What happens when we die? Does the light just go out and that's that—the million-year nap? As one ages, one of the interesting thoughts that occupy ones mind is what is there in the afterlife? Questions range from what happens to a person's essence after death to more mundane ones like “What will I do all day”? “Is there a place to plug in my lap-top?”
The notion that there is a life after this one on Earth is a widely held belief that predates recorded history. While cultures like that of the ancient Egyptians believed existence continued in "the Land of the Dead," the more modern Christian beliefs offer an afterlife in Heaven as a reward or in Hell as a punishment. Even more recent ideas suggest that life might continue in another dimension or plane of existence - perhaps even on another planet. Whatever the ideas, it's clear that humans want to believe - perhaps even need to believe in life after death.
Mary Roach, in her book “Spook”, examines an array of contemporary and historical soul-searchers: scientists, schemers, engineers, mediums, all trying to prove (or disprove) that life goes on after we die.
She starts her visit in the outskirts of Delhi chasing a claim of reincarnation by a five year old who could remember his past life in great details. What Mary did was to find the person who had recently died whose life mirrored the claims of the five year old. There were enough similarities to provoke research but not enough to provide proof.
In her search she then goes on to a University of Virginia operating room where cardiologists have installed equipment near the ceiling to study out-of-body near-death experiences. Along the way, she enrolls in an English medium school, gets electromagnetically haunted at a university in Ontario, and visits a Duke University professor with a plan to weigh the consciousness of a leech. She goes to the University of Arizona and meets with mediums currently working today; she tries her hand at telecommunication with the dead in the forests of California; and she even tries her hand at getting in touch with her own inner medium at a school in England. Her historical wanderings unearth soul-seeking philosophers who rummaged through cadavers and calves' heads, a North Carolina lawsuit that established legal precedence for ghosts, and the last surviving sample of "ectoplasm" in a Cambridge University archive.
Roach is dogged in her approach as she examines each phenomenon through the lens of scientific fact. In the end, however, she usually walks away skeptical.
A completely different approach is taken by David Eaglemen in his new book “Sum”. Since science could not prove the contours of the afterlife, whether it was the 72 virgins waiting in line or St Peter with a tablet as a gatekeeper, he felt free to imagine alternate afterlives that could be true.
In one afterlife, you discover that God understands the complexities of life. She had originally structured her universe with a binary categorization of good and evil. But She soon realized that humans could be good in many ways and evil men may have a lot of good in them. How to categorize them? A computer program to weigh all in balance and give a verdict seemed so, well, automated. So She decided She would grant everyone a place in heaven and that everyone would be treated equally. So was born true equality. But the communists were baffled because they have achieved true equality but only with the help of a God they don’t believe in. The meritocrats are abashed because they are stuck for eternity in an incentive less system with a bunch of pinkos. The conservatives have no penniless to disparage and the liberals have no downtrodden to promote. The only thing everyone is now agreed upon is that now they are all truly in Hell.
In the metamorphosis afterlife, you find that there are three deaths. The first is when the body ceases to function. The second is when the body is consigned to the grave. The third is that moment, sometime in the future, when your name is spoken for the last time. And all wait in the lobby until the third death. Some do not want to be remembered for the sins they committed in the past. But that is “the curse of the room, since we live in the heads of those who remember us, we lose control of our lives and become what they want us to be.”
In Mirror afterlife, you find that you were much better at seeing the truth about others than you were at seeing yourself and so navigated your life with the help of others who held up mirrors for you. People praised your good qualities and criticized your bad habits, and these perspectives helped you guide your life. In this way, much of your existence took place in the eyes, ears and fingertips of others. But in this afterlife, all of the people with whom you have ever come into contact are gathered and all their mirrors are held up in front of you so that you can see yourself clearly for the first time.
In one afterlife, you relive all your experiences in carefully categorized groups: sleeping 30 years straight, sitting five months on the toilet, spending 200 days in the shower, and so forth. In another, you can be whatever you want, including a horse that forgets its original humanity. There are afterlives where you meet God, in one a God who endlessly reads Frankenstein, lamenting the tragic lot of creators; in another a God, female this time, in whose immense corpus earth is a mere cell. In one afterlife you may find that God is the size of a microbe and is unaware of your existence. In another, your creators are a species of dim witted creatures who built us to figure out what they could not. In a different version of the afterlife you work as a background character in other peoples dreams. Or that afterlife contains only those people you remember or that the hereafter includes thousands of previous gods who no longer attract followers. In some afterlives you are split into all your different ages; in some you are forced to live with annoying versions of yourself that represent what you could have been. Perhaps we are mobile robots for cosmic mapmakers or we are experimental subjects for gods trying to understand what makes couples stick together. There are a host of other possibilities…
What both these books offer is an interesting insight into one of the most perplexing conundrum of human life- what happens in the after life. But neither offers any scientific evidence to bolster their viewpoint. The journey however is a delight as both are delightful raconteurs.
A final thought from Mary Roach: “ We live life as though we'll always be around, as though there'll always be a tomorrow in which we can do the things we dream about and say the things we want to say to our loved ones. I would encourage people to get real about their limited time on earth. Let the specter of death inspire you to start doing the things that matter to you. Just, you know, on the off chance that there is no afterlife in which to do them.”
anil
Thursday, July 23, 2009
Sunday, July 19, 2009
Sex, anyone ?
Ever since Bob Dole extolled the virtues of Viagra some ten years ago after his losing campaign against Bill Clinton, the TV screens in the US have been filled with ads urging everyone to join the pleasure caravan with blue colored pills. The main foci of these ad campaigns from the four or five different manufacturers has been on length- length of time to get there, length of time to stay there and well, just length!
Typically these TV ads begin with soft romantic music. In one ad a couple strolls into the frame holding hands and looking soulfully at each other—note that the age of the couple seems to increase as the evening wears on. Both say how the little blue pill has saved their marriage. A second ad has a more blunt message where a guy attempts to throw a football through a tire. The football keeps bouncing out, and the poor guy's face is a portrait of futility. When he takes pill, however, he rams the football through the hole—straight and true, again and again, with a great big smile. A third ad talks about the ability to be ready when you want to be and that over a 36 hour period while a fourth ad simply shows a line of wide eyed women lining up next to a hugely beaming man who has just taken the pill. But in all cases the spell is soon broken. First the music becomes louder, the screen darkens and the fonts become smaller- much smaller- as a voice in the background says quickly don’t take this pill if you have high blood pressure, or hypertension or a litany of other complaints. Then the music becomes even louder, and the voice, even softer, telling the viewer of the possible side effects of the pill. It seems that the side effects could range from headaches, facial flushing to an upset stomach. There could be a sudden loss of hearing with ringing in the ears or even a sudden loss of vision. Great, you can be ready at any time but you may not be able to see anything or hear anything! And the final indignity, the ads warn you, “if the erection may lasts more than four hours, go immediately to the hospital”.
The fact is that all these side effects were artfully concealed from the buying public till the FDA insisted that not only must the bottles be labeled but also the ads touting the product on TV. So the soulful ads needed to add the harsh reality of specific side effects such as nausea, abdominal pain, back pain, photosensitivity, abnormal vision, eye pain, facial oedema, hypotension, palpitation, tachycardia, arthralgia, myalgia, rash, itch, and priapism. One had to wonder if the cure was worse than the disease!
However Viagra does have other uses, for example, a low-concentration solution in water significantly prolongs the time before cut flowers wilt; one experiment showed a doubling in time from one week to two weeks. It helps in the prevention and treatment of altitude sickness such as that suffered by mountain climbers. And, if it helps, Viagra can aid jet lag recovery in hamsters. Of course you wonder since when have hamsters become frequent fliers! So it is a versatile pill, maybe.
One would imagine that the possible side effects would put off most people but the ad industry in the US is a burgeoning font of money -the US spent a total of $ 136 billion in 2008. The standard half-hour of television contains 22 minutes of program and 8 minutes of commercials - 6 minutes for national advertising and 2 minutes for local. Highly-watched programs can command rates in the millions of dollars. For example, a 30-second spot during the 2008 Superbowl sold for $2.9 million. One third of the ads on TV are for automobiles while about 10 % are for pharmaceutical products.
Despite the popularity of some advertisements, many consider them to be an annoyance for a number of reasons. The main reason may be that the sound volume of advertisements tends to be higher (and in some cases much higher) than that of regular programming. The increasing number of advertisements, as well as overplaying of the same advertisement, are secondary annoyance factors. A third might be the increasing ability to advertise on television, prompting ad campaigns by everyone from cell-phone companies and fast food restaurants to local businesses and small businesses. And of course some ads are just plain offensive and manipulative.
There are different ways that the TV ad industry seeks to influence the viewers to buy their products. One expert explains that there are twelve different types of ads--the first format is the "demo” which is a visual demonstration of a product's capabilities. The second seeks to "show the need or problem” by first, making it clear that something's not up to snuff in the consumer's life and then introducing the remedy—which is, of course, the product they are selling. Sometime the ad will employ a "symbol, analogy, or exaggerated graphic" to represent the problem. Others will use a "comparison" to show that their product is superior to those of the competitors. Another follows the "exemplary story" where the ads weave a narrative that helps illustrate the product's benefits. A popular approach is use the "benefit causes story" where the ad relies on imagining a trail of events that might be caused by the product's benefit. The simplest formula is using famous people to directly tout the product or the advertiser may showcase the type of people it hopes you'll associate with the product. Often these will be hip, funny, or good-looking people. But sometimes the associated users are goofy or geeky—it depends on the target market. Some ads will use the "unique personality property" which highlights something indigenous to the product that will make it stand out while others may parody the product. What all these approaches have in common is their ability to play on the viewers concerns persuading them to buy products they do not need or whose absence they had not hitherto felt like these famous pills that now dominate the airwaves.
An elderly friend was examining a number of these bottles that promised immediate ecstasy with great care. When I asked him why it was taking him so long to make up his mind, he replied that “I am trying to decide what I want to risk today – blindness or deafness.”
It puts one in mind of Jack Benny when was confronted on his show with a gun-toting individual who said:
"Your money or your life."
Benny hesitated. So the hold-up artist repeated:
"Your money or your life."
After more hesitation, Benny said impatiently:
"I'm thinking. I'm thinking."
Typically these TV ads begin with soft romantic music. In one ad a couple strolls into the frame holding hands and looking soulfully at each other—note that the age of the couple seems to increase as the evening wears on. Both say how the little blue pill has saved their marriage. A second ad has a more blunt message where a guy attempts to throw a football through a tire. The football keeps bouncing out, and the poor guy's face is a portrait of futility. When he takes pill, however, he rams the football through the hole—straight and true, again and again, with a great big smile. A third ad talks about the ability to be ready when you want to be and that over a 36 hour period while a fourth ad simply shows a line of wide eyed women lining up next to a hugely beaming man who has just taken the pill. But in all cases the spell is soon broken. First the music becomes louder, the screen darkens and the fonts become smaller- much smaller- as a voice in the background says quickly don’t take this pill if you have high blood pressure, or hypertension or a litany of other complaints. Then the music becomes even louder, and the voice, even softer, telling the viewer of the possible side effects of the pill. It seems that the side effects could range from headaches, facial flushing to an upset stomach. There could be a sudden loss of hearing with ringing in the ears or even a sudden loss of vision. Great, you can be ready at any time but you may not be able to see anything or hear anything! And the final indignity, the ads warn you, “if the erection may lasts more than four hours, go immediately to the hospital”.
The fact is that all these side effects were artfully concealed from the buying public till the FDA insisted that not only must the bottles be labeled but also the ads touting the product on TV. So the soulful ads needed to add the harsh reality of specific side effects such as nausea, abdominal pain, back pain, photosensitivity, abnormal vision, eye pain, facial oedema, hypotension, palpitation, tachycardia, arthralgia, myalgia, rash, itch, and priapism. One had to wonder if the cure was worse than the disease!
However Viagra does have other uses, for example, a low-concentration solution in water significantly prolongs the time before cut flowers wilt; one experiment showed a doubling in time from one week to two weeks. It helps in the prevention and treatment of altitude sickness such as that suffered by mountain climbers. And, if it helps, Viagra can aid jet lag recovery in hamsters. Of course you wonder since when have hamsters become frequent fliers! So it is a versatile pill, maybe.
One would imagine that the possible side effects would put off most people but the ad industry in the US is a burgeoning font of money -the US spent a total of $ 136 billion in 2008. The standard half-hour of television contains 22 minutes of program and 8 minutes of commercials - 6 minutes for national advertising and 2 minutes for local. Highly-watched programs can command rates in the millions of dollars. For example, a 30-second spot during the 2008 Superbowl sold for $2.9 million. One third of the ads on TV are for automobiles while about 10 % are for pharmaceutical products.
Despite the popularity of some advertisements, many consider them to be an annoyance for a number of reasons. The main reason may be that the sound volume of advertisements tends to be higher (and in some cases much higher) than that of regular programming. The increasing number of advertisements, as well as overplaying of the same advertisement, are secondary annoyance factors. A third might be the increasing ability to advertise on television, prompting ad campaigns by everyone from cell-phone companies and fast food restaurants to local businesses and small businesses. And of course some ads are just plain offensive and manipulative.
There are different ways that the TV ad industry seeks to influence the viewers to buy their products. One expert explains that there are twelve different types of ads--the first format is the "demo” which is a visual demonstration of a product's capabilities. The second seeks to "show the need or problem” by first, making it clear that something's not up to snuff in the consumer's life and then introducing the remedy—which is, of course, the product they are selling. Sometime the ad will employ a "symbol, analogy, or exaggerated graphic" to represent the problem. Others will use a "comparison" to show that their product is superior to those of the competitors. Another follows the "exemplary story" where the ads weave a narrative that helps illustrate the product's benefits. A popular approach is use the "benefit causes story" where the ad relies on imagining a trail of events that might be caused by the product's benefit. The simplest formula is using famous people to directly tout the product or the advertiser may showcase the type of people it hopes you'll associate with the product. Often these will be hip, funny, or good-looking people. But sometimes the associated users are goofy or geeky—it depends on the target market. Some ads will use the "unique personality property" which highlights something indigenous to the product that will make it stand out while others may parody the product. What all these approaches have in common is their ability to play on the viewers concerns persuading them to buy products they do not need or whose absence they had not hitherto felt like these famous pills that now dominate the airwaves.
An elderly friend was examining a number of these bottles that promised immediate ecstasy with great care. When I asked him why it was taking him so long to make up his mind, he replied that “I am trying to decide what I want to risk today – blindness or deafness.”
It puts one in mind of Jack Benny when was confronted on his show with a gun-toting individual who said:
"Your money or your life."
Benny hesitated. So the hold-up artist repeated:
"Your money or your life."
