Saturday, September 16, 2017

Holistic medicine , frogs and lizards

Temporins
The temporins belong to a family of short (8–17 amino acids), hydrophobic, C-terminally α-amidated peptides with antibacterial and antifungal properties that are synthesized in the skins of a wide range of North American and Eurasian frogs of the Ranidae family. Temporins adopt an α-helical conformation in hydrophobic environments and have the ability to perturb the integrity of target cell membranes. Not all temporins are cationic, but the number of positively charged amino acids correlates with antimicrobial potency. Temporins are mostly effective against Gram-positive bacteria, but some are also active against Gram-negative bacteria. Temporins show potential for development into therapeutically valuable anti-infective agents, particularly for use against antibiotic-resistant Gram-positive bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus faecalis, against anaerobic pathogens such as Clostridium difficile, and against the protozoan parasite Leishmania spp. Although the clinical usefulness of naturally occurring temporins is limited by high hemolytic activity, noncytotoxic analogs have been designed.

POTENTIAL CLINICAL AND COMMERCIAL APPLICATIONS The emergence of strains of pathogenic microorganisms with resistance to commonly used antibiotics constitutes a serious threat to public health that has necessitated a search for new types of antimicrobial agents. The temporins are promising candidates for development into clinically useful antiinfectives, particularly with regard to topical applications, such as treatment of acne vulgaris and infected foot ulcers in diabetic patients. Several temporins show high potency in vitro against nosocomial Gram-positive pathogens such as MRSA7,13 and antibiotic-resistant strains of E. faecalis.

Diverse family of Natural peptides

Wednesday, September 13, 2017

Is my mom's introverted personality is due to her childhood Bell's palsy?

I have read some articles about people who suffered from permanent damage from Bell's palsy who had other psychological problems.
Poverty
facial disfigurement
age difference between her and husband
upbringing

Is it true that patients in USA have a feeling that Indian origin doctors are more caring and efficient?

Is it true that patients in USA have a feeling that Indian origin doctors are more caring and efficient?
Is it true that the general population thinks that people of Indian origin are cheap and always looking for a bargain?

How do these two things go together?

Once again I quote from the book "T he pattern on the stone" authored by Daniel Hillis.
On page 148 "it's the weaknesses as well as its strengths stem from evolution's inherent blindness to the "why" of a design.

"The human brain takes advantage of both mechanisms: it is as much a product of learning as it is of evolution. Evolution paints the broad strokes, and the development of the individual in interaction with its environment completes the picture. In fact, the product of evolution is not so much as designed for the brain as the design for a process that generates a brain-not so much a blueprint as a recipe (emphasis mine). Thus, there are multiple levels of emergent processes operating at once. An evolutionary process creates a recipe for growing your brain, and the developmental process interacts with the Enron meant to wire the brain. The developmental process includes both internally driven processes of morphogenesis and the externally driven processes of learning. The maturational forces of morphogenesis cause nerve cells to grow in the right patterns, and the process of learning fine-tunes the connections. The ultimate stage in the brain's learning is a cultural process, in which knowledge acquired by other individuals over many generations is transferred into it.
I think the instructional processes of culture belonging to the older cultures such as the Hindu and the Jewish may have something to do with the ability of people who come from these cultures to have more empathy and also have more intelligent and efficiency in medicine.

amendments to the rules of war

Creation of international legislation, amendments to the rules of war

Ever-increasing regulation brings more and more unfunded mandates

Ever-increasing regulation brings more and more unfunded mandates and documentation requirements,
 which while very important to a degree, require extensive amounts of organizational and personnel time, detracting from patient care and increasing professional burn out.

microaggression another funny/stupid/misleading name for racism



MICROAGGRESSIONS DEFINITION
 Microaggressions are the everyday slights, indignities, put-downs and insults that people of color, women, LGBT populations and other marginalized people experience in their day-to-day interactions. Microaggressions can appear to be a compliment but contain a “metacommunication” or hidden insult to the target groups to which it is delivered. They are often outside the level of conscious awareness of the perpetrator, which means they can be unintentional. These messages may be sent verbally (“you speak good English”), non verbally (clutching one’s purse more tightly) or environmentally (symbols like the confederate flag or using American Indian mascots).

