The map is not the territory

If consciousness is the territory, current AI is at best a partial map of that territory.

Rare and Common Presentations and Conditions

Common presentations of rare conditions are more common than rare presentations of common conditions.

What does the above even mean?

There are a very large number — thousands — of individually rare conditions. So even though any single given rare condition is only rarely seen, having any rare condition whatsoever is relatively common. On the other hand, there are a limited number of truly common conditions: the common cold, reactive depression, and back pain, for example.

According to the geneticists, “A rare disease is generally considered to be a disease that affects fewer than 200,000 people in the United States at any given time. There are more than 6,800 rare diseases. Altogether, rare diseases affect an estimated 25 million to 30 million Americans.”

If we consider a rare presentation of a common disease to be defined similarly, this would mean that this would likewise be about a 1 in 1500 presentation of a common condition. If 1/3 of the US population has at least one common condition at any given time, this means that about 100,000,000 persons in the US have a common condition; if 1/1500 had a rare presentation, this would in turn mean that there are only about 70,000 persons with rare presentations of common conditions per year. This is much less than the over 25,000,000 with a rare condition.

So it turns out that, based on prevalence data, the number of people with a rare but otherwise typical condition significantly outnumbers the number of people with only a rare presentation of one of the common conditions.

The anxious patient doing an unfortunate Internet search for their diagnosis may err because they choose a rare presentation of a rare condition over the common presentation of a common condition from which they suffer, and not because they find a rare condition that truly fits them best.

The machine runs on: "The Machine Stops" by yearend in 2021, we hope?

If you've never read E. M. Forster's classic The Machine Stops, written when the telephone was cutting edge tech, 2021 is the year you should.

See this link:

The Machine Stops

Let us not forget that social distancing is not social. Quarantine and related distancing is a necessary evil, and necessary evils are still, well, evil.

The dysfunctions promoted by our isolation under fear of the coronavirus should not be permitted to outlast the need for isolation. There are far better solutions incoming, such as immunization.

Sanbokan Marinade

The Sanbokan lemon is an heirloom variety of mandarin/pomelo cross which makes a great marinade for meat in the style of the Japanese ponzu sauces. Note that, here in Hawaii at least, the Sanbokan fruit is at is juiciest just as it begins to turn from green to yellow, and gets only slightly sweeter, but much less juicy as it ripens to bright yellow.


1 cup tamari (soy) sauce

1/2 cup Sanbokan lemon juice

2 teaspoons fresh ground pepper

4 cloves finely chopped garlic

Marinade steaks or pork chops for at least 2 hours, turning about every 15 minutes. Grill meat on both sides (gas grill preferred).


The BOMC Test is above. Originally developed by British psychiatrist Blessed as the Blessed Information-Memory-Concentration Test in the 1960's, and later shortened and validated with autopst neuropathological correlation as the Blessed Orientation-Memory-Concentration Test in the the 1980's, the BOMC test is seeing a lot more use in clinical neurology here these days.

Why? Of the commonly used standardized cognitive tests for dementia, including the Mini-Mental State Examination (MMSE) and Trump favorite Montreal Cognitive Assessment (MoCA), only the BOMC can be done without passing the patient a prepared piece of paper upon which to draw, copy, or write. The BOMC can be done purely over the video telemedicine conference line, no physical contact required!

The coronavirus epidemic has had many unforseen effects on 21st century medical practice, and the increase in our use of an older but fully validated tool because of an unforseen virtue for telemedicine is a quirky such effect.


Am J Psychiatry. 1983 Jun;140(6):734-9. doi: 10.1176/ajp.140.6.734.

Validation of a short Orientation-Memory-Concentration Test of cognitive impairment

Authors: R Katzman, T Brown, P Fuld, A Peck, R Schechter, H Schimmel

PMID: 6846631 DOI: 10.1176/ajp.140.6.734


A 6-item Orientation-Memory-Concentration Test has been validated as a measure of cognitive impairment. This test predicted the scores on a validated 26-item mental status questionnaire of two patient groups in a skilled nursing home, patients in a health-related facility, and in a senior citizens' center. There was a positive correlation between scores on the 6-item test and plaque counts obtained from the cerebral cortex of 38 subjects at autopsy. This test, which is easily administered by a nonphysician, has been shown to discriminate among mild, moderate, and severe cognitive deficits.

Ono Recipe

We've had a big of mac nut collection from the front yard this season, as well as a few mangoes. The local fisherman still sells the days's catch from giant ice chests on the back of his truck a couple time a week. So, with a hat tip for the original recipe by Bev Gannon of Maui, here is a tasty recipe for cooking at home.

Mac Nut Rice Flour Crusted Ono

Use a cast iron skillet for frying and to hold baking fish.

Preheat oven to 425 degrees.


Fish: 2 lbs thick ono fillets


1/2 cup chopped fresh mango

1/2 cup white wine or grapes

1/3 cup sugar

1 tablespoon minced ginger

1/4 cup lime juice

Bring to a boil, add 1/4 cup sour cream and 1/4 cup butter, mix in blender.


Salt / pepper / garlic seasoning

1/2 cup macadamia nuts, whole or pieces

1 cup rice flour

1/2 cup fresh basil (or other green herb seasoning

Set seasoning aside for now. Grind nuts, flour, and herbs in blender until fully mixed.

COOKING 1: Coat fish with seasoning. Place ono skin side down in lightly oiled frying pan and lightly fry skin side.


1/2 cup good-quality mayonnaise

2 teaspoons Sriracha

Mix mayo and sriracha and spread on the skinless side of ono fillets.

Add rice flour mixture so that the spicy mayo sticks the flour mixture to the ono fillets.

COOKING 2: Flip ono flour side down in pan and brown flour side.

COOKING 3: Transfer to hot (425 degrees) oven and bake for 8
minutes, then shut off oven, vent, and allow fish to sit warmly in oven til time
to serve (will finish cooking during this time).

Serve flour side up with the sauce to ladle as a gravy.

The map is not the territory

If consciousness is the territory, current AI is at best a partial map of that territory.