March 19, 2017
Despite a vote by the American Medical Association (AMA) in 2015 recommending that Direct to Consumer Advertising (DTCA) be banned , the pharmaceutical industry (Big Pharma) continues to spend billions of dollars each year on consumer-targeted media campaigns. A year after the AMA vote to ban such advertising, the industry responded by increasing their 2015 DTCA budget by 19% spending more than $5 billion in 2016. Approximately 66% of that massive expenditure was on TV ads. (See chart below)  I am both relieved and disturbed that it wasn’t my imagination that the number of TV ads for pharmaceuticals has been increasing.
Drug advertising works
It’s no wonder billions are spent on pitching prescription drugs to lay people. It simply works. For every dollar spent on DTCA sales within the industry rise by $4.20.  A Kaiser Family Foundation health tracking poll  found that 28% of people talked with their physician after seeing an ad for a prescription medication. If a Primary Care Physician (PCP) sees 90 patients a week, that would mean 25 of those patients were there because of something they saw on TV. I would imagine that PCPs have honed their responses when a patient opens the conversation by saying they saw an ad on TV or on the internet.
DTCA is not a new topic of discussion. It seems that the only thing that has changed when I first broached the subject in 2010  is that spending has accelerated and the ever-expanding sources of media has allowed the pharmaceutical industry to finely target their advertising spend, e.g., Lyrica on the Food Network and Cialis on the Golf Channel.
America is an outlier
It doesn’t have to be this way. It’s only “normal” to see pharmaceutical ads on TV if you live in the United States or New Zealand. In all other countries in the world, advertising prescription drugs on TV is prohibited. If one does the population math, that means that only 5% of the world population sees this type of advertising.
It’s a sad commentary on American society that everything, including health care, is driven by sophisticated marketing with the primary goal of maximizing corporate profits. In this construct, people are simply fodder for corporations to exploit. The best thing we can do is to be aware of efforts to manipulate us and to recognize that the interest of big business and personal interests are often not aligned.
In the case of those TV ads for prescription drugs, the solution is simple. If you don’t feel well, then see your physician. He or she has the knowledge, experience, and context to help. Rest assured, they already know more about the conditions and medications than is in the TV ads. Being an effective healthcare consumer means being informed, but it also means not being be duped by a big pharma ad into believing you have the disease du jour.
How many coincidences does it take to establish causality?
The reality is that causality can never be established by coincidences, and attempting to do so risks falling into the realm of conspiracy theories. But, every so often, coincidences turn out to be the visible expressions of an underlying network of collusion. There must be a tipping point at which enough coincidences are recognized that an actual fact-based, structured investigation is undertaken to determine that now-elusive entity we call the truth.
In some cases, identifying and focusing on a single event that triggered the conversion from conspiracy to collusion is helpful. To be sure, in the case of the Trump/Russia nexus there are many apparent connections: Attorney General Jeff Sessions “forgetting” he had spoken with Russia’s ambassador to the United States, Sergey Kislyak, during the 2016 campaign, Trump’s political advisor Carter Page making a trip to Russia during the campaign, but wait. Do you see how easy it is to fall down the conspiracy rabbit hole when there are so many connections? Fortunately, others have been trying to make sense of all these connections, so let me focus on the one that seems too blatant of a coincidence to be a coincidental.
Follow the money
In the case of Donald Trump, the time-tested axiom of following the money will likely be the unifying thread that stitches together all the coincidences to create the tapestry of collusion. However, the tipping point for me came not by following the money, but by following the flights of Russian billionaire, Dmitry Rybolovlev. You may remember Rybolovlev from his purchase of Trump’s Palm Beach mansion in 2008. At the time, the economy was in free fall and had reached terminal velocity. Nevertheless, Rybolovlev paid $95 million for the property Trump had purchased four years earlier for $41.3 million.
Rybolovlev and those flights
I first learned of the peculiar flights of Rybolovlev’s private jet, M-KATE, from a segment on the Rachel Maddow show. Admittedly, MSNBC has a point of view, but the flights of M-KATE have been investigated by many other organizations without an ostensible political agenda. For example, Business Insider investigated the flights and concluded that the M-KATE flights that coincided with Trump were outliers from the plane’s typical flight history. Of course, the White House has denounced any coincidences as conspiracy theories. This denouncement is quite ironic given Trump’s own rich history in propagating conspiracy theories.
Bringing it in for a landing
I seem to be circling the airport and need to bring this posting in for a landing. I have distilled the massive flight data obtained by the Huffington Post into the two maps presented below.
