Blissful Life

When you apply skepticism and care in equal amounts, you get bliss.

Author: akshay

  • Three Stories On Connecting Health Data

     Story 1

    There was a small research institute with 20 people. Someone among the staff did an online survey to ask everyone their demographic details (name, age, gender, email address) and their diet.
    After four months, another person ran another survey. By then there were 23 people in this institute. This surveyor asked everyone their name, email address, haemoglobin.
     
    Now the director of the institute wanted to connect diet to haemoglobin levels. So they took up the older survey and assumed that since email addresses will probably remain the same, they could use that field to “connect” these databases together. But, alas, there was one person who changed her email from @gmail.com to @institute.org
     
    But never mind. They knew who it was. So they just fixed this by copy pasting rows in a spreadsheet.
    Story 2
    A survey was done in 20 villages. There were two teams of 5 data collectors who divided the villages equally. They went to households and collected from the people demographic details, answers to a lot of questions about health, and also the GPS location of the households.
    Then, 5 months later, the PI got more funding to do a haemoglobin study for 600 people. The PI decided to divide this fund in such a way that 300 people who come to a nearby hospital would get tested and 300 people from the previous survey (6 villages) would get tested.
     
    One of the previous data collection teams was called in. Turns out 5 of those villages were surveyed by the same team in the past. Fresh from the previous survey, they went to these villages and quickly located the households they had previously surveyed. Once they were in, they used the names of the individuals to locate their past record from the surveying app and added haemoglobin values too. But in some households there were no people as they had gone for work.
    In the remaining one village, they used the GPS location to find out the households. It was slightly harder, but it was doable because the application with which they collected the data could directly point them to the household location. It worked when the GPS would work. When the GPS wouldn’t work, they would look at the names of the people in the households and ask people whether they knew where those houses were. Somehow they made it work.
     
    In the hospital, meanwhile, some of those missing people from these villages had come and they were getting haemoglobin tests. But this data was not being collected.
    Story 3
    The Government of Karnataka decided to do tribal health research. They collected data (demographics, height, weight, BP). Then they assigned to each individual a unique ID number. Something called Namma-ID. They told them that they should keep these Namma-ID numbers safe and that these would give them benefits in healthcare, etc. And someone in the government had the idea that the data they collected should be available for researchers. Any researcher who signs a confidentiality clause would be given all the data (name, father/husband name (still patriarchal in 2021), home address, village name, Namma-ID, etc included). There was one doctor in the area who got themselves access to this data. This doc narrowed down the data to their own village and the set of people with hypertension and saved that in a spreadsheet. 
     
    Every time someone came to their clinic, the doctor would ask if they had a Namma-ID and if so the doctor would look at their height, weight, and BP from the GoK data. If they didn’t bring their Namma-ID, the doctor would ask their name and try to search. Sometimes the doctor would have to try various spellings to get the right person’s record. But somehow the doctor would find the right record and add more details when that particular visit was over.
    Then there were times when people who were new to the village came to the doctor’s clinic. The doctor would spend minutes searching for this new person’s record. The poor villager would be sitting on the patient’s chair wondering why the doctor wasn’t asking any question about the health issue.

  • Organizations, Like People, Have Values

    I stole the title from Peter Drucker’s Harvard Business Review article titled “Managing Oneself” [pdf]. It has been 4 years since I graduated medical school and in that many years, having worked with (and escaped having to work with) organizations of different kinds, I have come to the same conclusion.

    Organizations have values. These values can be determined by observing the way the organizations work. Whether or not you will feel happy working with an organization is determined by whether your values are compatible with the value system of that organization.

    The values of an organization exist independently of the values of people in its leadership. The leaders have a great role in determining the values of an organization. But often leaders are distracted by a “pragmatic” approach that usually follows money in an increasingly capitalistic world. And this makes them make compromises without even realizing what they’re giving up.

    And you can’t blame them. Organizations, by definition, have the motivation to grow. Growth is easier to achieve if an organization focuses on either money or power. Because they have a top-down nature, it is easier to wield money and/or power to direct growth. There might also be an argument that a top-down approach like that will lead to larger and faster results too.

    This also leads to a particular set of values. Even if the leaders of an organization have a different set of values in their personal life, their choice to focus on money/power will lead their organization to have a value system in which retaining and increasing money/power will be a core priority. That influences the kind of values that can thrive in those organizations.

