speed of similar thought). Forgetting ePluribus Unum for the moment, they have shifted into the cost-containment assembly-line of bureaucrats and administrators who team to determine what is good for the individual patient rather than the determination of the individual’s physician. The new dictum for the doctor is, “Review the computer data, check the box and the computer will spit out the best generic medication” their codified language is, “best bang for the buck.” If the doctor were to deviate from that, then all hell can break loose for the poor soul, both in the court of law and tattle-tale(d) by the insurer to the Medical Licensing Authorities. Fines, Suspension and Revocation of the privilege of managing patients (license) is the determined penalty. Oh, I am remiss in not laying that foundation; there is a person on some of the Licensing Boards from the Insurance company keeping the members of the Board abreast of who is following the guided dictum and who is deviating (and costing the Insurer more money) and therefore must be brought to his or her senses. One is reminded of the Latin phrase “Quis custodiet ipsos custodes?” Physicians these days are encouraged to follow the population-based guidelines. These guidelines are based on some variable and some flawed data under the guise of Evidence Based Medicine. Unfortunately, the “Evidence” mentioned here is the shifting sand. In the days of yore, past actions and treatments were soon ignored for their faults or lack of efficacy and newer managements were acted upon by reasonable and wise physicians. Not so in these days. Wisdom is found only on the computer screen. If the guidelines laid out are not followed, then the Insurance agency has the whipping power to deny care and it frequently does to the detriment of the individual patient. If multiple denials are enacted upon, soon the Licensing authorities are placed on alert and the parrots start chattering.

Another ongoing onslaught, and becoming more widespread on a day to day basis, in healthcare is the use of statistics. Using minor deviations from the means of means (average of averages) in small subsets of patients, is to claim success with marginally beneficial but extremely expensive drugs. With this slight of hand, large sums of money flow the pharmaceutical industry’s way. But as human behavior would wont to, gaming in statistics is a game for the throne. Becoming a CEO and staying as one, there is a lot of pressure to perform and maintain the million-dollar salaries and bonuses. This is a slight of hand that slights the lives of the many. A selfish thought transmuted into harmful action. A few live in luxury and the many weep in solitude.

For posterity's sake here is the link again... https://www.axios.com/the-sky-high-pay-of-health-care-ceos-1513303956-d5b874a8-b4a0-4e74-9087-353a2ef1ba83.html

Outside of human greed, the question still falls into that bucket of “why would you?” I mean why would you use a linear mathematical modelling template and ascribe it to human behavior, health and disease? Some say, it is inevitable that Artificial Intelligence will be upon us and make us more productive? And they claim life will be wonderful. Perhaps so, but there are a lot of sunrises before we ride into the “Matrix” sunset. Artificial Intelligence works best when it deals with a single variable or two. Throw the human brain, filled with desires, wants and actions, into the warp drive and AI will jettison itself like the ejecta from the neutron star, taking the human race with it. Some debate the benefits of logit a non-linear regression model cures these ills. Linear Regression models and Logit models are different they say. Yet, they are all arrived at from the same premise of a few variables in a small subset of individuals; to prove a conjecture (with the oft glorified p-value). What matters if a patient goes without proper care, without proper medicine, without the protective eye of a physician?  The argument of non-linear regressions as the focal point as an argument is vacuous at best. There is no form to feel. It cures no ills. It only raises the specter of the probable. Regressions are based on past data and forecast the potential of the future. Check your weather forecast for tomorrow and then experience it, you will know what I mean. A 20% chance of rain sometime turns into a wind-blown storm. A one-inch snowfall turns into two feet of unplowed streets. Ah, the butterfly wings! And by the way, the large arrays of parallel servers used for weather forecasting filled with algorithms are at work 24/7 whirring and whizzing away at peta-bytes of recent past weather data. While I am at this, let me spell out this little gem…The Artificial Intelligent models are created by software designers who are biased towards their own tiny, imperceptible bent. So human bias is always the suspect in all these probabilistic decisions meted out in percentages by the hardware. There is no restraint of culture, habit or nuance only the chips and the digital dust. Ultimately what Henri Poincre’ once said is true, “An outrage against common sense.”