After more hesitation, Benny said impatiently:
"I'm thinking. I'm thinking."
Wednesday, July 15, 2009
Departures
It is difficult to imagine someone making a full length movie about the care and dressing of bodies before they are cremated. Difficult but not impossible. A Japanese director,Yōjirō Takita, has taken the bold gamble in a lyrical piece of film-making that leaves the audience simultaneously uplifted and in tears. It was a full house when I saw this movie and there was nary a dry eye in the audience. (It is also the winner of the best foreign feature film at this year’s Academy Awards.)
“Departures” tells a simple story of Daigo, a young cello player who loses his job and returns with his wife to his village. Here he finds employment as one who prepares dead bodies for their viewing and subsequent cremation- a ritual known as "encoffinments". The details of the "encoffinment" are fascinating with as much attention to detail as in a tea ceremony. A "departures" specialist comes to the home of the diseased, discretely cleans the body ("Wash away the weariness and pain of this world"), changes the clothes of the deceased, poses the body and puts it into the wooden coffin that will be burned. This is done in full view of the family, yet no part of the body can be shown save the face.
But Daigo's new job is considered "unclean" by society and so unacceptable that he dare not tell his wife about it.He visits the bathhouse each night after work to scrub off "the smell of death." But despite ostracism from his friends,Daigo continues and slowly finds a new life ministering to the dead. He realizes the deeper meaning of the rituals of wiping down the body and clothing it in silk. And of restoring beauty for all eternity before the family to say their final goodbye. “Everything” reflects Daigo “done peacefully and beautifully". Departures is a loving tribute to the Japanese way of death. It shows us a place where death and the dead are treated with a respect the rest of the world should envy.
At another level, the film is also about death and the dignity that it should inspire. Death, the movie says, is a great leveler- whether you are a child or an old lady, a beloved wife or an estranged daughter, a grandmother with a taste for stockings or a son who chooses a life of woman. All need to be treated with love and dignity at their final moments. Strangely haunting in the way it lingers in the mind and heart after it’s over, Departures’ amazing achievement is in being a film about death that is truly beautiful, joyful and life-affirming. The repeated depictions of the careful and respectful honoring of the deceased’s passage to the afterlife gain resonance with each successive scene.It is a moving, powerful experience.
“The dead appear to me as serene, even beautiful” says Shinmon Aoki, author of “Coffinman: The Journal of a Buddhist Mortician,” the basis for “Departures, “During their lives I don’t know what right or wrong they might have done, but it seems to have no bearing on them now. It doesn’t matter whether their beliefs were thick or thin, whether they belonged to this denomination or that, whether they were interested in religion or not. Nothing they have done goes to making the dead wear such gentle faces.”
At another level, the movie is also a subtle morality tale and social commentary. It says no job is unclean especially if its objective is to help families to say goodbye to their loved ones. The hero is ostracized by his friends when they learn of his occupation and even his wife leaves him calling him impure, though they finally return. There is social criticism, too, particularly for the Japanese audiences. It is a little known fact that deep prejudice exists in Japan against those dealing with the dead, the untouchables, also known as burakumin. The burakumin — ethnically indistinguishable from other Japanese — are descendants of Japanese who, according to Buddhist beliefs, performed tasks considered unclean. Slaughterers, undertakers, executioners and town guards, they were called eta, which means “defiled mass”, or hinin, nonhuman. Since death was considered unclean, they were outcastes. Although they were legally liberated in 1871 with the abolition of the feudal caste system, this did not put a stop to social discrimination. The long history of taboos and myths of the buraku left a continuous legacy of social desolation. The topic of the buraku remains Japan’s biggest taboo, rarely entering private conversations and virtually ignored by the media until a movie like “Departures” comes along.
Another interesting side note to the movie is the possibility of a burakimin actually becoming the prime minister of Japan in the elections being held in August this year. For Japan, the crowning of Hiromu Nonaka as its top leader would be as significant as America’s election of its first black president.
And finally it tells you that whatever you do, you must do it passion and with grace and professionalism. It is necessary to accept that impermanence, grief and loss are basic conditions of every life. This unorthodox original story about literally touching death is a brilliant catalyst for the movie’s message of celebrating life.
And then there is the music. Here is an excerpt which will give you a sense of the haunting beauty of the entire movie.And also here and here
“Departures” tells a simple story of Daigo, a young cello player who loses his job and returns with his wife to his village. Here he finds employment as one who prepares dead bodies for their viewing and subsequent cremation- a ritual known as "encoffinments". The details of the "encoffinment" are fascinating with as much attention to detail as in a tea ceremony. A "departures" specialist comes to the home of the diseased, discretely cleans the body ("Wash away the weariness and pain of this world"), changes the clothes of the deceased, poses the body and puts it into the wooden coffin that will be burned. This is done in full view of the family, yet no part of the body can be shown save the face.
But Daigo's new job is considered "unclean" by society and so unacceptable that he dare not tell his wife about it.He visits the bathhouse each night after work to scrub off "the smell of death." But despite ostracism from his friends,Daigo continues and slowly finds a new life ministering to the dead. He realizes the deeper meaning of the rituals of wiping down the body and clothing it in silk. And of restoring beauty for all eternity before the family to say their final goodbye. “Everything” reflects Daigo “done peacefully and beautifully". Departures is a loving tribute to the Japanese way of death. It shows us a place where death and the dead are treated with a respect the rest of the world should envy.
At another level, the film is also about death and the dignity that it should inspire. Death, the movie says, is a great leveler- whether you are a child or an old lady, a beloved wife or an estranged daughter, a grandmother with a taste for stockings or a son who chooses a life of woman. All need to be treated with love and dignity at their final moments. Strangely haunting in the way it lingers in the mind and heart after it’s over, Departures’ amazing achievement is in being a film about death that is truly beautiful, joyful and life-affirming. The repeated depictions of the careful and respectful honoring of the deceased’s passage to the afterlife gain resonance with each successive scene.It is a moving, powerful experience.
“The dead appear to me as serene, even beautiful” says Shinmon Aoki, author of “Coffinman: The Journal of a Buddhist Mortician,” the basis for “Departures, “During their lives I don’t know what right or wrong they might have done, but it seems to have no bearing on them now. It doesn’t matter whether their beliefs were thick or thin, whether they belonged to this denomination or that, whether they were interested in religion or not. Nothing they have done goes to making the dead wear such gentle faces.”
At another level, the movie is also a subtle morality tale and social commentary. It says no job is unclean especially if its objective is to help families to say goodbye to their loved ones. The hero is ostracized by his friends when they learn of his occupation and even his wife leaves him calling him impure, though they finally return. There is social criticism, too, particularly for the Japanese audiences. It is a little known fact that deep prejudice exists in Japan against those dealing with the dead, the untouchables, also known as burakumin. The burakumin — ethnically indistinguishable from other Japanese — are descendants of Japanese who, according to Buddhist beliefs, performed tasks considered unclean. Slaughterers, undertakers, executioners and town guards, they were called eta, which means “defiled mass”, or hinin, nonhuman. Since death was considered unclean, they were outcastes. Although they were legally liberated in 1871 with the abolition of the feudal caste system, this did not put a stop to social discrimination. The long history of taboos and myths of the buraku left a continuous legacy of social desolation. The topic of the buraku remains Japan’s biggest taboo, rarely entering private conversations and virtually ignored by the media until a movie like “Departures” comes along.
Another interesting side note to the movie is the possibility of a burakimin actually becoming the prime minister of Japan in the elections being held in August this year. For Japan, the crowning of Hiromu Nonaka as its top leader would be as significant as America’s election of its first black president.
And finally it tells you that whatever you do, you must do it passion and with grace and professionalism. It is necessary to accept that impermanence, grief and loss are basic conditions of every life. This unorthodox original story about literally touching death is a brilliant catalyst for the movie’s message of celebrating life.
And then there is the music. Here is an excerpt which will give you a sense of the haunting beauty of the entire movie.And also here and here
Sunday, July 12, 2009
Decoding global warming
Global warming has become a major obsession in our press yet I find that few really understand the basics of the issues. Here is an attempt to decode the way the problem is presented.
First, it is clear that global warming is a reality. Human activity has been increasing the concentration of greenhouse gases in the atmosphere (mostly carbon dioxide from combustion of coal, oil, and gas; plus a few other trace gases) for a long time. There is no scientific debate on this point. The scientific community has spoken and the Nobel committee has endorsed these findings with their latest prize for Al Gore and IPCC. The IPCC- i.e. the intergovernmental panel on climate change- set up by the UN with participation from 2500 scientists in more than 130 countries, studied the issue for over a decade and came to the conclusion that climate change was real and that it was caused primarily by human intervention. Industrialization, deforestation, and pollution greatly increased atmospheric concentrations of water vapor, carbon dioxide, methane, and nitrous oxide, all greenhouse gases, which helped trap heat near Earth's surface causing global warming.
The IPCC projects a best estimate of global temperature increase of 1.8 - 4.0°C with a possible range of 1.1 - 6.4°C by 2100. This increase could lead to large-scale food and water shortages and have catastrophic effects on wildlife.
Now what were the main causes of the increasing levels of carbon dioxide in the atmosphere? From the IEA data, the main contributions come from the burning of coal, liquid fuels and gases. Humans have been pouring carbon dioxide into the atmosphere in much greater quantities than can be absorbed by the oceans and plant life. In 2006, of the total carbon dioxide contribution of 29.2 billion metric tonnes, coal accounted for 42%, liquid fuels 38 % and gas 20%.
And who were the main culprits in this ?When you look at the countries contributing to the emissions of 29.2 billion metric tones in 2006, the top of the charts were the US at 5.9, China at 6.0 and Europe at 4.7 billion metric tonnes representing almost 57% of all the emissions in the world. India contributed 1.29 billion metric tonnes, slightly more than Japan at 1.25.
It is now being projected by various authorities that the total carbon dioxide emissions will grow to 40.4 billion metric tones by 2030. Of these about 25.8 billon metric tonnes or about 63% would now come from the non OECD countries with China’s share of pollution rising to 11.73 billion metric tonnes.
It is important to note that the per capita contributions from the major countries project a different picture even in 2030 – US will still emit more than 17 tonnes per capita with Japan at 9.8 and OECD Europe at 7.96 while China at 8 and India at 1.4 are far behind. It is also worth noting that despite the public outcry in the US, the per capita emissions have only gone down marginally over the last two decades- US emitted 19.6 tonnes per capita in 1990.
While the per capital contribution is a relative measure, it becomes huge when you estimate the total contribution of these countries. Thus the US would contribute 6.4 billon tonnes (16%) while China would contribute 11.73 billion tonnes (or 29 %) and India 2.11 billion tonnes(5 %) of the total 40.4 billion metric tones in 2030. OECD countries as a whole would contribute 14.6 billion metric tonnes or 37%.
It is true, however, that from 1980 till now, the US emitted 141 billion metric tonnes and OECD 122 while the contributions from China were only 76 and from India only 20 billion metric tones. And despite their public postures both the US and OECD country’s per capita contribution of carbon dioxide emission has not declined appreciably in the last twenty years. In recent years both the US and OECD countries have tried to move towards some forms of carbon emission reduction either using a carbon tax or some form of cap and trade system. An excellent analysis of these options is in this article.
In the developing countries, however, the outlook remains uncertain. And this is for one reason – control of carbon emissions is seen as possible only if economic growth is lowered. One of the forgotten statistics in all this is the fact that the carbon dioxide emissions are an outgrowth primarily of increased energy consumption in these countries. And energy consumption is almost linearly related to economic growth. Put differently, for economic growth to occur, the developing countries need energy but increased energy consumption causes increased carbon dioxide emissions.
Since the per capita GDP of China in 2006 was $4690 while that of the US was $44,830,(and corresponding energy per capita consumption was 1433 kgoe and 7768 respectively), it is clear that the countries like China and India would continue to increase their energy consumption in their attempts to reach higher levels of economic development.
So what is essential is to realize that the carbon dioxide emission problem is at heart an economic development problem. Solutions will lie in increasing the efficiency with which energy is used for economic growth as well as spurring the means for reducing carbon dioxide emissions from the energy that is used by them. The first requires greater energy efficiency measures, while the later requires a shift in choice of fuel away from both coal and liquid fuels to either natural gas or renewable energy. Both require investments in new technologies. Hence the developing countries emphasis on transfer of technologies to help cushion the transition to a lower carbon based economies as well as their argument that it was the developed world which has polluted the planet in the past when they were growing economically and so needs to do more to control emissions than it has been willing to do.
The dilemma arises from the fact that if China and India were to reach the levels of the US in terms of energy consumption by 2030, an unlikely prospect, we would then be looking at world carbon dioxide emission at least double those estimated today- a prospect that nobody wants.
First, it is clear that global warming is a reality. Human activity has been increasing the concentration of greenhouse gases in the atmosphere (mostly carbon dioxide from combustion of coal, oil, and gas; plus a few other trace gases) for a long time. There is no scientific debate on this point. The scientific community has spoken and the Nobel committee has endorsed these findings with their latest prize for Al Gore and IPCC. The IPCC- i.e. the intergovernmental panel on climate change- set up by the UN with participation from 2500 scientists in more than 130 countries, studied the issue for over a decade and came to the conclusion that climate change was real and that it was caused primarily by human intervention. Industrialization, deforestation, and pollution greatly increased atmospheric concentrations of water vapor, carbon dioxide, methane, and nitrous oxide, all greenhouse gases, which helped trap heat near Earth's surface causing global warming.
The IPCC projects a best estimate of global temperature increase of 1.8 - 4.0°C with a possible range of 1.1 - 6.4°C by 2100. This increase could lead to large-scale food and water shortages and have catastrophic effects on wildlife.
Now what were the main causes of the increasing levels of carbon dioxide in the atmosphere? From the IEA data, the main contributions come from the burning of coal, liquid fuels and gases. Humans have been pouring carbon dioxide into the atmosphere in much greater quantities than can be absorbed by the oceans and plant life. In 2006, of the total carbon dioxide contribution of 29.2 billion metric tonnes, coal accounted for 42%, liquid fuels 38 % and gas 20%.
And who were the main culprits in this ?When you look at the countries contributing to the emissions of 29.2 billion metric tones in 2006, the top of the charts were the US at 5.9, China at 6.0 and Europe at 4.7 billion metric tonnes representing almost 57% of all the emissions in the world. India contributed 1.29 billion metric tonnes, slightly more than Japan at 1.25.
It is now being projected by various authorities that the total carbon dioxide emissions will grow to 40.4 billion metric tones by 2030. Of these about 25.8 billon metric tonnes or about 63% would now come from the non OECD countries with China’s share of pollution rising to 11.73 billion metric tonnes.
