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Forty One and Counting

Posted on November 15, 2008
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I went for a long run on Tuesday, here in Kailua, Hawaii. There is a little mountain near here and I decided to run up that if it was possible. It involved scrambling up a really steep slope and then preventing myself from slipping down badly an even steeper slope, with running in between along a knife-like ridge overlooking the little hamlet of Lanikai with the backdrop of the spectacular, jagged Ko’olau mountains on one side and the turquoise, aquamarine Pacific on the other. The trail was narrow and overgrown with bushes in places. The scenery was breath-taking.


Someone told me that it was essential to carry water to complete the ridge and a challenge was laid down. When I was at my peak, I could run a half-marathon with just a swig of water, midway through the distance. But I haven’t run more than 10 miles in the last nine months and not more than five the past month. I had no water, but something inside me said that I wanted to do this entire loop.

I met only two people during my run. I asked one of them how to go all along the ridge but drop back into Lanikai instead of the neighboring, but far away town of Bellows Air Force Base. Hang left all the time was the advice. And watch your footing. When I run, I plan the run upfront such as “I’ll complete a 10K today with 3 miles at my threshold running pace” or “I’ll do a half marathon today”. And I rarely waver from that plan. I don’t go charging up mountains, follow a completely unknown trail, not knowing how long it’ll take and not worry about my pace. When I returned to the cottage an hour and forty minutes later, I was tired but exhilarated.


This week, I celebrate my forty-first birthday. I’m as much a creature of habit and lassitude as anyone else. As I age, I want those to become less of a problem they can otherwise be. As we age, we become more conservative, they say. We stiffen both in our bones and in our souls. I want to stay limber. Running that ridge was an attempt to do that.

Forty years seems a marker just like thirty was. Many people tell me that whatever that they have not managed to accomplish by the time they’re forty, they don’t think they will accomplish after, that they will remain who they are once they pass forty. Two colleagues at work the other day shuddered as they talked of going past forty (which they will next year). People say that friends made in college or earlier are the best friends they ever had, that they have not managed to make close friends later in life. A study reported earlier this year using data from 2 million people from over 80 countries found that people are generally miserable in their middle age, that happiness over a lifetime is a U-shaped curve.

Part of the problem may just be the ideas we carry about what aging means. Many people dye their hair as they get older (I’ve been asked several times about why I don’t dye my hair). A friend got himself a convertible, to handle his mid-life crisis, he said. My parents carried on about how they had one foot in the grave, that they were old, starting from their late forties. A colleague at work told me wistfully how he had bicycled up and down the Canadian Rockies in his twenties and that he couldn’t dream of doing it now (he was in his late thirties). Studies seem to indicate that our ideas of age can influence how we react to aging.

Consider a study conducted in 1996 by three researchers from New York University that had volunteers (male and female graduates at NYU) rearrange groups of words that were scrambled to form the correct sentence (for example, “they her brother see usually”). The volunteers were told that they were undertaking a test of verbal acuity and flexibility. Unknown to the volunteers, one group was given words that stereotype the elderly such as ancient, old, lonely, Florida, forgetful, retired etc. while the other group was given words that were neutral i.e. they did not contain words that stereotyped the elderly. After they completed the words, one of the researchers thanked them and bid them goodbye. Unknown to them, the real test began now. Another researcher sat outside in the corridor and using a hidden stopwatch, measured the time each volunteer took to walk the length of the corridor to reach the elevator to exit the building. The researchers found that volunteers who were primed with words that stereotyped elderly took much longer to walk the corridor than the ones who were not. They were unconsciously acting as if they were older than they really were. They volunteers didn’t know that they had been primed with words that contained stereotypes of the elderly (the original researcher caught up with the participant at the end of the corridor and explained the real experiment and checked if the participant had detected that the words were stereotypes of elderly people).

