The revolution in the publishing industry

Some five years ago, I had finished my”magnum opus” and was searching for a publisher. I sent my draft manuscript to a few Indian publishers, fully expecting a reply as to whether they were interested in the first book to document India’s search for and mastery of offshore oil technology. 

I recalled that I had written my first book on ocean science and technology some twenty five years ago and had been called to a meeting with the Chairman of the National Book Trust to decide whether it should be published. Mr A.L.Dias looked at the book and said that he could not decide whether the book would be a flop or a best seller but that he would take a chance. That book has by now gone through four editions and still fetches me royalties. So I was expecting a reply but not the one I received. One said that they had too many manuscripts and could not even look at it for at least another six months, the other simply noted that they had the manuscript and would get to it some undetermined time in the future.

Since I was in a hurry- I wanted to see the book in my lifetime- I looked around for an alternative way of publishing and stumbled onto a website “lulu”. Despite its rather strange name, it offered budding authors a new way to publish and market their books.

In those early days these publishers were know as vanity publishers, who produced books at a price to the authors vain enough to want to see their name in print. But "lulu" democratized the process in a most interesting way. Now any author who had a manuscript he wanted converted into a book, would be helped to do it from the begining to the end. Thus people who wrote novels or dabbled in poety, or had a collection of receipes or photographs could all become authors and share their work with the rest of the world without jumping through the hoops of the self appointed editors of the publishing industry.

Once the author had completed his manuscript,"Lulu" offered to have it edited by an editor that you could select online. A number of editors were listed who had been rated by earlier authors and you had your pick of them. You negotiated a price and delivery time with them. The final draft could then be put into the publishing format. You could do it yourself or you could hire an online formatting expert to do it for you, again at a negotiated price. You could design your own cover or again have a design expert do it for you.

The best part of the arrangement was that you did not need to specify the number of copies you wanted printed. It was print on demand where the book was printed and bound and delivered as the orders came in.

The royalty structure was straightforward – lulu took 25 % of the cost of each book sold and the author kept the rest. 

Lulu also offered a marketing plan where they would have the book reviewed, add the blurbs on the book jacket, obtain an ISBN number from the Library of Congress, place the book on various online booksellers like Amazon.com and even organize author parties in various cities. In short, they would do everything the normal publishing houses did except they did it with you in charge of the entire operation.

The best part of this new publishing system was that you could get your book into circulation within four months from the time you completed it.

Since then, the number of online publishing services has grown by leaps and bounds and the cartel of publishing houses has faced completion and indeed some of them are rapidly facing extinction. As an aspiring author, I say "good riddance" and " hooray for technology".

The books of the future

“Books are living things and their task lies in their vows of silence. You touch them as they quiver with a divine pleasure. You read them and they fall asleep to happy dreams for the next ten years. If you do them the favor of understanding them, of taking in their portions of grief and wisdom, then they settle down in contented residence in your heart. “

Pat Conroy

While Conroy waxes lyrical on the virtues of book reading, a new wave of reading them is slowly washing over us. No more will books be simply words on a page bound within lovingly crafted covers taking the readers to wondrous places and climes. The books of the future that are now emerging will be far more than mere words.

Imagine if you will that when you read a book about a far away place, you can not only read the authors descriptions but, if you so want, you can actually see the place by clicking a little sign by the side of the ebook page. Or if the author seeks to evoke the beauty and music of the place, a click could transform you through a video or a musical interlude#. Reading Shakespeare can now be more than the words of the bard- you could now actually hear Lawrence Oliver speak those immortal words “ To be or not to be.” *Or if the sights are to be made real, perhaps a click could emanate the smells of these places as well. Reading a book then could be a total sensory experience.

Of course, this would mean that the authors of the future would have to work twice as hard in not only putting words on paper but also collecting the sights and sounds they so describe. Good writing is the hardest form of thinking. It involves the agony of turning profoundly difficult thoughts into lucid form, then forcing them into the tight-fitting uniform of language, making them visible and clear. Great words, arranged with cunning and artistry, could change the perceived world for some readers. There is no passion more rewarding than reading itself, that it remains the best way to dream and to feel the sheer carnal joy of being fully and openly alive. But now it is possible to go beyond mere words.