It is important to note that the per capita contributions from the major countries project a different picture even in 2030 – US will still emit more than 17 tonnes per capita with Japan at 9.8 and OECD Europe at 7.96 while China at 8 and India at 1.4 are far behind. It is also worth noting that despite the public outcry in the US, the per capita emissions have only gone down marginally over the last two decades- US emitted 19.6 tonnes per capita in 1990.
While the per capital contribution is a relative measure, it becomes huge when you estimate the total contribution of these countries. Thus the US would contribute 6.4 billon tonnes (16%) while China would contribute 11.73 billion tonnes (or 29 %) and India 2.11 billion tonnes(5 %) of the total 40.4 billion metric tones in 2030. OECD countries as a whole would contribute 14.6 billion metric tonnes or 37%.
It is true, however, that from 1980 till now, the US emitted 141 billion metric tonnes and OECD 122 while the contributions from China were only 76 and from India only 20 billion metric tones. And despite their public postures both the US and OECD country’s per capita contribution of carbon dioxide emission has not declined appreciably in the last twenty years. In recent years both the US and OECD countries have tried to move towards some forms of carbon emission reduction either using a carbon tax or some form of cap and trade system. An excellent analysis of these options is in this article.
In the developing countries, however, the outlook remains uncertain. And this is for one reason – control of carbon emissions is seen as possible only if economic growth is lowered. One of the forgotten statistics in all this is the fact that the carbon dioxide emissions are an outgrowth primarily of increased energy consumption in these countries. And energy consumption is almost linearly related to economic growth. Put differently, for economic growth to occur, the developing countries need energy but increased energy consumption causes increased carbon dioxide emissions.
Since the per capita GDP of China in 2006 was $4690 while that of the US was $44,830,(and corresponding energy per capita consumption was 1433 kgoe and 7768 respectively), it is clear that the countries like China and India would continue to increase their energy consumption in their attempts to reach higher levels of economic development.
So what is essential is to realize that the carbon dioxide emission problem is at heart an economic development problem. Solutions will lie in increasing the efficiency with which energy is used for economic growth as well as spurring the means for reducing carbon dioxide emissions from the energy that is used by them. The first requires greater energy efficiency measures, while the later requires a shift in choice of fuel away from both coal and liquid fuels to either natural gas or renewable energy. Both require investments in new technologies. Hence the developing countries emphasis on transfer of technologies to help cushion the transition to a lower carbon based economies as well as their argument that it was the developed world which has polluted the planet in the past when they were growing economically and so needs to do more to control emissions than it has been willing to do.
The dilemma arises from the fact that if China and India were to reach the levels of the US in terms of energy consumption by 2030, an unlikely prospect, we would then be looking at world carbon dioxide emission at least double those estimated today- a prospect that nobody wants.
Friday, July 10, 2009
Fathers Day thoughts
Most people remember their parents or close friends through some vignettes which have remained stuck in their memories for ever and ever. It is an accumulation of such memories that seems to define our view of their entire life. Rarely if ever do we sit down to think about placing these memories in some context to obtain a coherent and complete view of their entire life. It is these vignettes that define them for us. So it is for fathers.
When asked about their earliest memories of their fathers, many of us would have difficulty in defining them in some details. But ask us if we remember some action or thought that has defined our relationship with them, most would easily find quite few incidents from their lives.
So as I reflected on my fathers life- he has now been gone almost fifteen years- a few vignettes stand out which in a certain sense define him for me. Of them the earliest was when I asked why he became an economist. We were at that time discussing the profession I would soon choose for myself.It then came out that when he was a young student, he heard Pandit Nehru, the charismatic leader of the Indian National Congress urge all Indians to fight for complete independance on the banks of the Ravi river in 1930. He urged students to help rebuild the country and said that the country would need economists and engineers to lay the foundation for the future.That speech inspired the deep idealism in him to chose economics as his profession. ( Incidentally, mine was engineering).
Another defining incident was when I found that he chose to resign from his job as the editor of the premier economic magazine in the country, The Eastern Economist, rather than bow to the wishes of the proprietors to push the preferred policies of the industrialist who also owned the magazine.He was willing to lose his job rather than compromise on his principles.Since we had a comfortable house close to his office and we had to shift to hutments built for soldiers during the war, the change was a considerable downgrade at that time even though he found a job with the government.
A third incident occurred when I led a student movement against the powerful professor and head of the hostel at IIT, Kharagpur in the first year of my engineering course.Dr Muthanna was a tough as nails administrator who tolerated no dissent and when a group of students organized to challenge his policies and his executive abilities, he was not only outraged but he took action. Unbeknownst to me, he wrote a strong letter to my father threatening that he may be forced to expel me from the institute for my union efforts. My father sent him an equally uncompromising reply pointing out that Dr Muthana needed to deal with the students more sympathetically and that in any case it was unlikely that his son would be participating in any activities that were not right and justified. He had complete faith in my judgment and sense of responsibility.My father did not send me a copy of this letter -- indeed I found out about it only years later when I was going through his papers.
A few years later I won a scholarship to go to Berkeley but found that I had not enough money for the air ticket. I was busy selling off all my possession in order to raise the necessary funds when I received a letter from my father containing a check for the air fare.
We came to a parting of ways for a brief while when I got married and he refused to accept the choice I had made. We remained distant and silent for almost seven years- you see he had passed on his uncompromising attitude to me as well.He was a man of strong and rigid convictions. It took my children to bring him around finally which he did.And we were to spend his last years as close as we had been all our lives before the break.
And then a few years later, he was diagnosed with colon cancer requiring a major operation. I was then posted in Bombay and would fly down to be with him after the operation while my brother looked after him. He was to live with this for almost fifteen years till he died. But during this period I rarely heard him complain about the pain or the restrictions that these operations placed on him. We would discuss everything under the sun except his medical pains and problems. His courage and stoicism remained with him till the end and he refused to give up.
When I look back, it is these vignettes which define for me his life--his idealism, his courage of his convictions, his stoicism in face of pain, his love for his family and his willingness to confront life without compromise.
When asked about their earliest memories of their fathers, many of us would have difficulty in defining them in some details. But ask us if we remember some action or thought that has defined our relationship with them, most would easily find quite few incidents from their lives.
So as I reflected on my fathers life- he has now been gone almost fifteen years- a few vignettes stand out which in a certain sense define him for me. Of them the earliest was when I asked why he became an economist. We were at that time discussing the profession I would soon choose for myself.It then came out that when he was a young student, he heard Pandit Nehru, the charismatic leader of the Indian National Congress urge all Indians to fight for complete independance on the banks of the Ravi river in 1930. He urged students to help rebuild the country and said that the country would need economists and engineers to lay the foundation for the future.That speech inspired the deep idealism in him to chose economics as his profession. ( Incidentally, mine was engineering).
Another defining incident was when I found that he chose to resign from his job as the editor of the premier economic magazine in the country, The Eastern Economist, rather than bow to the wishes of the proprietors to push the preferred policies of the industrialist who also owned the magazine.He was willing to lose his job rather than compromise on his principles.Since we had a comfortable house close to his office and we had to shift to hutments built for soldiers during the war, the change was a considerable downgrade at that time even though he found a job with the government.
A third incident occurred when I led a student movement against the powerful professor and head of the hostel at IIT, Kharagpur in the first year of my engineering course.Dr Muthanna was a tough as nails administrator who tolerated no dissent and when a group of students organized to challenge his policies and his executive abilities, he was not only outraged but he took action. Unbeknownst to me, he wrote a strong letter to my father threatening that he may be forced to expel me from the institute for my union efforts. My father sent him an equally uncompromising reply pointing out that Dr Muthana needed to deal with the students more sympathetically and that in any case it was unlikely that his son would be participating in any activities that were not right and justified. He had complete faith in my judgment and sense of responsibility.My father did not send me a copy of this letter -- indeed I found out about it only years later when I was going through his papers.
A few years later I won a scholarship to go to Berkeley but found that I had not enough money for the air ticket. I was busy selling off all my possession in order to raise the necessary funds when I received a letter from my father containing a check for the air fare.
We came to a parting of ways for a brief while when I got married and he refused to accept the choice I had made. We remained distant and silent for almost seven years- you see he had passed on his uncompromising attitude to me as well.He was a man of strong and rigid convictions. It took my children to bring him around finally which he did.And we were to spend his last years as close as we had been all our lives before the break.
And then a few years later, he was diagnosed with colon cancer requiring a major operation. I was then posted in Bombay and would fly down to be with him after the operation while my brother looked after him. He was to live with this for almost fifteen years till he died. But during this period I rarely heard him complain about the pain or the restrictions that these operations placed on him. We would discuss everything under the sun except his medical pains and problems. His courage and stoicism remained with him till the end and he refused to give up.
When I look back, it is these vignettes which define for me his life--his idealism, his courage of his convictions, his stoicism in face of pain, his love for his family and his willingness to confront life without compromise.
Tuesday, July 7, 2009
Senior moments.
There are senior moments and senior moments. Have you had one lately? You know. You'll be talking along like at any other time in your life, and suddenly you can't remember the name of your best friend. Or the movie you saw last night. Or what you ate for lunch an hour ago? It's a sudden, embarrassing slice of silence. A senior moment.
There are others which cause more distress- like the time you were searching for your house key in Delhi when it was in Washington, or going through red lights because they looked green, or when it was easier to say “that thing” than recall a proper noun. All these senior moments creep up on you from the time you are say 50 but they become causes of concern only when your children are around you saying “Dad” or “Mom” in embarrassed tones or muttering Alzheimer’s under their breaths!
One explanation of these senior moments is the simple fact that our brains are overloaded after 50 or 60 years of input. Our brains bloat as the result of too much stuff in the head and so the forgetful symptoms begin manifesting. After all those years of cramming stuff into your head, it finally begins overflowing like a water glass unable to hold another drop without shedding something already there.
So the solution, this expert suggests, is to empty out what is already there to make enough room for more in your brain. Those dates you memorized in high school history class? They are still there, aren't they? Get rid of them. And all those kings and queens and wars aplenty. Forget them. Just think of the valuable space you will empty up. And those thousands of names back in there of folks you'll probably never even see again? There are probably hundreds of school chums alone stuck in the recesses of your head. Get rid of them. Don't worry. If they happen to be at your next high school reunion, they'll be wearing nametags. You won’t miss a thing or a name. But what we really need is a three monthly clean up system – like changing oil in a car- just dump all the irrelevant stuff out of your brain on a regular basis. You can then really enjoy the feeling of a full and often useful brain.
But seriously research now shows how you can avoid these senior moments. Besides the usual admonitions of walking for an hour, sleeping for eight, and keeping an active social life, experts advise that you need to avoid depression. Depression, they say, saturates our bodies with high levels of the stress hormone, cortisol, which can damage regions of the brain crucial to memory. A new study in Neuro-Image shows that when people brainstorm without editing their ideas, more blood flows to a memory-processing area of the brain. Growing evidence also shows that people who drink moderately are at lower risk for cognitive decline and dementia. Wines in particular seem to help with the memory. Crosswords are another excellent form of mental gymnastics, provided that you can (a) find where you last put down your glasses,(b) find the newspaper and (c) complete the crossword. Studies have shown that people who do crossword puzzles four days per week have a 48 per cent lower risk of developing dementia than those who did no crosswords at all. And best of all, eat dark chocolate- people who down a cocoa drink have a 50 percent increase in the blood streaming into memory centers of the brain.
And most importantly do not confuse these senior moments with the dreaded onset of Alzheimer's disease. It is true that Alzheimer’s disease, the most common form of dementia, affects 5.2 million Americans and is the sixth leading cause of death in the United States. But it is a long way from a senior moment to loss of memory or dementia .
Shakespeare called memory “the warder of the brain,” charged with keeping watch over an individual’s personal account of being. Today scientists describe four memory systems that process incoming information for storage and retrieval. The systems are episodic, semantic, procedural, and working. The episodic memory system is involved in remembering personal experiences, such as a phone conversation you had yesterday or the movie you watched last week. The semantic memory system manages the storage and retrieval of general knowledge and facts, such as the number of days in a year or the colors in a rainbow. The procedural memory system allows us to learn activities and skills that will then be performed automatically with little or no conscious thought. Examples are riding a bicycle or driving a car. The working memory system governs our ability to pay attention and concentrate, and it enables us to temporarily keep needed information in mind (such as a phone number or the directions to a restaurant). But according to the latest research memories are not stored in the hippocampus or, for that matter, in any other single site in the brain. Instead, they are stored throughout the brain.
It is normal, as we grow older, to have more difficulty recalling names or choosing the right word, experts tell us. But such garden-variety forgetfulness — formally called "normal age-related forgetfulness" (NARF) or more popularly “senior moments” — must be clearly distinguished from Alzheimer's disease and other forms of dementia. The normal forgetfulness of older age may be frustrating, but it is not disabling like dementia. And you should know the difference.
Here are some examples of the differences between normal age-related forgetfulness and dementia: (courtesy 2008 Johns Hopkins White Paper about memory):
• A person with NARF may at times misplace keys, eyeglasses, or other items; a demented person forgets what these items are used for or puts them in inappropriate places.
• Someone with NARF may momentarily forget the name of an acquaintance; a demented individual may not remember knowing that person.
• A person with NARF may on occasion forget to run an errand; persons with dementia, because they do not know what day or time it is, cannot run any errands at all.
• People with NARF may joke about their forgetfulness; demented people are unaware of their memory loss.
• While driving, a person with NARF may briefly forget when to make a turn; a demented individual can easily get lost even in a familiar place.
A common guideline is that people who worry about their forgetfulness are unlikely to be suffering from a serious memory abnormality. People with a serious impairment of memory tend to be unaware of their memory problems, don't worry about them, or else blame other factors when memory lapses are brought to their attention.
In short, you need not worry if you forget where you put your car keys; you only need to worry if you forget what they’re used for. If you worry about losing your mind, you probably still have it!
There are others which cause more distress- like the time you were searching for your house key in Delhi when it was in Washington, or going through red lights because they looked green, or when it was easier to say “that thing” than recall a proper noun. All these senior moments creep up on you from the time you are say 50 but they become causes of concern only when your children are around you saying “Dad” or “Mom” in embarrassed tones or muttering Alzheimer’s under their breaths!
One explanation of these senior moments is the simple fact that our brains are overloaded after 50 or 60 years of input. Our brains bloat as the result of too much stuff in the head and so the forgetful symptoms begin manifesting. After all those years of cramming stuff into your head, it finally begins overflowing like a water glass unable to hold another drop without shedding something already there.
