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Coming Soon...
-Real Patient Values Regarding Health Care (interesting).
-The Greatest Show on Earth: In September.
What shall we write about next? e-mail: responsicare.office@responsicare.com
Should Chevron Have a Right to View Crude's Unscreened Video Footage? It May Not Feel Good, and We're Not Really Keen on Big Oil, But, Yes.
Instead of renting a mind-numbing "blockbuster" this weekend, we think you should see if you can rent the documentary Crude by Joe Berlinger. Here's the trailer:
This amazing documentary will teach your kids about other cultures, big business and The Constitution. If you view this movie and don't come away from it with a whole new understanding of human rights, we'd like to here from you. The legal aspects of this video underscore the importance of the Constitution and a party's right to discovery evidence in a legal proceeding. Like we said, the latest news about this case doesn't make us feel warm and fuzzy, but we think even entities that we vilify still deserve their rights. We believe transparency is vital to the legal process. Mostly, though, look at the message the film sends about our fragile environment and disrespect for others' values and cultures.
What's your opinion? We'd like to hear from you @
Is Prevention Better Than Fixing? Unequivocably, Yes.
The best disinfectant is sunshine
~Louis Brandeis
 There are some Tea Party doctors out there who think healthcare should be likeautomobile or homeowners insurance-catastrophic coverage to cover huge sentinal or catastrophic events. Unfortunately, many of those people haven't worked in the Insurance Industry. I have. In case you didn't get the memo, the goal of the insurance industry is to retain premium, invest, and make more money. Period. The industry is not particularly interested in keeping you healthy, except insomuch as it helps the industry to retain premium to invest and make more money for its shareholders. Fortunately for our patients, and without much thanks to our medical professionals who traditionally benefit financially when people are sicker, not more healthy, insurance companies have dicovered a remarkable thing: keeping people healthy saves money while moderating premium increases.
If you don't believe me, check out Healthways, Inc. (HWAY) http://www.healthways.com/. This disease management company, employed by many traditional insurers to help curb losses due to catastrophic events had earning of nearly $180 million in just the first quarter of 2010 (Data from SEC and Q1 2010 Healthways Earnings Conference Call). Most people have never heard of disease management companies. That's how fast prevention is evolving as its own industry. Each year the 7 most chronic diseases cost the United States approximately $1.3 trillion (with a "T"). Put another way, that's more than the total of the predicted 2010 U.S. deficit.
Some people say that "ObamaCare" will make individual States the slaves of Washington. Nothing could be further from the truth. Medicaid is important for our children, our disenfranchised adults and poverty-stricken seniors, and will soon be important for our uninsured. One visit every month to a primary care provider for a whole year would cost, ostensibly, $750-$1000. To put things in perspective, one emergency room visit could cost triple or quadruple that amount. A hospitalization? Depending on the problem(s), ten to one-hundred times that amount or more. Most people hospitalized are seniors. With better primary prevention, birth control, and immunization programs, less and less of the patients typically enrolled in medicaid-children and young women-will have sentinel events or develop catastrophic illness. To say that increasing Medicaid enrollment for the uninsured makes us beholden to Washington is saying that we have no power to make things better as providers of healthcare. It says that we have no interest in changing the social status or opportunities of millions of Americans.
While it is true that most Americans will gladly pay to get their car fixed or their oil changed with their own money, inexplicably, many Americans devalue their health so much that they do not even understand the concept of paying for it themselves. So, there's the problem. Sad, but, undeniably true. If we decrease access to preventive services and allow more chronic diseases to go unchecked, more folks on public assistance die. But, hey, that's OK, because they're nameless, faceless poor folks that don't exactly live in your neighborhood and, in fact, many of those people will die quickly when they do finally gain access to care, so that should save some money, right? Nope.
Catastrophic events are even more catastrophic for the poor and under-educated due to their often fragmented and dysfunctional family units and lack of knowledge regarding healthcare services. They are re-admitted to hospitals more for want of robust and accessible support systems. That ultimately costs all of us more. Our inaction and unwillingness to roll our sleeves up every day to help these people better themselves is a disgrace.
