Dear New England Journal of Medicine

24 Feb

In the January 19th edition of the New England Journal of Medicine, a ludicrous article about creating a Yelp for doctors by and for the University of Utah was published on the front page of the journal.  I have severe reservations about the use of customer service metrics on complex professional relationships such as medicine.  While improved communication and compassion can and should be improved in American medicine, I feel this has been over-emphasized and avoids addressing the real structural issues of health care.  This also contributes to the narcotic epidemic as doctors are afraid of displeasing patients who are often pain-seeking.  With life expectancy falling for the first time last year, we need to think harder and smarter about this.  Below is a satire applying patient satisfaction to the practice of law.

Dear Editor:

Suppose we transferred “patient-satisfaction” ratings on to the practice of law.   Affordable access to the legal system is a matter of life, death, or imprisonment.

The Justice Department would devise a rating system for all large group practices and courthouses based on “star ratings.” Lawyers and their practices would pay Press-Ganey to administer randomized surveys to assess “client-satisfaction.”

Even though law is a diverse field with many specialties, many types of clients (who may have pre-existing criminal records), and many kinds of cases with varying evidence-based practice, client satisfaction surveys rate the ability of their lawyer based on bedside manner, promptness, and cleanliness of their office. The general public would then judge the law firms’ courtroom outcomes independent of any case-client-evidence specifics.

Would anyone buy this? Would any lawyer sit still or justify this idea in a premier law journal?  Would we decide judicial elections and presidential nominations by their satisfaction scores?  Or would we evaluate judges by the opinions of their legal colleagues and local bar associations?

I find it incredible that there are those in medicine who would justify patient satisfaction scores and evaluation systems when they have caused so much havoc in public education and the lawyers who wrote these laws would never consent to them being imposed on their own profession. No nation’s health system has improved based using such metrics, and we should not kid ourselves that such feedback systems have anything to do with the real, unseen practices of medicine.  We deserve better or at least as much as attorneys deserve.


A working physician



Issue LIX: The French Election and Mitterand’s Shadow

11 Feb

A hopeful presidential candidate wins office and ends a long period of conservative rule.  He promises a break with the past.  Disappointments rack up, he loses control of the legislature, but he manages to win a historic second term.  By the end of his rule, racist and xenophobic white nationalist organizations have started to grow in disappointed industrial areas.  His party lays broken.  Once staunchly left and unionized areas begin to shift towards the far-right.

Am I describing, dear reader, the end of two terms of Barack Obama?  No, actually this describes the situation after the disappointments of the first Socialist President of the Fifth French Republic, Francois Mitterand.  Instead of the Tea Party and the “alt-right”, we have the National Front and Jean-Marie Le Pen and his daughter Marine Le Pen blaming immigrants and castigating corrupt political insiders for the failings of the nation.  What does this year’s French presidential election tell us about what happens when the left fails in a time of economic crisis?

Dancing in the Street

When Francois Mitterand, after decades in the political wilderness, finally won the presidency the young rejoiced and danced in the streets of Paris in 1981.  He had helped found the French Socialist Party and its critical alliance with the French Communist Party.

He promised to move France beyond capitalism and beyond Swedish social democracy.  The poor, workers, and unemployed awaited the rupture with the past and for complete fulfillment of the French Revolution’s promise of liberté, egalité, and fraternité.  There would be increases in the minimum wage, nationalization of industry, decreases in the work week, and abolition of capital punishment.

By 1983, he performed a U-turn and ended the left’s promise to end capitalism.  Mounting financial difficulties and inflation led him to turn towards austerity and cutbacks in government spending and devaluations of the franc.  After a few years, disappointed voters kicked the Socialists out of the National Assembly leading Mitterand with divided government and power-sharing with the conservatives.  But like Barack Obama, he managed to win his second presidential election.

In his second term, Mitterand gave up on socialism and decided to go for creation of the euro and the European Union. Increased free trade with neighbors (“the Common Market”) and a common currency became his signature priority.  But these treaties came at a strict cost.

Euro rules prevent large deficit spending and would eliminate currency devaluations as a monetary strategy.  Common Market rules promoted capitalism, standardization of rules across the Continent, and effectively banning aid to industry.  In short, they were a straightjacket the prevented any chance of socialism or even robust Keynesianism ever occurring again in France.  He was called the gravedigger of socialism in France and the European Union.