Another study conducted in 1970 organized a five day retreat for people over 70 in which the people were made to think as if they were 20 years younger. For example, they were surrounded with magazines that were from the time they were in their fifties, listened to radio and TV shows from when they were in their fifties, encouraged to speak in the present tense about topics that were current when they were in their fifties. After five days, the results showed that the men had significantly improved their visual and memory acuities and even their joints were more flexible. The study reports that on average, photographs showed them younger than the photographs taken before the retreat. Making people think and live for five days as if they were twenty years younger made them physically and mentally younger.

I came across a saying many years back: “How old would you be if you didn’t know how old you were ?”

I’ve had a wonderful, blessed life so far. Been absurdly fortunate. Have Shanthala and Maya by my side and memories of Kitty to prove that. Less than a century ago, I’d most likely be dead already (average life expectancy in India was forty around independence time) . I was raised me with a lot of love. I could go on and on. A recent study found that rare, major happy events won’t make us feel as happy as lots of little ones. My life has been filled with both.

Some time when the river is ice ask me
mistakes I have made. Ask me whether
what I have done is my life. Others
have come in their slow way into
my thought, and some have tried to help
or to hurt: ask me what difference
their strongest love or hate has made.

I will listen to what you say.
You and I can turn and look
at the silent river and wait. We know
the current is there, hidden; and there
are comings and goings from miles away
that hold the stillness exactly before us.
What the river says, that is what I say. - Ask Me, William Stafford

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How Doctors Think: A Review

Posted on October 30, 2008
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The sister of a friend of mine in India suffered from Crohn’s disease, a disease of the digestive system that is rare amongst Asians. Her condition was misdiagnosed for several years, causing her an immense amount of suffering. I have another friend who’s wife is suffering from something that has not been identified yet. Every doctor seems to think something else is wrong and she’s subject to a different treatment each time. Even temporary relief is rare.

Studies based on autopsies indicate that 10-15% of diagnosis are wrong. What are the causes of these failures of diagnosis ? Is it that the condition is really rare such as in the case of Crohn’s disease that it is difficult for the doctors to know or is it something else ? Come to think of it, how do doctors think their way to a diagnosis ? And why is it that many times, two different doctors disagree on the diagnosis ? What if I were a drunk or if I was obese ? Does my doctor emotionally react to my state (in disgust, for example) or don’t they ? If they do, how does that color their care ? What if they were positively affected by my condition, seeing me fit, in good condition, articulate and well mannered ? Does their positive thinking about me negatively affect my care ?

How Doctors Think by Dr. Jerome Kroopman is a book that addresses these questions. Dr. Kroopman, himself a physician and a professor at Harvard Medical School, has written a brilliant, lucid and engrossing book that addresses the very nature of how doctors think. That our thinking is fraught with myriad cognitive biases is well accepted now. This book illustrates how those errors are at the heart of incorrect diagnosis and the conditions that cause them.

Dr. Kroopman says that experts studying misdiagnosis that caused serious harm to patients attribute most errors to errors in thinking, not to lack of medical knowledge. He quotes one study that attributed 80% of misdiagnosis to cognitive errors, and another study that parceled inadequate medical knowledge to only 4% of the cases. About 15% of all diagnosis were incorrect says a 1995 report in which doctors provided a diagnosis based on written descriptions of the patient’s symptoms and examined actors simulating patients with various diseases. The average diagnostic error in interpreting medical images (such as XRays, CAT scans and MRI) is about 20-30%, an alarmingly large number. In a study assessing 100 radiologists on chest x-rays, they disagreed amongst themselves 20% of the time, when asked the same question a few days later after studying the same x-ray again, they disagreed with themselves 5-10% of the time. 60% of them failed to identify a missing clavicle. But cuing them saying that these x-rays were part of identifying cancer, 83% of them identified the missing clavicle, when told that it was part of an annual physical, 58% missed the finding.

Over the course of 320 pages and 10 chapters, Dr. Kroopman looks at different kinds of doctors from ER physicians to family practitioners to pediatricians to radiologists to specialists and brings a keen eye to the nuances of each profession, their difficulties and their practices and how cognitive errors enter the diagnostic process. In an era where doctors find themselves squeezed by money on either end, by big money pharma on one end and by the insurance industry at the other end, the book also addresses the kinds of cognitive errors that result, in part, by the the role of these two major ecosystem players.