But think of the new ways this innovation could change our lives. I was watching the growth of my grandson from the day he was born. Imagine if you could write a book, which chronicled his life day by day, which showed his physical growth, which recorded his first words, which saw him grow from an infant to a strapping young man with his own aspirations and ambitions. No more simple albums for his life but rather an active recorded life instead.

Or imagine that you want your grandson to know his ancestors. In the past this would be through a few blurred photographs or faded memories, but now with these new ebooks, he could actually hear and see you. He could hear your sage advice as he plunged into his life. He could hear your counsel in times of trouble and feel that he was part of continuum of the life of his family.


The real beauty of the ebook will be that you the reader can determine if you simply want to read the book or if you want to have total immersion with sound, vision and even video.

The land of slot machines

I just returned from Las Vegas where we had gone to spend our 40^th wedding anniversary. The one lasting image of this trip was the sound and sights of slot machines. They were everywhere- bathrooms, hotels, gas stations, restaurants. You could not enter a hotel to get to your room without running a gauntlet through a sea of these “one armed” machines. As a matter of fact, all the hotels placed their theaters or shows so that the only way to get to them was if you were willing to walk past rows and rows of these machines, each one singing a siren song of “money , money”. Each of these machines offers a seductive, though thoroughly elusive, “jackpot” and one could see old ladies seriously pulling the slot machine handles in hopes of a major payout.

It turns out that Americans spend more money on slots than on movies, baseball and theme parks combined. There is now casino gambling in 38 states, which use the revenue from gambling to help solve their bloated budget deficits. The main attractions at these gambling halls are the slot machines - there are close to a million of them in the United States, twice the number of ATMs.

Old-fashioned slot machines let gamblers pull the handle and hope for three of a kind. From the player's point of view, here's how it appears:

·      The player pulls the handle.

·      There is a clunk, and three reels start spinning.

·      Then the three reels stop abruptly one at a time, followed by the payout (if necessary).

·      There are lots of bells and whistles all the while this is going on with flashing lights as well.

The "stopping one at a time" part builds suspense. If the first reel stops on the jackpot symbol, then you have to wait for the next reel to stop to see if it is a jackpot, and then finally the third. If all three display the right symbol, the player wins and all hell seems to break loose with loud announcements and lights.

With the passage of time, the old fashioned mechanical slot machines have changed. The modern slots are computerized and are like high tech video games that play music and scenes from TV shows. You can play hundreds of lines at once and instead of pulling a handle, you can bet by pushing buttons, which means each bet can be completed in as little as three and a half seconds. It looks like great fun, but it can be dangerously addictive. And no machine is better for that than the "penny slot," the most popular game on the casino floor. Because the bets are small, you can place hundreds of them at a time. In the past the payout sound was of cents pouring into a basket – but now this has been replaced by a receipt that comes out with your payout. But while no cents pour out, the machines have retained the sounds all right!

Why would you play slots over other casino games? What do slot machines provide that you can't get from the other games? What do Video Slots offer that you can't get from anywhere else? The biggest reason would be happiness. While games such as Blackjack and Roulette may have a better edge than online slots, their players are also constantly stressed and worried. Going over whether hitting or not was the wrong or right move. Fretting about the cards or where the roulette ball ended up.

By contrast, online slots players are carefree and happy go lucky, relaxed and chilled. All you have to do in slots is be able to press a button. You can leave your brain at the front door and take it easy. This is why slots are now the casinos' top revenue maker and their massive success shows no signs of abating. It has grown to the point where casinos would probably be in major financial strife if not for the billions, which slots contributed to their coffers.

Not only is it easy to learn how to play slots but also slots allow the players to play without too much thinking and the games themselves are interesting. Who wouldn't want to play a game of slots that is themed to I Dream of Jeannie or Star Wars? Or maybe The Simpsons or CSI? The nostalgia element, which the different slot machine types provide, is very comforting and reassuring and make players feel at home. Unlike any other game, slots and online slots are able to capitalize on what is hot and trendy in popular culture and create a slots game tied around it. Recent examples are the Desperate Housewives slot machine which was very popular with the ladies as well as the World Cup themed slot machine which revolved around the recent Soccer World Cup. No other game has the flexibility which slots has. In addition the bonus round and secondary games give slots an edge which no other game has. Like you have won access to a secret confined room which has loads of treasure which can be won.

