Pivoting on Pin Heads

Two individuals both bright in their presentation find the luster of success by trampling on another’s grief. Both huddled, for want of a better word, in the realm of a self-imposed totalitarian-styled narcissism

I came across them through their words and the words left me wanting for air. From those words, one can see that both have no difficulty of expression. Both find refuge in exploiting the right words for the intent in their meaning. Both seem remarkably astute in their discipline of what they wish for the reader to read. So when I read their words, it was an indictment of their intent and purpose.

Mentioning a brave and open person like Lisa Adams whose courage and bravery in fighting the tentacles of a wretched disease in the same flow and context as resource consumption is a travesty,

Yes, this world has changed from the compassionate comforts to the hard realities of fiscal constraints. We see time in terms of money. We see life in terms of money. We see work in terms of money. In fact money seems to govern every aspect of life. Money, it seems governs our lives, thoughts and actions. This stark reality only comes to face its own sets of demons when confronted with the likes of Lisa Adams @AdamsLisa who has led the charge in breast cancer advocacy since facing her illness and has inspired hundreds and thousands of others through her quest.

The “Hope” we have often heard about is the very essence of everyone’s existence. It is the measure of our respect for life. It is the measure of what we see as our future. This same hope is now being reduced to metrics that measure money. Comforting someone in the throes of an illness with euphemisms and sultry inconsequential words, all the while purposing the one object foremost on the bureaucratic mind is a testimony of how far and how deep we as a society have sunk.

And there are many like the Bill and Emma Kellers of the world, who see the world through their own eyes of cost-repair in a money-dominated minded society (here). Forgetting in the process that there are hopes and dreams of individuals other than their own, they cite personal stories to invoke emotions and passion in the current vogue of “Made to Stick” mantra that everyone seems to aspire. They miss the forest for the trees!

Jody Schoger @Jodyms is a wonderful writer, a disciplined and gifted advocate for patients, well-versed in the disease manifestation of breast cancer who lays out clear examples of the many weaknesses in the Keller arguments in her blog (here).which should be taken seriously. 

My medical oncology training and years of experiential reference has seen the world view change when observed through differing set of lenses. What once was is no longer. What was considered prudent has gained notoriety. What once we reveled now we revile. What once we took for compassion now we take as misguided idiosyncrasy. “Change” seems to have taken a path oft-traveled. If medicine is not about, healing, comfort, curative intent, and education, then we are truly adrift as people.

True, the term "Hope" has different meaning to different people. But ultimately it morphs into the cortex of each of our own being. Respect for that "hope" is what makes us human.

Times do change, but human emotions remain the same. The clock ticks and the second flies by, but history of that second should always be considered. If the Kellers and their pontificating kin have their sway we will morph into an even more intolerant society, where any weakness be it disability, infirmity or illness will become a societal burden, a consummation devoutly to be rid  and we know what happened with that way of thinking.

REGRESSION and the fallacy of Analytic Predictions

Lately I have been watching people, a singularly interesting time-occupier. And what have I learnt? A lot of things! Whereas the mores of the society in general are degenerating at a pace far exceeding other epochs in human history, the current goings on seem to be tied to the Gordon Moore’s law, only we are talking deviating brain activity rather than the chip transistors. It seems that humans have a tendency to go into the outlier territory once in a great while and then like the Foucault’s Pendulum regress back to the center. At least, I am hoping that will be the case this time too.

Regress? Why on earth would going back to the center mean regression? Oh that is an infinite jest of the language. Let me explain both sides of the y-intercept and the standard deviations to make a believer out of myself and hopefully you. The former is more at hand than the latter, for you might laugh out loud (LOL?).

Okay, here is the gist of the matter. We draw lines to predict the future. The trend is the trajectory and any future spot out there is the future. Through the lens of our crafty mathematical genius we are able to affix a point and time in the future and predict that that will be the case. We are not always right you know. For instance 1984 did not happen in 1984 but in 2014. The future immersive technology forecast in 2001 is showing legs in 2014. 

HAL-9000 has appeared in the rudimentary form of IBM’s Watson and both are equally ominous in information load and both are intimidating to the human counterparts and both will have streaming consequences on the human linear time.