The first map shows that on October 30, 2016, M-KATE flew to Las Vegas and stayed only a few hours. Coincidentally (?) Trump held a campaign rally in Las Vegas during the same time. Similarly on November 3, 2016, M-KATE flew to Concord Regional Airport in North Carolina where, coincidentally (?) Trump was holding campaign rally. The coincidences (?) didn’t end after the election. When President Trump hosted Japanese Prime Minister Abe at his mansion in Palm Beach on February 10,2017, sure enough, M-KATE flew from France to Miami, stayed for two days, and then flew back to Europe.
The second map elaborates on the North Carolina flights of M-KATE. The stop in tiny Concord regional Airport is odd as the reason given for the stop was for refueling. Later in the day, M-KATE flew 25 miles to Charlotte International Airport to share the tarmac with Trump’s private jet. Stopping for fuel at a regional airport makes no sense if the final destination was a major airport only 25 miles away. M-KATE would have burned more fuel taking off and landing at Concord than it would have used if it had just flown straight to Charlotte International. So why the stop at tiny Concord?
Speculation is fun!
Since this post has conspiracy theory characteristics, I will take the liberty of offering my speculation of what happened on M-KATE during the flight to North Carolina. I would posit that plan was for Rybolovlev to touch bases with the Trump campaign, maybe Trump himself, in North Carolina. I think there may have been a miscommunication where Rybolovlev believed they were to meet at the site of Trump’s rally in Concord. Upon arriving in Concord, Rybolovlev realized the mistake and decided to refuel as a subterfuge to explain the otherwise inexplicable stop at a tiny regional airport. M-KATE departed Concord Airport to rendezvous with the Trump who was already at Charlotte International Airport.
Of course, the reason for the flight of M-KATE to Concord is just speculation. However, wouldn’t it have been entertaining to have been part of the flight crew on that leg of the journey? If only the pilots were American, they could be subpoenaed to testify as to the real reason for the diversion to Concord. Since that will never happen, we’ll have to be content with connecting the dots of the Trump-Russia nexus. For me, connecting the dots on the map for a handful of flights is enough to convince me that the connections are not coincidental. I’m not sure how Trump believes that nurturing a relation with Rybolovlev will help make America great again.
(Because the Trump-Russia connection is real, it’s only fitting to provide the following translation of this post.)
Сколько совпадений требуется для установления причинности?
Реальность такова, что причинность никогда не может быть установлена совпадениями, и попытка сделать это рискует попасть в область теорий заговора. Но, так часто, совпадения оказываются видимыми выражениями скрытой сети сговора. Должен быть переломный момент, при котором признается достаточное совпадение, что фактическое, структурированное расследование проводится для определения этой неуловимой сущности, которую мы называем истиной.
В некоторых случаях полезно определить и сосредоточиться на одном событии, которое вызвало переход от сговора к сговору. Правда, в случае с Trump / Russia nexus есть много очевидных связей: генеральный прокурор Джефф Сесс «забыл», что говорил с послом России в США Сергеем Кисляком в ходе кампании 2016 года,  политический Трамп Советник Картер Пейдж, совершавший поездку в Россию во время кампании, , но подождите. Видите ли вы, как легко свалить кроличью нору заговора, когда так много связей? К счастью, другие пытались разобраться во всех этих связях , поэтому позвольте мне сосредоточиться на том, что кажется слишком вопиющим совпадением, чтобы быть случайным
Следуйте за деньгами
В случае Дональда Трампа проверенная временем аксиома следования за деньгами , вероятно, будет объединяющей нитью, которая сшивает все совпадения, чтобы создать гобелен сговора. Однако переломным моментом для меня явились не следование деньгам, а следование полеты российского миллиардера Дмитрия Рыболовлева. Вы можете вспомнить Рыболовлева от его покупки особняка Трампа в Палм-Бич в 2008 году. В то время экономика была в свободном падении и достигла конечной скорости. Тем не менее Рыболовлев заплатил 95 миллионов долларов за имущество, приобретенное Трампом четыре года назад за 41,3 миллиона долларов .
Рыболовлев и те полеты
Я впервые узнал о необычных полетах частного самолета Рыболовлева «M-KATE» из сегмента на шоу Рэйчел Мэддоу.  По общему признанию, MSNBC имеет свою точку зрения, но полеты M-KATE были расследованы многими другими организациями без явной политической повестки дня. Например, Business Insider исследовала полеты и сделала вывод, что полеты M-KATE, которые совпали с Trump, были выбросами из типичной истории полета самолета.  Безусловно, Белый дом отрицает любые совпадения как теории заговора.  Это отрицание является довольно ироничным, учитывая собственную богатую историю Трампа в пропаганде теории заговора.
