On DISTRACTIONS

“In the event you find yourself distracted, focus!” There is a certain hilarity in that statement, if one allows it to congeal in between the ears. If you are distracted, how do you know you are distracted, since distraction has got you trapped in its realm.

To illustrate that point let me tell you a real happenstance that occurred recently. On a clear day when the blue is all blue and not a spot of moisture hangs in the air, I decided to get three more Instrument Approaches under my belt to keep the currency in my proficiency, current. Tagged with a copilot, of many thousand hours in various Airforce jets and large aluminum bodied airlines, sitting beside me, I donned the “foggles” and off we went severing the surely bonds.

Immediately apparent to anyone inside the aircraft and probably those on the ground looking up, it was clear that I was a bit rusty. It took all of 10 minutes or more to clear those phugoid-oscillations that were human induced and had nothing to do with aircraft aerodynamics and forces of nature. The lesson was quite stark; the moment practice ceases, and the effort becomes an object of striving, it becomes subject to unhealthy distortions. Hence, constant practice makes imagination the object of cognition. Where one can foresee the immediate future to a related input, rather than constantly trying to catch up and overshoot.

As time would have it, the yaw-dampening finally and reluctantly happened and the non-turbulent air we were voluntarily bucking in became non-turbulent. My safety pilot let out a soft sigh, and I heard it loud and clear. No words needed to be said.

But that was not going to be the end of it. I had requested the ATC for a RNAV approach to Runway 31 into KACY and had been granted. Vectoring a long downwind over water was not my favorite thing especially at 2000 feet, but the controller had control. My safety pilot, probably seeing my struggle, suggested I use the Flight Director to make it easier on myself. Hmm…he must really think, I stink at this instrument thing, I thought. So, I pressed the FD button on the Garmin box and the Command bars dutifully popped up on the PFD. I protested a bit, protesting, that using FD is akin to cheating. But, I thought, why not since, the rust was defining itself in large patches. I surmised that flying the Flight Director, would make it easier on me and might impress him a bit. I figured the sharper sense of discomfort would quickly interweave with the bliss of past expertise and render my inadequacy moot. The sense of this relatedness was short-lived, however.

I had the Command Bar pegged to the FD and sailing along towards the final approach fix. I dutifully pulled the Manifold Pressure to 18 inches, RPM was at 2400 and the airspeed slowed to a comfortable soft drone. The aircraft steadily hurtled along the quiet path and I started feeling on top of my game again as the MFD peeled away the blue water behind and dragged in the green below us. Everything seemed whole again. My currency had aligned itself with proficiency. The final approach fix came, and I kept flying the Flight Director, enamored and comforted by the ease of automation. Another mile went by and I realized that I had failed to put the gear down at the final approach fix. Oops, so I did. I heard a distinct throat clearing cough from across the aisle. Damn, I thought this was a terrible exercise in progress. I needed to fix this quick. Mumbling my displeasure at my own actions, I resolved to do be more precise. That expanding idea. The resilient thought. The continuous play of motion in a 3-dimensional universe made all the more real the initial collapse of action. The desire to fix what had been broken ceased upon my nerves and now my multiple thousand hours melted away and I felt I was back in training. A certain drift of scent that emanates from failure hit me square in my nostrils and I realized that the Glide Slope Indicator had drifted down to the lower end in accordance with a required missed approach. Damn! Tracing across over the expansive countryside at race-car speeds without the object of arriving the destination in airline fashion was getting worse by the minute.

“It’s a Missed Approach!” I croaked.
“Yes,” is all my copilot said as I flew over the Runway at 1500 feet.
What happened? Is all I could think about. Common sense and Reason eventually unveiled causality, as they did.
First let me quarry the marble out of this flight and sculpt a Phoenix from it.

Distraction was the all-encompassing natural beast that had membered itself to my mental capacities. The suggestion of using the Flight Director when pushed by itself, will register stability in the Pitch and Roll mode only for the current flight path according to Garmin. If I had pushed other buttons as I should have done when flying the Auto-Pilot, namely the Approach mode button, then the FD would have taken me through the vertical descent as well. Automation has it’s, “If This Then That” moments and linearity of thought and action is what the black boxes seek from the pilot in conducting their affairs. None were apparent here, cobbled together in a ball of a single fixated distraction.

Total dependence on automation without careful monitoring-with-expectation is like tranquilizing oneself with certitudes of hope. Imagination as Cognition means to look at the forecast future from any action undertaken. A cluttered mind fails to register intentions akin to throwing pebbles in a stormy sea. Distractions clutter the mind and simple but necessary actions go unheeded.

