Vinay Kumaran

 Mindfulness is a state of mind in which one is focused on the present. There is no worry about the future or review of the past. One can be mindful while performing a relatively mundane task. Washing dishes, having a bath, brushing one's teeth. The key is neither being in a hurry nor being deliberately slow. Paying attention to what one is doing and not thinking about anything else. Experts in meditation have developed methods to get you into a state of mindfulness but most people can find the state of mind at least sometimes. Thoughtfulness is another state of mind, similar to, but not identical to mindfulness. It differs from mindfulness in not necessarily being associated with an action. For instance, one can be thoughtful while sitting in a comfortable chair as well as while driving a vehicle along a familiar route or walking along a familiar path. The thoughts, often abstract, are not associated with strong emotion. For instance, thinking about an article I'm planning to ...

  A few years ago I discovered a site called Quora. I searched for something on Google and it took me to an answer on Quora. For those who are not familiar with it, Quora is a site where people can post questions and other people can answer them. I found it intriguing and looked at some of the questions and the answers posted. Some of the answers looked vague and long drawn. More an attempt to seek attention than a real answer to the question by someone who knows about the subject. I created an account and answered some of the simple medical questions. Apparently, people like simple factual answers. If people like your answers they upvote them. Depending on how many of you answers are read and how many are upvoted, you can become an expert on a topic. Soon I was an expert on about 20 different topics ranging from liver transplantation to astronomy to Terry Pratchett to cricket. By now I was also posting answers to questions about politics (still brief and factual) and religion (dit...

I was talking to one of my fellows the other day. There was a discussion about dietary restrictions. He was surprised to hear that I have no religious affiliation and no dietary restrictions. He was under the impression that most Indians are Hindus and vegetarian. He told me that most Japanese people do not have a religious affiliation which, in turn, surprised me. My only visit to Japan was to Kyoto and most of the 'places to see' there seemed to be Buddhist temples. In any case, my thoughts turned to the manifest fact that much of the irrational human behavior of the modern age seems to be rooted in religion. Objections to abortion and stem cell research in the US, the fact that nobody from a minority religion or without religious affiliation has ever been elected to a major leadership position here, the conflicts between India and Pakistan, the middle east situation, Israel and the Arabic countries, the list goes on. In history too, some of the greatest crimes committed by...

I am not patriotic. I don't think 'my' country is the best country in the world. I don't even think it's useful to think of any country as the best in the world. I'm not even completely on board with the idea of countries. The idea that you can draw an imaginary line on a map and that people on one side of the line are somehow different from people on the other side seems strange to me. There are good things everywhere and there are problems everywhere. Wherever we find ourselves, there are things we can do to make life better for everyone, or worse. That's the only choice that makes sense. When I finished my fellowship, I returned to India because that's where I had skills that were needed. Now, after working in India for 12 years, I find that the skills I acquired there are more useful in the US where they're scarce so I find myself back in the US.  There are serious problems in both countries, beginning with the leaders they have elected. Those a...

I must admit I have trouble understanding the appeal of religions. When I was a child, I was told the tales of Hindu religion. The stories were enormously entertaining.  Hindu Gods were like the Avengers or the X-Men. Different Gods had different superpowers. Ram and Arjun were great shots with the bow and arrow. Bhim was like ' The Thing' from the Fantastic Four, immensely strong but not very intelligent.  Hanuman was like Superman, he could fly and lift mountains and swallow the sun accidentally. However, it soon became evident that the world of the Gods was a fantasy world. In the real world, people were good or bad on a spectrum and there were not necessarily consequences to either being good or being bad. Good people and even children not yet old enough to decide whether to be good or bad could suffer and die. Bad people could prosper and enjoy the fruits of their evil through long luxurious lives and nothing supernatural ever happened. Prayer, no matter how sincere, (a...

I must admit I gave up on 'War and Peace' many times. I started reading it, got mired in the number of characters with unfamiliar names, was put off by the clunky English of the translation and confused by the sheer proliferation of Princes. To me, a Prince is the son of a King but apparently the Russian word which was translated into 'Prince' by an uninspired translator means merely the son of a member of the nobility. In any case, I started several times and got distracted by another faster moving book and by the time I got back I realized that I had lost track of the characters (who had not yet done anything to distinguish themselves) and would have to start all over again. I asked my friend, Rajesh Behl, whether it was actually worth persisting. He said 'yes, it's worth it.' Perhaps I still would not have focused on it long enough if it had not been for a break from work of nearly 6 months during which I moved from India to the US and waited for the v...

