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

CHASING MIRAGES - "IS CAUSALITY DEAD?"

The evening was a welcome cool from the day’s sun. Summer was hesitant to give way. Perhaps it had a few more thunderstorms up its sleeve or was mostly tempting Fall. I couldn’t say. It was a magical evening nonetheless. As the fading light of the setting sun caressed the tall pine trees and disappeared ever so slowly a cacophony arose from the trees. The cicadas had arisen from their deep slumber and now vibrating their tymbals were taunting their predators with their rhetoric. It became constant and sort of annoying. It reminded me of the itinerant intellectuals who pass along their confined boxed-set knowledge as the truth. 

We seem to live in a world inhabited by Sophists; the Protagoras and Thales kind; forever drifting in the sea of their own making. Constantly deducting from a set of false premises. Plato would have set them free, but alas, very few ascribe to those ideals. Their drumbeat resonates in more ears with their tymbals than tongues splashed from the taste of fine wine poured from the vineyards of reality. Relativism seems to play a large part in our society. Be it moral, metaphysical or scientific. In every corner of the inhabited land a call for relativism is trumpeting the ever increasing vigilance of “All things are equal.” “There is no good nor bad, only thinking makes it so.” Hmm, where have I heard that before?

You see dear friend and reader, when we start preaching from that diamond-studded lectern and profess an intellectual high ground that is fortified only by false premise, someone, some day, with an average intellect will eventually find the key to the falsehoods. 

Now imagine the falsehoods being churned out in large numbers in science. And, I am speaking strictly about Medical Science. Causality is inferred through an elaborate scheme of statistical fiat. From the simple and easily understood Kaplan Meyer Curve that showed survival in a graphic form; The survivors in the treatment arm vs. in the untreated arm of a study. We have now launched into Forest Plots, Propensity Scores, Instrumental Analyses, p-Values and other elaborate probable causality forms. We continue to draw strong inferences from weak correlations. One can reach logical conclusions through reasoning based on any premise. And that is where the fly in the ointment sits. As the term “garbage in, garbage out” is used in computer input/output results, so are the conclusions based on inferences. Statistical Inference on the other hand provides us with a probabilistic “determinist reasoning” where predictability is circumspect in most cases relying on percentages. No wonder IBM’s Watson failed to provide the correct treatment in cancer cases - a failure of AI dependent on limited and incongruous data. Similarly having a false premise and even worse, falsified variables lead to false conclusions. By simply masquerading as a statistician or being one employed to determine a firm value to take to the bank, one can herald a meaningless treatment protocol costing hundreds of thousands of shekels to prove that an occasional survivor from an n of 14 will come forth and brighten the balance sheet. The data so incurred is as flippant as the coin being flipped. The cicadas are vibrating their tymbals ever louder as average people view the data through a clear lens and say, “What gives?”

What do we do. Should we let causality be an inferred determinant from correlated inferences? Should we simply bow down to these itinerant composers of rhetoric and their daily fusillade of useless information couched as “landmark studies?” We should reason! However, knowing well, If one questions the motives of these falsehoods, moral relativism will come into play and virtue-signaling, now an art form for some, will blind you, deafen you and vilify you to shut you down. Perhaps we might consider using the correlational inference as the intermediate step and then look hard for the proof on causality? Something akin to finding the Anopheles mosquito as the vector in Malaria, or lone star tick for Lymes Disease.

This storm of falsehoods and intemperate pseudo-scientific behavior will come to an end, one day. More transparency is being demanded by those that inhale this form of information because the links between therapy and disease outcome seem to move farther apart that neither the statistician nor the scientist/author can bring the opposing factions together in a cohesive bundle. Numbers can’t pull together what common sense says does not belong. After all, adding more salt or sugar will not displace the aged and oxidized fruit to a better shelf. Medicines that are used as treatment of disease are all the more of concern. Especially when lives and billions of dollars are at stake. Hiding behind the Progression Free Survival instead of Overall Survival will simply not do. After all, by the magic of “timed evaluation” a PFS can vouch for a “markedly significant” response although overall survival of the patient remains unchanged. Meanwhile billions of dollars go down the drain and precious lives are lost for the want of time. Read the literature and I promise, if you do it with clear eyes and open mind, a tear of sadness shall flow unannounced.

So once again I get back against their (Sophists) ideal, that there are some absolutes in this world. Vanquishing disease for instance, delaying disease as the next best, or simply creating comfort are the three modalities of care in cancer medicine and most other diseases. One should not have to pay dearly in finances and lose a fortune in the hopes of living longer when the ticking of the clock suggests that time-determinant survival is not prolonged, except on the bias of variables, a code for snake oil and the fiat of statistics. Those patient’s finances are better left in the hands of the individual and the family to be used for better purposes than in the hands of wealthy bureaucrats. Free Market is free only when there are no controls in place that displace the real cost of "something." Calling the current scenario in medicine as free market is tantamount to calling the sickle and hammer flag a beacon of Democracy.