The Cognitive Errors

Dr. Kroopman runs through the gamut of cognitive biases as he follows the minds of doctors during the course of their making a diagnosis. Many of these cognitive biases amplify each other resulting in a decision that seems rock solid to the physician but is not.

When a doctor sends a request to a radiologist asking for a check of the lungs for checking lung cancer, that question makes the radiologist think in a particular way, about lung cancer as opposed to say pneumonia. Or at other times, a doctor may send a patient to a specialist with a statement such as “I’m sending you a case of renal failure and diabetes”. Forcing doctors to think about particular outcomes makes them not think about certain others. This creates the framing error. A simple joke illustrates the framing error. Two friends go to a church for praying and one of them gets an urge to smoke. He decides to check with the priest before smoking. He asks the padre, “Father, is it OK to smoke while I pray” to which the father responds with utter horror and chastises him. When he reports the result to his friend, his friend says that he asked the wrong question and proceeds to ask, “Father, is it OK to pray while I smoke” to which the padre gushes, “My son, it is always OK to pray when you’re doing anything”. The first question activated the “smoking” frame and the second, the “praying” frame. The annual physical versus the cancer example quoted at the start of this article is a more pertinent and troubling example of the framing error.

A pediatrician seeing a stream of cranky children with fever who have the flu can easily overlook the one exception with meningitis. A doctor in India seeing a patient with diarrhea, vomiting and abdominal pain is more likely to consider irritable bowel syndrome rather than Crohn’s disease because that is the common case and Crohn’s is hardly seen. In other words, the brain arrives at a specific conclusion (or set of conclusions) based on the information that is easily available and we implicitly assume that “if we can think of it, it must be important”. This is called availability error. If I asked you if there are more number of words that start with the letter t compared to words which have t as the third letter, you’re more likely to think that it’s the former because of the ease with which you can come up with words that start with the letter t.

Once we’ve arrived at a conclusion, we tend to selectively look for data that confirm our conclusion and ignore or reinterpret the rest. This is called confirmation bias. Ego is a big factor here since we like to think of ourselves as more competent than we really are. Various studies show that the more incompetent we are, the more certain we tend to act (Sarah Palin effect ?). One example that Dr. Kroopman points to is a study comparing 100 radiologists in which the bottom twenty were more confident than the top twenty.

In another anecdote, a doctor looking for the cause of a persistent ache in the hand concludes that the cause are cysts in the hand when the problem was something else altogether. Search satisficing is caused by our stopping to look for causes once we’ve settled on one. For example, if you’re rushing to the airport and realize you’re missing your wallet, you start searching for it desperately; once you find it, elated, you rush out of the house, only to realize much later that you’ve forgotten the plane ticket inside. Having seen the cysts, the doctor stopped looking for other causes. Dr. Kroopman quotes a physician, “”Finding something maybe satisfactory, but not finding everything is suboptimal”.

Anchoring is another reason for search satisficing. In an experiment, participants were asked about the percentage of African nations that were members of the UN. They asked one group whether the percentage was more or less than 45% and they asked the other group if the percentage was more or less than 65%. Each group tended to anchor their answer around the number quoted to them, 45% or 65%. The doctor who arrived at the cysts as the answer, weighted his diagnosis by anchoring his decision on the importance of cysts.

Many of these errors are also caused by attribution error, especially if the patient is associated with negative stereotypes. Dr. Kroopman provides the anecodote of a patient who comes to a doctor after a decade of illness with labels of “anorexic” and “psychiatric” and how those labels helped many doctors give the patient a short shrift, arriving at a diagnosis rather quickly. Similarly, a doctor seeing a very personable, older patient may demur from subjecting him to a more invasive test that would really clear that little lingering uncertainty about the diagnosis.

Commission bias is caused because of the very nature of the medical profession (nay, the Western culture). It is the desire to act instead of observe. “Don’t just stand there, do something” is the Western mantra. Dr. Kroopman points to surgeons as examples of people with this bias.