Looking at Accidents and Incidents related to Approach and Landing Distractions;
1. 72% are acts of Omission,
2. 63% acts of crew lack of coordination
3. 52% from situational awareness and
4. 45% slow reaction.

All of these were in force at that RNAV approach I detailed above. All of them!
And Factors related to such events are:
1. Communications in 50-68%,
2. Head down activity 22% and
3. Response to anticipated Activity or situation 14-19%.

Again, all these factors were also at play in the above scenario. My total abdication of authority to the use of the FD without the anticipated need for additional inputs caused the Missed Approach.


How could it have been better?
1. Sterile Cockpit technique and not heeding to the use of FD during the vectoring phase without briefing myself.
2. Using a Checklist for the type of Approach.
3. Monitoring and scanning all data rather than fixation only on the FD.

Number 3 is of importance since our brains function to the laws of Recency. We are asked to repeat instructions to the ATC for the sole reason, a) we heard the correct instructions and b) we remember to input the instructions correctly in the black boxes. The short-term memory lasts in the short-term memory banks for 15-18 seconds. Repeating the instructions fortify them for a bit longer. Otherwise we resort to “Say again.” In this case the suggestion to use the Flight Director at the “last minute,” was the culprit that brought the entire universe of thoughtful actions to a halt.

We must remember that the human mind is filled with disquieting gaps of the daily life that fill in constant distractions. Achieving the purpose at hand requires clarity of mind and Focus. To keep distractions at bay: Securing a sterile cockpit and using Checklists brings back the required focus.

To illustrate the dangers of said distractions, here are a few facts and real-life examples:

1. A study found that children using cell phones are 43 percent more likely to be hit by a vehicle while crossing the street than children who are not using cell phones.

2. A 25 percent increase in pedestrian injuries among 16- to 19-year-olds over the last few years is being attributed to the increase in cell phone use.

3. Statistics show that texting and driving is three to four times more dangerous than operating under the influence of alcohol or drugs.

4. Two Northwest ­Airlines pilots who flew 150 miles past their destination at Minneapolis while going over schedules using their laptop computers.

5. Teterboro tower controller at a Piper’s departure was “engaged in a bantering personal phone call about a dead cat while directing traffic.” a phone conversation was implicated in the Hudson midair collision between a tour helicopter and a Piper Lance that killed nine people.

A few thoughts to keep in mind:
1. Conversation is a powerful distracter…keep it to a minimum
2. “Head-down tasks” during flying are distracting, especially in IFR conditions and disorienting.
3. Defer all Non-Critical activities.
4. Consider any Interruption as a “Red Flag.”

A SLOW WALK INTO OBSCURITY

 

Of all the temperate reasons for conformity, there is a methodological play at play here. It is slow. It is deliberate. And it started a long time ago. Where that was, exists in some obscure nebula of thought in the mind of in an idealized world human. Perhaps even a physician. But it happened and slowly morphed into a spectacle that one day will reap rewards for its inventor, who will not be alive to see it. These movements when putt in motion take time to evolve and evolving they are

What of this thought? It must have started with the hope of universal love or some sort of a utopian landscape, which only the fecund idle minds can dream of at any given hour. Perhaps it was envy, or perhaps it was desired. Either of those intents would bring us to where we are today. 

To start at the beginning of this modern age, medical care in the United States started to become a big business because the world war two population saw the infirmed limp back onto the shores with grim tales of bombs and bullets. The Baby Boomers, offspring of the “Greatest Generation” growing up with more than their parents ever had and having worked less for it, seemed bitten by the love of everything and anything in excess. Excess, as anyone with a little sense would know leads to some bad pathways in health and life. Needless to say, health became the overwhelming issue of our times.

Those times called for some restraint in out of pocket costs for such excesses. And the Insurance companies took notice of the need to step in. What once was pay as you go and collect from the Insurance later, slowly morphed into Physicians “Accepting Assignments,” to get paid directly by the Insurance Company rather than be beholden to the unreliable insured.

The Insurance companies having immersed directly between the Physician and the Patient and opened their pocketbooks to the demands of the physicians saw an opportunity for command and control. The Top-Line and the Bottom-Line for them, however, had to be controlled. A trial with Health Maintenance Organizations (HMO) seemed not to control their costs. Neither did the PPOs.

The next step in this game of chicken came naturally. The Insurance Companies started adding physicians to their “Networks.” The larger the network, the larger the patient catchment area. It seemed to be a match made in heaven for both the Insurance companies and the physicians. 

