CONTENTS
➡️ Artificial intelligence can never make true Art
➡️ LEAD ARTICLE: Making the medicines go down needs more than a spoonful of sugar
➡️ Second helpings - good reading from the web
Artificial intelligence (AI) can never make true Art
Weiwei A, The Guardian. January 2023
🆃🅻;🅳🆁 𝕄𝕪 𝕥𝕒𝕜𝕖-𝕒𝕨𝕒𝕪𝕤 𝕗𝕣𝕠𝕞 𝕥𝕙𝕚𝕤 𝕒𝕣𝕥𝕚𝕔𝕝𝕖
Specifically focusing on artificial intelligence (AI), this essay investigates the developing link between technology and human creativity. It is a reflection on the way in which technological improvements, despite the fact that they contribute to the growth of society, obscure the depth and warmth of human artistic expression. Artificial intelligence, while effective in imitating human jobs, is devoid of the fundamental human qualities of creativity and emotion. The essay makes the argument that genuine creative expression, which is founded on human experience, is impossible for artificial intelligence to do. Within the context of a society that is becoming more and more automated, the narrative highlights the need for sustaining human-centred art and draws attention to the unique attributes that distinguish mankind.
🇪🇳🇩🇶🇺🇴🇹🇪
"Art grapples with issues transcending rationality. Consequently, the advent of AI does not present a challenge to art itself; instead, it challenges the traditional understanding of how humans acquire artistic skills." -- Weiwei A
"Art is the lie that enables us to realize the truth.” ― Pablo Picasso"
LEAD ARTICLE
Making the medicine go down needs more than a spoonful of sugar
God-like status. The practice of Medicine is highly paternalistic. Doctors prescribe under the absolute conviction that their edicts cannot be challenged. There is little or no attempt at letting the patient be a part of the treatment process.
Doctors take it for granted that patients will comply with their recommendations without demurring. Wrong!
Hell, no! Worldwide, non-compliance is a major obstacle to the effective delivery of health care. Studies from the World Health Organisation indicated that only about 50% of patients with chronic diseases living in developed countries follow treatment recommendations, with particularly low rates of adherence to therapies for asthma, diabetes, and hypertension—three of the most common problems seen in practice. In respect of hypertension, 50% of patients completely drop out of care within a year of diagnosis.
The figures have to be much lower for developing and poor nations. As much as a third of all prescriptions never get filled at a pharmacy.
Being woke. Compliance is a paternalistic mode of assessment wherein the patient's behaviour is assessed against the physician's prescription with no attempt to include the patient in the prescription process, taking into account their personal situation: physical, financial, emotional, and social. Although the word has been in common parlance for ever, a preferred term is "adherence," where performance is assessed against a regimen where the patient is included in the decision-making process.
And then, there is "persistence" too. Medication compliance refers to the degree of sticking to the recommendations about day-to-day treatment with respect to the timing, dosage, and frequency. It's a cross-sectional assessment. Medication persistence refers to the act of continuing the treatment for the prescribed duration -- a longitudinal process. No single term combines these two constructs.
Patients can be compliant and fail to be persistent.
Consequences of poor compliance
1. Reduced effectiveness: Non-compliance can result in the treatment’s reduced effectiveness or even its complete failure. This could make the illness last longer and cause more symptoms.
2. Disease progression: It may be possible for an underlying condition or disease to progress if the regimen of medicines is not followed. In some of these diseases, constant management is necessary to protect against deterioration in symptoms, complications, or damage over time. Non-compliance could increase the risk of severe complications. Tuberculosis is a good example of the dangers of poor compliance. The emergence of an extremely dangerous form of TB - multi-drug-resistant (MDR) TB - is the result of poor compliance where suboptimal treatment has permitted the organism to evolve resistant strains of the bacteria.
3. Increased healthcare costs: Patients’ health may deteriorate if they do not take their medications as directed, requiring additional healthcare interventions like hospitalisation, emergency visits, or physician visits. These additional costs have an impact on the patient as well as the healthcare system.
4. Poor quality of life: Failure to comply with the prescription may result in a deterioration of quality of life due to symptoms persisting, impaired ability to function, and lower levels of overall wellbeing.
5 reasons, says WHO
Any attempt at strengthening compliance, adherence, or persistence must start with an understanding of why patients fall short of expectations. The World Health Organisation (WHO) provides a good system of understanding under 5 headings, each with 2 subheads.
