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What Makes Something ‘A Medicine’?


I have been planing to write this post for a long time.

I belong to several Whatsapp groups of friends and families. Many messages get forwarded on Whatsapp. There is a specific type of messages that get a lot of momentum. Messages that claim something is a herbal, Ayurvedic medicine.

So far I have received messages claiming medicinal properties in several fruits, vegetables, herbs, tree leaves, roots, barks, seeds, some common, some exotic. I have been told that anything from lemon to clove oil can cure cancer.

But I can tell you that when my father had cancer, nothing helped him other than established medicine. We tried many things, we really did. And some things did more harm than good. But the only thing that made any difference was Chemotherapy.

And that’s what prompted me to write this article.

There is a widely accepted theory that there is a big giant cartel of Pharma companies and doctors that is out to rip patients. And there may be some truth in that, but on a large scale, there are more good people than bad. There are plenty of companies and scientists working hard to find medicines for diseases. There is a very structured drug development process.

Before I begin to tell you the process let me tell you one thing. Have you heard of a sentence “You can fool others but you cannot fool yourself?” That’s a lie. You can fool yourself. People do that all the time. Your mind can play tricks on you. Psychologists have done plenty of research on that. These tricks are called cognitive biases. Here are a couple important ones.

Confirmation bias – where people like to look for information that proves what they already believe and ignore the information that disproves their belief. This is why Republicans read only news supporting Republican views and so do Democrats. Or to put in Indian context, BJP supporters read only news that makes BJP look good and Congress supporters do the same for Congress. This can lead them away from a balanced view. Sometimes there is a necessary correction that happens when you read other person’s viewpoint, but when you read biased news, that correction does not happen.

Availability bias – people tend to overestimate the probability of events that have recently occurred. This is why a large number of people buy earthquake insurance just after earthquake. Ironically a second major earthquake is much less likely after one has already happened, but people believe it is more likely because they have just experienced it.

If you want to read about cognitive biases, which I recommend you should do because it is fascinating, the Wikipedia article is here. It will make you aware of your own biases and will improve your decision making ability.

Coming back to the medicine world. There are some mental traps that are super common to the medicine development.

One very common mental trap observed in the field of medicine is placebo effect. People just feel better with the thought that they have taken medicine. Often times the relief in symptoms such as headache, nausea, dizziness is very significant and pronounced. This effect can even be seen when false medicine given to the person. Because what is helping them is the thought, not the medicine.

Second mental trap is confounders. E.g. one time doctors observed that a group of people drinking a particular type of wine were living longer. But upon more analysis they found that it was just a costly wine and those who could afford it were rich and could afford better healthcare. So it was not the wine that was helping health, but it was the money, which happened to be the reason why people could afford that wine.

Over the years scientists have developed a very mature and thorough process of deciding whether something is medicine that has checks and guards for most of the mental traps, or cognitive biases.

In the first stage of medicine development, mostly a mechanism is identified. How a particular drug has some effect on particular molecules. If an experiment can be repeated, an hypothesis is built.

In second stage, trials are done in petri dish. Or on animals. If satisfactory results are obtained, then human trials are planned.

In third stage, a small dose escalation trial is conducted. Few people take the medicine and the dose is taken up to see how much dose can be tolerated. If people tolerate the dose well, then the next step.

In fourth step, a larger group of people is selected. IT is made sure that the selection is as diverse as possible for gender, race, age, etc. Typically the experiments at this and next stages are “double blind placebo controlled randomized “. Placebo controlled means a some people get something that looks like medicine, but is really a harmless substance. Some people get the real medicine. If the number of people showing benefit from placebo group is almost same as number of people from medicine group, then you know it’s not the medicine effect but placebo effect at play. Also neither the people themselves, nor the scientists observing the people know who is getting what. This is to avoid their own mental bias. Because if they know who is getting medicine, they might suffer from confirmation bias. I.e. they will tend to focus more on improvements in people who took medicine and report that more prominently. The word randomized means it is decided randomly who gets medicine and who gets placebo. Otherwise if only men get medicine and women get placebo, and men were to respond to medicine better, that would give us a skewed result of how effective the medicine really is.

In fifth step, even a large group, perhaps hundreds or sometimes thousands is selected and same, double blind placebo controlled randomized study is performed. Details records are kept. Approvals are filed.

If everything looks good, at this stage the drug becomes a medicine. But it does not end here. The doctors keep a keen eye on patients taking new drugs and report their findings. That includes side effects, improvements, everything. Sometimes if there are too many serious side effects, drugs are recalled and banned.