Before I can talk about Asian American experiences at all, I have to kill off the model minority myth because the stereotype obscures many realities. I am an Asian American, but I am not good with computers...I would like to fail in school, for no reason other than to cast off my freakish alter ego of geek and nerd. I am tempted to be very rude, just to demonstrate once and for all that I will not be excessively polite, bowing, smiling, and deferring.. .1 yearn to be an artist, an athlete, a rebel, and, above all, an ordinary person  Wu 2002 page 39

Racial Microaggressions in Every Day LifeTheme Microaggression Message

Racial Microaggressions in Every Day Life

Alien in own land: When Asian Americans and Latino Americans are assumed to be foreign-born “Where are you from?” “Where were you born?” “You speak good English.” A person asking an Asian American to teach them words in their native language You are not American. You are a foreigner
Ascription of intelligence Assigning intelligence to a person of color on the basis of their race: “You are a credit to your race.” “You are so articulate.” Asking an Asian person to help with a math or science problem People of color are generally not as intelligent as Whites. It is unusual for someone of your race to be intelligent. All Asians are intelligent and good in math/sciences





Psychoneuroendocrinoimmunology: the basis for a novel therapeutic approach in aging.

Psychoneuroendocrinoimmunology: the basis for a novel therapeutic approach in aging.

Abstract

Along with the nervous and the endocrine systems, the immune system is one of the three major integrative systems in higher organisms. Growing evidence demonstrates an intimate relationship between the immune system and the endocrine and nervous systems: The psychoneuroendocrine system can influence the immune response and thereby the capacity of the organism to cope with illness, and the immune system can have an impact on neuroendocrine function. Such cross-talk among systems is dependent upon feedback loops working to maintain homeostatic equilibrium

What motivates theseTelugu computer geeks?

In 1994  when I came  to USA  I was  really hungry to  get  news  about  India

"India abroad" was the only news paper available in those day, except for some other throw away news / advertising sheets at Indian  groceries

 Then I discovered "Internet" at a  local library in North Olmsted Cleveland Ohio

 those  few  green letters on a  black background  which used to crawl  on to the CRT display   were like gold to me

  It had 8 or 16  KBPS speed I think

 In the last 2 decades technology has progressed quickly and now I have to actually shut my self from the  bombardment  of information much of it is junk, but still quite bit of it is  gold as far as Telugu  news, literature and poetry is concerned

 In the  early days of  Telugu use  on the internet  and  in computers in general a number of telugu  expatriates in USA along with some interested youngsters did much work just for the fun of it. I think there is a need to have a comprehensive history of theses efforts  I really do not know what motivated theses good Samaritans.
 some of the   well known names are
Srinivas Kanneganti
srinivas
rakeshwar


 Even today Telugu does lag behind other Indian languages in various computer software aspects.

many people without understanding the intricacies of computer linguistics and information technology think that it is on par with English.

really no other language has come near to English on computer related  use and the amount of software and hardware related to English

and Telugu seems to be stuck  few steps behind Tamil.

This is inspite of  more Telugu speaking  computer professionals working all over the  world compared to any other  Indian language speaking professionals.

Doctors who became rich by not being doctors


 Dr.Michael Burry of big short
ADHD?  aspergers ?