The right wing in politics is in the ascendant all over the world. In India, it is represented by the BJP and Modi, in the US by the Republican Party and Trump and in the UK by the Tories and Brexit. Erdogan in Turkey is another example. The right wing is comprised of otherwise normal people. Many of them are intelligent and have done well in their professions. They tend to be less educated, more religious and older than the left wing but that's a statistical measure. There are representatives from all ages and all levels of education. There is an excellent book by Jonathan Haidt called "The Righteous Mind" which attempts to analyse how the right wingers think and is well worth a read. It is obviously futile to dismiss right wing politics as 'short-sighted', 'self-serving' and 'cruel'. That strategy does not work and the fact is that they are in the ascendant. It is important to understand how they think so that a viable way forward can be fou...

The World Congress of Bioethics is being held in Bangalore next month. There is a pre-congress workshop for transplant coordinators where ethical issues related to brain death and organ donation are going to be discussed. One of the issues being discussed is how we define death. Before organ donation became an integral part of modern medicine, there was little discordance between the medical definition of death and the religious ones. If the heart stopped beating and the breathing stopped (usually in rapid succession), and if efforts to restart them failed then the person was declared dead. Religious leaders who defined death as the soul leaving the body were happy to confirm that the moment of the departure of the soul was when the heart stopped beating. It is still common for people who have recovered after a cardiac arrest to claim that they died and came back. Images created by disordered firing of neurons short of oxygen were interpreted according to the cultural norms of the s...

Discussions with a couple of my friends on Facebook persuaded me to write down my thoughts about religion and why I think most religions are doing more harm than good. Denial of Death. A factor which seems common to all religions is the denial of the finality of death. Practically all the religions seem to have the concept of a soul, something that continues after we die. The soul may be reincarnated (as in Hinduism and Buddhism), rewarded (Heaven in Hinduism, Islam, Christianity, Moksh in Buddhism and Hinduism) or punished (Hell, Purgatory, an unpleasant reincarnation etc). In any case, the soul apparently retains the memory of actions performed in life (what would be the point of punishing someone for a crime they do not know they committed?), retains the ability to suffer (Hell) or enjoy pleasures (Heaven, Valhalla). There is, of course, no reason to believe that anything like this occurs. One can imagine ancestors, intelligent enough to recognize that death is inevitable but no...

Consider an animal in a resource-scarce environment. It makes a crude kind of sense to be selfish. The animal, presumably being stronger than other animals, takes the food it needs and mates with partners of the opposite sex without or without their cooperation and leaves more progeny than weaker animals. However, this animal comes up against a problem if other animals, individually weaker than it, learn to cooperate. With force of numbers, they can fight off the selfish animal. They can cooperate to look after progeny and thereby, their progeny have a survival advantage over those of the more selfish animals. They form herds and prides and the purely selfish animals die out. The herds/ prides grow into tribes as intelligence increases and we get a situation like the human animal which seems set to take over the entire planet and then perhaps starve to death as the resources are used up by uncontrolled population growth. Humans are at a stage in evolution when they have clearly sur...

This is from an invited post I wrote on the Facebook group 'Learning General Surgery'. During my residency at Maulana Azad Medical College, I was initially assigned to the unit of the head of the department, Dr TK Malik. The less said about that part of my residency, the better. However, I did have good second and third year residents from whom I learnt how to look after patients. Halfway through my second year, Dr Malik retired and a new unit was created with two Consultants, Dr  Vinod Malik  and Dr  Ram Kaza . Being the most junior unit at the time, they had the Saturday emergency and were always short of staff. For a considerable period of time, there were no third year PGs, no first year PGs and no regular Senior Residents. There were, however, two second year PGs,  Brundaban Nahak  and me. Dr  Vinod Malik  and Dr  Ram Kaza  were gentle bosses, allowing us to figure out how to keep the day to day running of the unit going, putting up...