The Conditions

All these cognitive biases are heuristics that we resort to when we’re in a hurry. Most of these biases can be overcome by pondering. But in an age where pediatricians and general practitioners attempt to remedy their lowering reimbursements from HMOs by seeing more patients, ponder is something they cannot do. And in places like ER, the very nature of what they do forces the physicians to work quickly. One ER physician is quoted as saying that he feels like a circus juggler, spinning plates on a stick; slowing down will cause everything to crash. Similarly, a primary care physician is quoted as saying that looking for the out of the ordinary gets very hard because she feels like someone looking for a face in a passing train; if the train goes faster and faster or if you get distracted, you can easily miss that face. Dr. Kroopman states that on the average, a radiologist views 150 CAT scans over a weekend and a CAT scan has dozens of images; new technologies such as MRI produce hundreds of images. Scanning them visually looking for errors takes time and time is always pressing (on the other hand, a radiologist who looks at an image for more than 38 seconds, risks seeing things that aren’t there).

Physicians also have to walk a balancing act between raising unnecessary fears and ignoring real problems. Learning how to communicate becomes a key factor. Dr. Kroopman says that there is a myth that a brilliant doctor is a poor communicator and a good communicator is a poor doctor. Both are essential, he says. A good doctor is one who communicates well, listens and speaks. The kinds of questions (s)he asks can result in a diagnosis arrived at through a stream of cognitive errors. Most of us are afraid and anxious when we visit a doctor, we also don’t want to appear stupid, as somebody wasting the doctor’s time. If we perceive the doctor is rushed or don’t get asked the right set of questions, we may not provide the information necessary to arrive at the right diagnosis. A study found that on average, a doctor interrupts a patient 18 seconds after the patient first starts telling their story.

Dr. Kroopman also says that much of what doctors practice is a result of where and under whom they studied. Shanthala tells me of procedures that were insisted on in her MD program that the hospital where she works don’t insist and instead do it slightly differently. “Playing God” is a familiar term used to describe doctors. Part of that allure is the mask of certainty that most doctors exude. Dr. Kroopman says that the orthodox and conservative medical establishment fosters such attitudes.

What Can We Do

Reading books like this can leave us wondering if there’s anything we can do. Fortunately, Dr. Kroopman offers lots of suggestions, questions that we can ask to jar the doctor out of their heuristics. For example, we can ask what organs are around where we’re having the problem forcing the doctor to consider other possibilities than gall stones. Or we could ask the doctor to compare the lingering pain post-surgery to having a tooth pulled to get more specific answers. He even helpfully summarizes all these questions in a single epilogue.

Dr. Kroopman addresses these and much more in a book filled with real life anecdotes, many from his own life, both as a doctor and as patient; most of the cases are real cliff hangers. He rarely casts a jaundiced eye on either the doctor, the system or the patient, though he does sound skeptical about the current health care system with insurance companies and big pharma calling the shots. Overall, a very knowledgable and pleasurable read. Highly recommended.
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Encephalon

Posted on October 28, 2008
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I’m pleased as a punch that my entry on infantile amnesia got included in Encephalon, the compendium of the best brain and mind writing of the past fortnight. This edition was hosted on Mind Hacks, one of my favorite sites for reading up on neuroscience and cognitive science.
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Oh! Why Can’t She Remember

Posted on October 23, 2008
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Starting here, what do you want to remember ?
How sunlight creeps along a shining floor ?
What scent of old wood hovers, what softened
sound from the outside fills the air ? – William Stafford

I am four years old (or is it three ?), walking with my parents down a street in Coimbatore, a city in Southern India, where we lived at the time. All of a sudden, my parents start pointing to things on the opposite side of the street, hoping they can distract me. But, it’s too late. I’ve spotted the red bus in the display window of the toy store we’re passing and start demanding that they buy it for me. I kick up a ruckus in the street. My parents tell me that if I don’t stop, they’ll just abandon me in the street and go away. “Go ahead”, I said, like some miniature Clint Eastwood, “Leave me. I’ll just hop into an auto and tell them to take me to Tatabad and come home”.