So the solution, this expert suggests, is to empty out what is already there to make enough room for more in your brain. Those dates you memorized in high school history class? They are still there, aren't they? Get rid of them. And all those kings and queens and wars aplenty. Forget them. Just think of the valuable space you will empty up. And those thousands of names back in there of folks you'll probably never even see again? There are probably hundreds of school chums alone stuck in the recesses of your head. Get rid of them. Don't worry. If they happen to be at your next high school reunion, they'll be wearing nametags. You won’t miss a thing or a name. But what we really need is a three monthly clean up system – like changing oil in a car- just dump all the irrelevant stuff out of your brain on a regular basis. You can then really enjoy the feeling of a full and often useful brain.
But seriously research now shows how you can avoid these senior moments. Besides the usual admonitions of walking for an hour, sleeping for eight, and keeping an active social life, experts advise that you need to avoid depression. Depression, they say, saturates our bodies with high levels of the stress hormone, cortisol, which can damage regions of the brain crucial to memory. A new study in Neuro-Image shows that when people brainstorm without editing their ideas, more blood flows to a memory-processing area of the brain. Growing evidence also shows that people who drink moderately are at lower risk for cognitive decline and dementia. Wines in particular seem to help with the memory. Crosswords are another excellent form of mental gymnastics, provided that you can (a) find where you last put down your glasses,(b) find the newspaper and (c) complete the crossword. Studies have shown that people who do crossword puzzles four days per week have a 48 per cent lower risk of developing dementia than those who did no crosswords at all. And best of all, eat dark chocolate- people who down a cocoa drink have a 50 percent increase in the blood streaming into memory centers of the brain.
And most importantly do not confuse these senior moments with the dreaded onset of Alzheimer's disease. It is true that Alzheimer’s disease, the most common form of dementia, affects 5.2 million Americans and is the sixth leading cause of death in the United States. But it is a long way from a senior moment to loss of memory or dementia .
Shakespeare called memory “the warder of the brain,” charged with keeping watch over an individual’s personal account of being. Today scientists describe four memory systems that process incoming information for storage and retrieval. The systems are episodic, semantic, procedural, and working. The episodic memory system is involved in remembering personal experiences, such as a phone conversation you had yesterday or the movie you watched last week. The semantic memory system manages the storage and retrieval of general knowledge and facts, such as the number of days in a year or the colors in a rainbow. The procedural memory system allows us to learn activities and skills that will then be performed automatically with little or no conscious thought. Examples are riding a bicycle or driving a car. The working memory system governs our ability to pay attention and concentrate, and it enables us to temporarily keep needed information in mind (such as a phone number or the directions to a restaurant). But according to the latest research memories are not stored in the hippocampus or, for that matter, in any other single site in the brain. Instead, they are stored throughout the brain.
It is normal, as we grow older, to have more difficulty recalling names or choosing the right word, experts tell us. But such garden-variety forgetfulness — formally called "normal age-related forgetfulness" (NARF) or more popularly “senior moments” — must be clearly distinguished from Alzheimer's disease and other forms of dementia. The normal forgetfulness of older age may be frustrating, but it is not disabling like dementia. And you should know the difference.
Here are some examples of the differences between normal age-related forgetfulness and dementia: (courtesy 2008 Johns Hopkins White Paper about memory):
• A person with NARF may at times misplace keys, eyeglasses, or other items; a demented person forgets what these items are used for or puts them in inappropriate places.
• Someone with NARF may momentarily forget the name of an acquaintance; a demented individual may not remember knowing that person.
• A person with NARF may on occasion forget to run an errand; persons with dementia, because they do not know what day or time it is, cannot run any errands at all.
• People with NARF may joke about their forgetfulness; demented people are unaware of their memory loss.
• While driving, a person with NARF may briefly forget when to make a turn; a demented individual can easily get lost even in a familiar place.
A common guideline is that people who worry about their forgetfulness are unlikely to be suffering from a serious memory abnormality. People with a serious impairment of memory tend to be unaware of their memory problems, don't worry about them, or else blame other factors when memory lapses are brought to their attention.
In short, you need not worry if you forget where you put your car keys; you only need to worry if you forget what they’re used for. If you worry about losing your mind, you probably still have it!
Friday, July 3, 2009
The Last Lecture
Randy Pausch was a professor of computer science at Carnegi- Mellon when, in September, 2007, he was invited to speak as part of the university’s lectures titled Journeys – lectures in which members of the community shared their reflections and insights on their personal and professional journeys. The objective of the series was "if you had one last lecture to give before you died,what would it be". Except in this case, it really was his last lecture. Randy had been diagnosed with terminal pancreatic cancer and was given but 3-6 months to live.
His courageous and inspiring lecture was soon on the internet where it became an instant hit with millions of people tuning in. Here is the video and the transcript and you judge for yourself.
He spoke of his life and what he had learnt and some of his quotes below give you a sense of the man:
“ We cannot change the cards we are dealt, just how we play the hand.
...Have something to bring to the table, because that will make you more welcome.
...I probably got more from that dream and not accomplishing it than I got from any of the ones that I did accomplish.
...You’ve got to get the fundamentals down because otherwise the fancy stuff isn’t going to work.
...When you see yourself doing something badly and nobody’s bothering to tell you anymore, that’s a very bad place to be. Your critics are your ones telling you they still love you and care.
...Experience is what you get when you didn’t get what you wanted.
...Head fake learning is absolutely important, and you should keep your eye out for them because they’re everywhere.
...The brick walls are not there to keep us out. The brick walls are there to give us a chance to show how badly we want something. Because the brick walls are there to stop the people who don’t want it badly enough.
...It’s pretty easy to be smart when you’re parroting smart people.
...It’s very important to know when you’re in a pissing match. And it’s very important to get out of it as quickly as possible.
...Until you got ice cream spilled on you, you’re not doing field work.
...I can’t tell you beforehand, but right before they present it I can tell you if the world (his students project work) is good by the body language. If they’re standing close to each other, the world is good.
...If you’re going to do anything that pioneering you will get those arrows in the back, and you just have to put up with it. I mean everything that could go wrong did go wrong.
...Somewhere along the way there’s got to be some aspect of what lets you get to achieve your dreams. First one is the role of parents, mentors, and students.
And he (Andy Van Dam) said, Randy, it’s such a shame that people perceive you as so arrogant. Because it’s going to limit what you’re going to be able to accomplish in life.
...You just have to decide if you’re a Tigger or an Eeyore.
...I have a theory that people who come from large families are better people because they’ve just had to learn to get along.
...Loyalty is a two way street.
...Syl said, it took me a long time but I’ve finally figured it out. When it comes to men that are romantically interested in you, it’s really simple. Just ignore everything they say and only pay attention to what they do. It’s that simple. It’s that easy.
...You can’t get there alone. People have to help you and I do believe in karma. I believe in paybacks. You get people to help you by telling the truth. Being earnest.
I’ll take an earnest person over a hip person every day, because hip is short term. Earnest is long term.
...Apologise when you screw up and focus on other people, not on yourself.
...Don’t bail. The best of the gold’s at the bottom of barrels of crap.
...Get a feedback loop and listen to it. Your feedback loop can be this dorky spreadsheet thing I did, or it can just be one great man who tells you what you need to hear. The hard part is the listening to it.
...Don’t complain. Just work harder. That’s a picture of Jackie Robinson. It was in his contract not to complain, even when the fans spit on him.
...Be good at something, it makes you valuable.
...Find the best in everybody. Just keep waiting no matter how long it takes. No one is all evil. Everybody has a good side, just keep waiting, it will come out.
...Be prepared. Luck is truly where preparation meets opportunity.
It’s not about how to achieve your dreams. It’s about how to lead your life. If you lead your life the right way, the karma will take care of itself. The dreams will come to you.”
And he said that his last lecture was really for his three kids. Randy Pausch died on July 25, 2008.
His courageous and inspiring lecture was soon on the internet where it became an instant hit with millions of people tuning in. Here is the video and the transcript and you judge for yourself.
He spoke of his life and what he had learnt and some of his quotes below give you a sense of the man:
“ We cannot change the cards we are dealt, just how we play the hand.
...Have something to bring to the table, because that will make you more welcome.
...I probably got more from that dream and not accomplishing it than I got from any of the ones that I did accomplish.
...You’ve got to get the fundamentals down because otherwise the fancy stuff isn’t going to work.
...When you see yourself doing something badly and nobody’s bothering to tell you anymore, that’s a very bad place to be. Your critics are your ones telling you they still love you and care.
...Experience is what you get when you didn’t get what you wanted.
...Head fake learning is absolutely important, and you should keep your eye out for them because they’re everywhere.
...The brick walls are not there to keep us out. The brick walls are there to give us a chance to show how badly we want something. Because the brick walls are there to stop the people who don’t want it badly enough.
...It’s pretty easy to be smart when you’re parroting smart people.
...It’s very important to know when you’re in a pissing match. And it’s very important to get out of it as quickly as possible.
...Until you got ice cream spilled on you, you’re not doing field work.
...I can’t tell you beforehand, but right before they present it I can tell you if the world (his students project work) is good by the body language. If they’re standing close to each other, the world is good.
...If you’re going to do anything that pioneering you will get those arrows in the back, and you just have to put up with it. I mean everything that could go wrong did go wrong.
...Somewhere along the way there’s got to be some aspect of what lets you get to achieve your dreams. First one is the role of parents, mentors, and students.
And he (Andy Van Dam) said, Randy, it’s such a shame that people perceive you as so arrogant. Because it’s going to limit what you’re going to be able to accomplish in life.
...You just have to decide if you’re a Tigger or an Eeyore.
...I have a theory that people who come from large families are better people because they’ve just had to learn to get along.
...Loyalty is a two way street.
...Syl said, it took me a long time but I’ve finally figured it out. When it comes to men that are romantically interested in you, it’s really simple. Just ignore everything they say and only pay attention to what they do. It’s that simple. It’s that easy.
...You can’t get there alone. People have to help you and I do believe in karma. I believe in paybacks. You get people to help you by telling the truth. Being earnest.
I’ll take an earnest person over a hip person every day, because hip is short term. Earnest is long term.
...Apologise when you screw up and focus on other people, not on yourself.
...Don’t bail. The best of the gold’s at the bottom of barrels of crap.
...Get a feedback loop and listen to it. Your feedback loop can be this dorky spreadsheet thing I did, or it can just be one great man who tells you what you need to hear. The hard part is the listening to it.
...Don’t complain. Just work harder. That’s a picture of Jackie Robinson. It was in his contract not to complain, even when the fans spit on him.
...Be good at something, it makes you valuable.
...Find the best in everybody. Just keep waiting no matter how long it takes. No one is all evil. Everybody has a good side, just keep waiting, it will come out.
...Be prepared. Luck is truly where preparation meets opportunity.
It’s not about how to achieve your dreams. It’s about how to lead your life. If you lead your life the right way, the karma will take care of itself. The dreams will come to you.”
And he said that his last lecture was really for his three kids. Randy Pausch died on July 25, 2008.
Thursday, July 2, 2009
Governance- individuals or institutions?
There have always been two views about how to bring about change. One talks about how all good institutions are but “lengthened shadows of an individual", while the other argues that any sustainable reform effort will need to get into the nuts and bolts of management. Over the course of the last fifty years, I have seen both alternatives play out and evidence seems to favor the individual theory of greatness at least in the short term. The major successful reform efforts of the public sector in
Today the argument is once again reverting to the past. As economist Atul Shah argues “discussions about governance in
The basic question still remains – how should we make say a public utility like drinking water in
But how does this happen in advanced economies? The typical small town in an OECD country—and in many developing countries—has 24x7 supply of clean drinking water in the taps. This isn’t done by having a miraculously effective appointments process. There is a fairly humdrum process of recruiting fairly ordinary bureaucrats into water utilities, or contracting out to private utility companies, and the job gets done. In OECD countries, 24x7 clean drinking water in the taps is not exotic rocket science. It happens all the time, because the deeper institutions are structured correctly. This is clearly the scalable path. Of course, the basic assumption is that these institutions have been set up and structured for performance and public service which at least in the developing countries is not always the case. It is true that a few good successes in the appointments process might achieve 24x7 drinking water in a few towns. But the real problem lies in trying to find a solution that creates institutional mechanisms that can be rolled out all across the country, which will deliver 24x7 clean drinking water in all the towns.
Institutional change is hard, and all too often there is a temptation to paper over a dysfunctional institutional mechanism by demanding top quality leadership, which will produce good outcomes despite bad institutions. A good judge will overcome all problems in the legal system, work hard, process a large number of cases per month and deliver good judgments against the odds. A good doctor will rise above the terrible problems of a government hospital and heal patients all the same. These individuals are revered, and rightly so. Each good judge and each good doctor deserves the gratitude of society for being useful against all odds. But these are drops in the ocean. Good governments are not built out of good individuals. They are built out of good laws and good incentive structures. What we need today is the leadership that will change laws and incentives so that we achieve good institutional arrangements.
A useful analogy is TN Seshan’s role in building the election commission, which is now one of
So do we hire great men or do we build great institutional arrangements?
The answer is that we should hire the great men who will do institutional reform—the institution builders. As long as we are a third world country struggling to get ahead, we will remain vulnerable to the vicissitudes of the appointments process. But the recruiters should not look for the right person to man the system. His job should be to fix it. The interesting candidate is not someone who knows how to deliver on a critical project. He is someone who knows how to build up an institution that will remain long after he is gone.
It’s a dog’s life….
Pets outnumber people in the United States by about 60 million, with furry, feathered and scaly inhabitants numbering about 360 million, according to the pet industry. Of these there are a total of 94 million cats and 78 million dogs. Last year, it is estimated that about $42 billion was spent on all pets in the U.S including $ 17 billion for food, $ 10 billion for medicines, $ 12 billion for vet care, and $ 3 billion for grooming and boarding. This figure is larger than the total GDP of over 114 countries in the world. It is equal to the GDP of Sudan and higher than the GDP of Equador.
On average, an owner of a pet in the US spends between $ 1000 to 1500 per year on their pets. (see table).
How did it all start?
Humans kept pets as long as 4,000 years before livestock was domesticated. There are dog burials in present day Israel and Jordan that date back to about 14,000 years ago. It seems that dogs were the earliest animal domesticated, probably drawn as wolves to human encampments. Burial evidence of cats as pets dates back 8,300 years, roughly 4,000 years before the ancient Egyptians started depicting cats on tomb walls.
Humans have had a mutually beneficial relationship with these earliest pets. Dogs, whose diet overlaps that of humans, provided their early masters with companionship, warning and possibly hunting assistance. Cats aided ancient farmers by eliminating rodents that threatened grain harvests. But as humans domesticated cats and dogs, they selected traits that over time favored lack of aggression. These docile traits in turn led to a number of evolutional, physical changes in dogs. Things like lop ears and piebald (spotted) coats are things you see in domesticated animals that you don't see in wild animals. But another factor that comes in with selection for lack of aggression is greater playfulness, more sort of puppy or juvenile type behaviors. The most striking is a change in the configuration in the skull and a reduction in the cranial capacity, which implies that dogs become less intelligent as they became more domesticated. Thousands of years later, humans are still looking for these baby-like qualities in dogs, but for different reasons.