As long as we don’t give Watson a 100- year rechargeable battery with a sidewinder, we will be okay on, when to pull the plug. Oh, but I digress…

Back to regression.

Lets see. What we need are a few sets of numbers that are metrics of measurement for anything. IQ, EQ, OQ or for that matter DQ (dumb quotient). We place those numbers in a column and find the mean (average)-belonging to the independent (x) variable. Then we have another variable set of numbers as metrics for another measurement, say achievement (the dependent (y) variable). We do the same for this set of numbers and find the mean. The two sets: the independent set measures the IQ or equivalent and the dependent variable measures the achievement are needed to create a linear regression of sorts and in the end an answer of whether the achievement has any effect on achievement. And if they do we can prognosticate based on the standard deviations if the IQ is 185 what would be the equivalent achievement of that individual. Seems easy, doesn't it? Read on, if you are so inclined.

y = mx + c is the same as y' = b0 + b1(x)

The how part is kind of easy. Take each independent variable and subtract the mean, then square the result. we will use the following notations for the variables:

xi = Independent variable.

ẋ = Independent variable mean

yi = dependent variable.

ẏ = Dependent variable mean.

Ʃ = Sum of

Ʃ(xi-x’)^2

On the other side take the dependent variable and subtract the mean also and now multiply the un-squared independent subtracted variables from the mean to the dependent subtracted from the mean.

Ʃ(xi-x’)(yi-y’). That then becomes the numerator and the denominator is the squared independent variables from the mean. Now the regression line can be drawn from the dependent variable mean and must cross the means of both dependent and independent variables.

b1 = Ʃ(xi-x’)(yi-y’)/Ʃ(xi-x’)^2

The formula for linear regression then is: y'= b0+b1(x) and b0 (the dependent variable intercept) is easily solved as b0 = y’-b1(x)

Simple QED.

But here lies the problem:

We can see that the variances are squared and become the denominator in the equation and the standard deviation is nothing other than the square root of the variances. So all future probabilities have to lie within the realm of these standard deviations. Ah, so here we bring in the old skeleton of the Confidence Interval bounds and the p-values once again. The future probabilities are based on the assumptions that the line will either be in the negative or positive trend and follow the linear pattern along all new measurements and therefore will “likely” fall within the bounds of the standard deviations. These bounds will be +/-2.5% of the edges or in the 95% under the glorious Gaussian curve.

What if it doesn't? And, you guessed it...It doesn't all the time at least in the 95% model not to fall within the confines of the curve 5% of the time.

Standard deviation or δ = (square root) √ variance and variance = Ʃ(xi-x’)^2/(n-1)

And of course what is not measured are the humanity's frail and bold outliers on both below and above the line’s trajectory. Yet the consapevole are pleased to report in all sort of blinding studies that bring rapture to journals and books alike is the mathematical proof of what they have extracted from this formula. And off they go trumpeting the wonders of mathematics and the superiority of the science of probability as a testament to the absolute truth and the likely future.

But what of the outliers?

In this world of decay, they need not apply. You see we are now firmly entrenched in the sea of, “what’s good for the pluribus and who gives a damn about the unum.” These outliers are the very ones that can change society with one fell swoop. These are the “renegades” the real innovators, discoverers, creators and master minds. These outliers are also the weak and timid that Hitler once wanted to eradicate. Upon the burdens of these are created the wonders of new innovations to help the many. Upon the weakness of these the brave take charge and remodel the world’s mores. The two sets of outliers now in the throes of discard and destroy, not often but almost always in them lies humanity’s future.

So before you go drawing regression lies and use all sorts of catchy “student t-tests” and “Chi square tests” think also of the Pearson’s Correlational conundrums and then the outliers. Because sometimes the weak interfering correlations can confound the strong result in either extremes of benefits or lack thereof. The intent will find the one that feeds it.

The world and human health along with human behavior is a messy playing field that rarely conforms to the norms as established by the mathematical world. Yes we can make a safe prediction about what the S & P will do tomorrow and be wrong and lose some money or make some but boxing the variables of the multi-trillion human cellular milieu is fraught with errors.