Jun yoon of Palo alto investors


from financial samurai

A Good Doctor’s Financial Path

I feel kind of sorry for doctors. When they first entered medical school 15 years ago they were promised a much higher salary than they are receiving now. For example, my friend who has a post fellowship from Cornell Medical will be making roughly $200,000 as a cardiologist at 36 years old. When he entered medical school in 2001, he was expecting to make $300,000 – $400,000 to start!
For three years he made $40,000 – $50,000 a year as a resident after four years of medical school, and $60,000 – $75,000 a year as a fellow for the next three years after that. Luckily for him, his parents paid for all his medical school tuition. The median education debt was $170,000 in 2012, and surely higher today according to data from the Association of American Medical Colleges.
The good doctor will be able to comfortably buy my dream home when he’s roughly 50 years old. He’ll put down $2 million, take out a $1.8 million mortgage, and have $854,850 in liquidity or various investments. That’s 50 years old folks. Several of us won’t even live until that age! Because a big mortgage has been taken, the doctor will need to work for another 5 years to feel comfortable. If he wanted to pay for the home in cash, he could potentially get there around 53, but have nothing left.
I’m being very gregarious with my total compensation assumptions for doctors. Doctor’s salaries have done nothing but go down thanks to big government and difficult insurance companies. I doubt most doctors will ever make $1 million a year anymore, let alone $700,000. But I’ve thrown the figures in my chart anyway since this is one very special cardiologist.


 Dr.Michael Burry of big short
ADHD?  aspergers ?
Jun yoon  of Palo alto investors

"experience is devoid of the cherry-picking that we find in studies".

But then, having read his latest book, I actually know an awful lot about his diet. How he doesn't eat sugar, any fruits which "don't have a Greek or Hebrew name" or any liquid which is less than 1,000 years old. Just as I know that he doesn't like air-conditioning, soccer moms, sunscreen and copy editors. That he believes the "non-natural" has to prove its harmlessness. That America tranquillises its children with drugs and pathologises sadness. That he values honour above all things, banging on about it so much that at times he comes across as a medieval knight who's got lost somewhere in the space-time continuum. And that several times a week he goes and lifts weights in a basement gym with a bunch of doormen.
 "experience is devoid of the cherry-picking that we find in studies". 

Boris Johnson and the Oxymoron "moderate opposition" make up your minds you stupid Brits


"Valuable call with Dr Riyad Hijab @SyrianHNC_en. Situation in #Syria is tragic. UK stands firm in support of the Moderate opposition"

"I have had enough’ – veteran teacher tells school board" 'I have had enough’ – veteranDoctor tells patients and insurance companies and Government



I have had enough’ – veteran teacher tells school boardhttps://www.washingtonpost.com/news/answer-sheet/wp/2013/03/10/i-have-had-enough-veteran-teacher-tells-school-board/


 'I have had enough’ – veteran Doctor tells patients and  insurance companies and Government
( coming to my blog pretty soon 

Yesterday I was watching  some youtube  videos which were forwarded to me  via wats app from India .
One of them  was  by this  daring  young student  who  called  the  TV  media  to complain  about the lack of  an english teacher for a number of months  in  a school in India   intelangana ( I am still  trying to find  which school it was). Most of the comments about this video were  about  the  student  and his  courage  and  leadership abilities  and  how  we have  a budding leader/Politician.
very few people  reacted to the  actual  and essential problem .and  the  reason  for  taking this extrodinary  step by this  young  boy.

Lack of teaching in schools.

after this  I was lookingat another  video  about  no teachers at all  in some  villages in  Mahbubnagar  GaTTu manDalam  of  Mahbubnagar in Telangana.

How incompetent people make the life of competent people miserable

How incompetent people make the life of competent people miserable

EHR  IT depatment
"A growing proportion of Medicare beneficiaries are opting out of the government-run insurance program. They are instead choosing a private plan alternative, one of the MedicareAdvantage plans. The strength of this trend defies predictions from the Congressional Budget Office, and nobody can fully explain it.
( let me add my 2 cents. if you  watched  TV lately  you would have  noticed there are a bunch of advertisements  from AARP and  insurance companies on the medicare advantage  plans . As a physician  I find it  confusing  sometimes bewildering to choose  which  health plan to choose.No wonder  senior citizens are swayed by  insurance  medicare advantage plans)
Here’s another mystery. Traditional Medicare spending growth has slowed, bucking historical trends and expectations. Though there are theories, we don’t fully know what’s causing that either.
Pinning down explanations for these two mysteries is important. Doing so could help us understand the structure and cost of Medicare in the future."

Research as a business plan -how many think tanks are getting our tax dollars and inflating the healthcare spending on FLUFF.


how many think tanks are getting out r tax dollars and inflating the  healthcare spending on  FLUFF.