Sometimes when I contemplate a visit to the US, I am reminded of the many things we do better in India. Some of these might be surprises. Couriers. Indian couriers are much more economical and quicker than the monoliths in the US. Competition, lower labour costs etc contribute I assume. Advertisements. Most American ads are bland and boring. They tout things like awards or special offers. Indian advertisements are often funny or thought provoking and make a point about current affairs. The difference is so great they simply cannot be compared. This is an advertisement for Verizon. It is not only boring, it is misleading. The actual cost of an unlimited plan is $75 plus taxes. https://www.verizonwireless.com/plans/verizon-plan/ The advertisement is https://www.youtube.com/watch?v=t3zptG2nVmM. Now compare this with this advertisement for Fevikwik. https://www.youtube.com/watch?v=A4WZF74dAg4. Online grocery shopping. There are so many options from Big Basket to Grofers...

How long has it been since you actually listened to music? I know you probably have music playing when you're driving and you're probably also talking to someone and answering your phone and wondering which would be the best route home. The music is something playing in the background to which you are not paying much attention. How different from going to a concert hall and listening to a live performance. The difference, of course, is in focus. At the hall, you're not doing anything else. All your attention is on the performance and you are able to really appreciate it. It's like the difference between going to a theatre to watch a movie and watching it on TV at home. You get up to answer the doorbell, make a few phone calls, have dinner. At the end of the movie you wonder why people were raving about it when it was released. You can get the concert hall effect at home. Set aside enough time to give the music a fair listening. Don't do anything else. No TV, no m...

The patient was one of those lucky ones who were incidentally diagnosed with liver cancer when an ultrasound was done for unrelated symptoms. I told him, "you have a small tumour in the liver. It does not seem to have spread anywhere. Your liver function is normal. If we take it out, there is a good chance that you will be cured of the disease." "Will there be pain?". he asked me. "There will be some but we medicate you for it and do other things like nerve blocks. The pain will be tolerable. I have not had a patient tell me that if he had known how painful it would be, he would not have had the surgery." "I don't like pain", he said, "can't you cure it with medicines?" I confessed that there was no way to 'cure it' with medicines. "I have been told about a very famous homoeopathic doctor. He has cured many patients with cancer. I'll go to him." I said "I can't force you to have surgery but at l...

When we think about artificial intelligence we think in terms of something that can think like a human but better. Science fiction movies like the Terminator series have raised concerns about what such an AI would want. Elon Musk and Stephen Hawking, among others, have raised concerns about humanity becoming irrelevant once it is surpassed in intelligence and innovation by its own creations. It has been suggested that the first artificial intelligence smarter than a human being will be the last thing invented by humans. I have no doubt, there will eventually be computers which can think like humans, learn and innovate but let's look at things which are likely to happen in a shorter span of time. Self Driving Cars: this is something which is already nearly ready for introduction into society. The major problem with self driving cars is having to account for erratic, rule-breaking human drivers on the roads. Once more and more cars become self-driving, the safety factor can be enh...

'Saving Private Ryan' is an iconic movie starring Tom Hanks which won five Oscars, the movie is about a mission to save a soldier at the front. His brothers have been killed in the war and the generals decide that he must be removed from the front. It's a uniquely American idea which makes little sense to anyone else. Dozens of soldiers die in the course of this mission to save one soldier but apparently it is still a good idea. On my last trip to theUS, I decided to fly to Newark on the non-stop flight from Mumbai and take a bus from there instead of the usual hopping flights required to get to Pittsburgh. The flight landed on time. I got out of the airport in an hour. I got a taxi to the Greyhound Station. It was less than 4 miles from the airport. So far, so good. The Greyhound station was closed. It opens at 7.00 AM. For some reason the first bus to Pittsburgh leaves at 6.50 AM. There is no way to buy a ticket for that bus. The next bus to Pittsburgh is at 7.55 A...

A recent debate on using transplant center outcomes to decide accreditation with insurance and reimbursement reminded me of this article I had written on Quora some time ago. Copied and pasted. Upvote 20 Downvote Comments 2 Why Bill Clinton is alive and Steve Jobs is not Vinay Kumaran , Liver Transplant Surgeon Posted Dec 28, 2015  ·  Vinay Kumaran's Posts Transparency, the intention to treat and analysing data. or Why Bill Clinton is alive and Steve Jobs is not . How do you select a surgeon or a Hospital? How, assuming you are sufficiently rich and powerful that you want the "best in the world", do you find the best (or hire the best finder to find the best)? If you need a liver transplant, you can go to a website called  SRTR -- Scientific Registry of Transplant Recipients . At this website, you can look up the mortality, one-year survival, five-year survival, waiting list mortality and other such statis...