Causal inferences should be drawn from verified and validated data. If only 6 of 53 “landmark studies” could be validated by Amgen then something is wrong and twisted, in the land of numbers. And now with the Genomics at hand where thousands of genes are in play and perhaps thousands more of epigenetic forces (RNAs) are modulating that play, statistical paradise might have some more bad calls as we muddle through treatment of diseases.

Harkening back to the days when I was in my teens, I thought all knowledge about disease had been collated and complete, that there was no more knowledge to be had...

Oh man, was I wrong! 

I come back to the original correlational question, “Is Causality dead?” As Dylan answered, “the answer my friend, is blowin in the wind.”

The STORM

The other day, sitting by the window, I was gazing at the sunny outdoors, I noticed the bright light dimmed slowly and then precipitously to claim the twilight time in midday. Clouds overhead turned quickly from white to grey to mammatus black. The quiet breeze remained quiet no more. It started to blow. The leaves that had felt the stir were now in a state of panic as the branches of the trees roiled and rolled, swayed to the gusty wind that came upon so suddenly. Soon I could see the wind as the branches were forced to defoliate and the leaves swirled slapping against their brethren and onto walls and lampposts. It grew darker still and an eerie greenish hue circumscribed the neighborhood. Thunder advanced the agenda of this brewing storm. Lightening flashed its 5 mm bolts around the clouds arcing through the air ripping apart space and sending loud booming messages of what was to come. Soon large droplets crushed against the windowpane, splattering and flowing down to the pull of gravity. Then larger droplets still, arrived, each with more crushing strength and ferocity. The view was utter chaos. A few packets of unsustainable weighty hail pelted the ground dissolving on the warm grass, followed by more heavy rain. As the wind velocity increased so did the horizontal nature of the rain. Sheets upon sheets of linearities coalesced together hit without mercy, any and all natural and man-made objects. The drubbing continued for a while and as always, such trauma is never lasting, an hour later the wind soothed down, the rain became vertical and the trees breathed a sigh of relief. As quickly it came, so it moved east and away onto the ocean. The day turned from dark of the eve to light of midday again and the gathering of the clouds dissipated. A few stragglers of white puffy clouds, like the little ducklings walking behind mother duck pulled by the invisible tether followed suit, leaving behind the bright and clean beautiful hour. Such is the nature of storms. They come and go under the forces of nature, mostly announced via the weather stations but sometimes they popup without notice.

Life is like that. A bit of rain must fall in each life. It must, I say, because nature as life does not like monotony, stagnation and boredom. The clean and shine that follows is a new birth of ideas, demand and productivity. Humans are in a constant state of flux, moving and shaking the order of the current impulse. Those entrenched and stagnant in their ideation resist such change and are fearful of it. Those resilient, pliable, flexible with exposure of their minds to new thoughts disrupt the status quo and create a new worldview. Such change is what humanity needs.

Physicians are fighting such a storm these days, as entrenched profitable agencies well-endowed and improperly enriched create the chaos to resist the higher order of newness. Those firm and rigid physicians, unfortunately either lose heart, leave, get burned out or in some sad cases give up on life. These hardworking physicians who are forced by the nature of a few bureaucratic mindset ivory-tower-policy-makers, creating mandates, wear the badge of loss as they give up on life. Their whole meaning being to care for those in need is upended by needless hurdles. The pursuit of the storm makers on the other hand is to further enrich their enterprise to the detriment of all others. The dichotomy of purposes is like the storm, what creates the leaves swirling in the wind, lost in the sea of chaos and humility to an untimely exit. The resolute and flexible ones meanwhile plot their next strategy. Create new paradigms hatched from a conspiracy of multivariate thoughts. Once alignment of thoughts and process is nigh, execution is a mere action. Success arrives. “Fall down seven, get up eight,” is a reminder about resiliency and fight.

As Van Gogh said about storm aftermaths, "...there must be a little bit of air, a little bit of happiness, but chiefly to let the form be felt, to make the lines of the silhouette speak. But let the whole be sombre."

So, my dear friends, it is never too dark for too long. Neither is it torment forever. All of past is a memory. Choose the right memory to fight another day and get up and carry on to the next adventure.

My thoughts and prayers are for you and with you!!

The QUESTION of WHY?