    On the other hand, choosing to focus on things like “people” will lead to organizations being structured in very different ways, especially with regard to decision making. Such bottom-up structure fosters different values altogether.

    When I say bottom-up, I am not talking about a “top-down disguised as bottom-up” management structure. In fact, the right way to run any organization is that top-down, yet bottom-up way as explained in this article: “How to Design a Self-Managed Organization“. But eventually such an organization is still one where there is a leader who ultimately is in charge (even though they rarely use that control in day-to-day activities of the organization). I am not talking about that bottom-up style.

    I am talking about a truly bottom-up style where there are no leaders at all. This is akin to participatory research. 

    “Participatory research comprises a range of methodological approaches and techniques, all with the objective of handing power from the researcher to research participants, who are often community members or community-based organisations. In participatory research, participants have control over the research agenda, the process and actions. Most importantly, people themselves are the ones who analyse and reflect on the information generated, in order to obtain the findings and conclusions of the research process. ” ~ source

    What would organizations look like if they embraced the participatory approach? What would the role of a leader be in such an organization?

    The P2P foundation wiki has lots to speak about it. On the same, I found a link to The Three Ways of Getting Things Done by Gerard Fairtlough. This book provides two alternatives to hierarchy – heterarchy and responsible autonomy. 

    “If hierarchy is the power system of centralized systems, then heterarchical power is the power system of decentralized systems and Responsible Autonomy is the power system of distributed systems.”

    Similar thoughts about adaptive leadership is mentioned in Complexity Leadership Theory (H/T: Dr Ramakrishna Prasad).

    The question of money or “business model” also has a big role in deciding the values of an organization. Organizations who raise money before work is done tend to have made promises which decide how the work is done. The nature of these promises decides the value of these organizations.

    Sometimes, such commitments can make an organization take up values that are antithetical to their own mission. Especially when it comes to free software, or free knowledge, having financial commitments lead to organizations wanting to make money out of software and knowledge – which is arguably easier if you restrict freedoms.

    An organization with the wrong structure cannot have the right values. And if you find yourself in a situation where the people in an organization wants to have the right values but aren’t radically restructuring the organization, then run away as fast and far as possible.

  • Whose Responsibility is Health?

    How do you trigger a never-ending debate on Twitter about health? You have two options. Either talk about a bridge course from Ayurveda into modern medicine. Or talk about compulsory rural service.

    Why, though? The superficial reason is that Twitter is a stupid medium where there is not enough space to make a nuanced argument. The deeper reason is that it is not clear whose responsibility “health” is. And that’s because there are two ways of defining what “health” is.

    There are folks who take health to mean absence of diseases. Even when the community medicine department in medical schools keeps talking about WHO definition of health, many medical graduates focus on “diseases” because the rest of the medical school talks only about diseases. This percolates to the rest of the society and in the overall society there is a clear notion that health is the absence of diseases and that healthcare is access to curative services.

    The impact of this definition is most strikingly visible in what people coming out of medical schools tend to do with their lives.

    They seek specialties and super specialties (like interventional radiology, dermatology, and cardiology). They do not have a problem in spending one, two, or three years in trying to get post-graduation seats. They seek work in the largest hospitals in the largest cities. They make their life about “diseases” and restrict their role to providers of disease-curative services.

    But this definition is not just restricted to doctors.

    • Faculties in medical schools continue to teach students that health is about “diseases”. (Even in some community medicine departments).
    • Government of India spends a significant share of health budget on setting up/upgrading hospitals and on reimbursing curative services through elaborate insurance schemes.
    • When there is a pandemic, technologists rise up and try to “help” with their mathematical models. But they don’t think they have anything to do with health during non-pandemic times.
    • People think about health only during bouts of illnesses. They pay for healthcare only in the context of curative services. (Or insurance premiums for schemes that apply only to curative services).
    • There is no talk about health during election campaigns.

    There is a wider, (arguably more “real”) definition of health – as a “state of complete physical, mental and social well-being”. This is often forgotten. As per this definition, we have country full of unhealthy people. And people who stick to this definition make the case that health has as much to do with the society and its politics as it has to do with hospitals.

    They argue that education, opportunity (to make a living), dignity, equality, rights against exploitation, justice, access to technology, and so many other factors go into deciding whether individuals are healthy.