At each and every step, the reports of experiments are published in leading scientific journals and other scientists rip it apart to find faults in the theory, the experiment method etc. If the faults are serious, they are improved and experiments are repeated.

After such a long and arduous journey, something becomes a drug.

And when a drug goes through such a long process, we can trust it. That’s why Aspirin or Paracetamol works like clockwork for us. That’s why we know whether a drug is good for babies, or for pregnant women, or for old people. We know what are the most common side effects. We know what is the right dosage.

Now compare this to whatsapp message you received. Do you really think it has gone that much scrutiny? Just because it’s part of our folklore and tradition, should we let it escape all this scrutiny?

Believe me, I am not against herbal medicines. I personally have experience of one medicine that helps me when I have cough – Harad, or (Terminalia Chebula). However I think we should study them scientifically. I am not arguing against the type of medicine. I am arguing against the process by which we declare something a medicine. We have to perfect the process and rely on it. Not rely on personal opinions. Because? Persons have cognitive biases.

We should not just accept them because it’s mentioned in our old books. If it’s the truth, it will stand the scrutiny. If it’s not, we accept someone made a mistake in writing those books.

Often times I think people have cultural lines drawn in their mind. They think accepting superiority of Western medicine is accepting superiority of Western culture. Our culture has been wronged by Western culture, by colonialism specifically. And I get that. But nothing wrong or shameful in taking what’s right in the culture we have problems with. After all, we speak their language and wear their style of clothes.

Actually this type of rigorous examining, critical thinking was far too common in ancient India. They have entire field devoted to that called “Nyayashastra”.  It’s we who departed from our rich tradition of critical thought process  and logic.  We have given way to emotional reasoning. If it makes us feel bad, then it must be wrong. And this habit of reasoning is hurting us more than healing.

These messages and medicinal tips are always shared with good intentions. “May be it will help someone” is what we think. But as they say, the road to hell is paved with good intentions. Too many disasters caused in this world by good intentions that lack wisdom. Having too many medicinal suggestions but not knowing which one to put your confidence in, not knowing which one you can trust when your health is in delicate state, is not really helpful.

What’s most important is the truth. It’s the truth we need to make higher priority.And if we are not sure what is truth, then we must hold our good intentions in check till we find out what is the truth.

Next time if someone forward you a bunch of message describing something has medicinal properties, please forward them this article. Let’s educate ourselves and spread the truth.

Oh Mr. Chetan Maini, Where Art Thou?


Dear Mr. Chetan Maini,

You don’t know me. Yes, we both might be from India, but currently we live in different parts of the world, we probably speak different language at homes. But there is one thing common to us, a passion for electric vehicles. Because we both strongly believe that that is good thing for lots of reasons.

Well, you know all of that. And you were smart enough to start a electric car company way back in 90s. But then some things happened and at this moment you do not seem to be in the driving seat of that venture.

That’s the point that drove me to write this letter. We need to fix that. We need a person who is madly in love with electric cars to be in charge of making electric cars.

Why? Well, I am not going to go in to tons of reasons why electric cars need to be made. There are environmental reasons, there are national security reasons, there are human rights reasons. You know all of that.

I am going to make a different point.

I am currently residing in USA. There are giant car companies here. For long long time they were just in a slumber. Each one had tremendous money and knowledge invested in internal combustion engines. Each one sort of knew that others are too much invested in ICEs too and were not going to move away from burning gasoline anytime soon. Each one had no motivation to switch, so collectively the whole bunch had no reason to step up and make the switch to electric cars.

Here let me take a bit pedagogical tone. If we were to apply game theory to explain this social behavior, this would be a classic “Nash Equilibrium”, named after the great mathematician John Nash.

Wikipedia Quote -“In game theory, the Nash equilibrium is a solution concept of a non-cooperative game involving two or more players in which each player is assumed to know the equilibrium strategies of the other players, and no player has anything to gain by changing only his or her own strategy.”

So big auto players had anticipated each other’s strategy and had not much to gain by making electric vehicles, or at least they were not sure if the gains were worth the losses.

Then Tesla happened.

In less than a decade, the company shot to fame making world class electric cars that were selling like hot cakes and grabbing all the headlines. People loved the cars and were willing to be on waiting list rather than buy available big name cars. In a span of two years, model S went from nowhere to the top selling luxury car in the market.

Each of the big auto player knew that at least one other major player was going to emulate Tesla and make electric cars. And when one of them made a move, and if they were successful, perhaps more would make that move. And each big auto player knew that what they were thinking was exactly how everyone else was thinking too. At first they anticipated others not to change. Now they anticipated others to change.