But little did the physicians and patients realize by doing so, they were falling into the distilled trap of command and control and the levers of operations were at the hands of the bureaucrats. The Patients were no longer able to go the physicians of their choice and the physicians would have to refuse to see patients out of network and in most cases not get paid by the patient’s insurer. The Medical Revenue Cycle had begun and delays in payments to the physicians further increasing their frustrations became the norm of the day. READ

https://jedismedicine.blogspot.com/2013/09/the-medical-revenue-cycle.html?spref=tw

The screw turned and the momentum was unceasing in its force. Meanwhile, the population of the United States grew from 260 million to 340 million over a short span of a few decades as the insurers gathered a larger and larger share of patients in their network. That wasn’t enough though. The Insurers had to get the Hospitals to get in on the act as well. Now not only could you not see the physician of your choice but also you could not go to the hospital of your choice. If you did you were penalized with a higher Co-Pay. Meanwhile, the Market Caps of the Medical Insurers increased geometrically and the more the Revenue grew the larger their lobbying efforts grew. The Health Care market kept upping its ante on the GDP blowing through 15% to 19.7% of the United States GDP in a whiz-bang decade. If you saw the Bureau of Labor Statistics graph related to the rise of healthcare costs and the increase of the administrators, you would come away with the only conclusion that the graph offers.

Out came the fingers, pointing at the doctors. Accusations of greed and blame were aimed at physicians for the rising cost of healthcare. They were accused of ordering unnecessary tests and doing unnecessary surgery. Not only did President Obama state at a press conference: “The doctor may look at the reimbursement system and say to himself, ‘You know what? I make a lot more money if I take this kid’s tonsils out” – doctors faced fines, penalties, and even imprisonment. READ

https://www.wsj.com/articles/SB10001424052970204886304574308472181248330

And the dutiful minions including some Senators started publishing opinions in various newspapers and magazines about this or that doctor's greed and how it was hurting the patients. Admittedly there are a few bad actors in the system, but not everyone is bad. Nary a day goes by when Breaking News is in short supply that an article or mention on television does not visit the healthcare costs and associated physician greed. The constant churn is to burn the derogatory image into the public mind.

The regulatory capture of health care needed, another step to garner better control of the healthcare costs, was required. A be-speckled Judith Faulkner walked in as the benefactor supplying the Electronic Medical Records via the system EPIC. She was a major donor to the then President Obama’s campaign and won the lucrative venture making her a multi-billionaire. Her codes were proprietary hence none of the information could be shared between hospitals and physicians except with the government. The fix was in. - READ

https://www.lubbockonline.com/article/20130525/OPINION/305259922

Physicians had to be controlled. The Insurers were only too happy to comply. Thus, the force of denial of payments and preauthorization for procedures rapidly became an art form. Any expensive diagnostic procedure was subject to scrutiny and denial and any expensive procedure was subject to the same. There were no “sacred cows” of good healthcare. Everything the doctors did was subject to suspicion. The physician compensation based on the “Doctor Data Dump” by CMS (Centers for Medicare and Medicaid Services” in 2017 revealed that only 7% of the $1 Trillion spent in healthcare by CMS was physician’s compensation which included “Fixed and Variable Costs of the physician offices.” The rest of the 93% was for Hospital, Pharmaceutical, Device, and Administration. The Administrative costs were close to 38%. But the eye of the toothy tiger was on the physicians, not where the largesse was being distributed. -  READ

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Physician-and-Other-Supplier

As the population grew, the Medical Schools graduates' growth stagnated. Thus, was started a hue and cry about the coming, “Doctor Shortage.” Newspapers headlined Armageddon in health care. Meanwhile, the physicians burdened by the daily imposed mandates and reduced “reimbursements” from insurers and associated denials could not keep their offices open. The time was ripe for the Hospitals to acquire these practices and their “built-in” patient load. The hospitals offered initial incentives and then turned the screw on the physicians by hanging the sword of Damocles over their heads, “If this then that!” Or simply put, “if you don’t add this to the diagnostics and add that to the procedure, you will face the pink slip.” The dye was cast. Physicians had become the tools for the Hospitals to extract the largest amount from the Insurers and were now bereft of their own reasonings.