    When it comes to doctors (and other medical professionals), they have two ways to spend their lives in this society.

    1. Follow the narrow definition of health where all that matters to them is the survival of their “patients” – those who come to the hospitals.
    2. Follow the broader definition of health where they are leaders and change makers and politicians and advocates.

    Unfortunately, in the never-ending cycle of disease management and education to manage diseases, most of our medical professionals (doctors, nurses, etc) are not trained to take on the broader definition of health as their “job”. Which leaves them restricted to following the former kind of life.

    The broader definition of health is then left for a very small set of people to work on. They are variously known as “public health professionals”, “family physicians”, “primary care practitioners”, “community health specialists”, etc.

    The task for this small group of people, on the other hand, is humongous. While delivering curative services require to match demand with enough supply of resources (human and non-human), working on the larger definition of health often needs a whole different approach. For, the problems in (social (?)) determinants of health like gender, class, education, economic condition, and so on often require action beyond individuals and institutions. Some of these work span generations. And there is no linear progress. Sometimes societies regress to worse conditions too.

    Now, here is the problem. This bigger task should not be and cannot be done by “medical” professionals alone. It requires collaborative action from communities, lawyers, politicians, engineers, economists, artists, historians, every person imaginable. Because that work is not related to “medicine” alone.

    Now, let us look at the controversial topics that we started this post with.

    In both bridge courses and compulsory rural service what the governments seem to be trying to do is to increase the number of “qualified” doctors (and hopefully other medical professionals) in rural areas. We can assume that their assumption is that if there are enough trained curative service providers, there will be some respite.

    And they are probably not a 100% wrong in making that assumption. If a person with wisdom and training goes to a place that can benefit from that wisdom and training, that place will benefit at least a bit. (Taru Jindal’s story is an example).

    But there are some important counter-arguments

    • The nature of these policies are sometimes objectionable. “Mandatory” rural service is as controversial as mandatory military conscription. Bridge courses may often be seen as unscientific or unfair.
    • The training in medical schools (especially when they get more “specialized”) need not be tuned to the context and needs of rural communities. Even if medical professionals are trying to deliver only curative services, they can be quite disoriented when they find that they don’t have the investigations and interventions they need at arm’s length.
    • To stress on the point of training, there probably is very little of leadership training in medical schools and often in communities where the health system is next to nil leadership is a critical element in being able to set up systems.
    • The kind of leadership challenges one faces in rural communities could be different, and the solutions might often require larger systemic changes (refer the broader definition of health).

    It is counter-productive to train a generation of medical professionals in delivering curative services in cities and then expect them to perform in a broader, entirely different, and disproportionately more challenging role as health care leaders in rural areas. 

    You can send them to well functioning hospitals with all facilities in rural areas and they probably will find their groove. The irony is when you are sending them to rural areas to build such hospitals and/or systems for health without giving them any training in that.

    And it is not all medical school training that I’m talking about. It is also the societal training. We as a society are training many professionals (doctors, engineers, included) with a very narrow definition of purpose and meaning ascribed to their profession. If you are a doctor – the meaning of your life is to treat the sick. If you are an engineer – the meaning of your life is to plan and build things. And so on. When have we, as a society, encouraged people to ask larger questions. Like “Why are people falling sick?”, “Why does this thing have to be built?”, “What is my role in perpetuating the system the way it is?”, “How is it possible that there are widespread inequities in the world while there are enough resources for all humans to have a dignified life?”, “How are our decisions and actions endangering the survival of this planet?”, “What is the relation between care for others and democracy?”

    The questions that matter often have solutions that require collective action. And that often includes many kinds of individuals (no matter what their “job” or “background” is) to take action. Sometimes that includes you. Do you consider that as your responsibility? If you do not, then you are part of the problem.

  • Don’t Cook Your Meals

    Thanks to The Great Indian Kitchen a lot of discussions are happening on cooking. I wanted to note down a few of my thoughts in relation to cooking, etc.

    I find cooking boring

    There might be people who find cooking interesting. I am not one of those persons. I find food boring too. Anything healthy and tasty is good food for me. Probably that’s why I find cooking boring. Because cooking is about food.

    Cooking regularly for oneself is a massive waste of time, money, and energy

    This is especially true for people who have other engaging work to do – people like programmers, teachers, etc. Cooking regularly takes away a large amount of time from your daily life which you could have spent on reading, learning, etc.