Mathematics is the language of life. But it is also the invention from which evil springs to gloat, goad and destroy. Within the numbers and the formulas, lives the manipulative massage of the intent. As Barbie once famously said, “Math is hard, let’s go shopping!”

Just a thought…

THE curious CASE OF REWIRING

"Excellence is not an act, but a habit..." ~ Aristotle

Imagine!

And this is all about imagination…!

I saw an electricians wire the new house that was being built. They were busy drilling holes and laying down conduits and threading bundles of wires that seemed to zig this way and zag that way leading to various placements of various sockets and switches. Frequently they would re-drill and change the direction of the wires to bypass plumbing or other hurdles in the way. This went on for a while on a daily basis. Many pathways later the structure got its siding and then one day, the settlers came in and voila there was light and ceremony.

Now many years later an electrician’s truck was back there again. He was trying to snake the old burnt out wires but could not force them by pull or push. “Oh the settling of the house makes it difficult, so I have to drill new holes to create a conduit,” he said as sweat beaded his brow. “But,” he reflected for a moment, “I am not exactly sure what I am going to face.”

And it made me think!

What about this rewiring phenomenon? Why is it difficult? Take the human brain for instance. When the child is growing from infancy to about 5 years the brain expands three times in neuronal connections. With billions of neurons being created and trillions of synaptic connections being established, it is a high stakes game of circumstance and chance. The synapses are clicking and grinding in the motor and sensory cities of imagination and wonder. Everything is new and neuronal dendritic connections seek out and connect to any available or previously connected neuron as flashes of the immediate world images come in through the eyes at blinding speed. "Ah yes that face is my mother’s, she coos and laughs and cuddles and loves me. And that must be my father with the rougher face and occasionally the knitted eyebrow and that younger face must be the brother who cannot help himself from pinching me. And that face filled with kindness and joy must be my grandmother. But what is that furry creature that keeps coming up to sniff at me? Ah they call the furry thing Rex.” These pathways grow exponentially and as “Rex” becomes the dog affectionately called “Rexy” and then “Rexy baby” later new wires have taken hold within the old circuitry. The rough faced creature with the knitted brow becomes dad and the cooing lady becomes the all-important listening, advising, nurturing mom. The notion of school arrives and drives away all feelings of comfort and a new fear and longing initiate new connections. And one day, "love" comes knocking at the door and huge bundles of connection find their awy to the amygdala (the heart of emotions in the brain). As the house of life ages and connections that have not been made over and over seem to fade, faces are recognized held in some crucible of thought matched to an event, but names falter. Lovers like circuits might come and go, but emotions remain, like the steadfast sun, which rises in the east and sets in the west and remains a constant reminder of the passing time, many ideals conceived of logic or illogic fall prey to disuse. The compelling nature of the moment seems to lose its moment and pitch and many a connection are lost.

So the curious case of rewiring comes to mind. How to rewire the brain?

Indeed how to?

Like the house that is settled, a new hole has to be drilled. The old wiring has to be severed at both ends and withdrawn and new wiring has to take its place. It will require a consistency of effort and a daily workshop of fixing and changing to create the conduit to replenish the memory and since new switches are needed for other receptacles, a new wiring pathway needs to be constructed as well. The old switch is covered over by sheet-rock and now stands behind the armoire. New links are needed to join the switch to the sockets and new sockets are needed in place of the old ones that lie hidden behind sofas and chairs. The house needs work both outside and inside to remain a home for comfort. It needs constant attention like the lawn to rid of the weeds (bad connections) and planting flowers (new connections) fit for each season. The constancy of effort is a ongoing rewiring process. Hypotheses and Spins, like selection bias and statistics of small numbers, both fail to the Occam's Razor of verifiable, repeatable facts. Only a nimble and receptive mind, grows new connections and rewires new circuitry.

Relearning old tricks and new ones is a difficult process in an ossified mind that fails at agility. Like businesses or corporations that fail to see the future often get mired into harnessing old tactics to stay current and are met with customer disdain and ultimate loss of profitability, because they keep trying to force the new wires through the old conduits in a settled enterprise. Relearning needs rewiring and that also needs remaking. (Sears Holding might fit this picture). The agile on the other hand, are adaptable and align themselves to the future by constantly relearning and rewiring the concepts. (Apple seems to fit this one). Along with the concepts they also rework the old façade, “painting, fixing and creating new eye pleasing and sustainable ideas and concepts.”