The rant of a concerned parent, American education system is topsy turvy and sgnificantly Hypocritical

Many years ago (probably 16 or 17 ) during a parent  teacher meeting in  richardson  high school  near Dallas TX  where my daughter graduated from. I heard  a dad  becoming all emotional and  criticising  the  education  our kids are getting from  the school.
As a parent coming from India I did not have a good understanding of the education system in USA at that time ( I am not sure  even today  i really have  a great understanding)

I was greatly impressed by the facilities available in that school.and the air conditioned classrooms. well stocked library. my daughter was conducting PCR experiments ( I as a surgeon coming from  India heard of  PCR but used it only after coming to USA and doing a residency  in internal medicine)

I was not able to understand  why  this dad was so agitated,I see all theses wonderful text books with advanced  concepts which used to be  taught  at college level ,given freely to students, properly equipped labs teachers who seemed eager to teach and  for the first time some one from the  school wanting to hear from a parent about how the school was doing. compared what I had when I was studying back in India.
My wife was always worried that our kids are not getting  proper education and  we  should send them to private schools like the  Reddy, Rao, Patel neighbours were doing. i was not  convinced by the  arguments put forward by her and the neighbours and  being  a non believer in any religion ,I did not want  my children to imbibe christian dogma by going to these Private schools  and  learn nothing but snobbery.

Now after all these years both my  kids have graduated from college, they are finding it tough to decide what they want to do with their life . they are finding it  tough to find a meaningful career which pays a decent living wage.
I have these occasional discussions with my 26 year old son who completed a college degree in advertising  and journalism.He was recently explaining to me why he thinks he did not learn 'Anything" during his  high school after we moved from a lower ranking  ISD of Mesquite to a higher ranking  ISD  in Plano.

Why he admires me for not pushing him in to medicine or engineering as all the other DESI ( Indian immigrant) parents.
I admire and understand  much of what he  discusses and  feels.

what I realize is American education system is topsy turvy and  significantly Hypocritical and  sets up our youngsters for  failure.

where ever  I turn to and  read about a crisis  in American education system  such as the article  given below   there  is so much emphasis  on  inner city  African american kids and  how  high school students are not able to read,write or do math.
What about the above average children who play by the rules, th  highly educated( immigrant)parents who  are excessively involved in the children's academics. They still seem to be  not doing any better either.


"Public can sue Govt officials for inaction

Sana Shakil | Aug 27, 2015, 11.59 PM IST

NEW DELHI: Paving the way for making public servants accountable if they fail to perform their duties, a city court has stated that people can seek damages on account of their "inaction". Currently, no law exists under which government employees can be prosecuted or held liable for inaction. The move of seeking such damages, a first in the country except in defamation cases, if put to use effectively is likely to make public servants more responsible.
"Failure to act is an actionable wrong as much as any malafide action by such public servant for which the aggrieved person can seek damages for all the physical, mental, emotional, psychological, social and financial loss and sufferings caused to him. For this, a public servant would be liable in his personal capacity," Additional District Judge Kamini Lau said.
The judge noted that the general impression about personnel manning public institutions not performing and getting away with it needs to change. "It is this malaise which ails public institutions. Today that needs to be taken care of. It is time that public servants, particularly officers of the government, police, corporations, municipal bodies, etc., are made to answer for the inconvenience, trauma and loss caused to the public due to their failure to act on time and to make them liable for such inaction," the court said.
The court was hearing a civil suit filed by head constable Satish Chand against four other cops, including an inspector and an additional sub-inspector, who allegedly did not register an FIR on his complaint and instead booked him in a false case under Section 107/151 CrPC for breach of peace. Chand sued the four cops and sought a compensation of Rs 1 lakh on grounds of defamation and loss of reputation. His plea, however, was dismissed by a trial court so he appealed before the district court.
On June 2, 2004, the four cops refused to take action on Chand's complaint saying that his minor son was beaten up by some boys. In his plea, he said that instead of inquiring into the matter the cops started beating him and booked him in a false case in which he was later discharged.