This is among my first vivid memories of my life. Is it a real memory or one planted much later, made up after the countless repetitions of the event over the years ? I can recall playing with the maids who worked in the house at that time, a mother and daughter pair, a house on the second floor (first storey for the British versions) with a big balcony overlooking the street. I don’t recall any friends from that time nor any other details such as the school that I went to. I cannot recall anything earlier in my life.

As I played with Maya the other day, it struck me that she will not be able to recall the memory of that day and of all the days before that. The care, the love, the sleepless, exhausting nights and days will all be folklore, hand-me-downs from her parents. Yes, there will be the photos and the videos, but it’ll never be the same as remembering it herself. It seems like one of life’s ironies that we cannot recall those days, when we were so cared for, nursed to life when we were most vulnerable, how much we depended on parents and how selflessly they served us (though my father admits that when he wanted to sleep, he would rub a pain balm on my forehead that would burn, making me close my eyes and fall asleep). If we remembered those days and nights, would we be less angry at our parents as we get older ? Intelligent design ? Well, certainly ironic design.

Curious about everything associated with babies now, I wondered about this inability to remember our earliest times.

The condition is real. It goes by the name of infantile amnesia. The story of what causes it is a long one, it is the story of our attempts to understand the very fabric of ourselves, what makes me think of me as me, the story of memory. Saul Bellow famously wrote “Memory is life”. Several books, some of them bestsellers like Daniel Schacter’s “Searching for Memory”, are devoted to this subject. It is also an ongoing story because there is still much that we do not know. And sometimes new research throws out old, seemingly solid explanations. Here is my attempt to synthesize that story into something small enough to fit a blog post.

Memory is a many-splendored thing. There are many forms of it, many places in the brain where it is constructed and stored. For example, almost everybody is aware of short term memory and long term memory. Short term memory or working memory is how we experience the now, the immediately immediate past. It is where we store the telephone number long enough to dial the number. It is fairly limited in capacity, capable of storing about 7+/-2 items, be they telephone numbers or something else. Long term memory is the remainder of that immediate past, stored and retrieved many, many times, sometimes years later. Another kind of memory is what is called implicit or procedural memory. Even if an Maya can’t remember the details of these initial years, she is learning many things perfectly well, such as the ability to sit, crawl, walk, learning that a cry usually fetches one of us pretty quickly. Contrasting this implicit memory is explicit or declarative memory, the consciously recalled past. Explicit memory itself is made up of two kinds: episodic memory, an example of which is the story at the start of this entry and, semantic memory, which is our knowledge of how the world operates such as physics, maths, social roles and culture.

Like just about everything in neuroscience, or at least modern neuroscience, much of what we know is a gift from a host of unfortunate characters, people who’ve suffered some form of grievous injury to their brains, providing neuroscientists an opportunity to glimpse into the functioning of the brain. For memory, the main individual is known only by the initials H.M (or Henry M). Suffering from epilepsy from an early age, HM was referred to a surgeon, William Scoville, in Connecticut, USA. After localizing the cause of the seizures to his medial temporal lobe, Scoville surgically removed the structure in an attempt to stop the seizures. After the surgery, HM lost his memory, became an amensiac, suffering from severe anterograde amnesia i.e. he was unable to convert any short term memory into long term memory. However, he could still learn new motor skills, indicating that his procedural memory was intact, though he couldn’t remember learning the skills. Since HM had no amnesia before the surgery, the medial temporal lobe was held responsible in the functioning of memory.