Взятие его для приземления
Я, кажется, кружил в аэропорту и должен доставить это сообщение на посадку. Я перегонял массивные полетные данные, полученные Huffington Post, на две карты, представленные ниже.
Первая карта показывает, что 30 октября 2016 года M-KATE вылетел в Лас-Вегас и пробыл всего несколько часов. По совпадению (?) Трамп провел митинг в Лас-Вегасе в то же время. Аналогичным образом 3 ноября 2016 года M-KATE вылетел в Региональный аэропорт Конкорда в Северной Каролине, где по совпадению (?) Трамп проводил акцию. Совпадения (?) Не закончились после выборов. Когда президент Трамп принимал у себя премьер-министра Японии Абэ в своем особняке в Палм-Бич 10 февраля, то, конечно же, М-Кейт вылетел из Франции в Майами, пробыл там два дня, а затем улетел обратно в Европу.
Вторая карта рассказывает о полетах М-КАТЭ в Северной Каролине. Остановка в крошечном региональном аэропорту Конкорд является странной, поскольку причиной остановки является дозаправка. Позже в тот же день, M-KATE пролетел в 25 милях от международного аэропорта Шарлотты, чтобы разделить гудронированное шоссе с частным самолетом Трампа. Остановка на топливо в региональном аэропорту не имеет смысла, если конечным пунктом назначения был крупный аэропорт, расположенный в 25 милях от отеля. M-KATE сжигала бы больше топлива, взлетающего и приземляющегося в Конкорде, чем это использовало бы, если бы оно просто летело прямо в Charlotte International. Итак, почему остановка в крошечном Согласии?
Спекуляция – это весело!
Поскольку у этой должности есть характеристики теории заговора, я позволю себе высказать свои предположения о том, что произошло на M-KATE во время полета в Северную Каролину. Я бы сказал, что план заключался в том, чтобы Рыболовлев связал базы с кампанией Трампа, возможно, с самим Трампом в Северной Каролине. Я думаю, что могло быть недопонимание, когда Рыболовлев считал, что они должны встретиться на месте митинга Трампа в Конкорде. По прибытии в Конкорд Рыболовлев осознал ошибку и решил заправиться в качестве уловки, чтобы объяснить необъяснимую остановку в крошечном региональном аэропорту. M-KATE вылетел в аэропорт Конкорд, чтобы встретиться с Трампом, который уже был в международном аэропорту Шарлотты.
Разумеется, причина полет M-KATE на Concord – это просто предположение. Однако не было бы увлекательным, если бы он был частью летного экипажа на этом участке пути? Если бы только пилоты были американцами, их можно было бы вызвать в суд, чтобы дать показания относительно реальной причины утечки в Конкорд. Поскольку этого не произойдет, нам придется довольствоваться соединением точек связи Trump-Russia. Для меня соединение точек на карте для нескольких полетов достаточно, чтобы убедить меня, что соединения не случайны. Я не знаю, как Trump верит, что воспитание отношений с Рыболовлевым поможет сделать Америку великолепной снова.
February 25, 2017
The Trump administration selectively excluded reporters of the mainstream media organizations of CNN, the New York Times, Politico, the Los Angeles Times, and BuzzFeed, from attending a recent news gaggle. Unfortunately, Edward R. Murrow’s words from the dark days of xenophobic Senator Eugene McCarthy’s witch-hunts are becoming alarmingly more relevant.
Transcript of Murrow’s broadcast (emphasis mine):
Earlier, the Senator asked, “Upon what meat does this, our Caesar, feed?” Had he looked three lines earlier in Shakespeare’s Caesar, he would have found this line, which is not altogether inappropriate: “The fault, dear Brutus, is not in our stars, but in ourselves.”
No one familiar with the history of this country can deny that congressional committees are useful. It is necessary to investigate before legislating, but the line between investigating and persecuting is a very fine one and the junior Senator from Wisconsin has stepped over it repeatedly. His primary achievement has been in confusing the public mind, as between internal and the external threats of Communism. We must not confuse dissent with disloyalty. We must remember always that accusation is not proof and that conviction depends upon evidence and due process of law. We will not walk in fear, one of another. We will not be driven by fear into an age of unreason, if we dig deep in our history and our doctrine, and remember that we are not descended from fearful men — not from men who feared to write, to speak, to associate and to defend causes that were, for the moment, unpopular.