As artful as these puppeteers are, the long game was their mainstay. Another industry mushroomed: The Nurse Practitioner and the Physician Assistant industry! The growth of the 18-month thinly educated NPs and PAs grew at an astronomical rate. While the graduating medical students climbed out of the medical school with $200,000-$300,000 debt, the “others” came out with almost nothing. Almost to a “T” the experts started calling the Physicians, “Providers.” The logic was inescapable, call the MDs, Pas, NPs, RNFAs “providers” and you create parity and equality in everything; from education to reimbursement. - READ

https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm

First the experts allowed the NPs and PAs to do any procedures under the direct supervision of the physicians placing the onus of litigation burden on the physician while everyone else pretty much skated for free. But the NPs and PAs now emboldened with the desire of using the scalpel and the stethoscope but with a limited 1800 hour of knowledge started the push from State to State that they were capable of performing to the same level of expertise as physicians, therefore, they need not be supervised. Many state legislatures having limited information or knowledge wholeheartedly agreed so as to appear sympathetic to the “Needs of the Vulnerable Patients.” The game was afoot. the 1800 hours were being equated to the 20,000 hours of medical school, Internship, Residency, and Fellowship of the physician.

The techies, not to be undersold came up with the idea of “Telemedicine.” The ‘No-Touch” medicine was in full force. Any “Health Care Professional Provider” so desirous was eligible to sit in front of the computer camera and make diagnoses and suggest management with less than half the information needed by doing the age-old, “History and Physical Examination.”  - READ

https://www.healthleadersmedia.com/innovation/4-ways-telemedicine-changing-healthcare

Meanwhile, large corporations added their fuel to the inferno with walk-in clinics manned with Nurses, NPs and Pas to “Practice Medicine” under the umbrella of Pharmacies as in Walgreen, CVS, Walmart, Rite Aid, etc. A 24/7 clinic was available 365 days a year in these facilities. Staying ahead of the crowd, soon newspapers and magazines started touting the “better care” afforded by these “walk-in clinics’ as compared to the crowded doctor’s offices.  -READ

https://www.walgreens.com/pharmacy/schedule-appointment.jsp?frm=clinic#/location

Notwithstanding Telemedicine, the idea of Artificial Intelligence was soon co-opted as the next greatest thing since sliced bread. AI, they said was equal or better than the Physician reading the X-rays, CT scans, and MRIs. Articles jammed the Journals and new Journals had to be created to carry the motherlode of information touting the benefits of coders versus the human. The coding experts and their partners regaled the virtues of AI and that it would displace the Radiologists and soon the Doctor. Marching into the field in lockstep currently, are the Social Media Giants with oodles of money and deep-pocket lobbyists to make a grab for the $3.65 Trillion a year tax-payer expensed in healthcare. - READ

https://www.aamc.org/news-insights/will-artificial-intelligence-replace-doctors

In the end, it boils down to, a little more than “More Earnings” whether by buy-backs or tax-payer funds equals higher Earnings-per-Share (EPS) equals Higher Stock Price equals larger Salaries and Bonuses for the CEOs and their “managers.”

So, what is to become of this downward spiral in healthcare, where quality is being measured by unreliable metrics (the metric-makers are the insiders with a semester of statistics in their background) just to tout a certain profit line?

After all is said, the age-old Direct Patient Care by a physician without any intermediary Insurer to decipher and decide is what should be considered "the appropriateness of care." It seems the best and harkens back to the days when medical care was between the Patient and the Physician. -READ  https://www.statnews.com/2018/09/06/direct-primary-care-doctors-patients/

The patients are getting squeezed in all of this. Suboptimal care because of Insurer/hospital/ governmental expert pressures. Everyone, it seems has an ax to grind in the scheme of things and further it seems the forgotten in all this...is the Patient.

In Direct Care, unhappy patients leave the physician and go elsewhere as in the free-market in the business world, and not be in permanent servitude. The Health Savings Account is a simple mechanism for the patient to pay the doctor bills that are marked down by 70-80% compared to the Insurer prices. Negotiated prices individually by the patients with their physicians further reduces the cost of care. Instead of $14,500 on average Premium for a Family of 4 and a Deductible of $6,500 and a Co-Pay of $50-100 per visit, where the patient does not realize a single penny from the Insurer until he/she had divested a royal sum of $21,000 annually. For that much money, one can pay for catastrophic insurance that actually helps in dire circumstances requiring hospitalization and other expensive care for cancer etc. and the rest can be used for non-threatening illnesses. 

Quite a simple concept really, that the Insurers now fully vested and seeing the large ROIs will never allow to blossom, unless the public says, “'I'm as mad as hell, and I'm not going to take this anymore!”

It’s a slow walk into obscurity or a rise to reason. The choice is ours.

Science, Causality & Genes

The inference of causality is rampant these days. Nowadays any whisper of correlation is a causal event, ask the epidemiologists. But causality is more akin to “if this then that” (IFTTT). Using an oft-repeated term, a quid pro quo. A reaction to an action. Newtonian more than Quantum. No fuzzy behavior as with the electron but more of an antimatter-matter relationship. A good old deterministic...Poof.

