Frugal Immersive tech for healing chronic pain

IBS patient update - initially I was feeling bored and also wanted to change the topic rather than listen to tiny and probably useless points when she was speaking at very slow speed and I had to rush to read more for exam preparation but I tried keeping patience for sometime and what I got was something extremely amazing. She was slow as many stories she had lived like real life were going through her mind, where most if them were painful ones.. She was trying to evaluate them and make it in meaningful statement as how she is awake with eyes open but far far away from reality, feeling living in imagination which feels completely real and some moments are so slow as if time have stopped and this super slow scene stays there for long like many minutes or probably even an hour as she fails to keep track of real-time and these Stationary scenes gives her most amazing experience. Amazing in happy or sad way or what, can't explain clearly but may be can say the most powerful feelings. She detailed more about kind of stories she have lived but avoided giving much details, may be because fear of being judged, specially as I am a good friend now or also because risk of being Interfered as I needed to get back to study.. With details what beautiful thing I learnt was her "self hypnosis" Helping her to get big relief from chronic physical and emotional trauma and pain.

This show's a good opportunity for use of immersive tech like VR/AR/XR/MR against chronic pain (physical/emotional) management which has already started to become reality.

For a person practising self-hypnosis, it may be better to be guided by a professional who may help do better, safer and maybe less saddening ways. Interested to hear from trained clinical hypnosis practitioners or please share in comments if any relevant publications.

Self hypnosis = frugal, immersive (human tech).

Reply from RB sir -  Amazing write up 👏   Reflective self hypnosis is a great idea toward a new tech supported therapeutic tool 👍

even with lesser cost, why better healthcare?

https://www.numbeo.com/health-care/rankings_by_country.jsp

even with lesser cost, why better healthcare?

"It was recognized from the 1940s onwards that what was needed was a ‘health policy’ rather than a ‘disease policy’ as summed up by the director of the medical services Dr W. G. Wickremesinghe as early as 1945. Despite this ongoing acceptance of the benefits of preventive medicine the balance of government expenditure was overwhelmingly in favour of curative medicine as is the case in most other countries. One estimate of this balance in 1975 suggested that for every rupee spent on the curative sector only 12 cents was spent on prevention of disease and the promotion of health. This situation prompted the director of the Colombo Hospital to ask in 1970: “Was it more important to improve sanitation, nutrition, and health education and provide basic facilities for health and patient care for the masses of this country; or was it more important to go in for sophisticated and expensive programs like heart transplant units?” (Daily News, 3 Sept 1970). However, the hospitals were the visible symbol of Sri Lanka’s free health service and the symbol of modernity; switching resources to preventive public health was a highly politically contentious issue.

There were deep roots to the development of primary health care services in Sri Lanka and it represented at international level an example of what could be done without the levels of expenditure common in developed countries. Sri Lanka´s experience was an essential part of the debate on primary health care which took centre stage at international level in the 1970s. Furthermore, given the extent of its hospital based curative system it was also a perfect illustration of the limits of that model for low-income countries in the context of a burgeoning population and economic crisis. However, in the succeeding decades the challenge for Sri Lanka has remained that of finding the most effective route to reducing morbidity. This is now an ever more pressing priority with the demographic transition to an ageing population and the resulting double disease burden."

https://www.ncbi.nlm.nih.gov/books/NBK316260/

https://www.who.int/chp/chronic_disease_report/sri_lanka.pdf?ua=1

For India - Same scenario of double disease burden.

Trading and Medicine analogy (complexity, uncertainity, technology) - part 11

 Auditing the trades

A learning portfolio which is much important aspect of medical education and currently improving in adoption across institutions in India. It is not something much different from journal's used by doctors in the last century and before. Analyzing the qualitative and quantitative data gives rise to insights and hypotheses and even helps to improve pattern recognition (both conscious and subconscious/intuition-based). Reflective learning is the most important aspect of creating a learning portfolio and I try to do the same using this blog as a learning portfolio. 

Having a trading journal, analyzing why a trade is taken, what was the risk-reward and the outcome understanding it more by reflective learning and gaining insight is of similar high value in both domains. When this data is recorded and checked at the end of day/week/month along with P&L (preferably at month-end), it's auditing the trades and similarly in medicine also clinical audits are done which helps in improving the clinical outcomes.

Somewhat related to the risk-reward of a trade is the NNT and NNH data of an intervention. Based on the scenario we select risk and reward ratio while taking a trade, and similarly based on clinical scenario we select an intervention with an appropriate risk-reward ratio i.e. NNT , NNH  and proceed with hope.

ref - https://www.thennt.com/nnt/aspirin-acute-ischemic-stroke/

Sometimes the scenarios are unclear in trades and it's easy to not trade at that moment/time/day where there is an opportunity cost as a loss but may prevent a much bigger loss, but in medicine when the scenarios are unclear as in complex or rare undiagnosed cases, ignoring complexity is same as opportunity cost loss, but failing to find a diagnosis or suitable intervention is a helpless scenario. Hopefully, the more learning around patient-centred way and accessibility to those learning portfolios will help many more as have been already helping in a slower way by case reports published in journals.

full blog series here - https://classworkdecjan.blogspot.com/2021/07/trading-and-medicine-analogy-complexity_52.html

Trading and Medicine analogy (complexity, uncertainity, technology)

Why trading and medicine analogy?