The Rise of the National Front  

The far-right National Front began its rise in the 1980s after the disappointments of the Socialists.  Led by the former paratrooper, Jean-Marie Le Pen, it routinely began winning 10-15% of the vote.  This eye-patched anti-Semite first gained support from Algerian colonists who returned to France after Algerian independence and Vichy France-era Nazi collaborators.  After many unsuccessful years blaming immigrants for the lack of jobs and a lack of “law and order”, Jean-Marie Le Pen’s National Front gained steam while Mitterand developed consensus politics in France.  With no radical alternative on the left, disgruntled voters on the left began to vote for the National Front.

In 1995, Mitterand left office and conservative Gaullist, Jacque Chirac, won the presidency while Le Pen scored 15%.  In 2002, Jean-Marie Le Pen shocked the world by coming in 2nd at 16.86% to President Chirac’s less than 20% in the first round of the presidential election.  In the runoff, all the parties endorsed Chirac who won easily (82%) but Le Pen increased his vote to almost 18%.   After one more presidential run in 2007, he passed off the party to his daughter Marine Le Pen who has taken the party new heights.  But that too required faltering by the left and more unemployment.

The alteration of the presidency from conservative Nicholas Sarkozy (2007) to Socialist Francois Hollande (2012) has again supercharged the far-right.  The Great Recession ultimately did in Sarkozy’s presidency and the continued lack of growth in the Eurozone and terrorism has made Hollande the most unpopular President in the history of France (approval rating of 4%).  The euro, EU treaties, and German austerity policy have ruined any chance of economic stimulation occurring under any French president.  Once again, the failure of a social democratic solution (the old idea of a rupture with capitalism is off the table) has led disgruntled voters searching for jobs into the hands of the National Front.

Marine Le Pen has broken with her father and silenced the anti-Semitic element of her party.  She has pledged to re-enact the death penalty, kick out immigrants, re-issue the franc, and leave the euro.  If she wins, she pledges a vote on leaving the European Union (“Frexit”).  Marine Le Pen now polls around 25% and will likely win the first round of the 2017 presidential election.

Will the rest of the political establishment unite around the second candidate in the runoff the way they did in 2002 against her father?  Likely, but unity will not come as easy this time.  Leading candidates Francois Fillon and Emmanuel Macron pledge nothing but austerity, tax cuts, layoffs,  and more neoliberal economics.  After a year of Brexit and Donald Trump’s election victory, can we really count on Marie Le Pen losing the second round?  Out of touch neoliberal Washington and London elites have been shocked by angry, heartland voters.  Perhaps Paris is next.

Francois Mitterand, destroyer of dreams, thought he ended the chance for a radical transformation of society by creating consensus politics in France and Europe.  This year his straightjacket tears open…. but from the right.


Monocle Radio – “The French Left”
Daniel Singer – “The Resistible Rise of Jean-Marie Le Pen”

Issue LVIII : Ohio – Not the Swing State?

25 Nov

In this current era of “big data” and election statistics hype pioneered by, I figured I’d write about some of the interesting numbers I have seen.   Living in Ohio, I also wanted to expatiate on the idea that Ohio’s bellwether status may be on the verge of expiration.  For the popular vote, I am using the Cook Political Report’s Popular Vote Tally.  For Ohio, I suggest two books: Buckeye Battleground from University of Akron and The Bellwether from Ohio University.  I mostly extend my ideas from these two books.

What’s a Swing State?

A swing state must do two things: 1) consistently choose the presidential winner and 2) consistently be close the national popular vote.  Ohio for 200 years has been both in presidential elections.  As a relatively large state, winning it often determines the electoral college winner.  For a century, this meant choosing a presidential candidate from Ohio (birthplace of 8 presidents) but since the death of President Harding in 1923, this has just meant winning the state electorally.

The simplest way I explain why Ohio is a swing state is because Ohio represents different parts of American in one state.  The north is Northern and the south is Southern to put it roughly.  Buckeye Battleground divides the state into 4 quadrants with Columbus in the middle.

Northeast Ohio (Cleveland/Akron/Canton/Youngstown) was settled by people from New England.  Specifically it was part of Connecticut’s “Western Reserve.”  It was industrialized early on and has many similar characteristics to the American Northeast (industry, unions, immigrant Catholics, and African-Americans who moved from the South).  The original Western Reserve counties in fact still match the presidential vote results in Connecticut within a point or two since the 1890s.

