Monday 30 April 2018

FACTFULNESS – why things are better than you think?






When I read a good book I have this urge to share it with the world and when I hear about a good book I get impatient. So when none less than Bill Gates recommended this book I had to get my hands on it.......and I finished it in two days! FACTFULNESS is a book like no other, and when it comes from a Bibliophile like me, who reads everything from poetry to Times Classified, you would advised to take me seriously. On its cover the book boldly declares the author’s objectives: Ten Reasons We’re Wrong About the World-and Why Things Are Better Than You Think 


Written by Dr. Hans Rosling, a professor of international health at Sweden’s Karolinska Institute, this is a book about statistics and it shatters so many myths that after completing the book you are bound to be transformed into a far more optimistic person! Bestselling books about statistics are as rare as unicorns. If it becomes the No 1 bestseller it surely is as rare as a lunar unicorn. Factfulness by Hans Rosling is that moon-based creation.


I knew the author from his inspiring Ted talks https://www.ted.com/talks/hans_rosling_shows_the_best_stats_you_ve_ever_seen 

His first such talk thrust him into the international spotlight in 2006. In 2015, the Swedish professor asked an audience that included heads of state, titans of industry and a former UN secretary-general three multiple-choice questions about poverty, population growth and vaccination rates. To his delight — and dismay — they scored worse than average. Rosling’s well-educated audience in Davos did not know that the world’s average life expectancy is 70, that 88 per cent of children are vaccinated against disease or that in 2100 there will be 2 billion children below the age of 15 — the same number as today! Apart from in Africa, fertility rates have fallen so fast that populations have stabilised almost everywhere on Earth. One of Rosling’s favourite statistics is that Muslim Bangladeshi women have fewer children than Christian/atheist women in Sweden!  


Dr. Rosling left us for his heavenly abode on February 7, 2017. He was billed as the man in whose hands data would sing. The statistician in him was more likely to illustrate an idea with a few multi-coloured lego bricks than a PowerPoint presentation. In his lifetime had been described as everything from a data guru to a Jedi master of data visualisation. Rosling liked to call himself an “edutainer”. A talented presenter, whose signature animated data visualisations have featured in dozens of film clips, the statistician used humour and often unlikely objects such as children’s toys, cardboard boxes and teacups to liven up data on wealth, inequality and population.


FACTFULNESS has a very simple message - the vast majority of us get it wrong about the state of the world. We think it is poorer and unhealthier, more dangerous and violent than it actually is. The book explains how media bias, ideological preconceptions and statistical illiteracy makes most people believe in a gloomy and spectacularly wrong worldview. The book carefully explains by data and vivid examples how positive developments are systematically underreported, while disaster news is vastly over-reported. Rosling categorise the 10 most important sources of bias and misconceptions, some basic human instincts like fear, negativity, blame etc which caused a negative outlook of the world. He also carefully explained strategies on how to avoid them and develop an optimistic outlook.  


Our distorted picture stems partly from having media that inevitably report on tragedies such as starvation, war and school shootings, and from charities that accentuate the negative. Without ever dismissing suffering, Dr. Rosling argues that we need to keep two ideas in our heads simultaneously: things can be bad but they are also improving. In one provocative chapter, he celebrates the fact that “only” 4.2 million babies died last year, calling the number “beautifully small”. In 1950, when the population was much smaller, there were 14.4 million dead babies. We have made huge progress.


In the Chapter on ‘gap instinct’ Dr. Rosling debunks the Mega Misconception that “The World Is Divided in Two”. He goes on to how irresistible temptation we have to divide all kinds of things into two distinct and often conflicting groups, with an imagined gap—a huge chasm of injustice—in between. It is about how the gap instinct creates a picture in people’s heads of a world split into two kinds of countries or two kinds of people: rich versus poor, developed versus developing west versus east and so on


Factfulness is the product of his master craftsmanship of presenting the truth behind a deluge of data. He has in this book helped us identify where things are getting better and encourages us to counter the mainstream media’s agenda of doom and gloom and spread the message of improvement. This way the book and its author helps us to see the world more objectively and overcome the easy cynicism that so easily creeps into our way of thinking. The world has made huge progress which needs to be appreciated because only then we can look at a bad situation, which was worse once, and plan to improve it in future. This is the world view of a ‘possiblist’, one who believes that things could get batter and not that things will get better! Dr.Hans Rosling was a perfect ‘possiblist’.