In a nutshell, now the risk in ‘not doing anything’ was too much. The status quo was no more a reasonable strategy. The Nash equilibrium had broken down.

The effect was dramatic. In less than five years after arrival of model S, there have been announcements of at least 20 electric cars that will hit the market in coming few years.

This is what needs to happen in India.

Even in India, at the moment there is a Nash Equilibrium. Automakers are repeating electric vehicle problems like parrots and are showing no interest in solving them. Mahindra, who builds E2O, is doing a spectacularly  terrible job in promoting it.

We need someone to deny the big Indian automakers the luxury of a comfortable status quo convenient for the bureaucratic corporate culture. We need someone to light fire under their asses. We need someone to break this Nash Equilibrium in India. We need a cultural change, a revolution in this particular sector.

This is why we need you. Because at the moment you are the only person we can think of that has capability and passion to do this. And if you did this, we assure you that we, the electric vehicle enthusiasts in India will work hard.  Do not for a moment doubt our numbers. I visit India regularly and I have met plenty of people who have talked to me about electric cars without knowing that I am die hard fan of EVs. I have met dentists who talked Electric cars while drilling my teeth. I have met elderly women who talked about electric cars while making tea for me. I have met 11 year old who wanted to be engineer so he could make electric cars.

A few days back my cousin met a 97 year old woman who lived close to the river in Dahisar, Mumbai. That woman had lived in the area for her whole life and had swam and drank from the river in her childhood. She lamented the fact that you cannot cannot even go within 30 feet of the river because it’s so badly polluted. She does not know the world of high tech gadgets, but mention of anything that  will reduce pollution makes her eyes light up. So apart from tailpipe emissions, the issue of general pollution is in peoples’ minds and they want to make a statement whichever way they can. A good electric car just gives them an avenue to make a powerful statement.

What do you need? Crowdfunding? Done. Just start a page. You need grass root volunteers? Done. Just send a message on our board and social media. You need customers? Give us a good product and trust us , we will be waiting in line in rain. You need government support? Thing seem to be promising there too.

Breaking down of Nash equilibrium under right conditions can create impact on much large scale, wildly disproportionate to the amount of effort exerted. We have those conditions in India at the moment. We need someone to pick up the hammer.

So Mr. Maini, we need an electric car revolution, and we want you to start it. Will you?

I Have A Dream


Just a spiritual dream inspired by MLK

I have a dream.

I have a dream that some day the content of my character will have compassion for all sentient beings. The voices of judgement will cease and that my mind will be able to what the Zen calls “thundering acceptance” with a golden mantra, “it is what it is”.

I have a dream that I will embrace this life with open arms for all it has to offer, good and bad and everything in between. The struggles will cease and peace  will prevail. I will realize that undesirable experiences are just part of this life and have as much to offer as pleasant ones when it comes to enriching this life. I will remember what Joseph Campbell says “We all are here not to be happy, but to feel alive.”

I have a dream that I will be able to forgive myself and others with ease, for we are all just humans. There will be compassion for me as well as for others. There will be no guilt, no shame, because guilt and shame do not work. There will be no using self abuse as mechanism for self improvement. Willingness to inflict self abuse is the first thing that must be improved.

I have a dream that I will face the truth every waking moment. Because every moment we don’t face the truth, leads us to a wrong worldview. Every error in our worldview eventually leads to a conflict and confusion. Every conflict and confusion leads to a battle within ourselves. A battle within ourselves is a battle we always lose.

My dream is to have a fluid, all encompassing awareness of this world that is free of conflicts, ignorance and full of compassion and wisdom.

I have a dream that I will need very little from the world outside because I will have a rich inner world. My relationship with this world will be that of interdependence and harmony and not of consumerism and greed.

I have a dream that I may conquer fear of death, because as a soul, there is no such thing as birth or death for us, only transitions we remember and transitions we don’t.

I have a dream that my mornings be filled with gratitude , my afternoons with acts of compassion, my evenings with reflection and my nights with silence.

I have a dream that a large number of people on this earth share this dream and we all help each other to realize it.

 

Of Tesla and Tax Breaks!!


Came across a WSJ article by Holman Jenkins who is not happy that Tesla customers are getting tax rebates. We see articles like this pop up every now and then. I am not an expert, but can’t help thinking “Seriously?”

I don’t know if this is deliberate ignorance or lack of knowledge. The truth is the whole oil supply chain is extremely costly and extremely delicate affair. American taxpayers pay through their nose to keep this supply chain intact and running. It’ just we have never seen a world where oil is not necessary and we are desensitized to all the costs we are paying.