Rewiring is a constant process, which does not allow settling. Rewiring needs a new outlook every day and that needs an open mind, receptive to changes and desires. Some studies suggest that rewiring a new concept in the brain requires many days of repetition and that is true. The more difficult the doing, the more effort it takes, but once ascribed to the concept of relearning is done. Agility to adapt is all encompassing to align one’s needs with what one desires to accomplish in one’s life.

Go ahead…

Rewire!

MY THREE WORDS

Standing on the shoulders of these giants Bryan Vartabedian ( @Doctor_V ) and Greg Smith ( GregSmithMD ), I can see the relics of the past and the optimism of the future. The year is new. The resolutions are many. Time is always short. Life is filled. So the three words that hover around my mind’s eye are as follows:

1.       Think. Rene Descartes famously said, “Cogito Ergo Sum,” (I think therefore I am) there is much meaning in those words. I have been parsing the word “Think” in my many previously digitized posts but never in full practice. So resolving that conflict, I believe to consider and by consider, one might as well say, to think through the possibilities, all points of view whether they hurt my innate psychology of desire or for that matter enhance the substance of my past experience, will be finding peace in the comforts of my soul.

2.     Reason.  C.S. Lewis once said, “An explanation of cause is not a justification by reason.” and he may have his opinions based on his experiences, my thoughts are more in line with the Dalai Lama’s words, “The ultimate authority must always rest with the individual’s own reason and critical analysis,” Reason, is the base upon which a society exists. Although C.S. Lewis might have invoked his reasoning based on the falsehoods of forced justifications and man’s attempt to justify his immodest action. Yet “Reason” stands out as the only logical expanse of human behavior where time has bestowed thought and comprehension into considering the affairs of man. So reason in my mind is the second pillar of what I consider an important trait of my future existence.

3.      Inspire. Transcendence of any society is organized by those that inspire and lend shoulders of strength for others to stand on and view the future. Inspiring the youth and others to create a better future for us all is a motivation that needs no justification. I find that encouraging others is in itself a virtuous cause. One can only inspire through positivism based on reasonable thinking. The future will unfold as you dream it. So let us all aspire (me especially) to inspire the good to unfold our dreams.

2014 will be a better year.

SANITY v. INSANITY

I had a strange dream…

The phantasmagoria of the passing green fields riddled with picket fences and cows grazing the fields pass by at blinding speed. As I hurtled on the autobahn it was hardly the illusion of what sanity is made of. On and on the whoosh of the beautiful fancy passed me by at speeds that seemed unreal that all images stood still momentarily and then with the blink of an eye were gone. And as surely as the speeds tested the Mach number a sudden stop on a country mile brought images of the cows wearing bells clanking their way across the road as the traffic came to a dead stop. The calm within the storm.

The fields stretched far into the distance and there before me was a spectacular image of a beautiful rendering of a castle perched high atop a mountain with sweeping vistas of tall trees. 

Was it an illusion? painter’s imagination? Or was it a work of art? Or was it reality?

The castle stood quietly in its cloaked splendor a midst the floating mist of moisture laden clouds, which kissed it gently and with each stroke uncovered more of its majesty. This was the Schloss Neuschwanstein. The beautiful architectural rendering of what has been considered the imagination of a deranged mind. King Ludwig II of the House of Wittelsbach was declared insane for spending the family fortunes in building castles and bringing it to ruin. The “Mad King of Bavaria” was declared insane and deposed. Three days later on 13 June 1886 his body was found in a shallow lake near Munich along with the body of his psychiatrist.

The beautiful castle still stands in all its grandeur. It rises majestically as its turrets prick the clouds trying to shed the truth about its creator. Was King Ludwig II crazy? If he was why is this endearing legacy in the form of such architectural splendor a draw of fancy of every child and adult in the land and across the globe. Some call it architectural fallacy. Some just shake their heads in incredulity, while others shake their heads in awe. But my dream ends there and as I awaken from this strange corpus of mystified wonder, fresh questions arise.