Some of the statistics that Dr. Rosling produced were absolutely mind boggling. He categorized people by their income levels and emphasized the commonality that exists in each such level irrespective of where they live. Thus he has shown that people tend to buy shoes and bikes when they double their income from $ 2 to $ 4 a day irrespective of where they live – in the outskirts of Kinshasa or in the slums of Dhaka. So he went ahead to organize people along how they lived instead of where they lived and that way it was impossible for anyone to miss the progress made. His knack for presentation and delight in statistics come across on every page. Who else would choose a chart of “guitars per capita” as a proxy for human progress?


This is tremendously readable non-fiction.  It is well-researched, well-written, and organized for ease of learning, with honesty, humor, and personal perspective. The 354 page book is published by Flatiron Books and it costs Rs. 304.00 in Flipkart. The Kindle price is $ 4.21 and the hard cover is for $ 16.79. The PDF can be downloaded from https://soundcloud.com/free-ebooks/pdfepub-download-factfulness-by-hans-rosling-e-book

Wednesday 25 April 2018

GROWING THE ECONOMY AND STABILIZING THE DEBT








When it comes to planning a budget for the country the act is not very dissimilar to planning the budget for a family. The size certainly is very different but the intent and the purpose however are very similar. Just like a family, a country too has its wish list, a set of realistic goals for the year, it too has to identify all possible sources of income, list the expenditures according to its priorities and importance, and allocate funds for each of them, and save something for a rainy day.

The 7 Steps to a Budget are
·         Step 1: Set Realistic Goals. Goals for our money will help us make smart spending choices…
·         Step 2: Identify our Income and Expenses. ...
·         Step 3: Separate Needs and Wants. ...
·         Step 4: Design our Budget. ...
·         Step 5: Put our Plan into Action. ...
·         Step 6: Seasonal Expenses. ...
·         Step 7: Look Ahead.

While families manage to strike a balance between their income and expenditure on most occasions, governments are often not so smart. They end up spending more than they earn, thus adding to their Credit Card debt. A "government deficit" refers to the difference between government receipts and spending in a single year. And how does the government meet this deficit? Naturally by borrowing and this is “government debt”. So the government debt is the debt owed by a government.

This government debt can be categorized as internal debt (owed to lenders within the country) and external debt (owed to foreign lenders). Another common division of government debt is by duration until repayment is due. Short term debt is generally considered to be for one year or less, long term debt is for more than ten years. Medium term debt falls between these two boundaries. A broader definition of government debt may consider all government liabilities, including future pension payments and payments for goods and services which the government has contracted but not yet paid.

Governments create debt by issuing securities, government bonds and bills. Less creditworthy countries sometimes borrow directly from a supranational organization (e.g. the World Bank) or international financial institutions like IMF and Asian Development Bank. So government debt is effectively an account of all the money that has been spent but not yet taxed back. The ability of a government to repay this debt is dependent on how much it earns annually and this is its ‘Gross Domestic Product’ or GDP.

GDP is an aggregate measure of production equal to the sum of the gross values added of all resident and institutional units engaged in production (plus any taxes, and minus any subsidies, on products not included in the value of their outputs). GDP thus measures the monetary value of final goods and services—that are bought by the final user—produced in a country in a given period of time. 

The debt-to-GDP ratio is the ratio of a country's public debt to its gross domestic product (GDP). By comparing what a country owes to what it produces, the debt-to-GDP ratio indicates the country's ability to pay back its debt. Often expressed as a percentage, the ratio can be interpreted as the number of years needed to pay back debt if GDP is dedicated entirely to debt repayment. Generally, Government debt as a percent of GDP is used by investors to measure a country ability to make future payments on its debt, thus affecting the country borrowing costs and government bond yields. So countries with modest debt-to-GDP ratio can borrow money to meet their deficit at a lower rate and those which have alarmingly high debt-to GDP ratio end up borrowing at a much higher rate thus compounding their already fragile fiscal situation. If a country is unable to pay its debt, it defaults, which causes panic both in its domestic and international markets, as it has both internal and external debts. The higher the debt-to-GDP ratio, the less likely the country will pay back its debt and the higher its risk of default!

Governments have the unenviable task of achieving two goals at once:
1.      Faster economic growth that will create more jobs and bring the unemployment rate steadily down.
2.      A sustainable long-run budget plan that will halt the rise in the debt/GDP ratio or better still, put it on a downward trajectory.

The two goals reinforce each other and neither can be achieved without the other. Weak economic growth—or worse, sliding back into recession—will reduce revenues and make it much harder to reduce or even stabilize the ratio of debt to GDP. But the prospect of debt growing faster than the economy for the foreseeable future reduces consumer and investor confidence, raises a serious threat of high future interest rates.