But there is a downside to the slot machine as well. Apparently these can become addictive- sometimes dangerously so! Researchers at the University of Waterloo in Canada measured how players respond physiologically while they gamble, and showed that the new machines can make them think they're winning even when they're not. The gambler almost always gets some money back: if he puts in a dollar, he might get back 50 cents. But the sounds and flickering lights trick his brain into thinking he came out ahead. It seems that the constant feeling of winning creates so much pleasure that regular players can slip into a trance-like state, a place often called the "zone”. One gambler said that when he's in the zone he couldn't remember his children's names!

There are of course the purists who claim that slot machines represent a regressive tax that penalizes the poor more than the rich while it may raise revenues for the government. "As a revenue raiser, it defies every principle. It's regressive. In other words, it takes far more money out of lower income people's pockets than higher income. It is cannibalistic. In other words, it eats other forms of revenue. When you have your citizens dumping two billion dollars down the slots they're not buying a new car, and you lose that tax," State Sen. Tucker said.

In recent years the venerable slot machine is undergoing a generational shift. For more than a century, since its invention by a German immigrant named Charles Fey in the 1890s, slot machines have required little more than cash, faith and an ability to pull a lever or push a button. But now, a new class of machines, aimed at attracting younger players who grew up with video games, is demanding something else — skill.

Adding an element of hand-eye coordination, however simple, is just one way slot makers are laboring to broaden the appeal of the insistently bleating devices that have proved so popular among older players. Besides new devices that provide an extra payoff for game-playing dexterity, manufacturers have developed communal games that link clusters of machines — which are proving popular with people under 40. Coming soon are slot machines with joysticks, which the industry expects to be particularly popular, and others that will allow users to play in tandem or against one another, much as they do in many Internet games. Industry surveys show that those 21 to 40 — people who came of age as dozens of states legalized casino gambling and cable television channels made celebrities of poker’s best players — have fewer moral qualms about gambling than baby boomers and their parents. Young people are heading to Las Vegas and other gambling hot spots in large numbers. The problem for the industry is that they spend much less time in the casinos than the older players.

But gambling, particularly playing the slots, still pays the bills. Slot machines are sometimes called “beautiful vaults” in the industry because they bring in nearly three-quarters of the roughly $60 billion in gambling revenue that American casinos generate.

Most of the $1 billion-plus that the roughly one million slot machines in the United States take in on a typical day is paid to winners. But about 5 to 10 percent, depending on the casino and whether it is a penny, nickel, quarter or dollar machine, stays with the casino. It is therefore big business indeed!

My wife tried the one cent machines but alas came away with a net gain of a paltry $30 on an investment of $15. Not bad but not great either.

Why the left and the right are both wrong?

Two long pieces that accurately analyze the problems of the left and the right in the US today. While the two pieces are worth a read, I try and summarize the main points they make which have resonance with me:


Jon Chait takes the liberals to task for their insistence on absolute purity and standards of performance that are unachievable in actual political life. He tells them that "maybe there is something to learn from the frequent (anguished) comparisons liberals make between Obama and FDR. Part of the reason Roosevelt’s record looms so large from a distance is because historians measure these things differently from political activists. Activists measure progress against the standard of perfection, or at least the most perfect possible choice. Historians gauge progress against what came before it.

By that standard, Obama’s first term would indeed seem to qualify as gangsta shit. His single largest policy accomplishment, the Affordable Care Act, combines two sweeping goals—providing coverage to the uninsured and taming runaway medical-cost inflation—that Democrats have tried and failed to achieve for decades. Likewise, the Recovery Act contained both short-term stimulative measures and increased public investment in infrastructure, green energy, and the like. The Dodd-Frank financial reform, while failing to end the financial industry as we know it, is certainly far from toothless, as measured by the almost fanatical determination of Wall Street and Republicans in Congress to roll it back.

Beneath these headline measures is a second tier of accomplishments carrying considerable historic weight. A bailout and deep restructuring of the auto industry that is rapidly being repaid, leaving behind a reinvigorated sector in the place of a devastated Midwest. Race to the Top, which leveraged a small amount of federal seed money into a sweeping national wave of education experiments, arguably the most significant reform of public schooling in the history of the United States. A reform of college loans, saving hundreds of billions of dollars by cutting out private middlemen and redirecting some of the savings toward expanded Pell Grants. Historically large new investments in green energy and the beginning of regulation of greenhouse gases. The Lilly Ledbetter Fair Pay Act for women. Elimination of several wasteful defense programs, equality for gays in the military, and consumer-friendly regulation of food safety, tobacco, and credit cards.

