A nation addicted?

Dopesick (Miniseries; 2021)

Disney plus.

The medical fraternity has an uphill task. Too often than not, they have not lived up to their promise. The public cannot be blamed if they get the impression that this noblest profession has been infiltrated with financial gains, deviating far from what Hippocrates and ancient healers had in their minds. Medical professionals are looked upon as conniving smooth talkers who are just out there to cheat their clients blind through incomprehensible jargon and careful wordplay.

In the 1950s, thalidomide was hailed as the next best thing for pregnancy-related nausea and vomiting. Advertisers were out on a limb trying to sell it as a safe drug until the American courts banned its production after being linked to causing babies to be born with defective limbs (phocomelia). Then joining in the fervour in wanting to vaccinate the nation against poliomyelitis, the medical-industrial giants went on a crusade to produce a polio vaccine. Cutter Laboratories in California inadvertently had live active viruses in its vaccine instead of the live attenuated ones. Consequently, 120,000 children were injected with the Cutter vaccine, resulting in 40,000 recipients getting iatrogenic 'polio-like illness', 55 having permanent paralysis and 5 deaths.

From the Framingham studies to WHI studies, people have been painted with the same narrative by the medical business industries. Backed with scientific statistics, media presence, legal backing, bottomless financial wells and the medical professionals at their beck and call, Big Pharma can sell ice to the Eskimos. A Tamil proverb says, 'at the mention of money, even a corpse would open its mouth in awe'. In modern life, everyone and everything has a price. There is nothing like a bit of palm greasing would do.

Ad for thalidomide

Doctors often try to keep up with the latest advances in medical sciences via peer-reviewed articles and carefully conducted research. When research is tainted with grant money obtained by the drugmakers and vested interest is involved, one cannot get unbiased findings. The doctors are caught in the centre. They are in the unenviable position of bridging between the patients, who trust their good doctors and the vulture businessmen. The patients like to think that their doctors would put the patients' interest foremost, not the manufacturers', whose main appeal is showing profitability to their shareholders.

Doctors often try to keep up with the latest advances in medical sciences via peer-reviewed articles and carefully conducted research. When research is tainted with grant money obtained by the drugmakers and vested interest is involved, one cannot get unbiased findings. The doctors are caught in the centre. They are in the unenviable position of bridging between the patients, who trust their good doctors and the vulture businessmen. The patients like to think that their doctors would put the patients' interest foremost, not the manufacturers', whose main appeal is showing profitability to their shareholders.

In a world that constantly values material things over altruistic causes, it is easy for one to fall into the trap of materialism and have his soul sold to the devil. After all, they start their professional careers as debtors and spend their whole professional life trying to pay them off. Do they not deserve a little comfort in life after slogging their whole life through? 

If the recent pandemic taught us anything, it at least re-emphasised the fact that there are two sides to the story. What is accepted as the gold standard does not stay such for long. It gets 'oxidised' and loses its sparkle for new metal to emerge. First, the scientists posited that lockdown was necessary to curb transmission to avoid strain on the medical services. They promised that vaccination would help to hasten herd immunity. Then the scientific community suggested that a second dose was necessary to maintain immunity. The basic consensus about herd immunity suddenly took a re-definition. The classical dictum dictated that it is not the individual immune status that mattered but the whole community. If formerly 80% immunity was considered sufficient to ward off illness from the community, the 21st century warranted each individual to be mandated to have the vaccine, carry a vaccine passport and denied individual liberty if he decided that the whole exercise was bunkum.

Cutter polio vaccine

If all that was not enough, somebody decreed a third booster dose and maybe a fourth dose for the most vulnerable in society. The literature search for this topic becomes more perplexing. For every point substantiating a particular subject matter, there would be many opposing points depending on the type of media the issue is discussed or who is sponsoring the journal.

Almost like an afterthought, everything is off - no lockdown, no mask, no travel restrictions, no vaccine passport. I guess the financial gains from a lab-made virus have run thin.

Pain has always been thought a form of body self-defence. Injury to a specific area of the body triggers chemical substances within the vicinity to restrict the part's movements to curb further damage. Pain has always been accepted as a normal body response to trauma or inflammation. Ancient societies had even linked a virtue to this body response. Penance has been carried out to appease the divine forces. Life miseries have been assumed to be a test of faith, and the Lord's suffering on the Cross has its special meanings in Christianity.