 Sec 217 to 219 of IPC provides for punishing public servants under certain conditions. How many have been punished so far? I know every information commissioner under the RTI Act ... Read More
The district court set aside the trial court order and marked the matter to a senior civil judge. "The claims of those aggrieved by action of public servants cannot be thrown out casually. Unfortunately, in the impugned judgment I find no discussion on some important aspects," it said.
The judge also raised concern in the manner senior officials of Delhi Police treat their juniors, observing that "it needs to be checked." "Merely because the appellant is a junior functionary in the same force, it does not mean that his dignity and self-respect or his self-esteem/ reputation can be trampled," the judge said.
‘I have had enough’ – veteran teacher tells school board
https://www.washingtonpost.com/news/answer-sheet/wp/2013/03/10/i-have-had-enough-veteran-teacher-tells-school-board/

You make us pilot all of these new programs year after year that have been tried already (just under another name), not worked-and tried again. We keep reinventing the wheel! I hear often that teachers don’t teach any more. We don’t!

You have made us information pushers, test givers, and paper passer outers. LET US TEACH!!! You have taken all of this away. You give us a new common core curriculum that is almost impossible to finish in a year, and now you slide in Compass, new evaluations, JPams, and On Course all in a single year, and all which require more time that we just don’t have. You are setting teachers up to fail. Teaching was once a noble and creative profession. Learning was once fun! If you want kids to stay in school, make them want to come!!!
“v Would a doctor lose his job if his diabetic patient didn’t follow their recommendations for losing weight when that patient is hospitalized for his/her choices? Of course not! The educational system is no different. We should not be held responsible for apathy and wrong choices!( No buddy we are in the same boat.
We can  loose  if not  our jobs completely  certain  amount of money  for not making  our  unwilling and  noncompliant   patients  Healthy .

“If you really want to change one thing in our school system-start with discipline: SIMPLE nothing else, just DISCIPLINE. Follow through from first grade on up to twelfth grade. Be consistent, give consequences. Teachers should not be repeating rules to the same students over and over again. If you would listen to experienced teachers who have good discipline, it works and learning is going on. No fancy programs, no bells and whistles, just the teacher in charge. Stop moving students from school to school. This just dilutes other schools!
You are hiding the problems-NOT solving them! The same students that we saw get away with the “little infractions” over and over, and over again, are the same students that end up in the paper under “local arrests”. We are not here to be popular or please parents, we are here to teach children. Small things like uniforms, gum chewing, and tardies may seem small to you, but to a classroom teacher they are the small things that lead to larger problems like disrespect. If you don’t back us up on these issues, the students know it and lose respect for us. Don’t give in half way through the year, or keep changing things. Follow through. Back your teachers up! You have taken our “power” away. No Discipline=No Teaching-Period!

You want to save one child by not removing them from the classroom or campus because you don’t want THAT child to miss out on learning, but you are doing a TOTAL injustice to the average and above average students who want to learn and know how to behave. The others are NOT learning because teachers are spending their time repeatedly correcting, constantly documenting, meeting one on one, and conferencing with the one child who chooses not to behave. 
All teachers are different and that is what makes public education so special. Students get the affection, nurturing, life lessons, and education from each of them over their twelve years. Some experiences will be good, some not so good, but that is called life!!! Children need to learn to cope! They need this skill for the rest of their lives, so they can become good problem solvers on their own and not have everything catered and changed to their every desire. Having their parents just being able to call the central office and have teachers give in to “solve the problem” to make it easier for the child is not a coping skill. You are doing the students and parents a total injustice.

“There is SO much more to teaching then getting in front of a class and giving a lesson!