Defining causality is easy. A fact that delivers a verifiable consequence each time it is invoked. Flicking a switch turns the light on, that is causal. Pushing a button turns the motor on, again causal. But as you might extrapolate from the examples above, these are mechanical things. The mechanics and electrical circuitry are designed for a specific action or IFTTT. 

But now we haul off to the biological world and contemplate where the triggers are for causal effects? Where indeed? Perhaps the nearest example of such an event is a one-gene-one disease. Examples include; cystic fibrosis, sickle cell disease, Fragile X syndrome, muscular dystrophy, or Huntington disease.  

The concept of Gene therapy lies in replacing a faulty gene or adds a new gene in an attempt to cure disease or improve your body's ability to fight disease. 

These may be associated with Dominant gene mutations which are vertically transmitted from parent to child as in Huntington’s Disease or via a Recessive gene where it may skip generations. If you are interested in more look here: https://www.nature.com/scitable/topicpage/rare-genetic-disorders-learning-about-genetic-disease-979/ and here for the genetic therapies utilized thus far http://www.genetherapynet.com/JoomlaTest2/index.php?option=com_content&view=article&id=164:diseases-treated-with-gene-therapy-&catid=97:patient-information&Itemid=14 and yet more to come with the CRSPR technology that hopes to revolutionize healthcare in cancer management, cardiovascular and a whole host of other metabolic-related diseases; https://www.labiotech.eu/tops/crispr-technology-cure-disease/

The stumbling block in this hubris of “causality” suggests, we are still a long way away from that mountain we need to climb. Cancer, for instance, is a multigene-epigenetic-mesenchymal corrupted system of influence and a single silver bullet is not going to save the day. Adding to the complexity is the catacombs of multiple crosslinked-cross-talking pathways beneath the cell surface that invoke their own potential when blocked by small molecule antibodies. That cautionary statement must give us pause to reflect upon what to do? Work is underway to tease out the trees in the forest tying a yellow ribbon on each one as we delve into the forest in search of a cure.

That then brings up the casual semantics of the statisticians into the open. Where the science outside of the laboratories, is being marked down in percentages to the eyes of the beholders? Karl Pierson would have been happy to see his methods lauded and enriched with more analysis than has been done in any real science in the last 10 years so to speak. But disheartened at its abuse. With all the Regressions, T-tests, ANOVAs and MANOVAs sprinkled through most of the medical literature, a kernel of truth seems barely enough to ruffle the pure white undisturbed surface of the “scientific,” statistical landscape. The true question being; does “X” cause “Y?” The answer seems wanting in most of the medical literature that pervades the burgeoning load of journals proliferating faster than I can think, let alone write these words.

Relying on “p-value” SIGNIFICANCE https://jedismedicine.blogspot.com/2013/06/significance.html?spref=tw is fast becoming an albatross around the author’s neck as more and more non-statisticians begin to see the light thru the dark art of this field of doctored mathematics. I hear, recently someone proclaims that perhaps “we should not use the term “significant” with a p-value of 0.05. Indeed! But then the suggesting individual goes on to say, “we should perhaps use; less significant, fairly significant or most significant.” Tapering one’s bias into terminology through statistical manipulation will add another layer of opacity to an already opaque world in disguise.

Already the stark scientific world in cancer care has changed parameters for the Partial Response or PR when dealing with the drug effect upon cancer from >50% reduction in the size of the tumor to =30% as the definition (of a PR). And then in an obvious collapse of the norm, they proposed PFS (Progression Free Survival) as a surrogate to Overall Survival (OS). Read here: Progression Free Survival (PFS) https://jedismedicine.blogspot.com/2012/05/progression-free-survival-pfs.html?spref=tw The former can be massaged by using longer interim analysis to have a longer PFS. However, as many a study has shown that increasing PFS has NOTHING to do with OS in a large majority of cases. So why the change? It seems that utilizing the new surrogates leads to a host of quick, but unverifiable results rather than the tedious and methodical means of extracting the truest information. Today, once you get your p-value based on the selected variables and other flimsy outcomes, the publishers-a-plenty roll their rollers on their massive machines. And once the headline has been headlined and the Social Media has triumphed the unvalidated contrived result, who cares about what is on the 28 paged small-windowed retraction. Indeed, who cares because everyone seems to have attention deficit disorder these days. From the “scientists,” to the “marketer,” to the “consumer,” in one fell swoop. Yet even in these days of quarterly earnings, the long-lost art of tedium would still bear lasting fruit to the annual bonus of a manager and his or her longevity at the helm.