Are these Tea Party docs genuinely concerned about healthcare delivery, or are they just a bunch of contrived specialists worried about their status, prestige, or bottom line under a new healthcare paradigm? If we can agree that health and wellness is the real goal, then it becomes very easy to sustain the argument that rewarding those that succeed in keeping people healthy, not those who fail, is the logical solution. Under the current paradigm, physicians get paid for their work no matter the quality or outcome. That's plain wrong. Incentives should be aligned with outcomes, not just patient volumes. Physicians will be forced to hone their skills, as pay-for-performance metrics come online, and that will finally make things better for our profession and for our patients. Sad, though, that the engine that drives this new system must still be fueled by cash, not compassion.
 Stem Cell Research: Hope Need Not Be ControversialScott Anderson, M.D.
Every individual needs revolution, inner division, overthrow of the existing order, and renewal, but not by forcing them upon his neighbors under the hypocritical cloak of Christian love or the sense of social responsibility or any of the other beautiful euphemisms for unconscious urges to personal power.
It is under all circumstances an advantage to be in full possession of one's personality, otherwise the repressed elements will only crop up as a hindrance elsewhere, not just at some unimportant point, but at the very spot where we are most sensitive. If people can be educated to see the shadow-side of their nature clearly, it may be hoped that they will also learn to understand and love their fellow men better. A little less hypocrisy and a little more self-knowledge can only have good results in respect for our neighbor; for we are all too prone to transfer to our fellows the injustice and violence we inflict upon our own natures ~C. Jung
Before the discovery of a wonder drug called GLEEVEC,® my dad languished and died with chronic myelogenous leukemia (CML). From diagnosis to his passing: less than 2 years. Literally just months after his death, GLEEVEC®was
released. This fact made my loss a bit more bitter.
 There was a good chance this drug would have given my dad a reasonable, if
not good quality of life for, perhaps, several more years. I am certain he would
have been around to see the birth of my children, and we could have enjoyed
more quality time together. At 72, my dad was too old to tolerate a bone marrow or stem
cell transplant. However, had he been 40, these would have been options that
would have offered him a true chance of durable remission.
Even 10 years later, the subject of stem cell research still triggers
controversy. Those opposing such research argue, largely on religious basis,
that stem cell research destroys human life. However, there has never been
widely-accepted agreement in the non-scientific community regarding when life actually begins.
GLEEVEC® (imatinib mesylate)
Despite a majority vote in the House in 2007 for the Stem Cell Research Enhancement Act of 2007, a misguided President Bush,
pandering to his Evangelical base, vetoed the bill on July 19th, 2007-an action largely based on religious hyperbole, not scientific data.
 Meanwhile, while we debate the ethics of this issue, more people die. Here's the science: A fertilized egg, ex-utero, is pluripotent, and no different than a skin cell in its ability to turn into an intact human being. Science is clear that these cells represent life, but do they represent an entire human life?
Do we have the right to sanctify this group of cells any more than we have the right to damn the unregulated, but no less human-derived cells we call cancer?
Its easy to dehumanize things that scare us or things that seem different. Birth control is bad, except when its good (like for the preacher's girlfriend). Homosexuality is bad, unless it is between a priest and
an alter boy, right? The fact is, more human life has been lost and
will continue to be lost fighting over religious ideology and pride than has or will ever be lost through stem cell research or even abortion, for that matter.
These are ethical "hot buttons" that only serve to attempt to distract brilliant and capable scientists from their overarching mission: to alleviate suffering and cure disease.
No matter what your culture or religious affiliation, these are noble and sovereign causes that should not be subject to the ignorant proselytizing of the Evangelical Right.
Beliefs are what divide people. Doubt unites them.