Matthew Margolis, a professional dog behavior therapist and animal aggression expert from California, asks his clients why some of them get dogs, especially little dogs. Their response, he says, is, "Well, my children have gone from the home. I'm lonely. I want something to love." The response from young people without families often is that they want a puppy to raise before raising a child—kind of practice before starting out on the real thing!
Despite all this love, there are still almost 5 million dog bites reported each year. And this in turn has given birth to a completely new industry- pet disputes. There are now almost $400 million in legal claims, according to Margolis, who often testifies in pet-dispute court cases.
"Cats and dogs used to eat leftovers from humans, which isn't necessarily bad. But every species of animal has its own nutritional needs," Beaver said. "When you think of a cat you think of them eating a mouse," she said, explaining that a leftover piece of muscle meat does not have the same nutritional value as a mouse, whose body also offered bone and digested vegetables.
Since pets satisfy modern man's emotional needs and so the health of animals has reaped the benefits of human technological advances witness the high quality of pet food, vaccines, chemotherapy and surgical techniques for extending the life of pets. Thirty years ago in the U.S., the average age of a dog was 4 years; the average age of a cat was 3 years. These days the average lifespan of a dog is between eight and 12 years.
Pet owners' spending is not limited to the basics. The APPMA found in its National Pet Owners Survey that 27 percent of dog owners and 13 percent of cat owners buy their pets birthday presents, and 55 percent of dog owners and 37 percent of cat owners buy their pet holiday presents. But as one doting owner confesses "I don't think I've ever bought my dog a gift where he's turned around and said, 'Oh thanks, anyway,' "
Why do humans dote on pets to the tune of billions of dollars a year? Pet owners report it's because of the bond with their animals, which they may refer to as their best friend, a companion or a member of their family.
"Animals give you unconditional, unrestricted love”. And babies don’t?
On average, an owner of a pet in the US spends between $ 1000 to 1500 per year on their pets. (see table).
Annual average cost in $ Dogs Cats
1. Surgical Vet Visits 453 363
2. Food 217 188
3. Kennel Boarding 225 149
4. Routine Vet 219 175
5. Groomer/Grooming Aids 127 18
6. Vitamins 77 31
7. Treats 66 40
8. Toys 41 26
Total 1425 990
How did it all start?
Humans kept pets as long as 4,000 years before livestock was domesticated. There are dog burials in present day Israel and Jordan that date back to about 14,000 years ago. It seems that dogs were the earliest animal domesticated, probably drawn as wolves to human encampments. Burial evidence of cats as pets dates back 8,300 years, roughly 4,000 years before the ancient Egyptians started depicting cats on tomb walls.
Humans have had a mutually beneficial relationship with these earliest pets. Dogs, whose diet overlaps that of humans, provided their early masters with companionship, warning and possibly hunting assistance. Cats aided ancient farmers by eliminating rodents that threatened grain harvests. But as humans domesticated cats and dogs, they selected traits that over time favored lack of aggression. These docile traits in turn led to a number of evolutional, physical changes in dogs. Things like lop ears and piebald (spotted) coats are things you see in domesticated animals that you don't see in wild animals. But another factor that comes in with selection for lack of aggression is greater playfulness, more sort of puppy or juvenile type behaviors. The most striking is a change in the configuration in the skull and a reduction in the cranial capacity, which implies that dogs become less intelligent as they became more domesticated. Thousands of years later, humans are still looking for these baby-like qualities in dogs, but for different reasons.
Matthew Margolis, a professional dog behavior therapist and animal aggression expert from California, asks his clients why some of them get dogs, especially little dogs. Their response, he says, is, "Well, my children have gone from the home. I'm lonely. I want something to love." The response from young people without families often is that they want a puppy to raise before raising a child—kind of practice before starting out on the real thing!
Despite all this love, there are still almost 5 million dog bites reported each year. And this in turn has given birth to a completely new industry- pet disputes. There are now almost $400 million in legal claims, according to Margolis, who often testifies in pet-dispute court cases.
"Cats and dogs used to eat leftovers from humans, which isn't necessarily bad. But every species of animal has its own nutritional needs," Beaver said. "When you think of a cat you think of them eating a mouse," she said, explaining that a leftover piece of muscle meat does not have the same nutritional value as a mouse, whose body also offered bone and digested vegetables.
Since pets satisfy modern man's emotional needs and so the health of animals has reaped the benefits of human technological advances witness the high quality of pet food, vaccines, chemotherapy and surgical techniques for extending the life of pets. Thirty years ago in the U.S., the average age of a dog was 4 years; the average age of a cat was 3 years. These days the average lifespan of a dog is between eight and 12 years.
Pet owners' spending is not limited to the basics. The APPMA found in its National Pet Owners Survey that 27 percent of dog owners and 13 percent of cat owners buy their pets birthday presents, and 55 percent of dog owners and 37 percent of cat owners buy their pet holiday presents. But as one doting owner confesses "I don't think I've ever bought my dog a gift where he's turned around and said, 'Oh thanks, anyway,' "
Why do humans dote on pets to the tune of billions of dollars a year? Pet owners report it's because of the bond with their animals, which they may refer to as their best friend, a companion or a member of their family.
"Animals give you unconditional, unrestricted love”. And babies don’t?
Saturday, June 27, 2009
India's Fortune- a country on the rise
Ed Luce of Financial Times reviews Nandan Nilekhani's book on India. It is worth a read in its entirety. You should also see Nandan's own presentation here.
"Nandan' efforts", writes Ed Luce, "have produced one of the best and most thought-provoking books on India in years. Few Indian, or indeed Western, businesspeople would be capable of drafting such a dispassionate and self-critical account of their country’s prospects. And perhaps no other Indian public intellectual could write across so many disciplines -- politics, economics, finance, education, the environment -- with as much clarity and acuity."
"If only Indian policymakers would take note" Ed continues,"they could also turn the country’s relative lag when it comes to energy and the environment into an advantage. Nilekani offers many solutions, including building an integrated national gas grid to transport India’s growing supply of relatively clean natural gas. Many of the world’s most promising biotechnology and alternative-fuel entrepreneurs are Indians based in Silicon Valley. India could create a more attractive venture-capital sector to lure back more of its own scientists and entrepreneurs from abroad. Examples of potentially transformative Indian products that are already being developed at home include the $25 laptop and a carbon-positive electric car, which has a photovoltaic sunroof. Many more would be in the pipeline if India had a U.S.-style financial system for start-ups......India possesses the human know-how and natural resources to surmount its challenges. For example, it could devote much more agricultural land to growing biofuel crops such as switchgrass -- a move that would expand its energy stocks and relieve the country’s much-abused water table, which is being drained by water-guzzling crops such as rice and wheat. But reform would mean getting rid of the layer of bureaucrats and the groups of farmers who live off India’s lavish and grossly corrupt subsidy system......or good or for ill, the decisions of Indians will hold ever greater sway over the fates of other countries, including that of the United States."
"The solutions to India’s enormous problems" he concludes, " may not be around the corner, but they deserve very close attention. Nilekani’s book is an ideal place to start contemplating India’s great challenges and its no-less-breathtaking potential."
"Nandan' efforts", writes Ed Luce, "have produced one of the best and most thought-provoking books on India in years. Few Indian, or indeed Western, businesspeople would be capable of drafting such a dispassionate and self-critical account of their country’s prospects. And perhaps no other Indian public intellectual could write across so many disciplines -- politics, economics, finance, education, the environment -- with as much clarity and acuity."
"If only Indian policymakers would take note" Ed continues,"they could also turn the country’s relative lag when it comes to energy and the environment into an advantage. Nilekani offers many solutions, including building an integrated national gas grid to transport India’s growing supply of relatively clean natural gas. Many of the world’s most promising biotechnology and alternative-fuel entrepreneurs are Indians based in Silicon Valley. India could create a more attractive venture-capital sector to lure back more of its own scientists and entrepreneurs from abroad. Examples of potentially transformative Indian products that are already being developed at home include the $25 laptop and a carbon-positive electric car, which has a photovoltaic sunroof. Many more would be in the pipeline if India had a U.S.-style financial system for start-ups......India possesses the human know-how and natural resources to surmount its challenges. For example, it could devote much more agricultural land to growing biofuel crops such as switchgrass -- a move that would expand its energy stocks and relieve the country’s much-abused water table, which is being drained by water-guzzling crops such as rice and wheat. But reform would mean getting rid of the layer of bureaucrats and the groups of farmers who live off India’s lavish and grossly corrupt subsidy system......or good or for ill, the decisions of Indians will hold ever greater sway over the fates of other countries, including that of the United States."
"The solutions to India’s enormous problems" he concludes, " may not be around the corner, but they deserve very close attention. Nilekani’s book is an ideal place to start contemplating India’s great challenges and its no-less-breathtaking potential."
Friday, June 26, 2009
The Caregiver and the Patient
Some weeks ago I wrote a blog on the Caregivers Journey pointing out that there was nothing harder or more complex in life than to tend to a loved one whose life is slowly and painfully draining away and that the caregiver- be it the parent, spouse or sibling- face difficult and in some cases incredibly painful choices. It was a paean to the caregivers- all of them- and an ode to their patience, their compassion and their inspiration. But I had forgotten that the patients too carried terrible burdens which they rarely shared with their caregivers. They had a dual burden – besides dealing with the sickness, they also needed to think about the future when they would no longer be around but their caregivers would be.
This plight of the patient was brought home to me most poignantly recently when a friend of many years fell sick and in a space of a few months had to be hospitalized. He had been a robust, gregarious person with an active social life when he was stricken with neuropathy, an undiagnosed disorder that left him a shell of his previous self and full of pain and despair. I would often find him slumped in his chair holding his head in his hands complaining and fearing that his end was near and simultaneously worrying about his wife of five decades.
There is little in literature or research to help the patient negotiate these treacherous paths. Most focus on the patient’s ability to handle the shock and to help him through the next stages of depression and acceptance. Few help him to deal with the caregiver who normally keeps a stoic mien and cheerful exterior during this entire period. In the early days, it is normal for the patient to settle his temporal affairs, ensuring that his wife and family are well provided for, the wills written and all the other affairs taken care of. But as the time of sickness stretches out, it becomes more difficult to deal with the emotional impact of the impending separation.
There are no guidelines here. Many attempt to deal with it by retreating into silences or into religious ritual. Others attempt to create deliberately or subconsciously a schism with their loved ones so that their absence would be felt a little bit less. It is the same as many wives who create a quarrel with their husbands on the eve of their long journeys, hoping that their anger would tide over the early days of the separation. Some patients become rude and abusive towards their caregivers towards the end with the same objective. This friends wife came one day to us in shock and dismay , “ He says he wants a divorce”, she cried, “ We have been married for over 50 years and now he does not even want to see me.” It was hard for her to understand that this was not a request for a divorce lawyer but a plea from a drowning man trying his best to alleviate the pain that his impending absence would cause in her life. He was trying, in these rude ill chosen words, to help her cope with life after his departure.
The classic process by which people allegedly deal with grief and tragedy, especially when diagnosed with a terminal illness or catastrophic loss is described in the Kübler-Ross model of- denial, anger, bargaining, depression and acceptance. Denial is usually only the first stage and offers a temporary defense for the individual. This feeling is generally replaced with heightened awareness of situations and individuals that will be left behind after death. Once in the second stage of anger, the individual recognizes that denial cannot continue. But because of anger, the person is very difficult to care for due to misplaced feelings of rage and envy. Any individual that symbolizes life or energy is subject to projected resentment and jealousy. The third stage involves the hope that the individual can somehow postpone or delay death. Usually, the negotiation for an extended life is made with a higher power in exchange for a reformed lifestyle. Psychologically, the person is saying, "I understand I will die, but if I could just have al little bit more time...". During the fourth stage, the dying person begins to understand the certainty of death. Because of this, the individual often becomes silent, refuses visitors and spends much of the time crying and grieving. This process allows him to start to disconnect himself from things of love and affection. It is an important time for grieving for him that he needs must go through. The final stage comes with peace and understanding of the death that is approaching. Generally, the person in the fifth stage will want to be left alone.
The patient and the caregiver are both going through this cycle of grief. But what we have not understood is that many times they – the patient and the caregiver- are in different stages of the cycle. While one may have progressed to depression and then acceptance, the caregiver may still be in denial. My friend seemed to have progressed through the entire grief cycle in these three months. But his wife of over five decades, who was his prime caregiver, was still in the denial stage and found it difficult to adjust to his varying moods. The final stage of acceptance is not only for the patient but also for the caregiver. Denying that life will go on even after the patient has passed on is normal for the caregiver. But the double burden of the patient is to ensure that the caregiver will find that life does still exist and that she is a part of it. The real question is how to make others accept the inevitability that they now have to countenance and deal with?
As for the end, one would hope that we would celebrate a life and not only its end. It should be a special day when people, who loved a person, get together and celebrate his life, happily, and remember the person as he was...alive, and vibrant. It should be like the Irish wake, where there would be lots of food and plenty of drink to be consumed, people should come and socialize and remember the departed person's life. This should not be a time for tears but a celebration of his life. But it should also be simultaneously a renewal and a new life for the caregiver.
This plight of the patient was brought home to me most poignantly recently when a friend of many years fell sick and in a space of a few months had to be hospitalized. He had been a robust, gregarious person with an active social life when he was stricken with neuropathy, an undiagnosed disorder that left him a shell of his previous self and full of pain and despair. I would often find him slumped in his chair holding his head in his hands complaining and fearing that his end was near and simultaneously worrying about his wife of five decades.
There is little in literature or research to help the patient negotiate these treacherous paths. Most focus on the patient’s ability to handle the shock and to help him through the next stages of depression and acceptance. Few help him to deal with the caregiver who normally keeps a stoic mien and cheerful exterior during this entire period. In the early days, it is normal for the patient to settle his temporal affairs, ensuring that his wife and family are well provided for, the wills written and all the other affairs taken care of. But as the time of sickness stretches out, it becomes more difficult to deal with the emotional impact of the impending separation.