Starting from that event in 1953, we arrive at today’s understanding of the parts of the brain that are associated with the functioning of memory. Based on the outcome of the surgery on HM, the hippocampus is generally credited with playing a key role in the creation of new explicit memories. What that role is remains uncertain. A recently published study on two people who both suffered damage only to the hippocampus shows that while one of them showed no deficiency in memory, the other had difficulty creating new memories. The researchers theorized that a very specific location within the hippocampus maybe responsible for creating new memories. Unfortunately, even the most sophisticated techniques seem confounded in pinpointing this kind of detail. Amygdala, considered the emotional center of the brain, is responsible for emotional memory. For example, we tend to react and remember emotionally charged words and events more than non-emotionally charged ones. Damage to the amygdala causes us to lose this difference. The prefrontal cortex is considered important in remembering the when and where of our memory, the context of the memory. Called source memory, it is what enables us to distinguish between an imagined event and a real event. To remember what we were doing on October 22, 2008 compared to the date of our wedding. Since this is one of the last parts of the brain to mature, it is suspected to be responsible for why children are notorious at not remembering where they learned something. Besides these structures, a neurotransmitter (chemicals that are used to relay, amplify and modulate signals between a neuron and another cell), acetylcholine is considered to be responsible for promoting the creation of new memory. Acetylecholine is primarily sourced in the basal forebrain and it is the degeneration of that part of the brain that results in the memory loss in that dreaded disease, Alzheimer’s.

Neuroscientists theorize that the brain encodes a memory by strengthening the connections between groups of neurons that participate in the storage of the experience. Many contend that there isn’t a single place in the brain that encodes the memory of an experience. For example, the brain uses different systems for retrieving written and spoken information. Using all the different places where the experience is encoded, the brain reconstructs the experience of that past experience. New research reveals that the very same neurons that fired when we originally experienced something, fire when we remember the experience. But because the brain does not encode every specific detail about an event, it manufactures our memory of that experience by filling in the details from other memories. So what we remember is never really accurate. Worse still, the more we remember an event, the stronger becomes the way we remember it, until eventually we’re only left with our recollection of it, not what really elapsed, the “Rashomon” effect.

A psychologist, Caroline Miles is credited as the first person to have formally studied infantile amnesia, back in 1893. Sigmund Freud proposed the first reason for childhood amnesia. He suggested that we deliberately repress the memories of those early years because of the trauma that we suffer as a consequence of our psychosecual development. This theory has been mostly rejected.

The reasons why we fail to remember those early events are divided into two main causes: that it is a problem of storage and that it is a problem of retrieval . Some contend that the memory never was stored due to a lack of maturation of the two main structures of memory, hippocampus and prefrontal cortexThe “problem with retrieval” camp proposes many different reasons for infantile amnesia, mostly related to context. For instance, it is postulated that since language doesn’t develop until much later and much of what we explicitly remember is verbalized, infants can’t remember those early years. Another theory is that since we develop a sense of self only around two years or so, we can’t remember earlier events because we don’t think of them as pertaining to us. Context is crucial in our ability to recall. So, another theory suggests that we have difficulty recalling those baby times because we are never again placed in the same position as an adult that we were in as infants, surrounded by giants, actions that were beyond our comprehension. As one blog puts it: “Rather than being completely forgotten, our earliest experiences may actually be mislabeled”.

Despite our early, seemingly immature, episodic memory, our implicit memory seems quite up and ready at birth, or even before. Infants learn a variety of motor skills as they grow. Much of new newborn research is based on what is called operant conditioning, the ability to associate our action with subsequent reward or punishment. Infants are known to suck at different rates to obtain a particular reward such as mother’s face or her milk. Another source of figuring out what goes on insider their baby minds is a baby’s preference for new items, the novel over the mundane. An infant will pay more attention to new events and objects compared to older ones. Studies using this technique have shown than newborns can remember a visual stimulus for only a few minutes while a five month old can remember it upto three months later. Novelty preference requires that infants can recognize, distinguish the old from the new. This is also a form of memory that is now called pre-explicit memory, because it uses the same circuitry that explicit memory uses.

Interestingly, it has been found that girls recall much more vividly, much earlier events compared to boys. Studies of infant monkeys have revealed the cause to be the hormone, testosterone. Some others point to culture as the reason for this difference, that we engage girls more than boys when they’re infants. Even more interestingly, Maori children have been known to recall events from a much earlier age as compared to European children and Asian children tend to recall events from an even later age than the Europeans.

I sometimes am glad that infants can’t recall as well as we’d like them to. Maya maybe appalled at how inexperienced we are as parents.