Southeast Ohio is Appalachian and similar to West Virginia.  It has the smallest population and is poor, rural. and Scotch-Irish in ancestry.  Northwestern Ohio is heavily German and is similar to Indiana but also has a large automobile industry in Toledo which is very close to Detroit.  In fact the bellwether county for the state, Ottawa County, is in this area.

Southwest Ohio borders Kentucky and has Cincinnati which has been very Republican for over a century.  It is home to the Taft family, Macy’s, and Procter and Gamble.  This area is the most conservative part of the state and balances the liberal orientation of the Cleveland metropolitan area.  Columbus, the only major city in central Ohio, has gone from Republican to Democratic over the last twenty years and is home to Ohio State University but has Republican suburbs.

Nothing Special Here

Ohio is uniquely characterless due to the lack of a single city or industry dominating the state.  Cincinnati lead the state in population in the 1800s then Cleveland led in the 1900s and now Columbus has the most people.  None of the cities dominate the state the way Boston, New York, Philadelphia, or Detroit dominate their respective states.  In the economy, the Buckeye State does a little bit of everything.

Ohio makes cars (but not as many as Michigan), Ohio has insurance (but not as much as Connecticut), Ohio has banks (but not as much as New York), Ohio has coal (but not as much as West Virginia), Ohio makes steel (but not as much as Pittsburgh did), and Ohio has farming (but not as much as Indiana or Iowa).  Nothing stands out.

As you can guess, winning the state means a balancing act between the different regions.  Democrats need blowouts in the Northeast and need to squeeze votes out in the Southeast and Northwest (and these days Columbus) to win while Republicans aim to unite the Southwest and Southeast (and as much of the Northwest) against Greater Cleveland.  It really is Cleveland against the world.

No Longer Swinging

But alas, Ohio has not been doing so hot for the last few decades.  Deindustrialization and the death of coal and the car industry has hurt the state while new industries do not seem to pop up anywhere outside of Columbus.  Ohio has been losing electoral votes and congressional representation to southern and western states for years now.  Ohio used to have 23 electoral votes in 1900 while Florida had 4; now Ohio has 18 and Florida has 29.

I see Ohio as the perfect twentieth century swing state but Florida as the perfect twenty-first century swing state.  Ohio’s Hispanic population is negligible, and Ohio has very few immigrants nowadays unlike in 1900.  No part of Ohio resembles the American Southwest.  I had a feeling that in the era of Trump’s calls for building a border wall with Mexico that this would cause a large divergence from the Southwest.  Mexicans/Mexican-Americans in the United States live in the four border states and not really in the Midwest outside of Chicago (I find the blanket term “Hispanics” not to be useful politically or practically).  The small Hispanic population in Ohio tends to be Puerto Rican which would not face threats of familial deportations.  Without an appreciable Mexican population, Ohio was bound to diverge significantly from Colorado, New Mexico, Arizona, Nevada, and even Texas.

Trump Comes to Youngstown

Donald Trump blew Ohio out of the water.  He won Rust Belt towns like Warren, Ashtabula, Canton, Lorain, and even Dayton.  Hillary Clinton lost counties that even John Kerry won in his 2004 defeat.  He almost won Youngstown and apparently won the majority of union members.

His margin of victory of 8.5% diverged bigly from the national popular vote which Hillary actually won by 1.6% (not yet finalized).  Hillary was closer to winning in all the other swing states she lost except for Iowa (9.4%).  Arizona (3.6%) and Georgia (5.2%) were much closer than Ohio, and the Texas margin was only 9.1%.

Which state actually came close the national popular vote?  Minnesota (1.5%) almost got it exactly right while New Hampshire (0.4%) and Nevada (2.4%) bordered a little above and below the national margin.  Florida (1.2% for Trump) was much closer than Ohio.

With the archaic Electoral College system now breaking twice in 16 years (and a near-miss in 2004),  there is now a divergence between Ohio’s record picking the electoral “winner” and the popular vote winner.  From 1900 to 1996, Ohio chose the popular vote winner correctly every time except in 1944 and 1960.  Since 1997, it has a 3-2 record.

For now, Ohio still chooses the president but not the winner.  At this rate, it soon won’t choose either.



Notes on Election 2016

14 Nov

It all went the way it was supposed to right?