There are no guidelines here. Many attempt to deal with it by retreating into silences or into religious ritual. Others attempt to create deliberately or subconsciously a schism with their loved ones so that their absence would be felt a little bit less. It is the same as many wives who create a quarrel with their husbands on the eve of their long journeys, hoping that their anger would tide over the early days of the separation. Some patients become rude and abusive towards their caregivers towards the end with the same objective. This friends wife came one day to us in shock and dismay , “ He says he wants a divorce”, she cried, “ We have been married for over 50 years and now he does not even want to see me.” It was hard for her to understand that this was not a request for a divorce lawyer but a plea from a drowning man trying his best to alleviate the pain that his impending absence would cause in her life. He was trying, in these rude ill chosen words, to help her cope with life after his departure.
The classic process by which people allegedly deal with grief and tragedy, especially when diagnosed with a terminal illness or catastrophic loss is described in the Kübler-Ross model of- denial, anger, bargaining, depression and acceptance. Denial is usually only the first stage and offers a temporary defense for the individual. This feeling is generally replaced with heightened awareness of situations and individuals that will be left behind after death. Once in the second stage of anger, the individual recognizes that denial cannot continue. But because of anger, the person is very difficult to care for due to misplaced feelings of rage and envy. Any individual that symbolizes life or energy is subject to projected resentment and jealousy. The third stage involves the hope that the individual can somehow postpone or delay death. Usually, the negotiation for an extended life is made with a higher power in exchange for a reformed lifestyle. Psychologically, the person is saying, "I understand I will die, but if I could just have al little bit more time...". During the fourth stage, the dying person begins to understand the certainty of death. Because of this, the individual often becomes silent, refuses visitors and spends much of the time crying and grieving. This process allows him to start to disconnect himself from things of love and affection. It is an important time for grieving for him that he needs must go through. The final stage comes with peace and understanding of the death that is approaching. Generally, the person in the fifth stage will want to be left alone.
The patient and the caregiver are both going through this cycle of grief. But what we have not understood is that many times they – the patient and the caregiver- are in different stages of the cycle. While one may have progressed to depression and then acceptance, the caregiver may still be in denial. My friend seemed to have progressed through the entire grief cycle in these three months. But his wife of over five decades, who was his prime caregiver, was still in the denial stage and found it difficult to adjust to his varying moods. The final stage of acceptance is not only for the patient but also for the caregiver. Denying that life will go on even after the patient has passed on is normal for the caregiver. But the double burden of the patient is to ensure that the caregiver will find that life does still exist and that she is a part of it. The real question is how to make others accept the inevitability that they now have to countenance and deal with?
As for the end, one would hope that we would celebrate a life and not only its end. It should be a special day when people, who loved a person, get together and celebrate his life, happily, and remember the person as he was...alive, and vibrant. It should be like the Irish wake, where there would be lots of food and plenty of drink to be consumed, people should come and socialize and remember the departed person's life. This should not be a time for tears but a celebration of his life. But it should also be simultaneously a renewal and a new life for the caregiver.
Monday, June 22, 2009
Mysteries and Puzzles
Two articles recently have stimulated a discussion on the difference between mysteries and puzzles and why it is important to be clear about the distinction if we are to arrive at the right conclusions.
There's a reason millions of people try to solve crossword puzzles each day. Amid the well-ordered combat between a puzzler's mind and the blank boxes waiting to be filled, there is satisfaction along with frustration. Even when you can't find the right answer, you know it exists. Puzzles can be solved; they have answers.
But a mystery offers no such comfort. It poses a question that has no definitive answer because the answer is contingent; it depends on a future interaction of many factors, known and unknown. A mystery cannot be answered; it can only be framed, by identifying the critical factors and applying some sense of how they have interacted in the past and might interact in the future. A mystery is an attempt to define ambiguities.
Puzzles may be more satisfying, but the world increasingly offers us mysteries. Treating them as puzzles is like trying to solve the unsolvable—an impossible challenge. But approaching them as mysteries may make us more comfortable with the uncertainties of our age.
Osama bin Laden’s whereabouts are a puzzle. We can’t find him because we don’t have enough information. But we do know that he is somewhere and that he can be found. The right question here is finding the requisite information that leads to him.
Similarly during the cold war, much of the job of U.S. intelligence was puzzle-solving—seeking answers to questions that had answers, even if we didn't know them. How many missiles did the Soviet Union have? Where were they located? How far could they travel? How accurate were they? It made sense to approach the military strength of the Soviet Union as a puzzle—the sum of its units and weapons, and their quality. Initially puzzle-solving is frustrated by a lack of information. But eventually with the right information becoming available, the solutions are clear.
In contrast if you consider September 11th as a mystery, you have to wonder if the authorities asked the right questions at the right time. If you consider the motivation and methods behind the attacks of September 11th to be mainly a puzzle, then the logical response is to increase the collection of intelligence, recruit more spies, add to the volume of information. So in one case you want to improve the quality of your analysis, in the other the quantity of your information.
Sometimes, however, mysteries often grow out of too much information. Until the 9/11 hijackers actually boarded their airplanes, their plan was a mystery, the clues to which were buried in too much "noise"—too many threat scenarios. So warnings from FBI agents in Minneapolis and Phoenix went unexplored. The hijackers were able to hide in plain sight. After the attacks, they became a puzzle: it was easy to pick up their trail.Mysteries require judgments and the assessment of uncertainty, and the hard part is not that we have too little information but that we have too much.In the case of the Enron financial scandal, there was too much information available but no one had the skills to interpret the data. So rather than being a puzzle, it became a mystery.
Take another case- medical treatment. No matter how much patients may seek the clarity of a puzzle, healthcare, will remain largely a mystery. The goal of medicine is an absence—of illness and disease. But achieving that goal depends on many different factors. Tests are imperfect predictors of illness, and treatments interact or have side effects. Doctors base an initial assessment of a patient's health on propensity, as revealed by his or her medical history, and on diagnosis, determined through an examination. Dr Grootman ( How Doctors Think) alleges on average a physician will interrupt a patient describing her symptoms within eighteen seconds. In that short time, many doctors decide on the likely diagnosis and best treatment.If the doctor's initial assessment is of a high probability of disease, he orders more tests, which in turn refine that probability. Thus the route is one of seeking answers through more and more pointed questions and having the ability to ask the right questions.
Most discussions about energy, as well, treat it as a puzzle: so many million barrels of proven reserves in country X, production to "peak" in country Y at a particular date and so on. From a geological point of view, the puzzle perspective makes sense: any individual drill hole or field has so much oil. Yet energy futures are a mystery, not a puzzle. How much oil a given well can produce is not the same as how much oil is there: whether it makes sense to use secondary or tertiary recovery methods after primary methods no longer suffice depends on price. And beyond a single well, the factors multiply. How fast will the global economy grow? What new energy discoveries will be made? Which alternative sources will come on line at what price? This too requires a constant reappraisal of answers.
In essence a puzzle is mostly about the left side of your brain. It's a logical process of collecting data. Get enough data points and you'll be home free.Puzzles have straightforward answers. Collecting more data always helps you solve a puzzle, just as collecting more pieces of a real jigsaw puzzle gets you closer to assembling the picture. You know when you have solved a puzzle because all the pieces fit and the picture becomes completely clear.
On the other hand, solutions to a mystery live on the right side of your brain. The artistic, creative and non-logical side. Solving a mystery usually takes leaps of faith and judgment. Paradoxically sometimes adding more data to a mystery only serves to obscure the truth. In a murder mystery, such misleading bits of data are known as ‘red herrings’. Often mysteries do not have simple answers. Solving a mystery thus depends not simply on amassing data, but on developing an intelligent hypothesis and applying judgment to determine whether the hypothesis is correct. Mysteries contain inherent uncertainty.However rarely is a problem just a "puzzle" or a "mystery", usually it is both, requiring not just the careful analysis of existing information, but also the creation of new data.Thus the origin of life is a mystery to many, but to many scientists it is simply a puzzle requiring new information to resolve.
Finally to solve puzzles, you need the right data and information, to solve mysteries you need to ask the right questions.
There's a reason millions of people try to solve crossword puzzles each day. Amid the well-ordered combat between a puzzler's mind and the blank boxes waiting to be filled, there is satisfaction along with frustration. Even when you can't find the right answer, you know it exists. Puzzles can be solved; they have answers.
But a mystery offers no such comfort. It poses a question that has no definitive answer because the answer is contingent; it depends on a future interaction of many factors, known and unknown. A mystery cannot be answered; it can only be framed, by identifying the critical factors and applying some sense of how they have interacted in the past and might interact in the future. A mystery is an attempt to define ambiguities.
Puzzles may be more satisfying, but the world increasingly offers us mysteries. Treating them as puzzles is like trying to solve the unsolvable—an impossible challenge. But approaching them as mysteries may make us more comfortable with the uncertainties of our age.
Osama bin Laden’s whereabouts are a puzzle. We can’t find him because we don’t have enough information. But we do know that he is somewhere and that he can be found. The right question here is finding the requisite information that leads to him.
Similarly during the cold war, much of the job of U.S. intelligence was puzzle-solving—seeking answers to questions that had answers, even if we didn't know them. How many missiles did the Soviet Union have? Where were they located? How far could they travel? How accurate were they? It made sense to approach the military strength of the Soviet Union as a puzzle—the sum of its units and weapons, and their quality. Initially puzzle-solving is frustrated by a lack of information. But eventually with the right information becoming available, the solutions are clear.
In contrast if you consider September 11th as a mystery, you have to wonder if the authorities asked the right questions at the right time. If you consider the motivation and methods behind the attacks of September 11th to be mainly a puzzle, then the logical response is to increase the collection of intelligence, recruit more spies, add to the volume of information. So in one case you want to improve the quality of your analysis, in the other the quantity of your information.
Sometimes, however, mysteries often grow out of too much information. Until the 9/11 hijackers actually boarded their airplanes, their plan was a mystery, the clues to which were buried in too much "noise"—too many threat scenarios. So warnings from FBI agents in Minneapolis and Phoenix went unexplored. The hijackers were able to hide in plain sight. After the attacks, they became a puzzle: it was easy to pick up their trail.Mysteries require judgments and the assessment of uncertainty, and the hard part is not that we have too little information but that we have too much.In the case of the Enron financial scandal, there was too much information available but no one had the skills to interpret the data. So rather than being a puzzle, it became a mystery.
Take another case- medical treatment. No matter how much patients may seek the clarity of a puzzle, healthcare, will remain largely a mystery. The goal of medicine is an absence—of illness and disease. But achieving that goal depends on many different factors. Tests are imperfect predictors of illness, and treatments interact or have side effects. Doctors base an initial assessment of a patient's health on propensity, as revealed by his or her medical history, and on diagnosis, determined through an examination. Dr Grootman ( How Doctors Think) alleges on average a physician will interrupt a patient describing her symptoms within eighteen seconds. In that short time, many doctors decide on the likely diagnosis and best treatment.If the doctor's initial assessment is of a high probability of disease, he orders more tests, which in turn refine that probability. Thus the route is one of seeking answers through more and more pointed questions and having the ability to ask the right questions.
Most discussions about energy, as well, treat it as a puzzle: so many million barrels of proven reserves in country X, production to "peak" in country Y at a particular date and so on. From a geological point of view, the puzzle perspective makes sense: any individual drill hole or field has so much oil. Yet energy futures are a mystery, not a puzzle. How much oil a given well can produce is not the same as how much oil is there: whether it makes sense to use secondary or tertiary recovery methods after primary methods no longer suffice depends on price. And beyond a single well, the factors multiply. How fast will the global economy grow? What new energy discoveries will be made? Which alternative sources will come on line at what price? This too requires a constant reappraisal of answers.
In essence a puzzle is mostly about the left side of your brain. It's a logical process of collecting data. Get enough data points and you'll be home free.Puzzles have straightforward answers. Collecting more data always helps you solve a puzzle, just as collecting more pieces of a real jigsaw puzzle gets you closer to assembling the picture. You know when you have solved a puzzle because all the pieces fit and the picture becomes completely clear.
On the other hand, solutions to a mystery live on the right side of your brain. The artistic, creative and non-logical side. Solving a mystery usually takes leaps of faith and judgment. Paradoxically sometimes adding more data to a mystery only serves to obscure the truth. In a murder mystery, such misleading bits of data are known as ‘red herrings’. Often mysteries do not have simple answers. Solving a mystery thus depends not simply on amassing data, but on developing an intelligent hypothesis and applying judgment to determine whether the hypothesis is correct. Mysteries contain inherent uncertainty.However rarely is a problem just a "puzzle" or a "mystery", usually it is both, requiring not just the careful analysis of existing information, but also the creation of new data.Thus the origin of life is a mystery to many, but to many scientists it is simply a puzzle requiring new information to resolve.
Finally to solve puzzles, you need the right data and information, to solve mysteries you need to ask the right questions.
Sunday, June 21, 2009
Father's Day thoughts
Most people remember their parents or close friends through some vignettes which have remained stuck in their memories for ever and ever. It is an accumulation of such memories that seems to define our view of their entire life. Rarely if ever do we sit down to think about placing these memories in some context to obtain a coherent and complete view of their entire life. It is these vignettes that define them for us. So it is for fathers.
When asked about their earliest memories of their fathers, many of us would have difficulty in defining them in some details. But ask us if we remember some action or thought that has defined our relationship with them, most would easily find quite few incidents from their lives.
So as I reflected on my fathers life- he has now been gone almost fifteen years- a few vignettes stand out which in a certain sense define him for me. Of them the earliest was when I asked why he became an economist. We were at that time discussing the profession I would soon choose for myself.It then came out that when he was a young student, he heard Pandit Nehru, the charismatic leader of the Indian National Congress urge all Indians to fight for complete independance on the banks of the Ravi river in 1930. He urged students to help rebuild the country and said that the country would need economists and engineers to lay the foundation for the future.That speech inspired the deep idealism in him to chose economics as his profession. ( Incidentally, mine was engineering).
Another defining incident was when I found that he chose to resign from his job as the editor of the premier economic magazine in the country, The Eastern Economist, rather than bow to the wishes of the proprietors to push the preferred policies of the industrialist who also owned the magazine.He was willing to lose his job rather than compromise on his principles.Since we had a comfortable house close to his office and we had to shift to hutments built for soldiers during the war, the change was a considerable downgrade at that time even though he found a job with the government.
A third incident occurred when I led a student movement against the powerful professor and head of the hostel at IIT, Kharagpur in the first year of my engineering course.Dr Muthanna was a tough as nails administrator who tolerated no dissent and when a group of students organized to challenge his policies and his executive abilities, he was not only outraged but he took action. Unbeknownst to me, he wrote a strong letter to my father threatening that he may be forced to expel me from the institute for my union efforts. My father sent him an equally uncompromising reply pointing out that Dr Muthana needed to deal with the students more sympathetically and that in any case it was unlikely that his son would be participating in any activities that were not right and justified. He had complete faith in my judgment and sense of responsibility.My father did not send me a copy of this letter -- indeed I found out about it only years later when I was going through his papers.