Most arguments begin with the question “why?” No, not the arguments as in shutting down someone’s ability to speak or break down windows in someone’s property or set someone’s automobile on fire. Not those kinds. Here we are talking about the intellectual “why.” The one that requires reason and thinking, not the force of anger and vitriol.

I came across a “why,” recently and it had me in a vertigo, spinning in different directions. Without much ado, let me spell it out a bit.

Here is the portion of the article in question…

“Dr. Presley and colleagues used the Flatiron Health Database to identify patients with advanced NSCLC who received care at 191 oncology practices across the United States during 2011-2016. The 5,688 patients studied had stage IIIB, stage IV, or unresectable non-squamous NSCLC and received at least one line of treatment.

Overall, 15.4% received broad-based genomic sequencing of their tumor, while the rest received routine testing for EGFR and/or ALK alterations only, according to the results reported.

In the broadly tested group, merely 4.5% were given targeted treatment based on testing results. Another 9.8% received routine EGFR/ALK-targeted treatment, and 85.1% did not receive any targeted treatment.

The 12-month unadjusted mortality rate was 49.2% for patients undergoing broad testing, compared with 35.9% for patients undergoing routine testing.

In an instrumental variable analysis done to account for confounding, the 12-month predicted probability of death was 41.1% after broad testing and 44.4% after routine testing (P = .63).
Findings were similar in a propensity score–matched survival analysis(42.0% vs. 45.1%; hazard ratio, 0.92; P = .40), although there was some suggestion of a benefitof broad testing over routine testing in a Kaplan-Meier analysis among the entire unmatched cohort (HR, 0.69; P less than .001).”

And while one could easily glide through this information and come to some quasi understanding of it with a lurking intuitive prick in the temporal lobe of the brain. The question of “why” seems to dog the door open for a wider discussion one would think. And that is where we lay our scene…

The two most pressing arguments in these prediction-based paragraphs are:
1. Instrumental variable analysis
2. Propensity score–matched survival analysis
Big words that a statistician loves to go to sleep thinking about and the clinician or any other scientist either gets tortured or simply ignores and takes it as a matter of fact.

Well then! What do we do about these two posers of great intellect and coruscating aura?

Perhaps dissect them to their innards. You know the ad reduction absurdum and see what cellular cilia are left behind that make these notions tick.

I’ll blindly take the second argument first in my coin toss. The term “propensity score–matched survival analysis” is pretty hifalutin when you get down to it. But as Albert Camus asked… “but what does it all mean…?”

The “Propensity score–matched survival analysis” (A tool for causal inference in non-randomized studies) a fine idea to take a cohort of patients in the control group and rate them from 0 to 1 and another identical group of patients under the treatment arm and rate them between 0 and 1. Where 0 implies no effect and 1 implies 100% success. You then place the distributions of these two groups in opposing sides of a horizontal line (Top and Bottom) as in below…

Here comes an interesting and very clever part. If there is marginal or very little overlap one can consider those people on either side of the spectrum (perhaps called outliers in other statistical methodologies) as being “trimmed off” the discussion. 

In other words, we, (the smart intellectuals) will learn nothing from them because well they did not “match.” Ok so far so good! Did I? Hmm I meant to say So far so good? You see the dilemma that unfolds in a simple mind. Like (as millennials love to say), what the hell?

But continuing on our journey, moving further down this clearly tortuous rabbit hole we then after “trimming” the excess (fat, or unmatched cohorts) from the matched groups we then measure the standard deviation Here comes the next leap of faith, based solely on the enterprising decision-making-value-based interpretation of the statistician par excellence: Using a “Caliper” one can then multiply that standard deviation by an arbitrary number (most used 0.2 or 20%) but it can be changed to suit the motive of the designer to get the appropriate result and make the experiment a wild success. Using 0.15 (or 15%) increases that threshold while raising it 0.25 (or 25%) decreases the threshold of the “Aha” moment. So, the Propensity of this “controlled” experiment is done on the comfortable cushioned chair of an expert, as you can see.

Caliper? No Not This one!

This one!

“But, but…” cries common sense. “Shut up” cries the sound from the ivory tower of excellence, “this is above your pay grade. Just shut up.”
Aww…

Let me not forget that other piece of formidable intelligence folded like a ball of dough ready to make flat bread. The only thing needed is some heat. Our #1 statistical analysis or “Instrumental variable analysis” has to be dealt with, with a gentle but firm hand. The term appears very “scientific and seems an attractive method to control for unmeasured confounders in observational epidemiological studies.” (Wikipedia) You get the bold words in there don’t you? It is a statistician’s dream to solve the riddle of non-compliance in finding some causal inference between a treatment and its outcome where other unmeasured confounding variables might be at play. The attempt is to limit the unmeasured confounding variables – but how? By not doing so leads to a violation of the ignorability assumption and thus effecting (biasing) the causal effect estimates. But never mind that, we are on a quest to prove. And by Golly we will prove!