What is mentally insane? Is it the argument about squandering wealth? Was the “Mad King of Bavaria” mad because he loved the architectural challenge of creating such masterpiece as the Schloss Neuschwanstein? Was the dwindling fortunes of a family, the force that invoked the insanity declaration? Was his drowning a suicide or as some now claim it was a murder because of memory-recalled anecdotal evidence that seems to suggest of such a travesty? Whatever caused his demise, it leaves lingering doubts of what was the intent. If you were to venture into the castle’s interior you would find the trappings of a voracious reader fully ensconced in a perfectly royal “reading throne” next to the royal bed overlooking the Bavarian countryside. 

The tapestries adorning the walls and the rich texture of thought that seems to inhabit every piece of the furniture in the finished rooms suggest great concert between idea and perfection. The Swan room another fancy of the deposed King suggests his predilection to the beauty of the swans. He loved the image of a swan and everything in the room speaks of it. Was this idiocy, madness or a mind in love with the beauty in nature? If one looks critically at today, some girls are fascinated with princesses, and dress in their make believe land of holding court or some boys swing a 42 inch wooden stick and envision themselves in the trappings of a Yankee stadium galloping across the diamond after hitting the home run to the applause of thousands. Yes we all have dreams, but wherein lies this insanity that doomed the King?

Today the proliferating morass of psychiatric diagnoses fills a 991 page Diagnostics and Statistical Manual of Mental Disorders DSM-V book. The most common childhood diagnoses of ADHD and ADD now seem to afflict a large and significant number of adolescents in the U.S. and through the developed countries. Anytime a child is hard for the “busy parent” he or she is rendered as a “case” and stuffed with pills to keep him or her from invading the “calm and quiet” of the parents or teachers who have grown to have a depleting content of patience. In fact the increasing diagnosis is a boon for the mental health and the pharmaceutical industry. A pill and all is quiet for the parent or the teacher to indulge in their fancy. Is that a parental insanity escalated to levels of self-absorption that their mechanics of finding solitude be based on prescribed medication? So where is the true sense of sanity? Is there one? Is the person who fiddles in his pocket to make sure that his car keys are still there, the makings of an obsessive compulsive disorder, therefore a psychiatric conundrum? Is the perfect crease on a pair of pants an obsession in need of a pill? Is the parent’s desire for a successful child a fancy worth putting the weight of adulthood on him or her thus depriving that child of his or her “childhood-ness” an insane proposition invoked by the parent? Where does one or for that matter “who” who can draw the line between the thoughts of a wild imagination and the carefully controlled and constructed mindset of sanctified order?

Mental health issues stemming from “neuro-chemical imbalance” are widely appropriated to  a certain population because of their non-conformist behaviors but do these rise to the level of the challenges such as the shock, the stress, the horror of a war in the form of PTSD that need an understanding ear, a steady emotion and potential short term use of medication. When the flights of fancy of an imaginative soul are deemed insanity to prevent cost overruns, or invasion of “quiet time” then something is truly insane.

Do you brush your teeth every morning and before going to bed every night? Is that a ritual of good habit or a compulsion? Do you watch with intense disdain when someone sneezes into their cupped hands rather than in the crook of their elbow? Do you wear gloves to touch all doors, railings, banisters in public places or yearn for a tap with running water to wash your hands afterwards, or look for the ever-present bottle of Purell nearby to ward off the microscopic evils that might rob you of your health? Do you shake hands with people? You see where I am going with this? I once came across a famous female doctor who walked with her hands behind her back. She looked like a duck at times with the arch in her back as her rear end trailed behind. What were the metrics of her “saneness?”  

So we come back to my dream once again. Was the “Mad King of Bavaria” really mad or just indulgent of his fancies of perfection and beauty? Was the drive to depose him the arch purpose of the family or the kingdom to preserve the wealth and power of the family and the kingdom? These are difficult questions, but even more difficult is the premise of a wanton approach to label for selfish desires.