To put it in numbers. The Model S has federal tax rebate of 7500 $ which expires when 200,000 Teslas are sold. After that the rebate goes down to half of that for a few months and then 25% of that and then vanishes entirely in one year.

7500 x 200,000 = 1.5 Billion USD tax break value till phase out begins. Say Tesla sold a hell lot more vehicles during the phase out period and was able to get another 1.5Billion USD incentives to its customers. So that’s total 3 Billion USD for a company in its lifetime.

3 Billion USD. Certainly a good chunk of money. But that’s it. The loan that was given to Tesla was paid back with interest, years ahead of schedule, with prepayment penalty.

And remember, this money does not go to Tesla. It’s just what taxpayers keep.

To put it in perspective, consider the cost of  G W Bush Tax breaks. ‘1.4 Trillion (with a T) reduction in revenue’ is the most conservative estimates. Higher side estimates go as high as 3.3 Trillion dollars.

That sounds too much guesswork and maths? Need some concrete numbers? How about the bailouts? The the first installment to just one company AIG received was 164 billion USD under multi trillion dollar TARP program.

Coming back to industry specific “favors” by the government. Here are the three favors given by taxpayers solely to the oil and gas industry.

  1. Seen that deserted gas station around the corner? Such deserted gas stations are scattered all around the towns and cities in USA? Those gas stations are deserted because the underground tanks developed leaks and contaminated the areas around. If someone were to buy it and make it operational, they need to spend money cleaning the underground first. No businessman wants to take that risk because that cleaning could explode in millions of dollars. What happens to such gas stations in long run? Eventually they get cleaned with taxpayer’s money. Every year USA taxpayers incur hundreds of millions of dollars in clean up such gas stations. Here is an article that states the costs to just one state, New York state run into approximately 200 million USD per year.
  2. Remember the Strategic Petroleum Reserves? These are petroleum stockpiles permanently maintained perpetually as a safety measure against any major oil supply disruption? The amount of oil at the moment in SPR is close to 700 mil barrels. At present value of approx 50 USD per barrel, that’s 35 billion USD perpetually stuck underground. If we had electric cars, we could free some or all of that money for better use.
  3. Have you heard about the USA Military base in Tanzania? No? It’s because there isn’t one. But there is one in Kuwait, and Saudi Arabia, and Qatar. Tanzania does not have oil. Kuwait and Saudi Arabia have. There is a huge cost of operations of these bases, whose sole purpose is to keep oil flowing smoothly. It’s hard to get a good idea of those expenses because everything is secret. But the figure is definitely going to be in Billions of USD.

And we have not talked about cleanup costs of oil spills, or healthcare costs due to pollution, or human costs of wars launched for oils.

I am a taxpayer and I would much rather have my money diverted to a company that might bring a positive disruption than anything else.

 

Anger! An Investigation


A few days back I was in a situation where I vividly experienced a spike of intense anger. I usually don’t even like to harm insects. But in that moment, the only thing that stopped me from inflicting intense pain on the other person was fear of consequences, legal or otherwise. For a brief moment, I had no shred of empathy left within me. The amount of pain I was willing to inflict on the person in that moment was wildly disproportionate to the pain he inflicted on me.

What exactly happened?

At a shop alongside highway, one person was extremely rude to me.

It would have been alright if at this point if the person involved had taken a softening action. But he did not. What he did was perceived as “lack of concern, lack of empathy” in my mind.

The anger started building. I tried to politely point out his mistake. However my comment was dismissed. And without giving me a chance to fully say things I wanted to say, that person exited the situation entirely.

I was left with seething anger. But he was gone. I boiled for a while. Then I calmed down.

After a while, I took a deep breathe and started to pay attention to my response with curiosity. Here is unwinding of my emotional response. Peeling the onion so to speak.

First there was a feeling of victimization  and unfairness, injustice. Something rightfully belonged to me did not come my way.

Second there was a sensation of lack of empathy towards me.

Now a story was building in my mind. The combined feeling of victimization and lack of empathy led to the projection of future. I feared my own self respect decreasing, me judging myself harshly.

But the most compulsive part of my anger, the part that wanted me to dart out and beat the s**t out of him, came out of a thought that this person, if he gets away, will feel encouraged to do the same thing in future. And he will do it again and again. And he will face no consequences again and again. And the cycle might lead to some kind of apocalypse. This is how I am putting in words, but it was more of a flash thinking.

As if the course of future that was entirely dependent on my response in this moment. If I respond, the situation is corrected. If I do not respond, apocalypse.