Here the argument is to say that if Z modulates X (treatment) which changes Y (Outcome) and X is not changed but Y is by Z then we can measure the effect of Z on Y. Simple enough. So, it is making a causal inference of the effect on intent to treat based solely on the effect of a single variable. That simply refers to a single variable effecting change on the dependent category. The simplified formula would look like this E = Y^(Z=1) – E = Y^(Z=0). Where the presence or absence of Z effects the effect of Z on Y. But then we introduce another unbounded (unmeasured) variable U that effects both X and Y. To draw any causal inference between Z and Y or even X with U lurking around requires a pseudo-randomization between quasi equivalent parameters and not the usual Medelian Randomization required to answer the effect of Treatment on an Outcome. In other words, draw from a larger group of unmatched and fit them into the current “experiment” to create the appropriate graphs. As one’s sense gets fogged in and bogged down in this analytical enterprise, one realizes the true nature of current science which seems based more on slippery-mathematics and thought experiments through manipulation rather than on real experiments: Medelian Randomization vs. Pseudo or quasi-Randomization of ‘disparate’ groups or if I can be permitted to rake the term ‘a-priori,’ over the coals and pull the reluctant Bayes into this whole mishmash. By manipulating numbers to find causal links between treatment and disease rather than the real cause itself, aren’t we just creating false but intentional heuristic for the future harm to society? No matter how extensive a list of variables (Risks) it is, we simply cannot completely fathom the effect of a treatment and its related Outcome with using a simplified, contextually flawed, argument of using only the glaringly obvious one or two risk variables in determining where the argument goes to rest. Can we? A simplified case in point would be ascertaining Gene X mutation causes Disease X. Not knowing the Gene X modulations by other genes, epigenetic factors like RNA and Exons and the presence or absence of tumor suppressor genes, tumor promoter genes and the EMT transitions in the milieu, one simply cannot give an answer that Treatment X will have a 100% Outcome Y. What it will tell us that there is a likelihood given all other variables influencing the outcome the probability is Y% (And even that is dubious at best). And that is what patients and physicians need to know. Unfortunately given the tools mentioned above with a solid foundation of statistical tweaking, we cannot with certainty even say that. The “Y%” is a largely muddied concept of false premises and false promises. No wonder the big an upcoming poser, the Big Bluish IBM Watson failed to do render the right treatment and caused potential harm in posing as an Oncologist.
https://www.engadget.com/2018/07/27/ibm-watson-for-oncology-unsafe-treatment-plans-report

Ah my dear inanimate blue-colored friend, as Shakespeare might say, “There are more things on this heaven and earth, than are in your data-base.”

Remember the yesteryears when Jenner used Cowpox against Smallpox in 1796 and Fleming discovered a “Lysozyme in 1923 and then in 1928 discovered penicillin. Or for that matter Marie Curie (Skolodowska) discovered Radon and Polonium in 1911 after Henri Becquerel’s discovery of radioactivity in 1903. Today we make quasi discoveries by manipulating numbers and using soft correlations to get our p-values under 0.05 to win a lecturer-ship or tenure or a directorship and continued employment at a Fortune 500 company. No wonder Amgen failed to replicate 89% of the 53 landmark studies. Only 6 could be considered "validated." https://thenextregeneration.wordpress.com/2013/10/26/the-replicability-crisis-in-cancer-research/

Remembering that incidental, irrelevant concepts that breed perceptions affect our judgment and behavior. A few of these misadventures are honest but mostly they are intentional and with the verbal force behind them, are swift!

Representativeness judgments can influence estimates of probability, while Representativeness heuristics can play all kinds of havoc on a limitless number of judgments. Imagine the Azande people of Central Africa believing that burnt skull of the red bush monkey was an effective therapy for epilepsy, given the jerky and frenetic movements of the monkey itself. Or for that matter "Blood letting" as a means to cure pneumonia?

It is important to remember that concepts begotten of such Representativeness Heuristics oscillate in elegant and opposing waves and only time gives each side the temporary podium to win over the society of humans. Consanguinity of thought begotten from a intentionally biased point of view leads to monstrous results, ask the Habsburg(s) and their collapsing empire, their jutting jaws and their intermixed (Consanguinous) DNA short lives.

Chasing the pool of money with such manipulative fervor is harming us all. We need a better handle on reality rather than exist in the virtual world of “IF THIS THAN THAT.”