The reason I bring the issues of Gene therapy and statistics in the same paragraph is quite simply to arm the disarmed. Using gene therapy has its complications; unintended consequences to be sure. Deep Learning through Neural Network deployment to harness the “Gene Speak” between overexpressors (promoters) and (suppressors) is a difficult communication to decipher, let alone the Epigenetic chatter and its influence and the pleadings of the interstitial content with its Epithelial-Mesenchymal transitions. Read here: https://techxplore.com/news/2019-12-deep-gene-interactions.html Additionally the viral vectors used to transfer the gene into the DNA of an individual can have serious consequences. In regard to CRISPR editing, there are whole host issues that also need to be resolved before wholesale mainlining into science. Although a new study from Johns Hopkins seems to help the cause of the CRSPR technology, it is the first step and only used in mice. The scientists used a targeted gene epigenome editing approach in the developing mouse brain, Johns Hopkins Medicine researchers reversed one gene mutation that leads to the genetic disorder WAGR syndrome, which causes intellectual disability and obesity in people. This specific editing was unique in that it changed the epigenome—how the genes are regulated—without changing the actual genetic code of the gene being regulated. Read here: https://medicalxpress.com/news/2019-12-genetic-brain-disorder-mice-precision.html . One thing that we all must be cognizant about is that using the arbitrary probability methods of statistics would not be prudent in determining success. Failure, however, will be obvious to all. Failure may be due to a lack of incorporation of the genetic material in the genome, by antiviral antibodies against the viral vectors or other errors of methodology. Computational cataloging will help expedite the process as it has done in other sectors of human activity, as reams of data are processed to determine the causality in a disease. We will progress as we do in fits and starts. But the progress we do make, will only be through careful, methodical and tedious science.

I clamor because I am concerned. I write because I care, and I learn because I want to propel the young mind to greater heights than it thinks it can achieve. So, keep the faith in the tedium of real science and stay on the journey towards excellence.



Bon Voyage!

THE HUMAN FACTOR

The drumbeat for Artificial Intelligence is deafening. But when you look at the skinny, it all boils down to IFTTT. Doesn’t it? There is also this big overhang called the Big Data that seems to propose that the entire world’s knowledge is contained in a server somewhere from where the computational binary codes have determined the essence of life and death. Not so, it seems when you really look at it hard enough. And then you realize AI is about making a machine do the IFTTT with a select few variables. And that the machine does well. Let me give you an example that everyone will tout as their aha moment and immediately subjugate their humanness to the unfailing virtues of the AI. But hold on a bit, friend, hold on!

Can we translate the meaning of the human essence into a machine? Nope, not by any standard. Ah, but they say, in time, in time and soon. To that I am compelled to say, not so fast young Turk, not so fast. 

To give credit to the function of a machine working through the AI code of conduct, one needs to look at the Aircraft Autopilot for example. The entire premise of the Autopilot is based on four variables; Lift, Weight, Thrust and Drag. Compute those variables and all three X, Y, and Z-axis are easily manageable. At takeoff, the thrust outweighs both the parasitic drag and the weight drag on the aircraft. At Cruise, the lift created by the wings equals the induced drag and the weight of the aircraft. At descent, the thrust is diminished to allow the other mentioned forces to act accordingly and bring the aircraft transitioning to the landing phase. But what happens if a sudden force of moderate turbulence is applied to the aircraft? The Autopilot automatically disconnects, so the human can take over to override impact from the sudden change. Any sudden change in the wind parameters would raise the specter of a “Ding, Ding” followed by “wind shear” if the aircraft was so equipped with such a hardwired coded algorithm. So, if there are only a few, finite, known and calculated variables, the machine language codes well and delivers with flying colors. Add an additional insult to the quiet world of the AI and, then, you know who is the boss.  Autopilots need human managers who are fully prepped with nuances of machine shortcomings and failures. Sometimes, however, we the humans can take the autopilot’s beseeching warnings and hit the ocean or earth, with a ferocity of momentum and wonder, what gives? Humans too are fallible. That’s how we learn.