10 Reasons the U.S. Education System Is Failing
By Matthew Lynch on August 27, 2015 9:43 AM | 49 Comments
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Once upon a time, enthusiasts designed a formal education system to meet the economic demands of the industrial revolution. Fast forward to today and, with the current global economic climate, it seems apparent that the now established education system is unable to meet the needs of our hyper-connected society - a society that is in a constant state of evolution. Let's examine 10 problems that prevent the US education system from regaining its former preeminence.
1. Parents are not involved enough. Of all the things out of the control of teachers, this one is perhaps the most frustrating. Time spent in the classroom is simply not enough for teachers to instruct every student, to teach them what they need to know. There must, inevitably, be some interaction outside school hours. Of course, students at a socio-economic disadvantage often struggle in school, particularly if parents lack higher levels of education. But students from middle and upper class families aren't off the hook, either. The demands of careers and an over-dependence on schools put higher-class kids at risk too when it comes to the lack of parental involvement in academics.( Not true!,in most cases)
2. Schools are closing left and right.
3. Our schools are overcrowded. The smaller the class, the better the individual student experience. A study by the National Center for Education Statistics found that 14 percent of U.S. schools exceed capacity. At a time where children need more attention than ever to succeed, overcrowded classrooms are making it even tougher to learn and tougher still for teachers to be effective.
4. Technology comes with its downsides. 
5. There is a lack of diversity in gifted education. The "talented and gifted" label is one bestowed upon the brightest and most advanced students. Beginning in early elementary grades, TAG programs separate student peers for the sake of individualized learning initiatives. Though the ideology is sound, the practice of it is often a monotone, unattractive look at contemporary American public schools. District schools need to find ways to better recognize different types of learning talent and look beyond the typical "gifted" student model. 
6. School spending is stagnant, even in our improving economy. 
7. There is a lack of teacher education innovation..
8. 80 percent of students are graduating high school...yet less than half of these students are ready for what's next.
The U.S. Education Department reports that the high school graduation rate is at an all-time high at 80 percent.  Four out of five students are successful in studies completion and graduate within four years. While these statistics sound like a reason for a standing ovation, they are overshadowed by the crisis that is sweeping the United States. While 80 percent of high school seniors receive a diploma, less than half of those are able to proficiently read or complete math problems.
The problem is that students are being passed on to the next grade when they should be held back, and then they are unable to complete grade-level work and keep up with their classmates.
The National Assessment of Educational Progress (NAEP), the largest standardized test administered in the United States, reports that fewer than 40 percent of graduating seniors have mastered reading and math and are poorly equipped for college and real world life.  These students who are passed to the next grade are at a serious disadvantage and have an increased chance of falling behind and dropping out of college.
9. Some students are lost to the school-to-prison pipeline. 
10. There is a nationwide college-gender gap, and surprisingly, we are not focusing on it.
Some of these reasons are well-known and long-standing issues. However, others--such as the emergence of a screen culture--are new and even somewhat unexpected challenges. However, the nature of each issue does not matter. All of them are standing in the way of us becoming globally competitive.
Can you think of any additional reasons why the U.S. education system is failing?



Medicine has lost it's moral compass.