This idea of totally diverging future paths of the world, entirely dependent on a very narrow range of choices, is what creates strong compulsion.

But sanity prevailed. I waited out the impulse. And then I was hit with a realization that the future does not diverge that rapidly based on my choices. Universe is very fluid and self correcting. And it always presents me a wide range of choices to be happy and find peace. The bad man will meet his corrective punishment somewhere else. I will be able to move on no matter what.

Those Zen Masters were right again.

 

The Unproven Global Warming


 

I had an interesting argument with someone a few days back about global warming. The said person was of the opinion that global warming is all myth, perpetuated by special interest groups.

This post if basically a snapshot of my reply.

It surprises me when someone argues about proof of global warming. We cannot have airtight proof that global warming will destroy us. Because then we will be dead.

We have only one atmosphere to live with. And yes, global warming is a theory so far. With pretty good support from lots of data and simulations, but still a theory. Yes, that’s true.

But considering the danger it poses to humanity if true, up to what point you are willing to push your luck? You can wait till the theory is proven beyond doubt. But by that time the damage to earth’s atmosphere will be so catastrophic that the winner and loser in the argument will not live too long to reminisce in victory or come to terms with the loss.

With given scientific research, where do you put the probability of global warming to be true? 100% , 70%, 30%, 10%?

And now on a separate note, where do you put the probability of you having another car accident in next month? I am sure less than 10%, Where do you put probability of your country getting attacked by another big army? I am sure less than 10%. But yet we buy car insurance. And we support a hundreds of billions of dollars of expenditure on new fighter planes and boats.

Considering the catastrophe global warming can cause, and considering that most of the scientific community is in agreement of it’s seriousness, shouldn’t we be a little more concerned?

On this the individual pointed me out to a news clipping that said “there is not appreciable variation in earth average temperature over a last couple decades.”

Yes, there has not been appreciable variation. But the extreme temperatures are being more extreme. From livability of this planet point of view, average temperature does not tell the whole story. If your head is in a furnace at 140 degree f and your feet are in a freezer at 0 deg f, then average temperature of your body is 70 deg f. But that hardly means you are comfortable.

Growing up in India, I have personally witnessed tremendous expansion of cities and I believe that is happening all over the world. From the dawn of industrial age, which is barely 200 years, humans have managed to wipe out half the forests on this earth. And this has got to give in somewhere.

In India and I believe in most other countries, the push to counter global warming comes from conservative part of society. Because conservatives are more responsive to threat perception. But surprisingly it’s opposite in USA. In USA, the conservative part of society seems to be more opposed to the idea of action against global warming.

Why? The feeling you have while defending your country is “It’s my country and it’s the only country I have. I must protect this”. Why does this feeling not scale to the planet. It’s our planet and it’s the only planet I have at least so far. Why people are more responsive to the threat to their religion or country but not to their planet?

When you think of leaving your kids some wealth, do not forget to leave them clean environment. Otherwise  the piece of property and the fat bank account are of no use when there is no air to breathe.

 

Mind Shapes Words and Words Shape Mind


While walking in the park and trying to be mindful, I stumbled into the thoughtless, wordless state of mind. The engine that spewed out words just slowed down and stopped. At that point, the whole world around me remained just an endless stream of sensations. Breeze brushing against my skin, the sound of birds, the sight of trees and clouds, the road under my feet, all  were just there.

At that point I realized something. Not only the sensations shape the experience, but also the words we choose to describe the experience shape our experience . Calling weather “freezing” indeed makes it feel like a tad more cold than it is. When we utter or think of a word, all the previous memories of using that word are present and standing in the shadow of that word. We are so used to the endless  monologue going on in our mind that we don’t realize it’s power to shape our perception.

I had heard several spiritual speakers talking about this fact. But it’s always different when you experience it. I played with this while driving back. At the read light simply saying to myself “Oh, my luck is always so bad. I never get straight green lights.” indeed puts my mind in the victim mode. Or otherwise saying “I am not in a hurry anyway.” makes it not that big a deal.

Just like quantum particles exist as probabilities and collapse to concrete state at the moment of observation, the experience seems to be a set of probabilities collapsing into a structure, a narrative, the moment we use words to describe it.

According to Heisenberg uncertainty principle,  you can accurately determine either position of the particle or it’s velocity, but not both. The same way, we can either attend the sensations in the experience or attempt the capture in words. We can’t do both. It’s like at a tourist spot,  we can either look at  the beautiful mountains or try to get a good pictures so we can record it.

Just one more way our mind may possess quantum nature. It’s a mystery for sure.

 

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