As humans we have a cache of a thousand obligations thrust upon us and this cache is constantly being revised and burdened, just like the Windows program in PCs. More lines of code are being constantly added to the software without much pruning. More is thrust upon us from up on high than can be borne by any pair of shoulders. And yet the hits keep coming. The more lines of codes the more hang-ups and ultimately you get, “I’m sorry Dave, but I can’t do that.”

As John Steinbeck once said, “Virtue and vice were warp and woof of our first consciousness, and they will be the fabric of our last, and this despite any changes we may impose on field and river and mountain, on economy and manners. There is no other story.”

The 60th. BIRTHDAY

When they were young, Jim and Mirium never thought about it. It was all about the fun and frolic. Then came the raising of the children and seeing them grow and prosper. But now as the years ticked on there was the ominous feeling that entered Mirium’s mind and would not recede. It lay on her like a dark heavy blanket, blinding, perhaps even taunting her. She didn’t know what to do with it. She couldn’t talk about it with him to alarm him nor with any other members of his family. But there it was morning, noon and night like a colicky baby, screaming, inconsolable. 

Jim was entering his sixtieth year and she had planned a birthday party for him. Trying to drown her sorrows, she simply immersed herself in the planning phases and threw every fiber of her being into directed attention to the slightest bit of detail; the color of the flowers, the placeholders, the orchestra, the uniform of the waiters, etc. Nothing was left to chance. And yet as she turned every page of detail over, the dreaded thought crept back in like a slithering snake full of cold-blooded venom, forever hissing. 

It was the summer of that year, one afternoon when the hammer hit. Numb with disbelief and fearful of the impending loss that she had anticipated for several years, seemed to be coming true. Jim, her beloved husband had just received news after a “wellness” examination that he had to have a Computerized Tomography (CT) examination of his abdomen and pelvis. She had just nodded. No reply was needed. Even a word of encouragement seemed so futile in its existence that expressing it would be a sacrilege and a betrayal of her carefully crafted inner strength and any weakness would show her inner frailty. She kept the brave face in front of her husband. Her husband meanwhile seemed quite oblivious to all her angst and seemed to take it in stride, “nothing to it, after all I go to the gym 5 days a week and last week I bench pressed 240 pounds. You can’t do that if you are sick. Right? Right?” She just nodded ruefully as she twisted the cloth she was holding over and over again. She knew better. Or did she? There was hope. Wasn’t there? Clutching to straws, she prayed.

Jim’s father had died of a cancer of the throat that caused a “carotid blowout” one day late in the winter. With blood pulsing out onto the carpet and the linen, it seemed like a horror movie playing out in their bedroom. Shortly after, Jim’s mother fell ill with Ovarian cancer. The trauma of the loss was still raw with emotions when the foreboding of yet another malady seemed all to certain. There were multiple hospital visits and many debilitating chemotherapy sessions that laid bare the raw damage of the human body, once the belle of society dressed to the ninth, became the whimper of a human shadow. All dignity that could be preserved, was, until there was none left. Life became a long sleep as the withering frail body left only the skeletal raised relief underneath the freshly laundered linen. Her time grew shorter and shorter until one day when hope left.

Nature’s rebuke of the wonderful life, lived through the lens of pomp and circumstance seemed hard, relentless and outright cruel. But not till their first born, a strapping healthy man in his fifties was diagnosed with a fast-growing lung cancer. This malady seemed to come from nowhere and have total control of him. Yes, he was a smoker of a pack of cigarettes a day but he had not indulged in them for more than 10 years. Now he was left coughing in fits and spells, wishing he had never touched the vile weed. He knew his time was short after the radiation treatments failed to control the growing crab within his chest. He had just enough time to see his estranged child and try to reason with the unreasonable thought that life was a strange torture, painful in its suddenness and ruthlessness. He would never see him grow older. He was gone a few weeks later, having witnessed the horror of the loss of one of his parents earlier.