Remember HAL9000 from the 2001 Space Odyssey? We haven’t yet achieved full subservience to the red dot. Perhaps the example of the autonomous land vehicle crashing into pedestrians and fences itself is a reminder that machine-learned machines need to stay functional in the machine-machine world. Humans are unpredictable and therefore their drive for the unexpected is wrought with calamities. Touting the success of the Autopilot in the airplane and the boat and the cruise control in the car and comparing that to the wide world of a multitude of variables is hubris in a nutshell. The wide world has many rules from the Quantum mechanics to the Newtonian Laws to the Flows of Fluid and Thermal dynamics, to the continually in the motion of the living breathing planet, its aching tectonics, its atmospheric lifts, and its restless oceans. To punch in all those variables into the artificiality of a machine and expect it to perform with the agility and grace of multitasking, parallel processing human brain is asking for, way too much.

Reversing course from the machine to the human again, there are some who believe that AI will replace humans in healthcare? Perhaps the best we will get will be predictive analytics with percentages and potentials, but not what is needed to help save the human from a malfunctioning code in their genes. Even delving into reading X-Rays and diagnosing disease from the images is based on the IFTTT. Feed-in a million X-Ray images and code them with the disease accordingly and then let the AI figure out the diagnosis of the presented image. The missing context that humans rely upon is well, missing. The “mass” in the lung could be benign or malignant, it could be infectious or a fungal ball, it could be scar tissue or rampant virus, it could be fluid or the beginning of something really malicious. Context matters. Someone would say we can code for that as well. Ok then how about the overall state of the human being, one asks? We can code for that as well. Ok, how about human feelings? We can do that as well, by coding their facial characteristics? Ok, how about their fears and the subsurface emotions coursing their veins? Even humans can’t figure that out? Actually, with a little communication, we can. But one gets the message that the many existing variables that prevent the false negatives and the false positives from embracing the predictions by subjugating themselves to the zero is nigh impossible. But the trials and the beat will go on. We might succeed one day, but not today.

There is something to be said about the human factor. It might be messy, it might be chaotic, it might be fractured, it might also be grand as well or it might be the cause of a lot of human follies and the start of a learning process to make better that which is flawed and that, as they say, is the greatest of gifts contained within the 3-pound flesh solidly protected by its osseous protective confines. From the powered flight of the Wright Brothers to the behemoth million-ton flying machines controlled by a few levers upfront is a long way in hundred-plus years. The pace of progress accelerates as mundane tasks are relegated to the machines with the IFTTT and the human brain conceives ideas for the future! We live on ideas. We grow with ideas. We are the ideas that make the world go around.

“Second star to the right and straight on ‘til morning!’”

Steady as she goes!

SOCIOPATH & TRUST

I woke up from a nightmare. At least it felt like a dream about this monster. Well, he did not exactly look like a monster, but his actions were more like one. His balding lack of integrity was hidden beneath the baseball cap. He seemed affable enough to warrant one’s reflection. His smile was disarming but lurking somewhere in the deep furrows of his piercing eyes was the coldness that comes from a nature foreign to most human beings. The dream went on in some circuitous ways, without any coruscating droplets hanging a rainbow before my eyes. Stark reality, it seems, was in play. Everything in nature seemed like a sparingly decorated stark modern home. Nothing homely or comfortable or full of the memories from the past. Just here and now and bland.

We were in a restaurant with his wife, who seemed amiable enough and seemed to hide her insecurity behind memorized verses from famous poets, but she had a sharp tongue to match her fleeting frown to his cold stare that seemed to gaze at nothing in particular. We had to be seated several times to the complaints of the man. Both their sudden change of demeanor showed up like erratic flashes of lightning bolts, covered hurriedly by the dark impenetrable cloud of grey. The couple were strangely human but not so in their actions. They were disarming with their brief smiles and terrifying in their silence.

The dream went on, now we were at a funeral and she, the wife showed, what seemed genuine, a sadness in her eyes and the very next moment a hushed giggle. A classic personality disorder that would fill a psychiatrist’s hour and then some. The man in the baseball cap told tall tales of other people. He used easy words to disparage and gently vilify without showing any signs of vehemence. His woman nodded in silence and filed in words to enhance his statements. It was a classic dance between Ralph and Jack described by William Golding in the Lord of the Flies. Unsettled evil lurking beneath with restrained hostility and a hidden but easily provoked maleviolence. Like Ralph and Jack, this man and his woman had the feral qualities of the “beast” that exists in such humans.

We were suddenly transformed to an office setting, where he now appeared to be comforting me while I was in some feeling of distress. A strangeness overtook me as he leveled uncustomary compliments towards me. And just as swiftly, the forked tongue of this serpent had wrapped around me and I was back seated before him willingly agreeing to some nuanced version of reality that he had put before me. Thankfully all nightmares are life limited and I found myself in this multilevel home with the walls leaking water and the roof bowing under the weight of a deluge from above. Water was weakening the structure as the scaffolding groaned under the weight of this torrential storm. A good structure, like character will stand the test of these storms. The structure remained erect and secure, albeit wet. A safe refuge. It weathered the storm. The darkness passed.