This is no time for men who oppose Senator McCarthy’s methods to keep silent, or for those who approve. We can deny our heritage and our history, but we cannot escape responsibility for the result. There is no way for a citizen of a republic to abdicate his responsibilities. As a nation we have come into our full inheritance at a tender age. We proclaim ourselves, as indeed we are, the defenders of freedom, wherever it continues to exist in the world, but we cannot defend freedom abroad by deserting it at home.
The actions of the junior Senator from Wisconsin have caused alarm and dismay amongst our allies abroad, and given considerable comfort to our enemies. And whose fault is that? Not really his. He didn’t create this situation of fear; he merely exploited it — and rather successfully. Cassius was right. “The fault, dear Brutus, is not in our stars, but in ourselves.”
Good night, and good luck.
February 23, 2017
It’s becoming apparent to me that I seem to have some sort of fascination with the Dunning-Kruger effect. It’s the effect that I first wrote about in 2013 that suggests that a person’s self-assessment of their knowledge of a subject differs greatly from their actual knowledge. The idea is that most people tend to assume they know more about a subject when they in reality know very little about it, but as their knowledge of the subject increases, their self-assessment of their knowledge decreases.
I think the Dunning Kruger effect is real and can be used as a construct to understand the actions of people in various contexts. In October 2015, I indulged my frivolous side by placing several of the presidential candidates on the Dunning-Kruger curve. I had no idea at the time that the candidate I placed at the top of the first peak, indicating maximal delusion, would eventually become president.
Since Mr. Trump is now president, I feel compelled to revisit and revise the Dunning-Kruger chart I published in 2015 to more accurately reflect President Trump’s place on the curve. As you can see in the revised chart below, I believe President Trump has the distinction of being impossible to place on the standard Dunning-Kruger curve. Instead, he has earned his own curve.
It’s a curve that is fully contained within a chrysalis of delusion. No matter how much Trump learns about a subject, he will never reach the realization that he really doesn’t know as much as he thinks. Instead, his self-assessment of his knowledge continues to grow with any modicum of new information. I encourage mental health workers to ignore the Goldwater rule and offer their own opinions of why this may be true.
This chart may not mean much to anyone but fans of Dunning-Kruger. However, I do think it captures the danger that President Trump represents. It’s not just that he’s ill-informed and ill-prepared to be president. It’s that he thinks he awesome and doesn’t need to really know anything other than that which can be condensed into a 140 character Tweet.
I have to believe that most people entering the Oval Office for the first time as President have a feeling of “Oh Crap.” I think that visceral reaction would be an appropriate reaction indicating a degree of humility that an effective president needs. I think President Trump entered the Oval and thought, ‘How can I tell people in 140 characters how awesome it is for me to finally be here, where I deserve to be?”
Humility, introspection, intellect, and reason are virtues that serve presidents. their constituents, and the country well. These personality traits are discovered in those individuals that reach the far right side of the Dunning-Kruger curve. It’s difficult not to observe that President Trump is at the far left.
It’s becoming increasingly clear to me that what drives people’s decision making process is their yearning to believe they are in control of everything in their lives and that there are easy solutions to complex problems. Neither of those are true. And yet, there are many examples of people “going with their gut” or believing anecdotal reports over expert evidence.
Examples of this behavior can be seen in many areas ranging from believing acupuncture works , to fear of Genetically Modified Organisms (GMOs)  to those without celiac disease believing avoiding gluten is healthy.  None of those three examples is true, but convincing someone who believes they are will be challenging. The reason is that their position is based in a personal belief they are true and not in any objective evidence that they are.
It’s hard to convince a person with a belief-based opinion to change that opinion by providing facts. Just try convincing a Trump supporter that the President is wrong on any issue and you’re likely to get a response that includes not caring about the facts because the President makes them feel good. No matter how overwhelming those facts to the contrary may be, it is unlikely they will displace an opinion that is rooted in emotion. In fact, it’s possible the opposite may occur in what has been defined as a “backfire effect” where providing contrary facts actually causes strengthening of a belief-based opinion. 
The other problem in decision making is that people feel that every problem has a simple solution that they can personally identify and implement on their own. However, as H. L. Mencken observed in 1920, “There is always a well-known solution to every human problem—neat, plausible, and wrong.”  In some cases there isn’t a simple solution. That may be hard for some to accept so they substitute a belief-based solution that is unsupported by any facts. That imparts a sense of control that empowers regardless of the efficacy of the solution.