Stabilizing and reducing future debt does not require immediate austerity; on the contrary, excessive budgetary austerity in a still-slow recovery undermines both goals. But it does require a firm plan enacted soon to halt the rising debt/GDP ratio and reduce it over coming decades.

What is ideal debt-to-GDP ratio?
Economists have not identified a specific debt-to-GDP ratio as being ideal, and instead focus on the sustainability of certain debt levels. If a country can continue to pay interest on its debt without refinancing or harming economic growth, it is generally considered to be stable. A high debt-to-GDP ratio may make it more difficult for a country to pay external debts, and may lead creditors to seek higher interest rates when lending. Then again while governments may strive to have low debt-to-GDP ratios, government borrowing may increase in times of war or recession and government earnings may be depleted by poor harvest and mindless subsidies.

Some World Figures
Global debt reached a record high in 2016 at $164 trillion, or almost 225 per cent of global GDP. China alone has contributed to 43 per cent increase to global debt since 2007. Public debt is currently at historic highs in advanced and emerging market economies. Average debt-to-GDP ratios, at more than 105 per cent of GDP in advanced economies, are at levels not seen since World War II. The average debt-to-GDP ratio among Organisation for Economic Co-operation and Development (OECD) countries in 2015 was 111.2%. A number of countries had a debt-to-GDP ratio in 2015 that was over 100% including Belgium at 105.4%, France at 116.1%, Greece at 188.2%, Ireland at 132%, Italy at 147.4%, Japan at 232.5%, Portugal at 142.2%, Spain at 111.5% and the United Kingdom at 103.1%.

The United States had a debt-to-GDP ratio of 104.17% in 2015 according to the U.S. Bureau of Public Debt. The United States experienced its highest debt-to-GDP ratio in 1946 at 121.70%, and its lowest in 1974 at 31.70%. Debt levels gradually fell from their post-World War II peak before plateauing between 31 and 40% in the 1970s. They have been rising steadily since 1980, jumping sharply following the subprime housing crisis of 2007 and subsequent financial meltdown.

The U.S. government finances its debt by issuing U.S. Treasury bonds, which are considered the safest bonds on the market. The countries with the 10 largest holdings of U.S. Treasury bonds are Taiwan at $182.3 billion, Hong Kong at $200.3 billion, Luxembourg at $221.3 billion, the United Kingdom at $227.6 billion, Switzerland at $230 billion, Brazil at $246.4 billion, Ireland at $264.30 billion, the Cayman Islands at $265 billion, Japan at $1.147 trillion and Mainland China at $1.244 trillion.

Where is India?
India's general government debt remained relatively high, at 70 per cent of its GDP in 2017, but authorities are planning to bring it down over the medium term with the right policies. For economies that are growing rapidly, a higher debt to GDP ratio is acceptable. This is because its future earnings will be able to pay off the debt much more easily than a country with a slow growth rate. India on date is the world's fastest growing major economy. Another factor that determines the health of an economy and its debt to GDP ratio is its demographics. The older the average age of the country’s population, greater the cause of concern. For example, an ageing population like China's is a cause of concern as there will be more pensioners than earners. India on the other hand has the world's youngest population. India's external debt witnessed a decline of 2.7 per cent over its level at end-March 2016. The decline in the magnitude of external debt was partly due to valuation loss resulting from the depreciation of the US dollar with respect to the Indian rupee, but the role played by correct policy decisions cannot be under-played.

Avoiding Disaster, Growing the Economy and Stabilizing the Debt should be our mantra for future. Indeed, higher investment in science, education, and modern infrastructure is needed to foster future productivity and job creation. While savings in defence can be made over time, they should result from serious planning, not mindless cut, regardless of priorities as integrity of the Nation is non-negotiable.

Tuesday 17 April 2018

BROW RAISING FACTS ABOUT EYEBROWS






Remember how Priya Prakash Varrier with her dancing eyebrows winked her way into our hearts and became an overnight internet sensation! Eyebrows and expression have a long association and are invalable assets for the exponents of our classical dance forms - Bharatnatyam, Kathakali, Kuckipudi and Mohiniattam.


We Plastic surgeons have been bothered about the eyebrows for a very long time as drooping eyebrows make the face look aged and nice arching eyebrows signify youthfulness. So in our eternal quest of rejuvenation we have been working in and around the eyebrows since quite some time. It was only when we started replacing missing parts of the eyebrow did we realize that each one of them comprises of three sections – head, body and tail and the body has two halves upper and lower and all four of these parts i.e. head, upper body, lower body and tail, have hairs growing in different directions!