But he was not alone to suffer the trauma of nature’s cruelty alone. The middle child, a girl who had grown up with nary a desire that remained unfulfilled and always had the world at her feet. A smattering of beaus lining up outside the door testing the angry yet constrained eyes of her doting father. She had been spoiled with the embarrassment of riches she had grown up with, which seemed to constantly surround her even in the darkest of her moods that swung like a monkey on a tree branch. Yet here she was still primed for another 30 some odd years of fun and frolic after the loss of her parents and the enormous wealth that splattered around her like a massive welcome rainfall. Out of the blue the lightning struck and a mammogram revealed a tiny but angry looking whitish crab-like anomaly stuck deep with her bosom. The surgeon had their day and so did the radiation therapist followed by the oncologist, each whispering about the potential of future that was never to be. The crab-like radiological nemesis continued its march, swimming through blood streams and finding haven in places where imaginations of seasoned cancer specialists feared to tread. The once tiny crabby monster made its way to the pelvis, to the ear lobe and even to the bones in both her legs, leaving her bed ridden. Life could not imagine its domicile in that thinned shell for long and decided to leave quietly on a quiet cold fall’s morn. Gone like the breeze, the once vibrant youth who could be found collecting flowers from the flower beds as she did boyfriends from the handsome and striking airline captain crowd. Gone like the orange orchards and the grapevines from the scourge of a deadly virus. Gone were the memories of the ones whom she knew and who knew her. All gone.

Meanwhile life’s trauma had gnawed at Mirium slowly about the “what ifs” until the request for a diagnostic CT scan was made. She knew then, the serpent was near. She kept up the stoic exterior in front of her four children and silently cried herself to sleep in the darkness of her bedroom, where her only love, Jim breathed comfortably, oblivious to the growing darkness that was to arrive soon enough and overwhelm him.

“Why,” Oh God, why?” But there were no answers. It was in the stars or in the genes or somewhere in-between the heavens and the earth. Jim had just turned 60 as his father had and his mother and his older brother and his older sister, who had all succumbed to the vagaries of this awful and ruthless monster called cancer. And now, right on-cue just like the rest of them he would be faced with the enormous task of living through the infamy of the constant indignity.  The answer seemed to arrive as Jim’s health declined. He had, had a coronary bypass graft surgery for the “widow-maker” successfully until it was revealed that he had developed a case of an inflammation of the liver. The hepatitis symptoms after an acute phase seemed to abate and for several years only “minor blood tests” were done to determine the viral activity in the liver. Yet one day, the virus triumphed over the liver creating the wayward cellular multiplication and ensuing liver cell destruction leaving in its wake the crabby monster!

There were a spate of experts and specialists alike who opined about the best care. Jim was wealthy in his own right as well as the beneficiary of his parent’s fortune. Everyone thought the best mechanism of cure was a liver transplant. They brushed aside the CT scan findings of enlarged perihepatic lymph-nodes. “No,” the experts said, “During the abdominal surgery for the liver transplant, that he,” the able surgeon “would also do a thorough lymphadenectomy (removal of the lymph nodes) and that would result,” as the surgeon said, “in an R0 state.” 

Jim was all for it. As the preparation for the liver search grew with a fervor. Soon the liver was acquired from an unlikely source; a Chinese young man killed in the service of humanity by a freak motorcycle accident. Lo and behold the liver was grafted and all rejoiced. But shortly after the immune-suppressive therapy with Cell-Cept was begun another shadow appeared on the follow-up CT scan of chest and abdomen then another and another till all hope was thrown to the wind. Another of the misfortune family member shriveled into a ghostly apparition. It seemed that the cure of the transplant required immune suppression and suppressing that, caused the cancer to grow with abandon.

Mirium’s worst nightmare had come alive like the fire breathing dragon, which consumed her life, leaving in its wake the charring remains of tattered dreams.

Jim died in her arms surrounded by his four daughters. No sooner had his blood turned cold, did the youngest son, the angry rebel filed a law suit to gain all his brother’s fortune for himself. Ruthless like nature, he preyed on the father-less four children with a team of pin-striped suits parading through the court houses. Like leeches they sucked on every possible loophole in the will and like vermin they trolled poor bereaved Mirium. This human monster of a child, the last born of this once wealthy family had a penchant for money squandering. He spent and spent and spent to console an emptiness within that could not be satiated. Yet he persisted. 

He would turn 58 that summer.

Epilogue:

A fault in their stars was the causal determinant of the malady that was to befall them at their birth. A multi-gene mutation on one allele of the chromosome? A shortened tandem repeat of the Telomere?  Whatever the abnormality it sat quietly until smartly and quite purposely the second hit took place at the approximate appointed hour of the sixtieth birthday. Meanwhile the youngest one still awaits as the hours and minutes slowly tick away time into that dreaded 60^thbirthday. He refuses genetic testing, because, “it is unnecessary.” 

