Essays

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

Works somewhere…works everywhere?

The enlightenment philosopher David Hume wrote, “in our reasonings concerning matter of fact, there are all imaginable degrees of assurance, from the highest certainty to the lowest species of moral evidence. A wise man, therefore, proportions his belief to the evidence.” As I wrote in my last essay, the scientific method built on evidence, has… Continue reading Works somewhere…works everywhere?

Evidence of, Evidence for

In the human world, ideas and concepts are more robust and impactful than anything organic or material. Concepts and ideas often outlive their originators. As culture, language and their embedded concepts multiply and diverge, exchange and reconvene, they shape our world in unpredictable ways. One concept that has evolved to loom over all aspects of… Continue reading Evidence of, Evidence for

Intuitions in the Wild

In reality, there are probably no wild places remaining. The watering hole has a water tank and fences, the lions have identification tags, and are largely habituated to the gawking tourists with binoculars. Analogously, the emergency department has protocols, clinical guidelines, and triage scores. Both environments are semi-wild; neither completely open and wild nor fully closed… Continue reading Intuitions in the Wild

Wild Places

In the Tale of a Springbok, I narrated the story of a springbok approaching an empty but hot desert watering hole in Etosha National Park, unaware of the two lionesses sitting underneath the bush in the periphery. As the scene unfolded, I anthropomorphized and looked on with mixed feelings vacillating from suspense and excitement to… Continue reading Wild Places