A few years later I won a scholarship to go to Berkeley but found that I had not enough money for the air ticket. I was busy selling off all my possession in order to raise the necessary funds when I received a letter from my father containing a check for the air fare.
We came to a parting of ways for a brief while when I got married and he refused to accept the choice I had made. We remained distant and silent for almost seven years- you see he had passed on his uncompromising attitude to me as well.He was a man of strong and rigid convictions. It took my children to bring him around finally which he did.And we were to spend his last years as close as we had been all our lives before the break.
And then a few years later, he was diagnosed with colon cancer requiring a major operation. I was then posted in Bombay and would fly down to be with him after the operation while my brother looked after him. He was to live with this for almost fifteen years till he died. But during this period I rarely heard him complain about the pain or the restrictions that these operations placed on him. We would discuss everything under the sun except his medical pains and problems. His courage and stoicism remained with him till the end and he refused to give up.
When I look back, it is these vignettes which define for me his life--his idealism, his courage of his convictions, his stoicism in face of pain, his love for his family and his willingness to confront life without compromise.
When asked about their earliest memories of their fathers, many of us would have difficulty in defining them in some details. But ask us if we remember some action or thought that has defined our relationship with them, most would easily find quite few incidents from their lives.
So as I reflected on my fathers life- he has now been gone almost fifteen years- a few vignettes stand out which in a certain sense define him for me. Of them the earliest was when I asked why he became an economist. We were at that time discussing the profession I would soon choose for myself.It then came out that when he was a young student, he heard Pandit Nehru, the charismatic leader of the Indian National Congress urge all Indians to fight for complete independance on the banks of the Ravi river in 1930. He urged students to help rebuild the country and said that the country would need economists and engineers to lay the foundation for the future.That speech inspired the deep idealism in him to chose economics as his profession. ( Incidentally, mine was engineering).
Another defining incident was when I found that he chose to resign from his job as the editor of the premier economic magazine in the country, The Eastern Economist, rather than bow to the wishes of the proprietors to push the preferred policies of the industrialist who also owned the magazine.He was willing to lose his job rather than compromise on his principles.Since we had a comfortable house close to his office and we had to shift to hutments built for soldiers during the war, the change was a considerable downgrade at that time even though he found a job with the government.
A third incident occurred when I led a student movement against the powerful professor and head of the hostel at IIT, Kharagpur in the first year of my engineering course.Dr Muthanna was a tough as nails administrator who tolerated no dissent and when a group of students organized to challenge his policies and his executive abilities, he was not only outraged but he took action. Unbeknownst to me, he wrote a strong letter to my father threatening that he may be forced to expel me from the institute for my union efforts. My father sent him an equally uncompromising reply pointing out that Dr Muthana needed to deal with the students more sympathetically and that in any case it was unlikely that his son would be participating in any activities that were not right and justified. He had complete faith in my judgment and sense of responsibility.My father did not send me a copy of this letter -- indeed I found out about it only years later when I was going through his papers.
A few years later I won a scholarship to go to Berkeley but found that I had not enough money for the air ticket. I was busy selling off all my possession in order to raise the necessary funds when I received a letter from my father containing a check for the air fare.
We came to a parting of ways for a brief while when I got married and he refused to accept the choice I had made. We remained distant and silent for almost seven years- you see he had passed on his uncompromising attitude to me as well.He was a man of strong and rigid convictions. It took my children to bring him around finally which he did.And we were to spend his last years as close as we had been all our lives before the break.
And then a few years later, he was diagnosed with colon cancer requiring a major operation. I was then posted in Bombay and would fly down to be with him after the operation while my brother looked after him. He was to live with this for almost fifteen years till he died. But during this period I rarely heard him complain about the pain or the restrictions that these operations placed on him. We would discuss everything under the sun except his medical pains and problems. His courage and stoicism remained with him till the end and he refused to give up.
When I look back, it is these vignettes which define for me his life--his idealism, his courage of his convictions, his stoicism in face of pain, his love for his family and his willingness to confront life without compromise.
Monday, June 15, 2009
The will to succeed
One of the hardest tasks that aspiring youngsters in India face is entry to the prestigious Institutes of Technologies. Every year 230,000 from all over India compete for barely 5,000 seats in the country's seven IITs. With only a one in forty chance of getting in, the fact that one training school managed to get all of its 30 students selected for the IIT’s is an amazing feat, made even more amazing by the fact that all of them came from the poorest families from the poorest state in the country. Thereby hangs a tale worth telling.
Anand Kumar trains the poorest students in Bihar for entry into the prestigious Indian Institutes of Technology’s. A brilliant mathematics student himself, but from a very poor background, he could not take up admission at the Cambridge University even with a fellowship as he had no means to provide for his basic expenses. But he was determined to keep the tradition of Ramanujam, the mathematics wizard, alive and started giving lessons to the street children and those in the slums in the early 90s. He started the Ramanujam School of Mathematics in the mid-90s.
The task that Anand has taken on himself is to ensure that not a single underprivileged boy or girl in Bihar (with exceptional intelligence) is deprived of an opportunity to get ahead because of their lower social and economic condition. Anand is acutely aware from his own history that to be born with an extraordinary intelligence quotient alone does not guarantee success in life. He remembers all too clearly that he had to fight hard just to get to use the superior mathematical ability he realized he possessed early on in life. "The Super 30 was born with this idea in mind," explains Anand.
Super 30 is a highly ambitious and innovative educational program which hunts for 30 meritorious talents from among the economically backward sections of the society and shapes them for India's most prestigious institution – the Indian Institute of Technology (IIT). The normal group comprises wards of brick kiln worker, rickshaw puller, landless farmer, roadside vendor and the likes. During this program students are provided absolutely free coaching, lodging and food. This initiative is funded by the money Anand Kumar earns from his coaching. Founded in 2003, 18 students made it to the IIT’s in the founding year. The number rose to 22 in 2004 to 26 in 2005 to 28 in 2006 and 2007 and up to 30 in 2008 and 2009. Yes that’s correct! In the last two years, the super 30 boasts of a cent percent record with 30 out of 30 students coming through. The training school's feat is even more amazing in a state where more than two million children are out of school, and the literacy rate is a shameful 47%.
How did they do it?
The students come here to attend classes from Patna and also from faraway villages and make the journey every day by bus, on bicycles or even on foot. Those who stay in the hostels are provided free food and lodging. Each year 6,000 young boys buy the application form for Rs 60 from the Institute and submit it in the hope of making it to the Super 30. Candidates then take three separate admission tests to determine IQ, administered in ascending order of difficulty. Of the 500 short-listed initially, 30 eventually make it to the core group. The basis of the selection is that the candidate has to be from an underprivileged background. These are the poorest but with the most powerful minds. The training that lasts a year is rigorous and almost monk like in its intensity. But there are no drop outs from the program.
When you are trapped in a situation where you know you have the intelligence to conquer the world but you are crushed in by your circumstances, you'll do anything to break free. This is perhaps the true secret behind the success of Super 30. This and the commitment of a single individual to an idea.
Anand Kumar trains the poorest students in Bihar for entry into the prestigious Indian Institutes of Technology’s. A brilliant mathematics student himself, but from a very poor background, he could not take up admission at the Cambridge University even with a fellowship as he had no means to provide for his basic expenses. But he was determined to keep the tradition of Ramanujam, the mathematics wizard, alive and started giving lessons to the street children and those in the slums in the early 90s. He started the Ramanujam School of Mathematics in the mid-90s.
The task that Anand has taken on himself is to ensure that not a single underprivileged boy or girl in Bihar (with exceptional intelligence) is deprived of an opportunity to get ahead because of their lower social and economic condition. Anand is acutely aware from his own history that to be born with an extraordinary intelligence quotient alone does not guarantee success in life. He remembers all too clearly that he had to fight hard just to get to use the superior mathematical ability he realized he possessed early on in life. "The Super 30 was born with this idea in mind," explains Anand.
Super 30 is a highly ambitious and innovative educational program which hunts for 30 meritorious talents from among the economically backward sections of the society and shapes them for India's most prestigious institution – the Indian Institute of Technology (IIT). The normal group comprises wards of brick kiln worker, rickshaw puller, landless farmer, roadside vendor and the likes. During this program students are provided absolutely free coaching, lodging and food. This initiative is funded by the money Anand Kumar earns from his coaching. Founded in 2003, 18 students made it to the IIT’s in the founding year. The number rose to 22 in 2004 to 26 in 2005 to 28 in 2006 and 2007 and up to 30 in 2008 and 2009. Yes that’s correct! In the last two years, the super 30 boasts of a cent percent record with 30 out of 30 students coming through. The training school's feat is even more amazing in a state where more than two million children are out of school, and the literacy rate is a shameful 47%.
How did they do it?
The students come here to attend classes from Patna and also from faraway villages and make the journey every day by bus, on bicycles or even on foot. Those who stay in the hostels are provided free food and lodging. Each year 6,000 young boys buy the application form for Rs 60 from the Institute and submit it in the hope of making it to the Super 30. Candidates then take three separate admission tests to determine IQ, administered in ascending order of difficulty. Of the 500 short-listed initially, 30 eventually make it to the core group. The basis of the selection is that the candidate has to be from an underprivileged background. These are the poorest but with the most powerful minds. The training that lasts a year is rigorous and almost monk like in its intensity. But there are no drop outs from the program.
When you are trapped in a situation where you know you have the intelligence to conquer the world but you are crushed in by your circumstances, you'll do anything to break free. This is perhaps the true secret behind the success of Super 30. This and the commitment of a single individual to an idea.
Sunday, June 14, 2009
The great US health care debate
Recent months have seen the start of the great debate on health care in the US. The facts are clear- there are 45 million uninsured citizens in the richest country in the world which has the highest cost of health care but with no comparable favorable outcomes.
While the next months will see this debate demagogued no end, as a user of this health care system, some things are absolutely clear- there is absolutely no incentive in this system for anybody to control costs. Not the patient, who is insured, and has no interest in shopping for more cost effective care, just the best that is available; not the doctors, who on the plea of malpractice suits possibilities, order all or any tests that may be relevant ( and some of them performed by facilities owned by them); not the hospital which is happy to provide all the latest facilities needed or not as it adds to their profits; not the pharmaceutical companies who encourage new and costlier drugs rather than the generics on the plea of need of funds for further research, not the insurance companies who are happy to pass on the costs of all this health care to the public through rapidly rising premiums. In short everybody is happy with their health care - that is till the bill comes due!
An average US family today pays $ 500-1000 per month in health premiums, deductibles, medicines etc. I could see a tip of why after I insisted on a bill from the hospital I had just returned from -- in the itemized bill, an aspirin pill was charged at $ 8-- yes $ 8-- and a simple blood sugar test at $ 25 while every intern who visited me even for five minutes along with the team was happy to add his wages to the bill leading to a cost of almost $ 2500 per day for a simple stay in the hospital without any major surgeries. Clearly it is a system where the costs have run amok. In some ways it is the inverse of the major damage caused in the recent collapse of the financial system- in the financial system people were investing other peoples money in the riskiest of bets; in the medical health care system, people are spending other peoples money to ensure the least possible of risks for all operations !
But is that the way it should be ? Are there any no alternatives that offer cost effective care? Atul Gawande in a recent article pointed out that indeed there are alternate ways of delivering health care that are both effective and less costly since they align the patients well being with cost effective care. He does that by describing two operating systems in different parts of the country to make his point.
McAllen is in Hidalgo County, Texas has the lowest household income in the country but it has one of the most expensive health-care markets in the country. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns. The place has virtually all the technology that you’d find at Harvard and Stanford and the Mayo Clinic, and yet there’s no evidence that the treatments and technologies available at McAllen are any better than those found elsewhere in the country. Nor does the care given in McAllen stand out for its quality. Medicare ranks hospitals on twenty-five metrics of care. On all but two of these, McAllen’s five largest hospitals performed worse on average. McAllen costs Medicare seven thousand dollars more per person each year than does the average city in America. But not, so far as one can tell, because it’s delivering better health care.
Why is this so? It seems that doctors here order unnecessary tests just to protect themselves. Doctors were racking up charges with extra tests, services, and procedures- patients in McAllen got more of pretty much everything—more diagnostic testing, more hospital treatment, more surgery, more home care.Thus the primary cause of McAllen’s extreme costs was, very simply, the across-the-board overuse of medicine. This is further exemplified in its newest hospital in the area which is physician-owned which has a reputationfor aggressively recruiting high-volume physicians to become investors and send patients there. Physicians who do so receive not only their fee for whatever service they provide but also a percentage of the hospital’s profits from the tests, surgery, or other care patients are given, providing physicians an unholy temptation to overorder. It was clear that a few leaders of local institutions in this area took profit growth to be a legitimate ethic in the practice of medicine and a medical community came to treat patients the way subprime-mortgage lenders treated home buyers: as profit centers.
On the other extreme of medical practice lies the Mayo Clinic model, which is among the highest-quality, lowest-cost health-care systems in the country. Its core tenet “The needs of the patient come first”—not the convenience of the doctors, not their revenues is as different from McAllen as is possible. The doctors and nurses, and even the janitors, sit in meetings almost weekly, working on ideas to make the service and the care better, not to get more money out of patients. Decades ago, the Mayo Clinic recognized that the first thing it needed to do was to eliminate the financial barriers. It thus pooled all the money the doctors and the hospital system received and began paying everyone a salary, so that the doctors’ goal in patient care couldn’t be increasing their own personal income. Mayo promoted leaders who focussed first on what was best for patients, and then on how to make this financially possible. They focussed on rooting out problems like poor prevention practices, unnecessary back operations, and unusual hospital-complication rates- on patient well being rather than on profit maximization.
When you look across the spectrum from the Mayo Clinic to McAllen—and the almost threefold difference in the costs of care—you come to realize that there is a battle being waged for the soul of American medicine. But a choice must be made. Whom do we want in charge of managing the full complexity of medical care? We can turn to insurers (whether public or private), which have proved repeatedly that they can’t do it. Or we can turn to the local medical communities, which have proved that they can. But we have to choose someone—because, in much of the country, no one is in charge. And the result is the most wasteful and the least sustainable health-care system in the world.
It is interesting that the solution most opposed by the right wing ideolouges actually embraces the twin principles of market competition and individual choice !
While the next months will see this debate demagogued no end, as a user of this health care system, some things are absolutely clear- there is absolutely no incentive in this system for anybody to control costs. Not the patient, who is insured, and has no interest in shopping for more cost effective care, just the best that is available; not the doctors, who on the plea of malpractice suits possibilities, order all or any tests that may be relevant ( and some of them performed by facilities owned by them); not the hospital which is happy to provide all the latest facilities needed or not as it adds to their profits; not the pharmaceutical companies who encourage new and costlier drugs rather than the generics on the plea of need of funds for further research, not the insurance companies who are happy to pass on the costs of all this health care to the public through rapidly rising premiums. In short everybody is happy with their health care - that is till the bill comes due!