To become a trader we need to learn fundamental and technical analysis and understand about market and economy, the more we know and practice, the better we may become. Along with the above knowledge we also need to develop skills in identifying opportunities (diagnosing), using the right strategy as position sizing, stop loss defence, monitoring, (intervention, dose, duration, monitoring, follow up, change in plan, ADR check, etc.) 

And a few core principles like "never lose money" and it's equivalent in medicine as "do no harm" And all can be practised and visualized extremely fast in real-time with help of trades in the real market.  This can be a great educational strategy to explain the decision science concepts in medicine.

Read the 10 part blog series here - https://classworkdecjan.blogspot.com/2021/07/trading-and-medicine-analogy-complexity_52.html

Next, I plan to publish a journal article and a book in a case-based approach to help explore the concepts easily and in more detail. 

Open Access book link - https://docs.google.com/document/d/1Un30GEeSe1o6NZrKExBIGnJry7UInsBVoiIgJnWrjok/edit?usp=sharing

Trading and Medicine analogy (complexity, uncertainity, technology) - part 10

Iceland economy, and same globally, 2008 bubble, predicted by raghuram rajan in 2005 and similarly happened the dot-com bubble and many more.. One such bubble may be the hydroxychloroquine and similar eminence based, large scale and media promoted medications use for covid during the beginning which still being continued now to a great extent. The eminence based medicine even influenced official guidelines to a great extent and luckily the living guidelines /meta analysis got huge adoption to rule out the negative aspects.. The point to focus here is not the negatives of eminence medicine completely as when nothing was know about covid it was probably only way to go but as the world and research moved at super fast pace, it was more important to keep up with updates/data rather than keep playing blind and also to prevent misinformation based on updated information.

There are always some small/big bubbles, some eminence based guidance, biased eminence and evidence, and slow updates causing great damages. At an individual level overdiagnosis and overmedication is also one such problem to be managed actively by choosing wisely when to be a minimalist and when a maximalist, eg. In the recent flood of covid mild symptomatics, or hydroxychloroquine prophylaxis, etc. Where minimalist approach wouldn't have done any harm, specially when there was no data to support.

RB - 

"One way to implement rational minimalism is to first identify the "parachute" intervention (the one that hasn't been tested in an RCT and yet every physician knows they can't do without, for covid recently, it was oxygen) and then decide about the other interventions keeping wishes of all the stakeholders around the patient in mind rather than aim at covering all therapeutic targets with rational but marginal efficacies, all the while remembering that it's the trillion cells in the body that would be responsible for 80% of it's healing with time rather than the chemicals or molecules we deliver. 

In all this process the role of the doctor is very much like the man in this video 

https://youtu.be/klhOM2hxhRM,

who strapped a 100 year old US citizen onto his shoulders and jumped out of the plane along with him till he landed safely.

Rational minimalism may drastically summarize the three goals of medical care into one, which is to "be with the patient" till he lands safely. It would rely on strong and well designed complex empathy straps to hold the patient, doctor (and the family) together all through the plunge in regular best case scenarios."

ref - https://medicinedepartment.blogspot.com/2021/07/rational-minimalism-and-parachute.html

Trading and Medicine analogy (complexity, uncertainity, technology) - part 9

 Winning big, losing big, on similar trade.

It's commonly said but now I also feel that the market is a war between bears and bulls and my (and every trader to be successful) target is to be with the stronger one at the moment to get some profit and exit. It's so best to follow the trend and avoid catching tops and bottoms. 

I do mistakes frequently though, and one such mistake, when I tried catching the top, was when Delta variant started creating troubles in Europe recently as I was having the "intuition" based on medical knowledge as what it can do in the community at the national level and hence the economy. Sadly the trade was a failure initially and the market kept rising but after 2 days of big drawdown and losses in premium cost but finally, the market reversed and went down giving great profits. Similarly, when again I tried to catch the top but not with great logic, I failed badly. 

Learning point I want to emphasize here is its good to follow the trend, as good to continue the treatment that is helping, but sometimes logic may suggest a different idea or what logical may not seem to be helping in short term (minutes/hours/days depending on timeframe) but great in long term, and balancing the care plan by good decision making there is an art. A good simple example is TB medication where in short term the ADRs create bigger troubles but in long term view, sticking to it while minimising ADR where possible may be the best thing, similarly weaning of a ventilated patient though uncomfortable in short term but great in long term, and in a complex scenario where lots of unknowns and huge uncertainty efforts on analysing the case data by taking more/better/detailed history, available knowledge base etc. May be better than focusing on batteries of tests. It doesn't mean tests are not important, but it means patient centred research, analysis and maybe also N of 1 trials are more important to be utilized.