That dread is something that only the medical-knowledge naïve, Mirium realized, but could not do anything about.

AIRCRAFT ENERGY MANAGEMENT

A strange thing happened after a 4-hour IFR flight in the soup, the other day. The strange part was not the visual approach or the 6-mile visibility and the 6000 feet of runway ahead, but the energy momentum. I’ll add a bit of physics here, I was contemplating a nice landing with three souls on board and bags. In that contemplative mood, I turned a 1-mile final for traffic considerations as per the Tower at 800 feet. No biggie, one might say, and it shouldn’t have been. By the time Garmin’s faithful melodious voice stated “500-feet,” I was already looking at 4 white lights on the PAPI. And by the time I heard “minimums, minimums” (I program that on every flight where approach is available), I was rushing in at 85 knots or 9% over the VSO1.3.

Now in all likelihood most of us have done that one time or another. Maybe? And I have too, plenty of times, but determinately? Almost, never! Yet here I was plowing the slight cross wind hankering to take me off the runway. Nope, that was not going to happen. Even with a forward slip, I leveled off around 79 knots and then held and held and held till the lift dissipated and I touched down 750-800 feet past the threshold and ran the wheels for another 1400-1500 feet and then on to the third taxiway (and not a high speed one either). Hmm, I thought hope no one was watching.

One might say, so what? 

Let us look at energy as a stored form of force. As in potential energy that one gains by appropriating first the chemical energy (burning of fuel) and translating it to the mechanical energy (turning the prop and creating thrust) into stored potential energy as altitude. You go up in the air with a whole bunch of fuel burn and then coast down with a bunch less. But in that bunch less is a major wizardry of airmanship. How we manage that energy is what determines the difference between the sound generated by the repeating doppler-effect-engine-power-hog-jock and an aviator. The slow dissipation of energy by carefully manipulating the Throttle to achieve a steady state loss of that potential energy transformed into kinetic energy, is the key to good airmanship. When the Landing configuration is best at 1.3 VSo for normal landings and 1.2 VSo for short field landings, there is a specific need to adhere to that tenet. Or else you run the gauntlet of what might be. And most times it won’t be pretty.

Many a pilot has ventured past the runway end carrying more than needed energy. A case in point is the recent Falcon crash at Greenville Airport that killed both the pilot and copilot in their haste to land while the runway kept shortening in front of them. The NTSB has yet to finalize on that fatal accident, therefore, this statement is a hearsay opinion based on the video of that flight while in the landing phase.

Remembering that speed is a form of kinetic energy and it dissipates at a certain rate when thrust is eliminated: The stored energy is a thief of time and space. Knowing only through practice, conditions a pilot in it’s judicious use.

Let’s look at the correlations between Speed and Energy…

 Assuming a 3000-pound aircraft arriving at a runway at the given speeds creates the resultant force. (Kinetic Energy + ½ mass * Velocity squared)

65 knots of airspeed = 562,128 ft-lb of kinetic energy. 0% Baseline

80 knots of airspeed = 851,508 ft-lb of kinetic energy. +52%

50 knots of airspeed = 332,620 ft-lb of kinetic energy.  -41%

Given those dynamics, it behooves us to maintain the appropriate energy on final approach to the runway.

Additional benefits of proper speed/energy management also include:

The sudden deceleration, say, hitting a parked truck or a deer on the runway or a structure requires tremendous energy dissipation… 

Stopping a 60kt aircraft at 18 feet distance leads to a 9G force on the body (The limits of the FAA certified seat belts). 

Stopping that same force/energy in 9 feet distance leads to an 18G force on the body (limits of sustainability). 

And a sudden stop at 1-foot distance leads to 159 G force (unsustainable for the human body).

So, going back to my landing, I came in with near 10% higher speed/energy than required and I paid the price in runway used. Mind you, with that much stored/kinetic energy, I would certainly have taken out the runway end identifier lights on a 2000-foot runway.

A word of advice - Translate appropriate power and pitch for climb/cruise, appropriate power reduction and constant pitch for descent and zero power and changing pitch for level over runway and thence a smooth landing flare. Always concentrate on the VSo1.3 on normal landings and VSo1.2 on short field landings.

Fly by the numbers appropriate for the aircraft you fly and always fly safe.

7 Landings in 7 Minutes -VIDEO

https://youtu.be/ozrowvQYv_M