Each one of us comes replete with our own baggage of experiences, some experiences are tortured and others are comforting. It is the composite of this collective that makes us who we are. Where in these realms, is the demarcation line between what is and what is not sane? True the ones that have truly lost all temporal sense of existence need help to function. But here again where is that temporal boundary? When the frontal lobe and its cognitive sense of right and wrong, good and evil, yes and no has departed and the parietal lobe of the brain links action to a constant stream of a circular thought devoid of the temporal constraints then one is compelled to visit the malady with all the tools of rational thought and action to correct the imbalance. But what is sane? This question poses many others in our minds. How we answer these and other such questions might then become the defining path for a society. The pathos and ethos contained within the crucible of humanity might just be the elixir of existence and not the vectors between the sane and insane. For instance some would consider the price of this painting at $117 million, insanity. Would you?

We help others not to add to the ritual and decrees of making more use for the help we have created, but for the true sense of lifting another’s life. We do not add to the plethora of psychiatric diagnoses just to pigeonhole another fellow human into a life-long servitude to drug-promoted-mind-control. We live to better each other’s lives and in that we must rest our laurels. 

HOPELESS APPROXIMATIONS

Needless to say that time is the ultimate warrior against life. It is. We, humans live as if the end will be the big giant supernova and that remains a few billion years away. That it would be a big whoosh of collapsing dust into a black hole spreading our dust into the universe through its glorious accretion disk jets. Alas, the vision is sorely in need of revision. The four score years haunt the vessel that inherits the wide eyed immortality thoughts. No, it is a simple and tested hypothesis, observed over millennia and validated in its entirety. Life ends whether in a flash or with a whimper, it ends.

Humans are adept at visualizing grand obscure corridors of endless hallucinatory thoughts, of this or that. You know, like the ones we all have. Buy a lottery ticket and become an instant millionaire, live in palatial homes and travel with the jet setters, eating caviar and drinking aged wine to perfection, whatever that means. Yet we still inhabit the same shell with all its confines and a mind filled with the baggage of experiences. The collected images of the past, embellished through the lens of time, with fancy and incredulity foster and remake the person we are, for better or worse. No wealth or grandeur can escape the shackles of a buried past. We live therefore within ourselves, as us. And no hope will shake the limits of our destiny.

This one fine day, an elderly man with an eye towards perfection and a nose for a tale, held my interest. He was confined to his physical limits from arthritic joints, a stiffness that was pervasive in each movement. Yet he was as real in thought as you or I. He sat quietly without so much as the sound of his breath adding to the noise pollution around. My restlessness in my erect vertical stance leaning against the wall must have breached his sense of comfort at some level.

“Tough day?” he asked.

“Yes a little.” I replied.

“That is life.” He said quietly.

I looked up and smiled at his frail frame affixed in the shiny wheelchair. There was concern on his forehead and in his eyes that were weighted by years of wisdom could perceive through the cataracts of time and infirmity when hurt echoes within another’s silent flesh.

“What is it?” he said and after a pause added, “May I ask?”

“My patient is not doing well.” I replied.

“We are all humans, with limited abilities. Nature has her own sets of rules that defy anything we can think of or consider. We do our best and then let the Grace of God take over. We live and we die, and there hangs a tale. Nothing that is will be, everything will perish with the mind. We just do our best!” Never have words with such simplicity or clarity eased a burden as those did that afternoon. Something ticked. Comprehension! I still remember the echo of those words, expressed with the same lilting inflection as he had said them, so many years ago. Wisdom indeed is the paradise for the open mind of an experienced age.

We look for perfections where hopeless approximations are the rule. We look for science where art would better approximate and vice versa. We are forever looking for “something” other than what we have. Clearly something is wrong or right? That pot of gold at the end of the rainbow is what Leprechauns are made of and 1 in 170 million chance of winning the big bonanza is out of reach for the remaining, yet hope springs eternal to find, to discover, to invent, to redeem, to prosper, to live.

Even with our best intellectually crafted approximations in face of what Nature has in store, we still manage to change the world incrementally in small quantum hops as a different place for all. For better or worse, that is what humans do. We are destined to the limits of our virtues, vices and deeds. We are an interesting species. After all we are the “quintessence of dust” approximating the angels on one hand and the devil on the other. We are constantly bouncing off the firewall of Perfection.

"After all we are all humans doomed to live a life of Hopeless Approximations."

EMRs - MEANINGFUL USE ?