Of the postwar presidents, only Johnson exceeds Obama’s domestic record, and Johnson’s successes must be measured against a crushing defeat in Vietnam. Obama, by contrast, has enjoyed a string of foreign-policy successes—expanding targeted strikes against Al Qaeda (including one that killed Osama bin Laden), ending the war in Iraq, and helping to orchestrate an apparently successful international campaign to rescue Libyan dissidents and then topple a brutal kleptocratic regime. So, if Obama is the most successful liberal president since Roosevelt, that would make him a pretty great president, right?” Liberals and moderates need to learn to honor these achievements and not constantly bewail that perfection has not been achieved.

David Frum in turn takes on the suicidal turn that the republican party has taken over the past few years and shines a bright light on the underlying causes of this malaise. He complains bitterly that “It was not so long ago that Texas governor Bush denounced attempts to cut the earned-income tax credit as “balancing the budget on the backs of the poor.” By 2011, Republican commentators were noisily complaining that the poorer half of society are “lucky duckies”.. In 2000, candidate Bush routinely invoked “churches, synagogues, and mosques.” By 2010, prominent Republicans were denouncing the construction of a mosque in lower Manhattan as an outrageous insult. In 2003, President Bush and a Republican majority in Congress enacted a new ­prescription-drug program in Medicare. By 2011, all but four Republicans in the House and five in the Senate were voting to withdraw the Medicare guarantee from everybody under age 55. Today, the Fed’s pushing down interest rates in hopes of igniting economic growth is close to treason, according to Governor Rick Perry, coyly seconded by TheWall Street Journal. In 2000, the same policy qualified Alan Greenspan as the “greatest central banker in the history of the world,” according to Perry’s mentor, Senator Phil Gramm. Today, health reform that combines regulation of private insurance, individual mandates, and subsidies for those who need them is considered unconstitutional and an open invitation to “death panels.” A dozen years ago, a very similar reform was the Senate Republican alternative to Hillarycare. Today, stimulative fiscal policy that includes tax cuts for almost every American is “socialism.” In 2001, stimulative fiscal policy that included tax cuts for rather fewer Americans was an economic­-recovery program."


Why did these dizzying u-turns occur? According to David, there are deep underlying demographic changes as well as the recent downturn in the economy that are the causes of this suicidal turn. The fact is 
 the U.S has entered into “an era in which politics increasingly revolves around the ugly question of who will bear how much pain. Conservative constituencies already see themselves as aggrieved victims of American government: They are the people who pay the taxes even as their “earned” benefits are siphoned off to provide welfare for the undeserving. The reality is, however, that the big winners in the American fiscal system are the rich, the old, the rural, and veterans—typically conservative constituencies. ..Any serious move to balance the budget, or even just reduce the deficit a little, must inevitably cut programs conservative voters do like: Medicare for current beneficiaries, farm subsidies, veterans’ benefits, and big tax loopholes like the mortgage-interest deduction and employer-provided health benefits. The rank and file of the GOP are therefore caught between their interests and their ideology."

Another issue is the developing mood of pessimism and anger among the republican constitueancies. In postrecession America, employers seem to show a distinct preference for foreign-born workers. Eighty percent of the net new jobs created in the state of Texas since 2009 went to the foreign-born. Nationwide, foreign-born workers have experienced a net 4 percent increase in employment since January 2009, while native-born workers have seen continuing employment declines. And “It is precisely these disaffected whites—especially those who didn’t go to college—who form the Republican voting base."Birtherism, the claim that President Obama was not born in the United States, expressed the feeling of many that power has shifted into alien hands. That feeling will not be easily quelled by Republican electoral success, because it is based on a deep sense of dispossession and disinheritance.

And one must not forget the role played by the media- especially on the right “Over the past two decades, conservatism has evolved from a political philosophy into a market segment. An industry has grown up to serve that segment—and its stars have become the true thought leaders of the conservative world. The business model of the conservative media is built on two elements: provoking the audience into a fever of indignation (to keep them watching) and fomenting mistrust of all other information sources (so that they never change the channel). .But the thought leaders on talk radio and Fox do more than shape opinion. Backed by their own wing of the book-publishing industry and supported by think tanks that increasingly function as public-relations agencies, conservatives have built a whole alternative knowledge system, with its own facts, its own history, its own laws of economics."