However, to modern society, pain is a meaningless annoyance that they can do without. Perhaps, the comforts of life have turned mankind into fragile mimosa pudicas. In the 1990s, alleviating pain was the pharmaceutical industry's primary concern. The problem with oral pain medication is that the most effective of the pain reliefs are the habit-forming addictive narcotic analgesics. Purdue Pharma somehow convinced everybody, including the FDA, that their slow-release narcotic formulation, Oxycontin, is unique in minimising addiction. Addiction was determined to be less than 1% through dubious inpatient studies!

FDA and soon the medical fraternity bought the Purdue Pharma story wholesome. Doctors followed the sciences, and the scientists' recommendations were good enough. Pretty soon, doctors become more and more liberal with their prescription of Oxycontin for their patients' even the mildest of pain.

In an effort to treat pain adequately, the American Pain Society, in 1996, classified pain as a vital sign to monitor (after pulse rate, blood pressure, respiration, temperature). They even have a visual assessment chart to quantify pain to administer adequate analgesics. Interestingly, pain is very subjective, and patients tend to overscore the pain they feel, making doctors overprescribe. Purdue was not complaining. The demand more Oxycontin increased. The previously unmentioned subject of tolerance to Oxycontin came to light. Pretty soon, America saw a spate of drug-related violence. Many states with mining industries, including the Appalachian region, saw a phenomenal increase in break-ins into pharmacies. Drug addicts even started snorting Oxycontin. It piqued the interest of a particular DEA officer and a few lawyers in the AG office of the State of Virginia.

This miniseries is a dramatisation of one of the events that started the fall of the domino in the trust of the medical institution. It tells its narration with the journey of a dedicated small-town doctor who is duped by the drug company to widely prescribe and use the drug for himself. He spirals down the bottomless pit of drug addiction. He almost kills a patient and loses his medical licence. 

Part of the story involves a young Appalachian girl in the same town who was prescribed Oxycontin for a mining injury. Another part tells the moral dilemma of a drug sales representative for selling drugs with questionable benefits. Then there is the question of family dynamics within the board of Purdue Pharma.

This type of misinformation is not exclusive to the medical profession. What would a client think when his case gets dragged till it reaches the Court of Appeal and wins? Is there a hidden agenda for the lawyers to prolong his representation for more lucrative remunerations? Despite all the contributions from philanthropic members of the congregation, why is it that houses of worship are perennially short of cash and demand contributions?

This work is licensed under a Creative Commons Attribution 4.0 International License.

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2 million hits milestone!

 The 2 millionth mark reached!

Get out of your comfort zone!

Antifragile - Things that gain from disorder

Author - Nassim Nicholas Taleb (2012)

This is a thick book written by a mathematician, a hedge fund manager, a derivatives trader, a businessman and polyglot, Nassim Nicholas Taleb. He reads ten languages.

People, like things around us, are of three kinds. They are either fragile which crumple or break with pressure, robust which can withstand stresses or the others which actually grow stronger with strains. These are the anti-fragile. The analogy of a fragile situation is like Damocles in the palace of Dionysius standing precariously under the sword held on by a strand of horsehair. A robust person is like the Phoenix who, despite defeats, come from the ashes to fight back. He can fight, but he is as durable as before, not stronger. The perfect example of an anti-fragility is Hydra, the mythical Greek creature who grew two heads every time one of its heads was cut. In other words, it grew with adversity.

The author suggests that Nature, over the years, has a recurring demonstration on antifragility. Whatever does not kill us will make us stronger. Our civilisation turned us into 'fragilitas'. We have been shielded all through our young age, thanks to immunisation, protection from diseases, helicopter parenting by football mums and or education system which paves a smooth path into adulthood. 

Take the example, the story of Agrippina, Roman Emperor Nero's scandalous mother. Knowing a bit or two about poisoning, after allegedly killing her husband earlier, she suspected Nero of trying to poison her. To make herself resilient against possible poisoning, she started consuming minute and incremental doses. This is the basis of homoeopathic medicine, administrating highly diluted substances for the body to heal itself. Pharmacologists coined the word 'hormesis' when a small dose of harmful material is actually beneficial for the organism, acting as medicine.

Just like how carrying weights increases the bulk and endurance of our muscles, intermittent stresses encourages post-traumatic growths (as opposed to PTSD). Randomness in life also strengthens people against Black Swan events in politics and economics.