References:
- Wikipedia (the image is from there)
- Searching For Memory by Daniel Schacter
- What’s Going on In There by Lise Eliot
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The Debate Last Night

Posted on September 27, 2008
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When I first came to the US, back in the fall of 1992, we were a few days away from the presidential elections. My friend, a political junkie (and an economic one) with whom I shared the apartment, wanted us to buy a TV immediately so that we could watch the the presidential debates. Unfortunately for him, the debates were already over. Personally, I was glad about it because I didn’t want to cough up the money for a TV when we were earning so little money. But I was intrigued by the idea of a presidential debate, telecast live. In my naivete, I fantasized how wonderful the whole event would be, serious discussions about the things that mattered, by the two people who in a short time would have the power to assert the most influence. I presumed I’d be awestruck by the display of intellectual rigor and the presentation of facts. Yesterday, I watched the first of the presidential debates this year between Obama and McCain on my laptop, intermittently and with not much interest. What happened between 1992 and 2008 that made me feel so jaded about an event that I had been so in awe of ? Was it just middle age (drat, there I admitted it) and fatherhood ?

The presidential debates are an artifact of the modern age of TV, though a few debates did occur in the past, the most famous being the Lincoln-Douglas debates of 1858. They were proposed by a student at the University of Maryland which caught the attention of the national press and a few years later, in 1960, the first debate was held between John F Kennedy and Richard Nixon, which many acknowledged Kennedy had won. After a hiatus between 1960 and 1976, the presidential debates resumed in earnest in 1976.

Presidential debates are more theater than substance, as just about anything that befits the TV is bound to be. I remember reading that if TV was around when FDR was running for president, he may have never won, being stuck in a wheelchair in his last term. Drummed up and opined by the media who declare the winner and the loser, gaffes – such as Gerald Ford’s statement in the 1976 debate that “There is no Soviet domination of Eastern Europe” – or witty remarks – such as Reagan’s in the 1984 debate, when he was 73: “I will not make age an issue in this campaign. I am not going to exploit, for political purposes, my opponent’s youth and inexperience.” – can be a leading cause of defeat or victory at the polls. Looking wan as he was recovering from an injury and two weeks at the hospital and wearing a suit that caused him to blend into the background, Richard Nixon came out looking worse compared to a relaxed and healthy looking Kennedy. Flash over substance, matter over mind.

However, in the intial years, The League of Women Voters which had sponsored the debates from 1976 to 1984, is reported to have done a good job in running the debates in a non-partisan way, preparing questions and setting the agenda in a way that made it difficult to provide canned responses. So, the two parties began to fight for tighter control of the debates to make their candidates come out looking better prepared. In 1988, LWV withdrew its sponsorship, disgusted:

“The League of Women Voters is withdrawing sponsorship of the presidential debates…because the demands of the two campaign organizations would perpetrate a fraud on the American voter. It has become clear to us that the candidates’ organizations aim to add debates to their list of campaign-trail charades devoid of substance, spontaneity and answers to tough questions. The League has no intention of becoming an accessory to the hoodwinking of the American public.”

Since then, the debates have been controlled and run by a commission headed by both the major parties in this country. Third party candidates are not permitted to participate in the debate, though Ross Perot, the only third party candidate to have made some dent in a largely two party country, did participate the first time he ran for presidency. Other third party candidates such as Ralph Nader have been denied a chance to participate despite protests and lawsuits. In 2000, when Nader’s name was on the ballot in most of the 50 states, attempted to enter the debate auditorium as a spectator (granted a ticket by a sympathetic student), he was barred from entering the location by police officers and an official from the presidential debate commission. Prominent media outlets like the New York Times have also been on the side of excluding third party candidates from these debates.

So, in the self-proclaimed world’s greatest democracy, people who have a legitimate voice in the discourse have been barred from participating in it. The debates themselves are so staged, there is little of substance that is said, it being more important to come across as pleasing or commanding or whatever the word that grabs the fancy of the country that year, rather than speak substance. Al Gore who attempted professorial answers to questions was snubbed and said as being too wooden and pontificating. This year, the worry was whether Obama would come across similarly, giving long answers instead of short, pithy responses.