“Outside this alternative reality," David continues, " the United States is a country dominated by a strong Christian religiosity. Within it, Christians are a persecuted minority. Outside the system, President Obama—whatever his policy ­errors—is a figure of imposing intellect and dignity. Within the system, he’s a pitiful nothing, unable to speak without a teleprompter, an affirmative-action ­phony doomed to inevitable defeat. Outside the system, social scientists worry that the U.S. is hardening into one of the most rigid class societies in the Western world, in which the children of the poor have less chance of escape than in France, Germany, or even England. Inside the system, the U.S. remains (to borrow the words of Senator Marco Rubio) “the only place in the world where it doesn’t matter who your parents were or where you came from.”

We used to say “You’re entitled to your own opinion, but not to your own facts.” Now we are all entitled to our own facts, and conservative media use this right to immerse their audience in a total environment of pseudo-facts and pretend information. This conservative shift to ever more extreme, ever more fantasy-based ideology has ominous real-world consequences for American society."

A question of honor

I recently returned from a small ceremony in the British Embassy to honor a friend of mine for a thesis that he wrote almost four decades ago. The interesting thing about the ceremony was that it was to honor a Canadian who had written this doctoral work working then as a Hong Kong student in England. How all this came about is a story in itself..

Gerald had come to England as a student from Hong Kong to work on a doctoral program. He was a student in Leeds University in 1966 when he selected a topic to work on for his thesis which was financed on a contract from the Ministry of Defence. He finished his work in the contracted period of three years, submitted his work, was awarded his phD and went to a successful career in Intelsat. A few years ago he retired from Intelsat and took up Canadian citizenship. One day a friend of his from the Intelsat days, Phil was visiting him for dinner who idly asked what Gerald had written as his thesis some four decades ago. Gerald was able to locate the thesis and showed it to his friend. Phil took a long look at it and said that in his view this was a seminal piece of work and that it had probably been used by the UK navy for communication with their nuclear submarines and was a key piece of the deterrent during the days of the cold war. He felt that the work needed to be recognized and set about pursuing the bureacracy in UK. Gerald, of course, knew nothing about what use his thesis had been put to in all those years since 1969 and was delighted to learn that his work may have contributed in no small measure for maintaining the peace during the cold war.

After four years of determined pursuit, the UK Ministry of defence finally acknowledged the author of  the work and its contribution to nuclear deterrence. Apparently the theoritical work Gerald did was on low frequency communications which could penetrate the oceans and connect the headquaters in London with the submerged nuclear submarines without their having to surface.The embassy in Washington arranged a function to give a citation to Gerald for his work at a small dignified ceremony attended by a small group of family and friends.

The really interesting thing about this story is how a friend selflessly chose to pursue this over a period of four years, the willingness of the UK Ministry of defence to acknowledge a long forgotten contribution of a foreign student, and the grace of the Embassy in Washington in organizing this ceremony. What loyalty, what honor and what grace.

It is rare for a country to honor contributions of its own citizens, it is rarer still for them to seek out and honor those who come from other countries.

During his acceptance speech, Gerald added another twist to this unusual story: " The contract of the University for this work was for three years but I still needed another few months to complete it. So I went to the Ministry of defence to ask for an extension but they flatly refused. I was a poor student and did not know how I would complete the work. But then I noticed that I had been paying unemployment insurance during the past few years and so I enquired if I was eligible for unemployment compensation. I was delighted to learn that I was. So I finished the work only because I was on the dole!"

The recipe for happiness

Wouldn’t it be great if you could walk into a store and buy a recipe for lifelong happiness?

Recent research seems to suggest that that objective may no longer be out of reach. All you need to do is to follow a few key precepts. Be just, have a goal and be generous. That’s it.

“The just man is happy, and the unjust man is miserable,” Plato declares in The Republic. A noble thought, to be sure, but Socrates’ most famous student didn’t have data to back up his belief. But now the World Values Survey, which has been measuring these parameter in 100 countries since 1981, has the results for happiness.  As part of the 2005-06 wave of the World Values Survey, respondents were asked in face-to-face interviews: On a scale of 1 to 10, how satisfied are you with your life? There were also four ethics questions that ask how acceptable or unacceptable they felt a particular practice is: claiming government benefits to which you are not entitled; avoiding paying your fare on public transportation; cheating on taxes; and accepting a bribe. The University of Missouri economist “ found a correlation between how people responded to ethics questions and their satisfaction with life. ..generally, people who believe that these particular ethical scenarios are not acceptable also tend to indicate they are more satisfied with life.”