What did meaningful use mean? Wrestling with this concept as an inducement to get paid for a spent cause is hardly the realm of a wonderful idea. And then to wrap it up in the cloak of universal utilitarianism of benefits is another blow to the human intelligence, as if there was any left in this drone milked society of ours today.

They haven’t yet proved it, that the use of EMRs has any beneficial effect on a patient’s health. But what they have proven without prejudice or bias that the imposition of this multi-billion dollar enterprise borne of an inquisitive mind to gather a fully populated big database of who does what to whom at what cost, was a boon to technology, to the middle-service-providing-people through pocket-lined contracts and a bane to the patient and the doctors, for whom it was the next coming since “pet rock.”.

Why the harsh sentiments? Why indeed?

If all you see in the pupil of your physician’s eye is the pixilated glare and flicker when you ask a question, a need has been met. But whose need, you might ask?

Yet salvaging from this experiment the emerging theme of observational science become evident too. EMRs have filled some classic gaps in the field of “this therefore that” philosophical construct through data mining. But then one would ask, is that not a good thing? Surely that question sends pings of synaptic pleasures through every epidemiologist’s veins in the form of an endorphin glow. But does a win for the individual, the patient that sits patiently on the opposing side of the flickering screen?

Thus far and this from variously sponsored studies from the pros and cons tilting windmill landscapes of contingent data, the answer remains elusive, for the propagandists  to outright, no for the pragmatists!

But lest we forget that there is a larger purpose in the linkage between the patient’s personal data and the unified correlates of big data, and the minions that spend countless hours mining it, one heap of digits at a time, we might miss that hot breath of the fire breathing dragon. And Lo, just as we question, here comes a fleeting wave of “Eureka” heralding the new dawn of discovery. Ah we have arrived at the threshold of a new paradigm. The net to bag the big fish has been cast. The rewards is well nigh at hand. “This might be a paradigm that will change the very essence of humanity,” they claim. We will know what drives what. We will know what genes are the presentiments of a given somatic discontinuity. We will know! We will know! We know! We know!

This new door into the cross-linked informational landscape between phenotype and genotype is the brainchild of big institutions, by cross-referencing a “Phenotype-wide Assay” with the “Genotype-wide Assays” and finding the needles that rule the haystack of diseases, we will, they claim harness the power. Well that is good you would think, right? And in many ways it might be. We might for instance know the multi-tasking genes that commit adultery in the soma and create a conundrum of metabolic disorders, of cancers, of heartaches and depressed human thoughts and even what makes us laugh at a bad joke or cry at a good one. All laudable concepts, all worth the congratulatory accolades! But, and this might be a mini-but, what about the gene drivers and the soma (Lamarckian) drivers within the individual. The interacting forces of these two cross-referenced Morlocks and Eloia might have differing opinions to that viewpoint. No? Might we not be surging in our minds towards a paradigm flawed in reality but gorgeous in concept?

Let us presuppose that a typical phenotype is associated with a specific genotype, that would be great, now modify the genotype and the scourge visited upon the phenotype would vanish. Voila! QED. But not so fast, lest we forget that there are incoming volleys that serve different masters within the cell and thus are automated upon invariant schedules and rise up to demands from different sources, via a supply chain of differing mechanistic pathways and cross-talks, the only rational thought we might be able o entertain is yeah, there is a “probability” that this might be associated with that, since it seems to occur in 60 or 70 or 80% of the populace.

Oh but there goes that probability thing again. This probability thing that garners almost a 100% of medical literature comes face to face with the “Ioannidis’ nightmare,” which shows more than 50% of the studies cannot be replicated due to the false gods of bias.  After all the trust lies at the feet of the curator of that big data... But I digress. Oh hey, why not! Educating the mind is a reasonable rational rewarding thing to do. Sometime as someone clever said, I would rather be an octopus and slap eight people at the same time to jog their thinking in one fell swoop, rather than a shark going after chum.

So have we resolved this matter? For now, maybe not but we might have started thinking about unintentional pathways and byways and alleyways that might pose a burden to those that do not represent the rich majority of specified shared genotype-to-phenotype-magical-shoots-and-ladders-type-approach. Just so you feel inclined to shoot the messenger here, read this one about changing landscape of the statins.

Come on give in a little and explore this concept…