The next moment I felt as if I was flying under my own powers, bending metal to the will of my mind. And then as suddenly that dream dissipated.

I realized what my nightmare was conveying to me, that there are people in this world who take pleasure in harming others. These are the 4% of the populace. One in 25 people have this affliction. These are the sociopaths next door, that we never find out. They are geared from their earliest waking moments through their gradual descent from possible lack of good nurturing, to cause harm to others. Others to them do not have meaning. Others merely exist to be exploited at their hands.

I woke up in a sweat! The nightmare became a memory that finds its way into my mind, jogging the wheels of reality from time to time. It is a distant past that fades with each passing night but the lessons it taught me, remain true to this day.

These fiends are also to large degree cowards, fearful for their own person and their personal wrongfully attained gains. They lash out at others to benefit their plans, pointing fingers at others while gaming the system for their own purpose, while having no remorse in harming others to achieve their aims.

These are the Sociopaths. And history is replete with them. Those that dabbled in high stakes and got caught with their hands in the cookie jar include the following: In Finance names like Bernie Madoff and Rajaratnam, in Medicine, Dr. Kermit Gosnell, in Pharma, Martin Shkreli, come to mind.

Based on that dreadful nightmare, I researched about sociopaths and so allow me to share some of the tricks they use:

1.    Feigned Empathy. These monsters will drop a tear as an emotional expression at a funeral when the death of the person means absolutely nothing to them. They will act out sadness over an unknown person to show others how empathic they are to someone’s else’s tragedy, trying to prove their virtuous self. They will use the other person’s distress and claim it their own. They will virtue signal anything to the targeted victim to bring him or her into their fold of blinded ignorance.

2.    Exploit Weakness. Most humans are gifted with a sense of truth and justice based on Natural Laws. Every one of us has a weakness, be it gullibility, desire to be someone’s friend, desire to do good, honesty, virtue, giving comfort to others etc. These monsters exploit these gifts. If you are honest, they will vilify other’s lack of it, If you are giving comfort to others, they will mention someone else as being poor in that regard to give false sense of admiration directed at you and simultaneously say the same about you behind your back. They will cultivate your weakness into a full-blown friendship to win your trust. They will always try to gain a level of control over anyone who is susceptible to their sweet-nothings, by boldly promising to kill the beast of their own creation and resident in themselves.

3.    Temper Strength. They will constantly undermine your strengths under the pretext of “helping” you get better as a person. Always undermining your strengths and exposing and amplifying your weaknesses with “friendly” corrective mechanisms. They will try to show they are sophisticated and strong but your strengths are actually your weakness.

4.   Surrogacy. To further emphasize their point of views, they usually have a very select cabal of one or two others that whisper the same messaging so as to reinforce the designated points of view. These surrogates are usually their partners in some previous crimes, hence joined at the hip for self-preservation. In doing so, they will reward these surrogates with other’s ill-gained money. This monster man and his woman type live their lives, firing volleys from other’s shoulders, shielded from reprisal by convincing others to do their bidding.

So, what did I learn from that nightmare?

1.    Trust no one without verification. Listen to them. These monsters will unknowingly express their inner thoughts and potential focus of harm. Listen to advice from those close to you before according them the benefit of acquaintance, then continue on with your research into their modus operandi and keep listening to their words and watching their deeds. Depending on your own strengths and weaknesses, your honesty, and gullibility, your desire to be nice and friendly to others, these nasty sharks will slowly worm their way into your life. Their persistence and cleverly disguised methods win over most skeptics. They are relentless and gauge your response constantly, adjust accordingly, because their eyes are always on the prize; your life’s worth. The monster in my dream never wanted to be seated with a window or door behind his back, indicating he had done harm to others.

2.    Beware of those constantly heaping praise on you.

3.    Beware of lofty promises.

4.    Beware of those desperately wanting to be in your friend circle, with no friends of their own.

5.    Beware of those who tell you they are very selective in having friends or have none at all, but they want to be in your circle.

6.    Beware of false pretense, false empathy, false bravado, false rhetoric, it shows if you keep an open mind.

7.    Beware of someone who exploits others to show their prowess in managing people.

8.    Beware of someone who demeans your long-term friends. Their fear is that those closest to you will find them out.

9.    Beware of giving away trust for a false kind word.

-->And teach your children the same.

"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.”