If you compare modern human beings to our prehistoric ancestors, one of the most obvious physical differences you'll find is the lack of a massive brow ridge. Over time, human evolution led to us developing finer facial features, smoother foreheads, and eyebrows. But why did this happen?


A recent study, published in Nature Ecology and Evolution claims that eyebrows that are mobile help people with non-verbal communication, which is one of the traits that make us the most advanced human species to ever exist. In contrast, the Neanderthals' jutting brow was used for displays of dominance and sexual attraction instead, similar to the function of a stag's antlers.

"Sexually dimorphic display and social signaling is a convincing explanation for the jutting brows of our ancestors," said Paul O'Higgins, senior author of the study and professor of Anatomy at the University of York. "Their conversion to a more vertical brow in modern humans allowed for the display of friendlier emotions, which helped form social bonds between individuals".

Around 100,000 years ago, human groups began to diversify their social networks, which is why it made evolutionary sense to prioritize emotional responses over violent adaptations. Scientists claim that it is around this point in history that human being began to develop smaller and flatter brow ridges, as well as the mobile eyebrows that we still have today.


Eyebrow movements allow us to express complex emotions as well as perceive the emotions of others. A rapid "eyebrow flash" is a cross-cultural sign of recognition and openness to social interaction and pulling our eyebrows up at the middle is an expression of sympathy. Tiny movements of the eyebrows are also a key component to identifying trustworthiness and deception. On the flip side, it has been shown that people who have had botox which limits eyebrow movement are less able to empathize and identify with the emotions of others.


But why do we have them in the first place? Is it only to communicate through our expressions? The consensus seems to be that eyebrows keep moisture, like sweat and rain, from running down a person’s forehead straight into the eyes. This explanation is easy to visualize when you look at the morphology and facial features involved — most notably, the pronounced slant of the eyebrow hairs which directs water away from the eyes. This has obvious evolutionary survival advantages. Sweat tends to be very salty, and salty liquids getting into your eyes while you’re running in an African Savannah would be a severe hindrance to hunting. It could also be a potentially deadly problem when the tables are turned and you are fleeing hungry predators. Eyebrows give those potentially deadly distractions a detour to the side of the face, instead of right into your eyes.


Beauticians have been dabbling with the eyebrows since ages. According to them there are six facial shapes - Oval Face, Round Face, Long Face, Square Face, Heart shaped Face , Diamond shaped Face and there is a best eyebrow shape suited for each facial shape! Party heart-throbs, brides and cine-artists have all had special attention paid to their eyebrows to make them look more beautiful and sexy. What they as for can then do with this ammunition, only sky is the limit!


Geneticists have established that the shape, color, and thickness of your eyebrows are inherited traits. In one major study in 2015 ( https://www.nature.com/articles/ncomms10815 ), scientists found a strong relationship between inheritance of specific genes and eyebrow appearance. Four separate genes may affect eyebrow hair texture, one gene may determine eyebrow shape, five genes affect eyebrow hair color, and one gene determines whether or not you develop a monobrow. But, environmental factors also have a lot to do with how your eyebrows look. Years of waxing or tweezing your eyebrows can permanently affect their shape. Injuries to the skin near your eyebrows can also affect hair growth and eyebrow shape.


Just as eyebrow characteristics are inherited, so are abnormalities affecting the eyebrows. One of the most common abnormalities affecting eyebrows is madarosis, or loss of eyebrows. The term madarosis can also refer to loss of eyelashes. This can be caused by many different inherited disorders. Several congenital facial clefts also traverse the eyebrows, clefting them too!


So, eyebrows are the Swiss Army Knife of the human body—they do everything!




Monday 2 April 2018

Knowledge and technology: A turbulent marriage!





KNOWLEDGE and TECHNOLOGY are two comets that we are trying to ride at the same time. Both are fast and we have no control over them. We are holding on, with great difficulty, to the searing tails of these two Comets, hoping that they will take us to the right place at the end of the ride. Sometimes we pray that we can hold on for the entire ride. Sometimes we find ourselves praying that Almighty God will be merciful and just let us fall off. What we shudder to think is what will happen the next time the two Comets choose to move in opposite directions as they have undoubtedly done in the past.