    In the video above (in Malayalam), around 15 minutes, Maithreyan also tells something to this effect. On the economics of cooking.

    Mass production of cheap and healthy food should be a reality

    In VMH, I used to eat from the canteen three times a day. I was never starving and even though I missed chicken and beef, I was eating okay. I lost the 4 kgs I gained during internship eating Biriyanis all day. But once I moved to Bangalore, I couldn’t find a replacement for this canteen.

    Zomato/Swiggy etc are a problem because of two reasons

    1) The amount of plastic.
    2) The cost because someone has to burn petrol and drive a motorcycle all the way from the restaurant.

    The hotels were all catering to the occasional outside diner and would cook expensive and often unhealthy dishes.

    Hiring the service of a maid is good for many reasons

    For a long time I used to feel icky about hiring the service of a maid. Perhaps I didn’t think a lot about it. I used to feel that it is wrong to rely on someone else for one’s basic needs like food, cleaning house, etc.

    But during COVID when people were all losing jobs and we were literally asked by someone at the local bajji shop whether we needed house help, Swathi and I decided it is time we hire someone’s service.

    And then I figured out how by redistributing money through such hiring is actually good for everyone. It frees my time and mind. It gives someone who would otherwise be unemployed a chance to do work.

    Cooking can do with a lot of innovation

    Here’s a recent talk I enjoyed watching.

    It talks about how bras have remained the same for over a century. Perhaps cooking is like that. At least home based cooking. Nobody has thought about revolutionizing cooking. Sure there are innovations like mixers, grinders, and my all time favorite – rice cookers. (Fun fact, did you know the rice cooker works by the principle that water when still boiling cannot exceed temperature of 100°C? The thermostat of a rice cooker cuts power off when the temperature exceeds that because by then there wouldn’t be any water left as liquid).

    But we haven’t redefined cooking the way cloud computing has redefined servers or the way ebooks have replaced libraries. Maybe some day we will find food pills and that will be it.

  • The Great Indian Kitchen – A Great Movie About the Not So Great Indian Kitchen

    If you know Malayalam, you are better off reading Joshina Ramakrishnan’s review which captures the whole essence of the movie and places it smack in the middle of the collective conscience of Malayalis.

    The first thing that appears on the screen after CBFC certificate is not a 2D Ganesha idol. It is the words “THANKS SCIENCE”. What follows is 100 minutes of silently violent, nauseating, sensitive, beautiful modern cinema.

     

    There are a million things said without saying and to spoil them in a review would be a disservice to the movie. I suggest that you head over to neestream and get a week’s pack to watch this movie ASAP. English subtitles by 1″ barrier will help non-Malayalis catch the subtle dynamics between characters. 

    But to appreciate the brilliance of this movie you don’t need to know Malayalam, because many important dialogues in this movie are the sounds made by the kitchen in response to the woman who is forced to converse with it against her wish.

    But don’t for a moment be under the impression that The Great Indian Kitchen is about the kitchen. It is also about the bedroom. And the rest of the house. And the entirety of the society.

    The characters in this movie are all of us. The movie is thus a mirror. What we see in it is what we should see in ourselves. But who has ever looked in a mirror and decided to change their life?

  • Questions to Ask About Vaccine Data Tracking

    In vaccine data tracking debate, please question the assumption that the government needs to track who is taking vaccine.

    What are the implications of not tracking who is taking vaccine? What are the risks and benefits? Who gets excluded when IDs are required for vaccine? What is the government trying to prevent by making IDs mandatory? What are the costs of tracking vaccine beneficiaries? What will the tracking be used for?

    Only if tracking people is required does discussing the mechanism of such tracking make sense.

  • Wonder Regimen to End Tuberculosis in India

    Have you ever looked at Tuberculosis and thought, “Hmm. I wish there is a way to end this disease”?

    Well, wonder no more.

    Anurag Bhargava, Madhavi Bhargava & Anika Juneja have come up with a regimen that can achieve your dream.

    Another good news is that treatment with this regimen can also be helpful in many other diseases.

    Even better, it is a non-invasive regimen.

    Want to learn the regimen and start using it in your practice?

    Click here [PDF, 1.9MB] to know more. (You might want to skip to the end for the actual prescription, but read the full paper for context).

    Dr Anika Juneja, one of the authors of this paper, has won the India HPSR Fellowship this year.