By Dr Saurabh Jha
It is the beauty of evidence-based medicine (EBM) that a scientist can at once be a Pope and a Galileo. His transmutation is as effortless as it is discretionary. If you think you’ve met Galileo — a rebel, a free thinker, a rocker of the establishment — the following week he is a Pope, castigating detractors, censoring critics, and celebrating uniformity. He changes by a roll of the dice. His change is decided by a quirk in hypothesis-testing known as statistical significance. If the p-value is 0.051 he is Galileo, if the p-value is 0.049 he becomes the cardinal. He is one day a raging skeptic and another day a true believer.
The latest fight between orthodoxy and free inquiry is about the benefits and harms of statins for primary prevention. A review, and an editorial, in the Lancet said the benefits of statins are real, the harms are exaggerated, and skepticism of benefits of statins should be censored because doubt can harm the public who may not take their statins and thus die prematurely. Stated differently, skepticism kills. The lead author of the review once asked the BMJ to retract a study which he felt overplayed the harms and denied the benefits of statins. The editor compared the fear about statins to fear about vaccination. Statin skeptics, like vaccine deniers, are now medicine’s truthers.
It is unclear what will send the skeptics to the Gulag. Is it a denial that statins have any benefits or a quibble about the precise benefits? Will you be sent to the gulags if you incorrectly say the number needed to treat (NNT) is 150, when it is in fact 100; if you get the confidence interval wrong; or if you underestimate the significance level? The Spanish Inquisitors made it simple — deny Jesus is the son of God, and you’re in the torture chamber. The new truths are probabilistic — God is statistically significant with p-value perched precariously at 0.05.
The BMJ, at the crossfire of this inquisition, responded to Lancet’s accusation in kind. The fight between Britain’s two major medical journals is like the recent spat between the leave and remain camps in Brexit — that there was a winner shouldn’t detract from the pettiness, or the close margin, of the dispute. I shall spare you the granular details of the statin war (excellent summary atCardioBrief and a raucous take by Michel Accad are worth reading). Granularity in EBM is not the same as looking at the night sky through a telescope. You won’t be awed by magnifying the details. However, if you suffer insomnia, the 30-page review of statins in Lancet might be what the doctor ordered.
What are the harms of statins? Aside from remembering to take the pill, which should no longer be burdensome, but a fact of life like wearing a seatbelt or filing taxes, the harms include muscle pain. Muscle pain? Are you thinking what I’m thinking? Muscle pain! BFD! Is modern man, who by now was supposed to have colonized Mars and traveled to Proxima Centauri in search of a new planet, arguing about muscle pain? What an anti-climax!
The dispute doesn’t have the same metaphysical significance as Earth versus the sun at the center of the universe. Galileo’s captors saw in Galileo’s musings the contradictions of their religion. But the contradiction of statins is more divisive than heliocentricity. But let us not falsely elevate the fatigued quadriceps muscle to martyrdom. The statin war is not about skeletal muscle. It is about ossified ideologies. The statin war asks medicine’s most primal question – what is the role of medicine in society?
It is a war between two movements in medicine, which itself has become a religion with the physician as its high priest. Medicine is divided into two sects. One is the less-is-more movement. The other movement, the antithesis of less-is-more, doesn’t have a name, but I will call it the “unlimited medicine” movement. One emphasizes medicine’s limitations, the other medicine’s possibilities. One is short-sighted, the other can stare only at the horizon. One is too willing to press the brake, the other ever eager to press the accelerator. One seeks redemption in data; the other seeks salvation in venture capitalists. One wants to be guarded by budgets and opportunity costs, the other wants to break chronological budgets. One sees man as mortal, the other dreams of transient, incremental, immortality.
The two movements are profoundly similar. The men who fought for Richard the 1st and Saladin in Jerusalem in the Crusades, though fought against each other, all thought they had God on their side. Both the less-is-more and unlimited medicine movements believe they have history on their side. Both movements are sincere, overly sincere, yet disingenuous; both can be dogmatic, both are sentimental, both are self-righteous. Both are right, neither is wrong, yet both are wrong.
The less-is-more movement is at least forthright in its objectives. It believes medicine is doing too much. It believes medicine is overtesting, overtreating, overdiagnosing, overstepping, and over intruding in the lives of private citizens. It believes medicine has lost its moral compass. Just like a nosey mother-in-law extracts too much for the occasional babysitting, medicine extracts too much for extending longevity by too little


On the face, the less-is-more movement is the more ideological and self-righteous of the two. This movement has made two strategic errors. It has erred by ascribing to malice what can be ascribed to chance. It believes, implicitly, that doctors do too much because of greed supported by the incentive structure. This naïve reductionism, which can easily be countered, has alienated many doctors. This is a double blow for the movement which has lost not only its key message but supporters of that message. The movement should, instead, have emphasized that medicine is an art, an imperfect art; that the art is minimalism, and minimalism needs judgment and skill; that the art is not uniform and can vary between its practitioners, but that’s ok; that the art can be ruined by diagnostic and therapeutic incontinence. It has not done so because it does not believe medicine is an art but a precise scientific enterprise. It is this belief which is the root of its second, more fatal error.
The movement believes its core principles can be justified by science, that minimalism is scientific.
 Evidence based medicine (EBM)is the oddest of odd sciences.
 It is not a science of precision but a science which specifies trade-offs. You win some, and you lose some, and EBM, when done right, tells you how much you win and how much you lose. EBM quantifies trade-offs. EBM doesn’t abolish trade-offs. The less-is-more movement doesn’t acknowledge trade-offs. It fails to acknowledge that therapeutic incontinence saves a few, very few to be precise, but few nonetheless. It denies that overuse of CT for pulmonary embolism, for example, saves a few lives from fatal pulmonary embolism who would have escaped the net if medicine were practiced as a fine art. It cannot get itself to say “we overtest and overtreat and yes we help a few, but it’s not worth it.”