While it is so true that we cannot hold on to the older proven techniques and should continue to strive for excellence at all times, the reality is that all that is new and available is not invariably good and useful. There is a lot of market driven euphoria and baseless jingoism with quite so called new gadgets, hence our reluctance to succumb to them. When confronted with a new machine / technology we should ask whether we are the masters or the slaves of technology. Once we understand that we must be the master, the rest is fairly simple. The ultimate purpose of any technology is to help its master to do his or her job better. Our job is to cure patients, improve the quality of recovery and patient's well being, and reduce the sufferings of those we can not cure. We also must make treatment efficient and cost effective. If a product of the new technological boom does not meet these criteria, we must ask “Why are we doing this?”

State of the art technology is no substitute for state of the art knowledge; in fact it is quite useless and on most occasions downright harmful without it. Technology has not always taken us to the crest of success. The moment we have allowed it to lead our knowledge, with our subconscious connivance, it has led us astray, or more correctly we have allowed technology to lead us astray. Extracorporeal Shock Wave Lithotripsy (E.S.W.L.) has broken millions of stones in the kidney, ureter, and bladder. Thinking it to be a stone breaking machine, a few amongst us tried to crush stones in the gall bladder expecting them to disappear like magic. We conveniently forgot to compare the anatomy and physiology of the two organs - in one clear urine washes down the debris through a straight ureter and in the other thick viscid bile slowly finds its way down across a serpiginous course and through a valve. The result was a disaster of enormous proportions - all because we did not do our homework well. The marriage of knowledge and technology is a very turbulent one as both are highly ambitious and growing rapidly. A postal delay in the delivery of two journal issues leaves one fairly behind in patient care and ignoring seminars and conferences makes one antique.

If necessity is the mother of invention, then strategy should be its father. Technology should not evolve spontaneously. Its evolution should be our responsibility. Where do we go from here? What technologies are on the horizon? How do we open our minds without closing too many doors? Surgeons are looking at various technology that could enormously improve patient care and even put them out of business; technology that can fix things without touching them, and touch things without seeing them. These are weary yet exciting times!

The future very often arrives faster than expected. In 1996, a renowned biologist, Lee Silver of Princeton University, wrote that it is impossible to clone mammals via cell-nucleus transfer. His book had not even reached the bookshops when scientists of the Roslin Institute in Scotland announced that they had succeeded in cloning ‘Dolly’ the sheep. The best way to predict the future is to invent it. Delightfully mesmerizing visions of the future created by research laboratories, think tanks, science fiction authors, other visionaries and clairvoyant sooth-sayers not only form a matrix for the social perception of tomorrow's world but also open up a plethora of opportunities. Such futuristic thoughts are known as memes, which propagate in society like a cultural gene. Mass media dictates the collective expectations of society, hence they can analyze the memes. Cinema can project new technologies as being real even if they are in the developmental stages and society will accept it, at least in the subconscious mind. The most radical ideas from science and fiction may find solutions to problems that we face in real life. On the other hand, consumer expectations are also programmed in this way. Microvascular transplants of severed limbs were seen in comic strips half a century ago; today they are a reality in a general hospital near you!

Human life might also become programmable. Families will be designed and children selected according to catalogs. The gender of children might be reversible during the course of pregnancy and the little brother may be a robot! Thus, our notion of family happiness might be programmed and human beings would like to make the entire world a theme park where spectacular experience boosters are available. One-minute holidays and artificial hibernation of unproductive times will become the order of the day.

In the healthcare sector of the future, less emphasis will be placed on curing illnesses than on prevention and well-being. Beings and machines will merge; body and consciousness will be rewired. The new combination of natural and artificial hardware and software will create mechanical humans and human machines. Death might become optional with artificial parts increasingly replacing diseased organs. The secret of self-healing will be decoded, changing the treatment pattern of today. But human evolution will continue and result in new intelligent beings.

The future belongs to those who tell the best stories about the future; in other words, only creative thinkers will get an opportunity to contribute towards future professional needs. Plastic Surgery is generally considered to be a skill-based specialty but we have begun to establish our knowledge base. As a knowledge-based specialty, adoption of new technology is a natural extension of our commitment to patient care and not to skill-based bravado. Many new technologies are adopted from other fields viz. nanotechnology, lasers, etc. With a solid knowledge base, we will not be afraid of technological failures and will adopt technology as early as possible. Many technologies are popularized by corporate investments, which may not be inherently interested in patients but be more of business opportunities. This profession has to manage the pressures of the market without ignoring the science because ignoring them totally will be fatal to our future growth. Knowledge has to remain a step ahead of technology and riding these two comets, though not easy, has to be done throughout the active professional life of a professional.