Humans are emotional creatures. When the going is good, we are lulled to believe that everything will be alright forever. Like a turkey, we will be thankful to the farmer for feeding promptly, not knowing that come Thanksgiving it will be culled. What makes the species stronger is not peace but adversity.

Modern society reduces variations. Taleb brings in the example of Procrustes who cuts the legs of his travellers or stretching them to fit them into the beds. Modernity is the Procrustean bed that tailor-makes its occupants.

Our ancestors probably were right with their age-old practices which were handed down to them from people before them. After looking at the ups-and-downs of the environment around us, they must have thought, of our grandmothers' remedies and advice that should logically stand the test of time. And we do not need double-blind controlled studies for everything. Especially when it comes from the pharmaceutical companies or physicians who have vested or economic interests in its outcome and usage.

The book goes on to discuss in length into many subjects related to antifragility, making oneself secure in facing adversities. Procrastination may not be all bad. Many creative thinkings materialised when thoughts were pushed aside, let to simmer in the hidden crypts of the brain. Even Darwin's last book took 38 years to be published. Creative juices sometimes flow after long procrastination. Perhaps, it is not wise to practise this during an emergency situation.

Lernean Hydra

Degrees are not the sure way to solves every of world's problems. Many getting their hands dirty in the field would realise that people who work their way up from scratch are more adapt to handling work-related uncertainties. It is like riding a bicycle. No amount of theoretical knowledge of physics can keep a rider balanced on two wheels. We cannot lecture birds on how to fly.

Sometimes people who are passionate about a subject bring more knowledge to a topic than those who are paid to do it.

On a related note, modernity has made us creatures who have to be fed continuously. Our overindulgence in food has strained our internal systems which had caused many metabolic diseases. To reduce overconsumption, intermittent fasting and food deprivation are suggested ways for our body to economically burn fat efficiently.

Everything is gained from volatility, time is a test of unpredictability and innovations come from uncertainties. Intermittent jolts in life will help us faithful to our intended path in life.

"Perhaps being deprived of poison makes us fragile, and the road to robustification starts with a modicum of harm." – Nassim Nicholas Taleb.

This work is licensed under a Creative Commons Attribution 4.0 International License.

Damn statistics

Freakonomics (2005) Steven D Levitt & Stephen J Dubner
A Rogue Economist Explores The Hidden Side of Everything

The conventional thinking is that economists are nerds who fancy numbers, statistics and balancing GDPs and expenditures. Now, we have come to realise that economics is more than statistics. Statistics are the greatest lies invented by mankind. It can be made to work for either side of the fence if you know how. The same numbers can be used to assert both sides of the argument if you know how. That is the reason for the frenzy of data in the 21st century. Information is knowledge.

The authors try to freak us out with numbers that baffle us with information that actually questions whether our supposedly scientific approach to solving our day to day problem is indeed appropriate. For a starter, they suggest that the reason for the reduction in crime in the 1990s is not because of great policing, increasing prisons or use of resources to curb crime but instead due to the legislation of allowing termination of pregnancy. 

Morality represents the way we want the world to work, to create a utopia but economics is how it actually works. Business lies at the very intersection of morality and economics. People have always been assumed to have goodness in them. Even without expecting anything in return, they would do what is best for a fellow human being. But then, could anyone resist the temptation of evil if his acts would not be undetected. The numbers do not. 

Capitalism thrives on the disparity of information. Information is a double-edged sword. It gives empowerment, but at the same time, it creates fear for uncertainty. We say one thing and do another. We associate truth with convenience, self-interest and personal wellbeing. We make promises best to avoid awkward situations or unwelcome dislocation of life.

How does the termination of pregnancy reduce crime?  People who are least capable of being good or exemplary parents are the ones who have the most number of children. These children do not complete school, get into gangs and get in crimes. The world would be a better place without their existence.

Is it not interesting that parenting rules always change with time?  Anyway, parenting has nothing to do with the outcome of the future of the child. The book also brings up many salient interesting points about naming children and that swimming pools kill more children than guns in the US. Are we going to ban swimming pools or increase security there?

https://asok22.wixsite.com/real-lesson 

This work is licensed under a Creative Commons Attribution 4.0 International License.

A giant step for the blog; hardly changing mankind!