While Princeton professors have to eat insects on TV because they predicted the predictable wrongly, luckily the Bhatany Report did not make any official forecasts for the presidential election.  Donald J. Trump, America’s Mogul, in alliance with Rudy Giuliani, America’s Mayor, romped the Electoral College in a Rust Belt blowout that really lived up to his claim of a “Brexit times 50.”  Watching CNN in a historic downtown Los Angeles theater, I knew the end was nigh when Hillary’s U.S.S. Pennsylvania triangulated into a red iceberg in the Allegheny Mountains.  I almost laughed at the room’s maladroit hipster anger until I thought about, you know, the consequences.

Like  Caesar galloping into Gaul, Mr. Trump astounded the inbred and sheltered pundits and pollsters and number-crunchers in the capital.  They shed tears for their career paths in the once and future queen’s court.

This sack of Rome by a ragtag band of alt-right deplorables led by a Penn graduate received its votes from a population so sick and tired of politics as usual that they held their noses and voted for a birther and groper just to send Washington a message and get jobs back in exchange.  They were under no illusions that Trump was a well-bred taxpayer.  This was not 2004.  The naïve voters were the Democrats, not the Republicans.

Andrew Jackson Trump

Earlier this year, I warned people that a Trump-Clinton race would smack of the nasty 1828 presidential election when the last American presidential dynasty crumbled before the rage of Greater Appalachia.  The “most qualified man” to ever run for president, John Quincy Adams, a former secretary of state and son of a president, had won the 1824 presidential election by a vote in Congress due to an Electoral College deadlock despite getting many fewer popular votes than Andrew Jackson. J.Q. Adams still, by far, has the record for the highest IQ of any president. A well-educated Harvard gentleman, he refused to stoop to “campaigning.”

Andrew Jackson, a wild man with wild hair, hailed from Tennessee. He claimed to speak for the common man but was a fairly wealthy slaveowner and land speculator by the time he ran for president. And he did not just imagine shooting someone on Fifth Avenue, he actually did! He executed soldiers as a general and shot a man in a duel long before running for president. He did not have many ideas and not much experience compared to the series of secretaries of state turned presidents preceding John Quincy Adams. But he instead inveighed against the “corrupt bargain” in Congress that gave Adams the White House and the speaker of the house, a Cabinet job.

Running against a corrupt, elitist system, Jackson made inroads in the North with some sharp alliances (Chris Christie anyone?) and overblown rhetoric about Washington D.C. The Adams camp accused him of being a violent bigamist living in sin and adultery with his wife. Jackson supporters called Adams a pimp who supplied women to the Russian czar as ambassador.

You can guess the outcome; Jackson wins bigly, but his wife dies from depression after the election from all the negative campaigning. He throws a wild party of an inauguration by inviting the masses to the White House who promptly trash it and break all the china looking for spiked punch. Old Hickory goes on to deport the Cherokee and cause a financial crash by destroying the Second Bank of the United States and unleashing a wave of shifty loans in the West.

We have a lot to look forward to America.

Debate Questions You Won’t See

9 Oct

Since today’s absolutely disgraceful debate taught no one anything, I figure I will throw my hand in writing questions for the last debate since Anderson Cooper and Martha Raddatz clearly could not ask a substantive question.

Foreign Policy

  1. The Founding Fathers, including George Washington, warned against foreign alliances. Is it wise to keep NATO now that the Soviet Union is long deceased? Is it provocative to add members bordering Russia?
  2. Why should the United States value partnership with Saudi Arabia over Iran?  Is Iranian or Saudi society more compatible with American and/or Western values?  Which government is more compatible or potentially more compatible with the United States
  3. Why is Apple not paying taxes here or in Ireland? Why is the IRS defending Apple from NOT paying its taxes in the EU?
  4. The euro crisis has slowed down world economic growth due to indecisive leadership.  Should Greece either exit the euro, declare bankruptcy, or both?  What would you do as an American president on the euro crisis?
  5. The European Union as currently constructed functioning in a democratic fashion?  Is its consensus politics working or failing the majority of workers in the European Union?

