Essays

Great Expectations

Visual illusions (see below) provide unique insights into the generative aspects of perceptions and the gaps between perception and reality. They not only illustrate the disproportionate impact our implicitly, explicitly, and innately acquired knowledge of the world - our priors - has on our perceptions, but also that perception is not a direct reflection of… Continue reading Great Expectations

Feelings Felt

We learn early in our education about the five senses - visual, auditory, gustatory, tactile, and olfactory. This processing of information from the “external environment” is termed exteroception. Intermittently, salient sights, sounds, tastes, smells, or touches enter our awareness but for the most part exteroception happens subconsciously. However, the brain not only monitors the external… Continue reading Feelings Felt

Language and Its Discontents

Ludwig Wittgenstein wrote, “the limits of my language mean the limits of my world.” Fortunately, human communication carries multiple layers of signals - verbal and non-verbal, conscious and subconscious - with language or consciousness representing summarizations of all those signals. Similarly, the patient-physician interaction also is laden with signals.  Even without considering the vagaries of… Continue reading Language and Its Discontents

Worlds Far and Wide, Near and Close

Who we are emerges out of the dynamic interplay of what we are (the person), where we are (the situation), what we say we will do (intentions), and what we do (actions). Medicine has built a model of disease with a focus on the person in a hospital or a clinic and their intentions. In… Continue reading Worlds Far and Wide, Near and Close

The Person and the Situation

It has almost become a truism to attribute the causes of diseases to social determinants of health (SDOH).  By one estimate, SDOH account for 60% of premature death in the United States. According to the CDC, SDOH are the conditions in the environments where people are born, live, learn, work, play, worship, and age. While… Continue reading The Person and the Situation

The Wanderer

A core functionality of biological organisms is to track regularities in the environment and utilize those regularities as a substrate for predictions. In general, organisms that can identify markers of risk, danger, and safety and respond appropriately to those markers are better adapted than organisms that lack this functionality. Thus, the largely reflexive fight-flight-freeze responses… Continue reading The Wanderer

Steep Hills

As I discussed in my last essay, social relationships - the types, the numbers, and the nature - constitute a major risk factor for health. It rivals well established medical risk factors such as hypertension, hyperlipidemia, obesity, and physical fitness. In fact, by one estimate nearly 60% of the variation in health outcomes is caused… Continue reading Steep Hills

The Systems Above

The 17th century poet, John Donne, famously wrote, “No man is an island, entire of itself; every man is a piece of the continent, A part of the main.” In reality, even an island is not an island - structurally or functionally. Islands are separated (or connected) - depending on perspective or purpose - to… Continue reading The Systems Above

The systems above, the genomes below

In medicine, it is often said the exceptions are the rule and atypical presentations of diseases are typical. However, diagnoses are also often preceded by typical symptoms, accompanied by diseases, and succeeded by other symptoms and diseases. There are patterns in these journeys and they often follow consistent trajectories.  A heart attack is announced by… Continue reading The systems above, the genomes below

Histories

Winston Churchill wrote, “the farther backward you can look, the farther forward you can see.” However, looking backwards is often obscured by time, form, or perspective. Nonetheless, if viewed through a reflective and measured lens, it is clear that like all life on Earth, humans are also a historical species, we carry the markers of… Continue reading Histories

The Arrow of Time

Psychologically and experientially the passage of time is malleable. It accelerates during novelty and decelerates with redundancy. It is cyclical but also linear. Depending on perspective or motives, it can be progressive or regressive. The natural world is rooted and synchronized to the cyclical nature of days and nights and the rhythms of the seasons.… Continue reading The Arrow of Time

Charnel Grounds

The practice of interment and its associated rituals are features of human symbolism and practiced by most cultures. One unique burial ritual prevalent in ancient and medieval South Asia was the sky burial. These burial sites - termed charnel grounds - were typically found near large river banks or on mountain plateaus. At these sites,… Continue reading Charnel Grounds

Ash Heap of History

The tendency to group and categorize phenomena in dichotomies seems to be an inherent feature of our species. We have even dichotomized our bodies into the mind and the body. Other dichotomies such as nature/nurture, emotional/rational, induction/deduction, learn/instinct ossify into naturalized and distinct categories. The consequence of this naturalization is that they operate at below… Continue reading Ash Heap of History

The Art of Progress

As I wrote in my last essay, real world evidence (RWE)  generated from “big” real world data (RWD) is upending the hegemony of traditional randomized controlled trials and the evidence hierarchy. RWE is being used for epidemiological evidence to identify targets for drug development, for safety surveillance of approved medical products, for examining changes in patterns… Continue reading The Art of Progress

Shattered Mirrors

Ibn Khaldun, the 15th century North African historian, wrote  “the past resembles the future more than one drop of water resembles another.” Implying that the patterns and lessons of the past are applicable to the present and can be applied to  predict the future.  Explanations and predictions are the outputs of science and the scientific… Continue reading Shattered Mirrors