Friday, December 30, 2016

Healthcare 2017- Ditch Robots And Bring Back The Doctors

Healthcare 2017- Ditch Robots And Bring Back The Doctors

After yet another fruitful year of practicing what I preach, I thought it’s time to put up a post on my pet peeve, again. The said peeve being, the practice of medicine is slowly being changed into a robotic occupation, where a doctor is given a set of instructions and told to follow them to a “t”. But unfortunately the human body doesn’t not cooperate with this by the book approach as every individual is unique by himself and every disease affects a person differently. Given a set temple and asked to follow the protocols given is the surest way to prolong disease till the patient is deceased. And that’s the reason why I always take evidence based medicine with a pinch of salt.

Evidence based medicine to give its due, works in a fairly efficient way, in a limited spectrum. But given its limitations it is inefficient at best and dangerous at its worst. And why, I will explain now. For those not familiar with evidence based medicine- it’s a set of treatment protocols (usually developed in western countries) which says after checking these protocols this is the best treatment for this disease and hence, everyone worldwide needs to follow these protocols whenever/wherever they see this same disease.

The problems with this approach are manifold. Let me just discuss the top two. Firstly most if not all of these protocols were developed for simple diseases and straightforward diagnostics/treatment procedures. If you have any complicated disease requiring multiple procedures, you just cannot follow any protocol template, you have to diagnose and treat case by case using all your years of experience and intuition and hope for the best. Which in turn defeats the very purpose of evidence based medicine. You need best evidence protocols for the most difficult cases because these are the ones which test you to the limits and are prone to end up with the death of the patient and the doctor being blamed for inadequate/insufficient treatment. Where others who have the luxury of time, weeks and months to study the symptoms will second guess the decisions you make in seconds by the patient’s bedside as the patient lies gasping for air and fighting death minute by minute. What’s the evidence say? Did you follow the treatment protocol? These questions are very easy to ask in hindsight but doesn’t help at the moment when most required.

The second major disadvantage with this protocol based approach for treatment is that the template developed most often uses a particular procedure using a particular piece of equipment which study in turn is sponsored by that particular equipment manufacturer. You can’t blame them – for most of these studies are really expensive and require large scale funding which governments never do and hence the researchers raise money from private players who naturally have a vested interest in promoting their products. So even if there is a better or more simpler or more low cost way available to treat that particular disease it will never be accepted as mainstream – because no one does research on it and no one publishes it and no one by which I mean no respectable medical board or journal accepts it- which results in the low cost or simpler alternative having the status only of quack medicine. While the costlier company sponsored study gets accepted in prestigious journals and then becomes the accepted standard of care worldwide merely because there is no other alternative to it.

This grant of legitimacy to costly treatments in the absence of alternatives is the primary reason that doctors from developing countries hate evidence based medicine. It’s all very well to recommend protocols followed in Boston or the Massachusetts general hospital but not everyone is lucky to be practicing in Boston or Massachusetts. What about somebody practicing in Nigeria? Or Nellore? With no access to the level of diagnostic or treatment machinery as given in the protocol as per evidence based medicine? Is it fair to punish that doctor for treating that patient but not following the best established practice protocol? Whose fault is that and how can you apportion the blame?

This craze of getting more and more evidence based protocols also has the side effect of developing and insisting on more and more tests, more than 90% of which are unnecessary- like treadmill test, stress test, angiogram, CT slice- 64/128/216 machines – all of them being developed just to rule out any cardiac disease and your doctor has to prescribe these unnecessary tests every time you go for a simple muscle sprain or gastric distress and indigestion or any other condition which does not involve the heart. But because the best evidence based medicine protocol says you have to rule out heart disease in all cases, everyone gets to do a CT scan at the highest possible resolution beyond 64, beyond 128 beyond 216 slices- even if you are a healthy person with absolutely no evidence of any heart disease. But because the protocol formed in SanFrancisco or New York or London says so- you have to get that CT scan, every time you over eat samosas and have gas. If this wasn’t a waste of resources and such a tragedy it would be such an inside joke, but I can’t laugh at it now. And neither should the poor unfortunate patients who end up paying for all that waste of time.

So the best thing that you and I can hope for is that the government gets into the act and funds medical research in a big way so that individual researchers do not have to go begging bowl in hand to equipment companies who in turn dictate the treatments to be researched and published. And secondly the realization that data mining and rigid protocol’s don’t work for human beings. There is ample space in medicine for hard won experience and intuition based on it. Or otherwise we will continue to take angiograms for every patient who comes to the hospital with an acidity problem and advocate cardiac by-pass surgeries based on miniscule blockages seen in every minor blood vessel, whether they want to or not get a major heart surgery done. Why? Because the evidence says so, and you want to get the best possible treatment at international level don’t you?

I hope national governments realize the immense damage being caused to local healthcare managements by these artificially imposed from abroad protocols and either help in developing local protocols for local people or at least stop penalizing doctors for using years and years of experience to treat patients instead of following Boston rules. Support doctors not robots. 

Thursday, December 29, 2016

Part 2 of The 20/80 Principle- Sex In The City

Part 2 of The 20/80 Principle- Sex In The City

As I said in my last post, the vocal minority of 20% drowns out the rest of the silent majority and in turn the ever sniffing dogs of the yellow media pick up these so called social media influencers rabid and contrarian views and highlight them as the views of the common man everywhere. Case in point- sex. Now I agree that sex sells and the more you write about sex the more eyeball catching it is. But why not write the truth about sex? Won’t that sell too? Why just the sensational stuff which makes a mockery of the real thing is the question on my mind when it comes to the biased media reporting on sex which strives to make us all look like sex crazy maniacs with nothing else on our minds 24/7. This kind of crap reporting on sex has the side effect of making many gullible people to believe in these lies and half truths which the media propagates and disperse them to others as gospel truth and worse to practice it in their everyday life. Case in point- a friend of mine who ogles at every passing female and her body parts- legs, buttocks cleavage it matters not. When I questioned him whether he really felt a necessity to lust after every single random female who passes us, he gave me a honest to god explanation on how it was necessary to keep in touch with your sexual side by craving for sex all the time otherwise, and I am quoting directly here, if you are too good a person and don’t lust after sex, how will you satisfy your wife after marriage?. And this is precisely the point I am trying to make here.