Admittedly, this measure of ethics is less than ideal. It certainly does not reveal the actual behavior of people. However, the four statements have a common, underlying ethical construct, which is that each of them expresses an action that could either directly or indirectly harm others, or society generally. Also, the measure of happiness is relatively crude. If someone asks you how satisfied you are with your life, your answer can be affected by many things that happened to you that particular day or week or month. But still these findings are consistent with the view that happiness is derived from doing well, and from meeting psychological rather than material or hedonistic needs. While income, personal characteristics and societal values play a role in affecting happiness, so do personal ethics. Plato had it right " the just man is happy".

According to a new study in the Journal of Happiness Studies ( yes, there is such a journal), people who engage in activities that increase competency, such as exercising, studying or working, experience decreased happiness, lower levels of enjoyment and higher levels of stress while doing so. Yet in spite of the negative effects they felt on an hourly basis, the participants reported that they felt happy and satisfied with the same activities when they reflected on them at the end of the day. The study investigated whether people who spend time on activities that fulfill certain psychological needs — the need to be competent, feel connected to others and be autonomous or self-directed — experience greater happiness. They also examined the effects of fulfilling these needs on a person’s moment-to-moment happiness.

It seems that activities promoting autonomy and connectedness increased happiness on an hourly and daily basis, but the greatest increase in momentary happiness was experienced by participants who were involved in something that contributed to their sense of autonomy. It looks like Albert Einstein had it right when he advised, “If you want to live a happy life, tie it to a goal.”

Then there are two new studies that suggest giving to others makes us happy, even happier than spending on ourselves. What’s more, our kindness might create a virtuous cycle that promotes lasting happiness and altruism. In one of the studies, published last year in the Journal of Social Psychology, researchers in Great Britain had participants take a survey measuring life satisfaction, then they assigned all 86 participants to one of three groups. One group was instructed to perform a daily act of kindness for the next 10 days. Another group was also told to do something new each day over those 10 days. A third group received no instructions. After the 10 days were up, the researchers asked the participants to complete the life satisfaction survey again. The groups that practiced kindness and engaged in novel acts both experienced a significant—and roughly equal—boost in happiness; the third group didn’t get any happier. The findings suggest that good deeds do in fact make people feel good—even when performed over as little as 10 days—and there may be particular benefits to varying our acts of kindness, as novelty seems linked to happiness as well.

But kindness may have a longer, even more profound effect on our happiness, according to the second study, published online in the Journal of Happiness Studies in April , where the researchers made two big findings. First, consistent with the British study, people in general felt happier when they were asked to remember a time they bought something for someone else—even happier than when they remembered buying something for themselves. But the second finding is even more provocative: The happier participants felt about their past generosity, the more likely they were in the present to choose to spend on someone else instead of themselves. Not all participants who remembered their past kindness felt happy. But the ones who did feel happy were overwhelmingly more likely to double down on altruism. The results suggest a kind of “positive feedback loop” between kindness and happiness, so that one encourages the other.

So the recipe- be just, have a goal and be kind. Simple isn’t it?

What should we do with the old people?

The world welcomed the 7^th billion baby this week leading to a furor that the earth is unlikely to be able to provide for this growth in population with its limited resources. Clearly the growth in babies is not being balanced with the departure of the old. With medical advances, the old are living longer and longer and the lowering of child mortality further accentuates the problem. And hanging above it all is the cost of medical support for the elderly leading many to proffer, very guardedly, that perhaps the time has come to limit these costs in the waning days of the old. The question is how do various cultures around the world deal with the problem of the aged?

When people grow old in many parts of the world, family and friends care for them at home until the end. In America, the elderly are more typically sent to an assisted living or a skilled nursing facility, a contrast that may appear selfish, uncaring and even callous.

Eastern cultures place enormous value on family and the elderly, often adhering to traditional age hierarchies. The Confucian doctrine of ‘filial piety’ continues to have a strong presence in Chinese and Asian culture. It simply means showing obedience, respect and deference to your elders. It’s considered a privilege to be in the enlightened company of an elder, and ancestral reverence remains vitally important today. In these and other cultures, it is considered utterly shameful not to take care of your aging parents.  