In an age where speed and monetary growth are the two most lauded and sought after values, we don’t have (nay, don’t want) the time to pause, consider a measured response and reflect. Everything has to be reduced to sound bites, so nothing detracts us too long from our pursuit of life, liberty and happiness (or should I call it by what it really is, collection of material artifacts to hide our hunger and emptiness in connecting and feeling connected). Part of the desire for pithier responses also comes because we’re tired of hearing long, obfuscating answers to questions not asked. But, in a world that is growing more complicated with the set of challenges that face humanity, our craving for simple answers, one word fixes, quick fixes, is dangerous. When you want to question the very framework of the questions, you cannot respond in sound bites. The questions assume a particular world-view and to challenge that view requires more than just a few words. Nuclear power seems an easy enough answer to global warming, given that we’ve learned to associate the problem with oil. But why it is not the answer requires more words, words that people don’t have the time for. This is why Noam Chomsky is never interviewed by the mainstream media.

We’re also a people who value certainty more than doubt, knowledge more than learning, the result more than the process, doing more than being. So a candidate who expresses ignorance or doubt is cast aside like a leper. To change one’s mind, to admit being wrong is a sin. Instead of being aghast at the enormous cost of unwilling to change his mind in the face of facts, many admired George Bush’s pigheadedness in staying the course, calling it tenacity. Where is sagacity ?

We’re not as rational as we like to think we are. Studies are emerging with increasing frequency that attest to that line from the Simon & Garfunkel song: “All lies and jest, still a man hears what he wants to hear and disregards the rest”. For example, a recent article talked about how refuting incorrect information doesn’t change by much the views people formed on hearing the misinformation. For example, 56% of Democrat volunteers disapproved of the detainee treatment at Guantanamo Bay before being shown a Newsweek report that a Koran had been flushed down the toilet. After being told about this, 78% of the volunteers disapproved of the treatment. They were then told that Newsweek had detracted the article and that it was false. But the number of volunteers who disapproved the treatment dipped to 68%, still higher than the original 56%. Lies when repeated over and over again, have the power to sound true. Cheney attested over and over again, despite all evidence to the contrary, that Saddam Hussein was lined with 9/11. Even today, many people seem to believe it, as evidenced by Sarah Palin’s regurgitation of that lie. So while fact checks are published after the debate is over on the various statements made by the candidates, I wonder if they have the power to really change people’s minds or if they merely provide fodder to each camp to exult in the mistakes of the other.

Yesterday’s debate was another tired rehash of positions. People expressed disappointment that there was no drama, no fire. What little there was, with McCain saying “Oh please” in response to a strawman that he posed to Obama, was sufficient for me to not desire for more. I neither heard anything new or anything fresh. But then, I didn’t expect any. I was just secretly hoping that Obama wouldn’t do so badly as to be considered as having lost the debate.

So, there, I’ve admitted it. Yes, I do prefer Obama over McCain, not because I think their positions are that vastly different on many key issues. Obama wants to fight in Afghanistan instead of Iraq, agrees that defending Israel is important and is willing to talk the war talk as much as McCain is, is almost as hostage to lobbyists as McCain is and is as nationalistic as McCain is. But, there are many other counts on which I feel a McCain presidency would push this country in a wrong direction. There is a difficulty in this country of understanding the difference between science and theology, between ideas and dogma, a confusion between the map and the territory. A presidency driven by an agenda from the Bible is no better than one driven from the Koran, though a Christian country would have difficulty admitting that. A friend wisely remarked that one of the lasting legacies of the Bush government would be a conservative Supreme Court, a prediction that has been borne out, I believe. For the first time, there is a possibility of abortion being considered illegal again. Decisions in favor of the authority are handed out more often than in favor of the dissenters, more in favor of corporations than people. I’ve also been saddened to see the levels to which McCain is willing to stoop to win and at the latent racism, blue collar workers, white women and Hispanics willing to bet on McCain because Obama is black.

So, while I don’t pay much attention to the presidential debates, I still hope that Obama doesn’t stumble, give cause to people looking for an excuse to switch to McCain.

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