  • The Art of Setting Up Success

    What makes a great surgeon? Do they have long fingers? Or steady hands? Or the heart of a lion?

    I think it is the preparation they do right before they make the incision.

    In VMH, I would be assisting various surgeons, especially Dr MR Seetharam in orthopedic surgeries. MRS is very methodical in preparation for a surgery. Every surgery is different. One might require an expensive equipment, or a team of skilled surgeons. The patient might have severe comorbidities that make post-surgical management difficult. The economics might not work out. Functional recovery maybe more important. There are many factors that go into choosing the right kind of surgery for the right kind of patient. MRS will be thinking of all these as soon as becoming aware of someone who has an issue. But that’s not the preparation I’m talking about.

    Inside the operation theater, with the patient and others eagerly waiting, there’s a final and crucial step of preparation that MRS does. The X-rays are put on the viewer where it can be seen from the operating table. Another look is given at the X-ray to review the approach and the location of the fracture fragments. The fractured part is positioned with great attention to allow the views and manipulations that would be required later during the surgery. Extra tables are brought in if so required. The position of each assistant is decided. All the props are set up exactly where they have to be. The C-arm (A C-shaped X-ray machine that can be rotated around the patient during the surgery to see the bones and the implants near real-time) is brought in and out of the field to ensure there are no hurdles. A shoot is made in each position that the part would be during the surgery to be sure there is no obstruction in the C-arm’s view. All the implants and instruments are reviewed to make sure they’re right. The assistants are warmed up on the procedure and the tools that’ll be used. The success of a surgery is decided before the incision is put.

    That last sentence might sound like this speech by Harsha Bhogle. Or the saying “The more you sweat in practice, the less you bleed in battle”. But I am not talking about the years of dedication one puts in before one becomes a fine surgeon.

    I am specifically talking about the setup. Take this example of a setup for arterial blood draw.

    Depends I think. If you’re crammed between the wall and the ICU bed on an obese hypovolemic patient whose diaper you cannot remove completely and you’re drawing the femoral artery with a plastic syringe not meant for it, should be sufficiently difficult.

    — Akshay S Dinesh (@asdofindia) December 31, 2020

    That is a setup for failure. If one compromises on the setup, they would often have to compromise on the result as well.

    * * *

    What I realized as I was writing this is that I tend to compromise a lot. I don’t know whether I do it as a way to challenge myself so that I feel good about myself if I luckily succeed. Or because I’ve not learned how to negotiate better. Or maybe I don’t know what I need. Or maybe I don’t think. Or maybe I think being accommodating is a virtue.

    Perhaps accommodation isn’t a virtue. Perhaps if you don’t ask for the right working conditions, you’re going to end up being ineffective and lowering the standard all over.

    But you’re never going to have all that you need. “You’re going to have to compromise” is the folk wisdom. It’s difficult to imagine having everything I need. That’s a contradiction.

    Perhaps then my core premise is wrong. It is probably not about the setup. Or maybe it’s a bit of everything. Maybe I’m partly right.

    Maybe you can compromise on the setup if you can compensate with your skill (or luck). Or maybe that’s too much strain on you.

    I don’t know. Maybe I’ll have clarity later.

    PS: I was wondering whether to make the latter section “PS”. But maybe that’s the script. It’s a blog, after all.

  • Science is Broken Because Scientists Can’t Think Rationally

    Scihub is being sued in Indian courts by the journal industry. There are some people worried about it. But it is funny how our knowledge system works. Take this tweet for example:

    Scientific publishing sure is rigged & broken. But hoping that the very bandicoots that are getting fat from the status quo will take hints and improve the system is beyond naive. The telling lack of collective resistance from scientists too enables this perverse model to thrive. https://t.co/ye9SuxlYQM

    — M D Madhusudan (@mdmadhusudan) December 24, 2020

    The reason why journals charge exorbitantly and still get away with it is because almost all academicians publish only in those journals. And why do academicians publish in those journals? Here comes the greatest hypocrisy/logical fallacy of academicians.

    They think that publishing in “prestigious” journals bring “prestige”. They even have a way of measuring prestige without making it sound like it’s an emotional thing – impact factor. It is all part of the same logical fallacy – argument from authority. A cognitive bias that makes humans think that “authority” is right.

    The only purpose of journals in the internet age is to exude authority.

    The same purpose of universities.