Domestic Policy

  1.  Given public antipathy to the two major parties and your candidacies, why is it defensible that the United States have the most restrictive laws on forming third parties of any democratic nation?  Is it not unusual that not a single state legislature has a single third party member for a nation of over 300 million people?
  2. Competition has not reduced health care costs both inside or outside of the United States.  Why is it routinely mentioned as a solution for reducing health care costs?
  3. Labor force participation rates for men have been slowly falling for decades while more and more men are on disability.  What are the causes and what should be done about it?
  4. How would we make Congress once again after years of falling productivity and increasing partisan rancor?
  5. Do hospital chains improve health care?  Is it desirable for the United States to have a national policy of “rating” hospitals and doctors?  Do these ratings in any way improve the real health care needs of America or encourage a “patient knows best mentality” that has contributed to the narcotic epidemic?

The Case Against Everyone: The America you don’t see

7 Jun

As the primary season winds down today with the last gasp from the Left Coast, we can look forward to a general election featuring the two most-detested major party nominees in polling history.  The media worked strenuously to avoid doing its job filtering, interviewing, and probing the views and histories of the two soon-to-be nominees.  This year’s series The Case Against Everyone will indeed include a case against the presidential candidates (Mr. Trump was covered last year) and will also include highlighting the issues and forgotten corners of the American and international landscape that are rarely asked or intelligibly discussed.  Answers may or may not exist, but dear readers, you will soon know the questions to hold your elected officials to account.

Mr. Donald Trump and Sen. Bernard Sanders (I-VT) have drawn large crowds throughout the nation.  TV news finds this puzzling; rarely are audiences asked why they came to see these candidates.  If the answers are not coherent, perhaps the longing for a different nation could be translated by the media into recent statistics, surveys, and polls.  These surveys should shame the media who unabashedly proclaim the American political and economic system open, democratic, and fair.

The Associated Press-NORC poll revealed shocking numbers about the trust of Americans in the two major parties and the three branches of government.  The only major paper to cover it was the Denver Post.

  • 8% of Americans think the Republican Party is extremely or very responsive to ordinary people.  62% do not.
  • 12% of Americans think the Democratic Party is extremely or very responsive to ordinary people.  46% do not.
  • 12% of Republicans think their party is responsive and only 25% of Democrats think their party is responsive to ordinary people.
  • Confidence in Congress is 4%, confidence in the executive branch is 15%, and 24% in the Supreme Court
  • 55% of people feel helpless about the election and 2/3 of young people do too.

Not exactly views promoted every day by the talking heads on TV.  Their flag waving about the American political system is not reflected by actual Americans.  In the mean time, Puerto Rico voted in the presidential primary and while everyone was complaining about the decrease in polling locations, there was no substantial discussion about the economic crisis of Puerto Rico.

  • 2% of Puerto Ricans have left the island in a year.  Florida may soon have as many Puerto Ricans as New York.  More Puerto Ricans lives on the mainland than on the island for the first time in history.
  • Tax breaks that propelled the island’s pharmaceutical industry have ended, killing the manufacturing base and jobs.  The U.S. territory is effectively bankrupt.

The fact that the only substantial discussion of Puerto Rico has been by a comedian on HBO puts to shame the election “coverage.”  Meanwhile health indicators point to a sickness in body politic.

  • Nobel Prize winning researchers have shown that death rates for non-college educated whites have risen dramatically since 1990, likely linked to decline in the manufacturing economy.  Suicides, overdoses, and alcohol abuse are all likely culprits.  No other nation or ethnic group has shown such a reversal.  Half a million people are dead who should not be dead.
  • Suicide rates are rising to recent highs.
  • Opiate (and its related cousin, heroin) abuse deaths are at record highs which are at least partially related to commercialization of health care and “patient satisfaction scores” imposed by hospitals and Medicare.  This McDonald’s “customer service” approach is killing medicine and the morale of health care providers.

These are glimpses of the desperate situation of real America not discussed in “election coverage” and vapid celebrations of the American “political process.”  What little is mentioned is insubstantially probed or run past “political” experts not content experts.  These are some of the many issues to be discussed with friends, colleagues, co-workers, and elected officials to play our collective roles as good citizens.


Book Review : A Brief History of Seven Killings

21 Dec

This was posted last week on the website of the Cleveland Book Award from the Anisfield-Wolf Foundation.  The author, Marlon James, won their award this year and the Man Booker Prize.  Here I review and compare the book to Sacred Games.


In 2007, when I asked my driver in Caracas if evangelical Christianity had been making its way into the oil-rich jungles of Venezuela, he nodded, smiled, and said, “Yes, they say officially they are here for the Church of Pentecost, but I think they are here for the Church of the CIA.”  In every developing nation, that nod and that smile and that second story represent the beginning of almost every great storytelling session I have had about recent history and current events.