Yay! A giant landmark in the blog's history. Today we hit the psychological mark of 1 million hits. Thank you to all visitors for their support all these years, seven years to be specific.

Asia's Rise - How and When

The Wild Wild West

Lawlessness seems to be rearing its ugly quite too often of late. The respect of the law sounds too arcane for modern man to follow. He is looking for ingenious ways to get around the man-imposed sanctions. Laws are made to be broken, he says. Perhaps they could be broken as the enforcement is lax or sometimes, non-existent. Many things work on autopilot.  Wanting of intelligent life forms, everything operates at a single arc spinal reflex.

A lorry driver high on stimulating intoxicants is let loose on the highways. Sure, he goes for tests! When he is sober, of course. Random on-the-spot are not feasible they say, blaming the logistics. No attempt is made to correct the status quo. Hakuna Matata.

The driver has many outstanding summonses for flouting the traffic. There is a system to hunt down the wrongdoers but nobody cares. He is carrying more tonnage than he is permitted to but he still does. He knows he can get away with it. After all, daily living has become harder but he wages remain meagre. So, he has to make more trips to make ends meet, hence, the stimulants.

His path is blocked by double parking spectators of a football stadium. He has a dateline. With the contaminants in the system and his desire to provide, what does he do? Bad judgement. He drives through scrapping the sides of parked car. Why does he do it? The fear of being reprimanded does not sober his senses. Somehow, even in the deep of the crevices of his grey matter, he knows he can get away.

Why do people double park anyway? Because deep inside they know the enforcement would not catch up with them. The numbers of wrongdoers are too many and the local council is toothless to enforce the law. The loopholes in the system are far too many.

The paper man makes it his call to highlight the state of the nation, in tatters he says. He hopes that by bringing to light the lethargy of the system, the general public would arise from their slumber, to rise to the occasion. Sure, the public respond. In angry letters and sarcastic phone calls to radio stations they do. Their pitch reaches a deafening roar. And it mellows. Shuffling again to silence, deafening silence!

The perpetrator rises to the occasion. Once he is sober, his conscious did prick him. He makes himself for the public to judge. So does the man in blue, as he adjust his look to the lights and camera. Or did conscience prick? Is he waiting for the detectable levels of intoxicants be indiscernible?

The long arm of the law drags itself into synchrony. The public interest is kindled but they already other pressing gossips to indulge in. The few months’ old story of damaged cars, a drunken lorry driver with no valid licence is as stale as last week’s yoghurt. A new crisis has erupted.
People do not notice that the accused got scot free due to technicality issues and bungling by the inefficient prosecutors.

And yet again, another non-event is swept under the proverbial carpet. 

Statistics are statistics

And they were always meant to be so... Unfortunately, we have always used statistics to generalize. Cancer of the lung had always been associated with male smokers. Of late, young non smoking ladies have also been struck by an aggressive form of this dreaded neoplasia.
The last thing that you would expect to be stricken by this malignancy who be a young mid 20 fit non-smoking male who does not indulge in unhealthy activities. A pious individual with his whole future paved right in front of him with a new job and a soon-to-be bride awaiting to dream of matrimonial bliss and all the dreamy memories that come with it. It makes it worse when you have seen the boy grow right in front of your very eyes stricken by this infamously deadly crab. Armed with a chest full of hope and passionate divine mercy the family is throttling along, praying for a miracle with diligent medical advice.
About twenty years ago, through the course of my work, I came in contact with a family who never really got over the fact that the fit youngest member of their big closely knit family went for a football game with his friend and returned home as a corpse. The family could not fathom why a 22 year old active athletic male could die from pulmonary embolism (clots in veins of the lung, commonly seen in obese, sedentary or pregnant individuals). The explanation of the Divine forces had bigger plans that we, mere mortals would not comprehend, was unacceptable. The stopped visiting the House of God and observing certain religious practices that they religiously held close to their hearts. One thing that they never failed to do was to place a memorial reminder in the papers annually on his death anniversary.
There are three kinds of lies: lies, damned lies and statistics as quoted by Twain.

Figures often beguile me, particularly when I have the arranging of them myself; in which case the remark attributed to Disraeli would often apply with justice and force: "There are three kinds of lies: lies, damned lies and statistics."

- Mark Twain's Own Autobiography: The Chapters from the North American Review

Illustration by Peter Newell from COSMOPOLITAN, August 1898