Evidence based medicine (EBM)is the oddest of odd sciences.

 therapeutic incontinence saves a few, very few to be precise, but few nonetheless

What is intelligence?


When I was growing up I did get a number of complements as an intelligent boy?

  As I am growing older I am asking this question  more and more what is intelligence?

also  from the various  theories  it seems like  I lack in  emotional intelligence.

" "While your IQ, which is sort of language logic, will get you behind the desk, if you don’t know how to deal with( deceitful,dishonest) people, if you don't know how to read yourself, you’re going to end up just staying at that desk forever or eventually being asked to make room for somebody who does have social or emotional intelligence.""

Of Course watching the  American Presidential debates causes one to question if there is anything called intelligence.but any way
From google ( is it decreasing or increasing our intelligence/)

in·tel·li·gence
inˈteləjəns/
noun
  1. 1.
    the ability to acquire and apply knowledge and skills.
    "an eminent man of great intelligence"
    synonyms:intellectual capacity, mental capacity, intellectmind, brain(s)
    IQbrainpowerjudgment,reasoningunderstandingcomprehensionMore

  2. Neuroscientists have mapped the brain structures that affect general intelligence. The study adds new insight to a highly controversial question: what is intelligence, and how can we measure it?

Therapeutic incontinence



Thus, rational use of a clinical prediction rule, rather than testing based on convention or habit, allowed for equivalent care with less testing and lower utilization of resources. Put another way, providing a valid mechanism to reach a level of diagnostic certainty can also help reduce over utilization.
Unfortunately, the promotion of rational testing may be undermined by other factors, including who owns the testing. When talk of the “profit motive” in medicine arises, it is easy to blame industry or even “corporate medicine,” but the problem may lie with us as doctors as well.
It turns out that the more equipment we own, the more we are likely to use it – a 2004 article in the Journal of the American College of Radiology estimated that self referral for imaging by non-radiologists cost the US Medicare system at least $16 billion every year (and that was 10 years ago). So, “if we own it, we will use it”—how often have you done a test “because it was there,” even though in the end it made no difference to your management? This is not to say that all self referral for in office imaging (or other investigations) is purely out of avarice or greed, but the easier a test is to obtain, the more likely we are to do it—even if, in the end, it makes no difference to our clinical decisions.

In short, it appears that the more well rounded we are, the better equipped we may be to deal with the tensions of uncertainty, possibility, and partial knowing—instead of pursuing more and more detail that may add little or no benefit to our patients’ care.

one big nose and one step forward fighting Malaria

A new study by Johns Hopkins researchers suggests that a specialized area of the mosquito brain mixes tastes with smells to create unique and preferred flavors. The findings advance the possibility, they say, of identifying a substance that makes "human flavor" repulsive to the malaria-bearing species of the mosquitoes, so instead of feasting on us, they keep the disease to themselves, potentially saving an estimated 450,000 lives a year worldwide.

healthcare is price inelastic when it matters most

Hospitals are known for their mark-ups, which are so feral that they make price gouging water in the Sahara desert a noble endeavor in comparison. 

it would be difficult to meaningfully shop for the best deal for “heart attack care” while your heart muscle is slowly melting, and fluid is filling your lungs, making it difficult for you to breathe.
When you’re dying you will call the ambulance, not place a bid on Priceline.

healthcare gets more, not less, expensive, because there are new diseases to treat. Equality costs. Fairness costs. Safety costs. Prevention costs. Being prepared for potential epidemics such as Ebola costs. New drugs cost. New discoveries cost. Reducing healthcare costs also cost – such is the cruel irony of healthcare