An average US family today pays $ 500-1000 per month in health premiums, deductibles, medicines etc. I could see a tip of why after I insisted on a bill from the hospital I had just returned from -- in the itemized bill, an aspirin pill was charged at $ 8-- yes $ 8-- and a simple blood sugar test at $ 25 while every intern who visited me even for five minutes along with the team was happy to add his wages to the bill leading to a cost of almost $ 2500 per day for a simple stay in the hospital without any major surgeries. Clearly it is a system where the costs have run amok. In some ways it is the inverse of the major damage caused in the recent collapse of the financial system- in the financial system people were investing other peoples money in the riskiest of bets; in the medical health care system, people are spending other peoples money to ensure the least possible of risks for all operations !
But is that the way it should be ? Are there any no alternatives that offer cost effective care? Atul Gawande in a recent article pointed out that indeed there are alternate ways of delivering health care that are both effective and less costly since they align the patients well being with cost effective care. He does that by describing two operating systems in different parts of the country to make his point.
McAllen is in Hidalgo County, Texas has the lowest household income in the country but it has one of the most expensive health-care markets in the country. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns. The place has virtually all the technology that you’d find at Harvard and Stanford and the Mayo Clinic, and yet there’s no evidence that the treatments and technologies available at McAllen are any better than those found elsewhere in the country. Nor does the care given in McAllen stand out for its quality. Medicare ranks hospitals on twenty-five metrics of care. On all but two of these, McAllen’s five largest hospitals performed worse on average. McAllen costs Medicare seven thousand dollars more per person each year than does the average city in America. But not, so far as one can tell, because it’s delivering better health care.
Why is this so? It seems that doctors here order unnecessary tests just to protect themselves. Doctors were racking up charges with extra tests, services, and procedures- patients in McAllen got more of pretty much everything—more diagnostic testing, more hospital treatment, more surgery, more home care.Thus the primary cause of McAllen’s extreme costs was, very simply, the across-the-board overuse of medicine. This is further exemplified in its newest hospital in the area which is physician-owned which has a reputationfor aggressively recruiting high-volume physicians to become investors and send patients there. Physicians who do so receive not only their fee for whatever service they provide but also a percentage of the hospital’s profits from the tests, surgery, or other care patients are given, providing physicians an unholy temptation to overorder. It was clear that a few leaders of local institutions in this area took profit growth to be a legitimate ethic in the practice of medicine and a medical community came to treat patients the way subprime-mortgage lenders treated home buyers: as profit centers.
On the other extreme of medical practice lies the Mayo Clinic model, which is among the highest-quality, lowest-cost health-care systems in the country. Its core tenet “The needs of the patient come first”—not the convenience of the doctors, not their revenues is as different from McAllen as is possible. The doctors and nurses, and even the janitors, sit in meetings almost weekly, working on ideas to make the service and the care better, not to get more money out of patients. Decades ago, the Mayo Clinic recognized that the first thing it needed to do was to eliminate the financial barriers. It thus pooled all the money the doctors and the hospital system received and began paying everyone a salary, so that the doctors’ goal in patient care couldn’t be increasing their own personal income. Mayo promoted leaders who focussed first on what was best for patients, and then on how to make this financially possible. They focussed on rooting out problems like poor prevention practices, unnecessary back operations, and unusual hospital-complication rates- on patient well being rather than on profit maximization.
When you look across the spectrum from the Mayo Clinic to McAllen—and the almost threefold difference in the costs of care—you come to realize that there is a battle being waged for the soul of American medicine. But a choice must be made. Whom do we want in charge of managing the full complexity of medical care? We can turn to insurers (whether public or private), which have proved repeatedly that they can’t do it. Or we can turn to the local medical communities, which have proved that they can. But we have to choose someone—because, in much of the country, no one is in charge. And the result is the most wasteful and the least sustainable health-care system in the world.
It is interesting that the solution most opposed by the right wing ideolouges actually embraces the twin principles of market competition and individual choice !
Thursday, June 11, 2009
The human heart
The cockroach has survived every civilization known to man.Evolution has favored cockroaches above human beings, at least when it comes to the functioning of the heart. A cockroach’s heart will continue to beat even when one of its chambers has failed; in similar circumstances, a man will die. Thus the lowly cockroach is at the heart of successful research by scientists who are developing an artificial heart. Using the roach’s heart as a model, the new prototype promises to be much cheaper and more reliable for implantation in humans than models currently in use.
The key to the new heart involves the insect’s unique breathing system. The cockroach is blessed with thirteen blood-pumping chambers while humans only have four. When a chamber fails in a human heart, it usually leads to a fatal cardiac arrest but in a cockroach with its 13 chambers,linked like a string of sausages, it can keep pumping even if one breaks down!A cockroach’s heart is a tube that runs the length of its body. As each chamber contracts, the blood within is pumped to a higher pressure. Each successive chamber increases the pressure. A human heart, by contrast, has four chambers. Two of these pump blood to the lungs, where it picks up oxygen, then the other two pump this oxygenated blood throughout the body. One of these four chambers—the left ventricle—contracts most strongly to pressurize the blood.
The artificial hearts developed so far have mostly mimicked human ones. The first devices, developed in the 1950s and 1960s, were large machines placed on trolleys next to the patient and attached by tubes. Modern artificial hearts are less cumbersome, but they are still rather unwieldy because they use compressed air to pump the blood and are powered by heavy batteries. They are used temporarily, usually for a few days or weeks, until a real heart is available for transplant.
Instead of trying to mimic the action of the left ventricle, Dr Guha’s design uses a multi-step approach borrowed from the cockroach. His device, made from plastic and titanium, is the same size as a human heart but with five chambers arranged like the layers of an onion. Each chamber acts in succession to increase the pressure of the blood. The contraction of each chamber is controlled by a motor driven by bulky batteries. "Our model is based on the cockroach system, where we build up the pressure in smaller steps. So even if one chamber fails, a person can still live. This model does not stress the other components (pumping elements) and there is less stress on the blood cells”, says team leader Professor Sujoy Guha.The artificial heart, named TAH ( total artificial heart) is being tested on goats, with human trials scheduled for next year. If these are successful, the device could be on the market in three to five years.
The multi-step approach makes this artificial heart much cheaper to build than those that use compressed air to pump the blood. Dr Guha says it would cost $2,000-2,500 about thirty times cheaper than the present models.
I read these reports with great pleasure for a number of reasons. First the research was led by an Indian. Secondly it was done in India. And even more importantly the work was done at the Indian Institute of Technology at Kharagpur, my alma mater. I graduated from this IIT in 1961 and visited the institute only last year- as the institute had decided to honor me as a Distinguished Alumnus. But the most inspiring news was that the leader of the team was Sujoy Guha who graduated with me in 1961! Wow indeed.
On a more personal note, I spent the better part of 2007 in Johns Hopkins hospital in Baltimore being evaluated for a heart transplant.I was not approved for a human heart transplant, but perhaps the cockroach inspired TAH of Professor Guha would be the replacement! To have your heart redesigned by your own classmate- how cool is that!
The key to the new heart involves the insect’s unique breathing system. The cockroach is blessed with thirteen blood-pumping chambers while humans only have four. When a chamber fails in a human heart, it usually leads to a fatal cardiac arrest but in a cockroach with its 13 chambers,linked like a string of sausages, it can keep pumping even if one breaks down!A cockroach’s heart is a tube that runs the length of its body. As each chamber contracts, the blood within is pumped to a higher pressure. Each successive chamber increases the pressure. A human heart, by contrast, has four chambers. Two of these pump blood to the lungs, where it picks up oxygen, then the other two pump this oxygenated blood throughout the body. One of these four chambers—the left ventricle—contracts most strongly to pressurize the blood.
The artificial hearts developed so far have mostly mimicked human ones. The first devices, developed in the 1950s and 1960s, were large machines placed on trolleys next to the patient and attached by tubes. Modern artificial hearts are less cumbersome, but they are still rather unwieldy because they use compressed air to pump the blood and are powered by heavy batteries. They are used temporarily, usually for a few days or weeks, until a real heart is available for transplant.
Instead of trying to mimic the action of the left ventricle, Dr Guha’s design uses a multi-step approach borrowed from the cockroach. His device, made from plastic and titanium, is the same size as a human heart but with five chambers arranged like the layers of an onion. Each chamber acts in succession to increase the pressure of the blood. The contraction of each chamber is controlled by a motor driven by bulky batteries. "Our model is based on the cockroach system, where we build up the pressure in smaller steps. So even if one chamber fails, a person can still live. This model does not stress the other components (pumping elements) and there is less stress on the blood cells”, says team leader Professor Sujoy Guha.The artificial heart, named TAH ( total artificial heart) is being tested on goats, with human trials scheduled for next year. If these are successful, the device could be on the market in three to five years.
The multi-step approach makes this artificial heart much cheaper to build than those that use compressed air to pump the blood. Dr Guha says it would cost $2,000-2,500 about thirty times cheaper than the present models.
I read these reports with great pleasure for a number of reasons. First the research was led by an Indian. Secondly it was done in India. And even more importantly the work was done at the Indian Institute of Technology at Kharagpur, my alma mater. I graduated from this IIT in 1961 and visited the institute only last year- as the institute had decided to honor me as a Distinguished Alumnus. But the most inspiring news was that the leader of the team was Sujoy Guha who graduated with me in 1961! Wow indeed.
On a more personal note, I spent the better part of 2007 in Johns Hopkins hospital in Baltimore being evaluated for a heart transplant.I was not approved for a human heart transplant, but perhaps the cockroach inspired TAH of Professor Guha would be the replacement! To have your heart redesigned by your own classmate- how cool is that!
Sunday, June 7, 2009
Pakistan on the brink
Pakistan is close to the brink, perhaps not to a meltdown of the government, but to a permanent state of anarchy. Even as most Pakistanis have concluded that the Taliban now pose the greatest threat to the Pakistani state since its creation, the president, the prime minister, and the army chief have, until recently, been in a state of denial of reality. One can therefore expect a slow, insidious, long-burning fuse of fear, terror, and paralysis that the Taliban have lit and that the state is unable, and partly unwilling, to douse.
The Taliban have taken advantage of the vacuum of governance by carrying out spectacular suicide bombings in major cities across the country. Having won Swat, the Taliban have made clear their intentions to overthrow the national government. Although the group has no single acknowledged leader, it has formed alliances with around forty different extremist groups, some of them with no previous direct connection to the Taliban. Moreover, the Afghan Taliban have become a model for the entire region. The Afghan Taliban of the 1990s have morphed into the Pakistani Taliban and the Central Asian Taliban and it may be only a question of time before we see the Indian Taliban.
Ahmed Rashid in his latest article paints a grim picture of the impending failure of Pakistan and its likely repercussions.
The Taliban have taken advantage of the vacuum of governance by carrying out spectacular suicide bombings in major cities across the country. Having won Swat, the Taliban have made clear their intentions to overthrow the national government. Although the group has no single acknowledged leader, it has formed alliances with around forty different extremist groups, some of them with no previous direct connection to the Taliban. Moreover, the Afghan Taliban have become a model for the entire region. The Afghan Taliban of the 1990s have morphed into the Pakistani Taliban and the Central Asian Taliban and it may be only a question of time before we see the Indian Taliban.
Ahmed Rashid in his latest article paints a grim picture of the impending failure of Pakistan and its likely repercussions.
Empathy anyone ?
During the past few weeks, ever since Obama announced his pick for the supreme court justice, there has been one word at the center of all discussions-- empathy. It was important for people to have empathy as they preside in the supreme court. But what is empathy ? It is the ability to be able to feel someone else's pain and be able to walk in their shoes?
From the time of Adam, the one thing that men have never learnt is to empathize with their better halves- witness the tomes written on " understanding women". But once in a while, a writer gets it just right. Here is Dana Jennings on his brief life as a woman..
From the time of Adam, the one thing that men have never learnt is to empathize with their better halves- witness the tomes written on " understanding women". But once in a while, a writer gets it just right. Here is Dana Jennings on his brief life as a woman..
" As my wife and I sat on the couch one night this past winter, reading and half-watching the inevitable HGTV, I started sweating hard and my face got so fevered and flushed that I felt as if I were peering into an oven. I turned to Deb and said, “Man, I’m having a wicked hot flash.” And she said, “Me, too.” Then we laughed. You laugh a lot — unless your hormones are making you cry — when you’re having menopause with your wife."
Dana was taking a course in hormonal therapy as part of his cancer treatment and one of the side effects was menopause like symptoms."The side effect that surprised me most were the hot flashes" he writes, " — not that I got them, I was expecting that, but by how intense they were. They often woke me in the middle of the night and made me sweat so much that I drenched the sheets. In midwinter I’d walk our miniature poodle, Bijou, wearing shorts and a T-shirt. I sometimes felt as if Deb could fry eggs on my chest. (It’s also a bit disconcerting when your hot flashes are fiercer than your wife’s.)"
"Hand in hand with the hot flashes came the food cravings. I lusted after Cheetos and Peanut Butter M&M’s, maple-walnut milkshakes, and spaghetti and meatballs buried in a blizzard of Parmesan. Isn’t it funny how cravings very rarely involve tofu, bean curd or omega-3 oils?
Then there was the weight issue. During the six months I was on Lupron I gained about 25 pounds. That was partly a byproduct of the cravings, but it also stemmed from the hormonal changes triggered in my body.
And I hated it, hated it, hated it. I had never had to worry about my weight, and I began to understand why media aimed at women and girls obsess over weight so much. It was strange and unsettling not to be able to tell my body, “No,” when it wanted to wolf down a fistful of Doritos slathered with scallion cream cheese.
When I wasn’t devouring a king-size Italian sub or smoldering from a hot flash, it seemed that I was crying. The tears would usually pour down when I got ambushed by some old tune: “Sweet Baby James” and “Fire and Rain” by James Taylor, “That’s the Way I’ve Always Heard It Should Be” by Carly Simon and, yes, “It’s My Party” by Lesley Gore. Not only was I temporarily menopausal, but it appeared that I was also turning into a teenage girl from the early 1970s.
There were other side effects, too, like headaches and fatigue. But when I started drinking Diet Coke for the first time in my life, my son Owen couldn’t take it anymore. He said, “Dad, are you turning into a chick?”
Even though Dana only got to spend a brief time on the outer precincts of menopause, it did confirm his lifelong sense that the world of women is hormonal and mysterious, and that we men don’t have the semblance of a clue!
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