Listen to me now.  Me warn him… Long time I drop warnings that other people close, friend and enemy, was going get him in a whole heap o’trouble.  Every one of we know at least one, don’t it?  Always have a notion but never come up with a single idea.  Always working plenty of scheme but never have a plan… Me not going name who but I warn the Singer…. Me love that man to the max.  Me would take a bullet for the Singer.  But gentlemens, me can only take one.

Writer Marlon James has won this year’s Anisfield-Wolf and Man Booker prizes by driving us past recent Jamaican history.  In a cacophony of voices, versions, and views, James writes a fictional exploration into the 1976 assassination attempt on reggae superstar Bob Marley.  In A Brief History of Seven Killings, quoted above, readers embark on a violent and entertaining ride through Kingston slum fights (sponsored by warring political parties) that become a Cold War flashpoint in Michael Manley’s Jamaica.  Marley, perceived to be supporting the socialist People’s National Party, falls victim to that fateful winter election and the CIA. The book then shifts to the United States where Jamaican political gangs morph into nonpartisan drug smugglers, tolerated by intelligence communities willing to overlook drug money if it goes towards fighting socialism and communism.  Until it gets out of hand.

The book, whose rights have been sold to HBO for a TV series, should do well as a long form television drama.  A populous that once stood at the docks to snatch up the latest installment from Charles Dickens now awaits the latest weekly HBO serial, one of contemporary America’s strongest art forms. James novel fits the format with its motley mix of characters and politics (“Game of Thrones”) and urban and police violence (“The Wire”).  As East becomes West, the West too has become East by picking up a taste for epic legends with endless sub-stories, ambiguous facts and no definitive, singular truth.  All thrive on a range of viewpoints, versions and classes.

From the deceased MP to the barely intelligible ramblings of a crack-fueled shooter, readers absorb from top to bottom a long overdue cultural multiplicity in A Brief History of Seven Killings. No one knows who served Mr. Darcy tea, but we all know who serves Lord Grantham tea.  All of this points to progress.  It points to the widening of the literary establishment’s mind but not perhaps as wide as it celebrates.

sacred gamesJames’s novel most reminds me of Vikram Chandra’s magnum opus, Sacred Games, about a Mumbai police investigation into an Indian mafia don.  Thick with pages and characters, Sacred Games exposes the connections between the underworld, police, politicians, and the film industry.  Chandra also leaps into the future and the past with intercalary chapters that covered Naxalite rebels, Indian secret intelligence and the Partition of British India.  Few novels set in the developing world can parallel A Brief History in quite the same way.

Published to positive reviews, Chandra’s novel did not have the sales or impact other South Asian books did.  Even compared to other literary and popular books about South Asia (Bookseller of Kabul, All the Beautiful Forevers, Three Cups of Tea, Shantaram), it never received critical or popular mass appeal.  It is rare to find on bookshelves today.

Why A Brief History of Seven Killings and other South Asian novels would have similar trajectories while Sacred Games did not is clear to me.  The former have appeals to Western sensibilities that the third does not.  Three Cups of Tea (for example) has a strong element of Orientalism with the classic story of a Westerner coming to Asia and educating rural women.  A Brief History of Seven Killings tells a story about music and a musician famous throughout the West that cannot help but arouse interest in the United States.  American characters from Rolling Stone and the CIA help ease the transition into the unfamiliar worlds of Jamaican politics and Kingston slums.  If the book was about an assassination attempt on Prime Minister Manley and not Marley, we may not be having this award or book review.

Meanwhile film and music references in Sacred Games were unabashedly Bollywood; secretive government agencies were the CBI not the CIA, and the bogeyman feared is Pakistan not Russia or Cuba.  No one smuggles drugs to the United States or London.  No white people, no Christianity, no Clint Eastwood references, and no colonialism at all!

A Brief History of Seven Killings is a fantastic book, and it will make a fantastic HBO series given the novel’s natural similarity to the channel’s specialty—epic dramas.  But Sacred Games moved me more deeply as it was a book deeply rooted in its culture and unapologetically Indian.  Perhaps when we award books we should examine why some get attention and some do not and question the cultural biases we have against looking deeply into a truly “foreign” book.  A truly open mind can wade into another world mentally without needing the props of the world it just left behind.