This insistence by the mainstream yellow media for the past several years that Indian wives (leave alone house wives) are not satisfied in sex by their husbands but are indeed looking to have affairs and orgasms with other men is the very raison d’être of this post.  Indian women or just women in general are not such sex starved persons as depicted by the media. Women don’t choose to have affairs just to orgasm- there are lots of other factors involved when a woman chooses to cheat on her lawfully wedded spouse.  And this constant sniping at male’s confidence in the guise of how will you satisfy your wife after marriage, leads to more questions than answers in the average male mind and is directly responsible for licentiousness behaviors like ogling, catcalling or even rape just so a man learns how to satisfy a woman, any woman, even if she is a total stranger and is not willing to indulge in intercourse with him. This constant sniping at fragile male ego’s, this undermining of male confidence has only resulted in longer queues in divorce courts. It has not taught the male that women need more than multiple orgasms and night long intercourse to be satisfied with marriage.

Satisfying a woman via sex is just an urban myth, something like buying your wife or girlfriend diamonds to apologize or whisking away to Bali islands if your forgot her birthday. All these are the works of marketing gurus and creative minds at ad agencies who are trying to hard sell sex to the more mundane minded average Indian male or female partner. Collateral damage to these “profit alone” minded marketing geniuses are the irreversible damage to society and marriages caused by the gullible believing that their wives are indeed sex craved and need to be satisfied constantly and so let’s start learning on the streets with other women- any random woman in a vulnerable place to be exploited.

So to come back to my original premise, the title of this post- just as all men are not rapists, likewise all women are not sex crazy nymphos  as made out in posts by prominent social media experts and picked and highlighted by mainstream media as indicative of women’s mindset. If you talk to a regular average woman, as I have done repeatedly, they are more worried about more mundane things like work, peer pressure, office politics, compensation packages, misunderstanding with family members etc. They seek more supportive spouses who would help them achieve more at work than look for husbands who can “satisfy” them in intercourse. Sex is secondary to everyday life concerns in total contrast to what the vocal minority bleat about on media.

So let’s totally disregard these keyboard warriors who constantly seem to set the agenda for everyone else and give due credence to the real aam admi or aurat who may not air their views on sex in public but know what they want and know what’s important and what’s not for a happy married life in the real world. Sexual deprivation is overrated and is only media overkill. Everyone is getting enough sex even if they don’t talk about it or even think about it. The only ones deprived are the depraved and there is no solution for them except to snatch away their keyboards and smart phones and ask them to look at the real world all around them. And to shut the hell up and not speak for everyone else. 

Wednesday, December 28, 2016

The 20-80 Principle – When Trolls Bray Loudly To Drown Out the Rest…

The 20-80 Principle – When Trolls Bray Loudly To Drown Out the Rest…

Recently I had a resounding argument with a couple of friends on internet trolls and social media warriors. One of the most intriguing points we discussed was on the vocal 20% idiots who monopolize social media space 24/7 and drown out the rest of the voices and thereby get the undeserved tag of social media influencers. These morons with their disproportionate reach on social media due to their shrill volubility and idiotic arguments are often mistaken for representing the silent majority who prefer to keep their opinions to themselves, partly to avoid being trolled by these idiots and partly because they are too busy with their real lives to spend much time arguing on social media platforms. The first issue we debated in depth was the almost unanimous support to the demonetization debacle by social media warriors and specifically the software groupies.

One of the most oft repeated clichés of these keyboard warriors is that demonetization is a disruptive event and disruptions are good in general. Well as a common man let me tell you that I agree with you that disruptions are good in shaking up moribund societies, but those disruptions are meant to happen over decades and centuries, not in 50 days. Disruption, whole scale disruption in the short scale, happens when a foreign invader, say Timur the Turk, invades our country and builds a pyramid of skulls of our people, or a large scale tsunami wipes out entire coastal communities and changes our very shorelines. Those are the ones which classify as disruptive events in the short term which bring change willy-nilly to society. And they are always called as disasters when viewed with the long term focus of history.

Human lives and human society is not a software product which exceeds its lifetime and needs to be disrupted with a new product. These are lives we are talking about not lines on a computer. The biggest example to me of how our society has failed in regulating engineering colleges mushrooming everywhere resulting in substandard graduates with hollow degrees and no independent thinking capacity is the level of support software engineers have shown to demonetization merely because of the word “digital” added to it. So as I said in the beginning the braying of the idiotic 20% is drowning out the voices of the sane rest. This post too, I anticipate will attract the ire and venom of the vocal minority and time on their hands trolls.

But as history repeatedly shows when the good cease to speak the evil runs rampant. And hence I decided to raise my voice against all these online trolls, to stand up and be counted when it matters. And just to clarify who a troll is? If you speak against me, you are a troll, if you disagree with this post, you are a troll, if you criticize or comment against this post, you are a troll, if you debate any of my contentions or conclusions, you are a troll, if you think I am wasting your time writing this post and making you read this, just think for a moment about our troops standing on the ice cold borders of Pakistan facing terrorists and then tell me whether your time is more important that theirs and whether just reading this post is a bigger sacrifice than our suffering troops on the border. I rest my case.