    If scientists step down from their pedestals and start looking at the world without bringing in their cognitive biases (like every scientist should be doing), there can be a world where knowledge is produced and consumed with lesser hurdles.

    There definitely is a side to this where the omnipresent, omnipotent “system” is oppressing academicians and forcing them to continue with this prestige based publication. After all, scientists are humans who would rather give in to the way the world works than stand up against anything.

  • What to Do with Privilege?

     I have had the privilege to think and write about privilege often. I have written about how privilege affects Indian software industry’s ability to innovate. I have written about why the privileged should think about how they’re part of the problem. I have looked at my privileges visible to me. I also felt guilty/responsbile and came up with a probably stupid idea of distributing my time to help others.

    Today morning I came across two interesting tweets.

    Your achievements reach far beyond your own benefits, they inspire others to excel. Keep rocking.

    — Venkat Subramaniam (@venkat_s) December 22, 2020

    The next tweet requires a bit of context. New York Times had published a very interesting story about pollution in Delhi by following two kids from different backgrounds and measuring their pollution exposure. You should absolutely read the story (the reality) if you haven’t.

    Something about this article is disturbing. Did the girl sign up to be portrayed as this symbol of “privilege” in this piece? To be fair they might have changed names or whatever. But still. Something off I feel.

    — Deepak Varughese, MD (@VarugheseDeepak) December 19, 2020

    This made me think about the book by Michael Sandel that I recently finished reading – The Tyranny of Merit. It is a book about privilege, inequities, affirmative action, and the idea of justice. 

    The book starts with examination of a US college admission corruption scandal. A few rich parents had paid some people to get their kids fake certificates that would make it easier to get college admission. This was seen as highly unfair and corrupt.

    But being born with privilege automatically gives people an edge. I didn’t have to fake any certificate, but I grew up in an environment where I could “earn” those certificates. Conversely, people who have lesser privileges start with a disadvantage.

    Affirmative action steps in there. The idea with affirmative action is to give those who didn’t have the background a chance to succeed. Reserved seats (or diversity quotas) “level” the playing ground.

    But affirmative action comes with lots of problems. See the replies on this tweet, for example.

    No. It’s an attempt towards balancing the scales so that the industry doesn’t remain so biased towards one gender.

    We’ve seen what the industry looks like without such interventions – a male dominated one. So can’t expect nature to just run its course and fix everything. https://t.co/enPEhdIZjI

    — Balasankar “Balu” C (@balasankarc) October 27, 2020

    Affirmative action makes those who do not benefit from affirmative action feel lots of resentment towards those who do benefit from it, especially if the former view themselves as disadvantaged in a way that is not considered as a disadvantage in the affirmative action program. For example, in this case, male candidates from rural/poor background feel that Google hiring female candidates exclusively is unfair.

    Michael Sandel then questions the very idea of merit. Is it possible to have an Utopia where everyone has equal privileges? Imagine a heavy autocracy where everyone is born in the same conditions. What happens when different human beings are born with different cognitive/physical capacities? Isn’t being born with better genes a privilege? Is it okay for people to use that privilege to get ahead of others?

    Affirmative action is an attempt at ensuring equality of opportunity. But no matter how hard we try there are certain opportunities which everyone cannot equally have. At the same time there is a large amount of wealth inequalities that arise. And also a lot of inequalities in terms of esteem. Those who are privileged feel guilty of their success. Those who benefit from affirmative action are shamed that they couldn’t “qualify” without the same.

    I have thought in the past specifically about college admissions. What if everyone could access high quality of education and nobody had to miss out on the opportunity? Then we wouldn’t need reservation and selection. But, we have created an artificial scarcity of seats. Why do we give universities the monopoly over knowledge like that? Why do we have professions like programming which anyone can enter and then professions like law which people are barred from entering?

    It might be my pet peeve that there are regulated professions. But Michael Sandel also calls for dismantling meritocracy and ensuring equality of condition. The book, like the Justice course, makes you think and rethink the idea of justice.

    Coming back to the tweets above. I think that looking at privilege as a shameful thing is useful for nobody. Giving up privileges is a waste of privilege. The right use of privilege, in my opinion, would be to use it for reducing inequities in the world. The rich family that agreed to be part of the NY Times article therefore need to be applauded. And those with privilege need to acknowledge their privileges and work towards making those privileges irrelevant.