In stark contrast, Western culture encourages families to strike a balance between allegiance to the elderly and individual freedom. Values of Western cultures tend to celebrate youth, self-reliance and individualism. Routinely, seniors do not live with their children and it’s often considered a big hassle to take care of your parents, even if you really want to do so. The “cult of youth” and emphasis on the virtues of independence, individualism and self-reliance also make life hard on older people as they inevitably lose some of these traits. Then, there’s America’s Protestant work ethic, “which holds that if you’re no longer working, you’ve lost the main value that society places on you.” Retirement also means losing social relationships, which, coupled with America’s high mobility, leaves many old people hundreds or even thousands of miles away from longtime friends and family.

While modernization has brought many benefits to the elderly — most notably improved health and longer life spans — it has also led to a breakdown of traditions. Modern literacy and its ties to technology are also putting the elderly at a disadvantage. “Modern literacy means that we look up things in books or on the Internet — we don’t go ask an old person. And lightning-speed technological advances “mean that the things that old people do understand got technologically outdated.”

According to UCLA professor Jared Diamond, “The idea that it’s human nature for parents to make sacrifices for their children and, in turn, for their grown children to sacrifice for their aging parents — turns out to be a ‘naïve expectation,’ This assumption, he said, ignores undeniable conflicts of interest between generations.” From a common sense perspective, “Parents and children both want a comfortable life — there are limits to the sacrifices that they’ll make for each other.”

In a provocative article, sociologist Amitai Etzioni, argues that the Eskimo solution of “putting the old on an ice floe and left to float away into the sunset” is not the right solution. Of course, he would argue that – after all he is 83! But his reasons for dismissing this are cogent and logical.

According to a recent study, Dr. Alvin C. Kwok and his colleagues find that surgery is common in the last year, month and week of life. Eighty-year-olds had a 35% chance of going under the knife in the last year of their lives; nearly one out of five Medicare recipients had surgery in their last month and one in 10 in their last week. Nobody doubts that some of these surgeries were necessary. But major medical and ethical figures argue that they reflect our reluctance to accept death or let go, the surgeons' activist interventionist orientation and the way the incentives are aligned.

As the surgeon Atul Gawande put it in The New Yorker: "Our medical system is excellent at trying to stave off death with eight-thousand-dollar-a-month chemotherapy, three-thousand-dollar-a-day intensive care, five-thousand-dollar-an-hour surgery. But, ultimately, death comes, and no one is good at knowing when to stop."

Focusing on care for the elderly, some others warn that our present attitudes "doom most of us to an old age that will end badly: with our declining bodies falling apart as they always have but devilishly -- and expensively -- stretching out the suffering and decay." They hence call on us to abandon the "traditional open-ended model" (which assumes medical advances will continue unabated) in favor of more realistic priorities, namely reducing early death and improving the quality of life for everyone. They further advocate age-based prioritization, giving the highest to children and "the lowest to those over 80."

The journalist Beth Baker summed up this position: "After people have lived a reasonably full life of, say, 70 to 80 years, they should be offered high quality long-term care, home care, rehabilitation and income support, but not extraordinary and expensive medical procedures."

Etizioni argues that “once we set an age after which we shall provide mainly palliative care, economic pressures may well push us to ratchet down the age. If 80 was a good number a few years ago, given the huge deficit and the pressure to cut Medicare expenditures, there seems no obvious reason not to lower the cut-off age to, say, 70. And nations that have weaker economies, the logic would follow, should cut off interventionist care at an even younger age. Say, 50 for Guatemala?”

But if we do not use age as a criterion for abandoning serious surgical and costly medical interventions, what is the alternative?

Etizioni argues that the correct criterion is the capacity to recover and return to a meaningful. Thus, if a person is young but has a terminal disease, say, advanced pancreatic cancer, and physicians determine that he has but a few months, maybe weeks, to live (a determination doctors often make), he may be spared aggressive interventions and be provided with mainly palliative care. In contrast, an 80-year-old with, say, pneumonia -- who can return to his family and friends to be loved and give love, contribute to the community through his volunteering and enjoy his retirement he earned with decades of work -- should be given all the treatments needed to return him to his life.

The real moral is that we should learn to accept death more readily; we should stop aggressive interventions when there is little hope; we should provide dying people with palliative care to make their passing less painful and less traumatic. And finally we should learn from the Eskimos -- they long ago stopped abandoning their elderly just because they got "too" old.