A belief-based approach to life may be seductive because it is easy. One does not need to commit to the effort required to be a critical thinker or to have mindset of a skeptic. It is far easier to exploit motivated reasoning and find “facts” that appear to support a position based in belief.  Equally easy and equally wrong is to fall prey to the trap of logical fallacies. For example, your physician may not be able to relieve your leg pain so you take matters into your own hands and visit an acupuncturist. Even if you might accept that there’s no scientific evidence to show that acupuncture works, you may believe it works because it’s been around for centuries – a classic example of the appeal to antiquity logical fallacy.
The way to combat the false beliefs that acupuncture works, GMOs are dangerous, or Donald Trump is competent, is to accept that such beliefs are based in emotion and not fact. The next step is to then commit to challenging yourself to spend the time and effort to objectively assess the evidence and be willing to concede your long-held beliefs may be just that – beliefs.
It’s perfectly acceptable to reject the succor of “ignorance is bliss” and approach all decisions with a healthy dose of skepticism and objective, critical thinking. If you do, you may find yourself offended by GMO-free labels on food and offended by Donald Trump being president. Both are nonsensical.
I noted in a posting last November (February 19, 2017 – Holding President Trump Accountable for “soundly and quickly defeating ISIS”) that Donald Trump should be held accountable for his unequivocal proclamation:
“We are going to convene my top generals and give them a simple instruction.
They’ll have 30 days to submit to the Oval Office a plan for soundly and quickly defeating ISIS.”
Today is February 19, 2017, the date certain by which Trump promised to have a definitive plan to soundly and quickly defeat ISIS. I have a simple question – where is it?
I think the obvious answer is that there is no such plan and to the President, it really doesn’t matter that there isn’t. It was preposterous proclamations such as this one that ginned up his base, fueled the machine of Islamophobia, and ultimately made him the President. He has consistently and artfully exploited the disconnect between truth and facts.
But we should not forget that Trump rode to victory by exploiting the fears and gullibility of his base. We should take every chance to hold him accountable for statements he has made. It will be challenging. When journalists have pressed him for details on his strategy for addressing terrorism and global conflicts, he unapologetically channels President Nixon and hides behind the subterfuge of those plans being kept secret for strategic purposes.
Whether the chaos of the first 30 days of the Trump administration is by strategic design or is merely an expression of Trump’s personality, I fear one consequence is that accountability for unambiguous proclamations such as this one will be lost in the fog.
So, I ask again my simple question. Mr. President, where is the plan you promised you would have today?
February 19, 2017
I embrace being different. Diversity of ideas, experiences, and perspectives is the foundation of great friendships, exceptional relationships, profitable businesses, and prosperous countries. However, the mere fact that someone is different from a group in some manner does not necessarily mean that person automatically has superior competency to address important, complex issues.
It seems to me that the loyal supporters of President Trump conflate being different with being competent. Their argument goes that Trump must be doing something great because so many Washington insiders disagree with him. Yes, President Trump is definitely different on many levels, but time will eventually show that those differences are more effective in achieving TV ratings and Twitter followers than accomplishing anything positive for America, or even his loyal supporters.
I have called Trump the Potemkin president because there is little intellectual substance behind his 140 character tweets. There is little substance to his executive orders. I can see little substance in anything he says. Well-reasoned substance no longer emanates from the Oval Office as it has with all previous presidents. In that regard, President Trump is truly different.
Maybe it’s his random birth into a life of privilege that feeds his self-delusion that he is more than one of the facades in Potemkin. Or, as some have suggested, maybe he really does suffer from NPD – Narcissistic Personality Disorder.
Regardless of the cause, I don’t know which is worse- a person who actually believes he or she can excel in a job for which they have no experience, or the person who knows they are incompetent but doesn’t care. Neither personality trait is consistent with being president of the United States. Such actions may be more aligned with what I’ve observed in some CEOs of companies.
Sarbanes-Oxley notwithstanding, there is a small subset of CEOs that may have deluded themselves into thinking they have the luxury of insulating themselves from bothersome facts. The delusion includes believing that in the event of failure there is always a golden parachute and bankruptcy to protect their personal wealth. Neither of those options are viable when leading a country as its president.
America in not a business and does not need a CEO with a cheerleader enthusiasm that requires no supporting facts. Surely you, too, have at one time heard the delusional cheers. Your team is down by 40 points with minutes to go and the cheerleaders are enthusiastically shouting cheers of impending victory. It simply doesn’t work that way, and it’s a dangerous delusion to think it does.
In politics, as in life, success is achieved by hard work. In Washington that means working with opponents to compromise on solutions that neither side loves, but in the end gets something done. No great compromises were ever hammered out in Twitter. I would like to think that anyone who embraces the sophomoric slogan of make America Great Again would also realize that their false goal would not be accomplished by Tweets. The reality is they probably do and that is the real problem.