1. The disorder.
Symptom severity: This one's easy to figure out; the more severe and life-threatening the symptoms are, the more likely it is that a patient will stay compliant—at least until the intensity of the condition abates.
Immediacy of relief is an important corollary. Some conditions, typically behavioural problems like depression, require medication to be taken for several weeks before any effect is noticed. Patients give up during this period.
Effectiveness of treatment: Let's look at some examples. A 3-5-day course of an antibiotic that will completely clear the infection is likely to be fully adhered to. Long-term treatment for disorders like hypertension and arthritis that have no permanent cure and need lifelong treatment will see low rates.
2. The treatment.
Complexity of the prescribed regimen. Medications are most likely to be taken if given once a day, at a fixed time like bedtime or before breakfast. Many drugs are available as long-acting formulations that stay effective for a day. Some can even be given as "depot" injections that last for weeks. As the daily frequency increases, doses might be skipped because of the inconvenience involved in taking them. Similarly, the fewer drugs given, the better the compliance.
Side effects. This is easily the most common reason for discontinuance. It's worth mentioning the "nocebo" effect, where patients will encounter side effects if their expectations of the drug are negative—the opposite of the placebo effect.
3. The patient.
Inadequate knowledge and misinformation. The connection is obvious. The internet and "Dr. Google" spawn a whole lot of poorly reasoned and unsubstantiated thinking that can be propagated widely, in short order.
Stigma of disease. Many conditions, especially behavioural disorders, carry social and cultural stigmata. Employers may refuse to hire people with known disorders like TB and epilepsy. Patients can be very reluctant to letting their social circles know about their condition. These emotions can be deeply entrenched and difficult to counter.
4. The healthcare system.
Access. Even today, there are many parts of this country where patients have to travel long distances, under arduous conditions, to reach a hospital or healthcare provider. Daily wage earners can lose a day's pay. Compliance naturally suffers.
Poor rapport. The attitude of care givers is an important part of compliance. Rude, abrupt, and cursory communication styles are common in public hospitals, which have to deal with large loads of patients.
5. Social and economic factors.
Medication costs. A "no-brainer" - particularly common in the popular practice of polypharmacy, where a long list of drugs is given out. Patients will cherry-pick their way through the list, often omitting the most important treatment in favour of worthless tonics and nutritional supplements.
Cultural beliefs. It can be very difficult to break through thinking that is entrenched in communities and societies regarding illness. To this day, there is an unassailable belief in the power of injections. There are very few situations, most of which require hospital admission, where drugs cannot be given in oral form, yet patients don't feel adequately treated unless they are jabbed with a needle.
That's a good list of 10 reasons. Providing solutions and workarounds can demand creative, lateral thinking. Let's look at some examples.
Let me see you swallow. In conditions like tuberculosis, where treatment has to be given for several months without interruptions, poor compliance is the rule. An innovative strategy called "DOTS (directly observed therapy, short-course)" is remarkably effective in ensuring adherence and persistence. Volunteers from the community undertake to watch patients swallow prescribed medicines in front of them. Obviously, this can work only under specific conditions.
Drug bioassay. If the situation is serious and it's vital that adequate quantities of a drug be present in the circulation, there are blood tests available that can measure the level of a drug accurately. In real life, only a small number of situations can justify this difficult process.
Oh Yes. There's an app for it. Considering the near-universal availability of mobile phones, there are smartphone apps that help patients track their medication intake and provide reminders. Those who need it most are the ones who are least likely to be able to access it.
An ideal prescription should be one that:
* Completely cures the disorder or is the most effective agent for control.
* Gives relief in quick time.
* Can be given in the shortest, least complicated, compact schedule (drugs and frequency).
* Has rare, mild side effects, if any.
* Is cost effective.
* Respects the emotional and cultural beliefs of the patient.
* Is given with full explanation of the process.
* Is prescribed by a caring, empathic doctor.
Tough order but not impossible.
SECOND HELPINGS
Good reading from all over
Unlocking the truth about diabetes: 'The science has been pretty awful'
'Meditations' by Marcus Aurelius – Stoicism in Modern Language - video
Here's why you should (almost) never use a pie chart for your data
Thanks Arjun, I enjoy reading your posts!