~Peter Ustinov
Here's a question: would you accept the blood of an atheist if you needed a life-saving transfusion? How about offering up
a cure for cancer for your 3-year old child if it was developed by a Hindu scientist? If you answer in the
affirmative, then, perhaps it should be harder to reconcile frowning on stem cell research. Logic and reason dictate
that applying religious ideology to any treatment does not alter the basic properties or attributes of such treatment. Remember, the
Roman Catholic Church used to burn "witches," (Pope John XXII) until they found out that witches do not actually exist. Sadly,
organized religion has historically been a stumbling block to progress in Science and Medicine by arbitrarily picking and choosing the morality du jour. We need only look at ancient Greek civilization to see the regressive effects of dogmatic theology.
I would submit that most religious leaders are no more capable of ascertaining the absolute morality of this issue
than proving the absolute existence of their respective deities. What people need to understand is that, within a milieu of ever-increasing religious hipocracy, scientific research is being dismantled by ill-informed leaders and their cronies ascribing to over-simplified and corrupted reasoning. Perhaps if we rise a little above the fray, things will be clearer.
Think about someone you know suffering the ravages of MS, diabetes, cancer, or Parkinson's disease and see if you still think this
is a bad idea. Or, better yet, think about how stem cells could possibly produce a cure for whatever hateful disease
this poor guy had:
 The thought that comes naturally is probably the right one. If we forge ahead in an enlightened manner,
will future generations of so-called Christians be loath to accept the benefits of such research? I think we know the answer. History has told us that "Christians," when desperate enough, could care less about where something comes from as long as it benefits them in their time of need. Many scientific discoveries that benefit all humankind were discovered or synthesized in "non-Christian" labs. Many of the drugs you take today were made in labs where the majority of biochemists may worship Brahma, Vishnu, or Shiva, not Jesus Christ. In fact, they're on the shelf at most major pharmacies in the U.S., and you've gladly taken them, because you won't pay to take more expensive U.S. made brands. As Christians, how do you reconcile financially supporting companies that do not share your belief system? If your Christian leaders eschew investments in certain industries on the basis of morality and religion, why do you support them yourselves? In the mid-90's after the Southern Baptist Convention finally (sort of) condemned racism in the Church, they had a new target: Disney. That's right. They boycotted The Walt Disney Company. Why? I guess they were a little too "friendly" to their gay and lesbian employees. However, just like about everything else, the Southern Baptists could not comply with their own rules, and only 30% of all Southern Baptists carried through with the boycott. After all, it IS Disneyworld. How could you not take the family to Disneyworld? Recall that Heritage USA has been defunct since about 1989, and there have been no other "respectable Christian theme parks" to take the family until...this place opened:
 When you think of a carefree vacation with the kids, you should consider the Holy Land Experience. You can grab a your favorite soft drink and watch this guy full of blood stumble down the street in front of your children. When they stop crying, you can try to help them understand why the nutjob that you are took them to such a place where they were supposed to be having fun. I think Disney might be more appropriate for my kids, but that's just crazy me. After all, if the girl in the Minnie Mouse costume has a girlfriend instead of a boyfriend, my kids will never know. Besides, the Easter bunny still exists, doesn't he?
Do you want Science and Medicine to be controlled by misguided protestant Evangelicals and crazy Catholics, or do you want advances guided by intelligent and progressive individuals? You decide. Logic dictates that, if Science works for you on one hand, than it has to work on the other. You cannot praise the scientific method with regard to cures for your afflictions and ignore the same method to cling to creation theory and the Garden of Eden.
"Jesus" crucified daily at the Holy Land Experience in Orlando, FL
Your DNA is scary close to that of an ape and a pig for a reason. Yes, lets all say it together: EVOLUTION. Porcine and bovine insulin works just fine for human diabetes, and we can make bacteria synthesize actual, genetically identical human insulin by using plasmid DNA. Yes, we can insert HUMAN genes into bacterial DNA and it works more than adequately. Hmmm...Perhaps we need to be enlightened further. Read The Greatest Show on Earth when it is released this September and try to evolve your thinking. I predict a NY Times bestseller. See if I'm not right (er, I mean, correct).
Instead of clinging to your belief in holy water, revivals, and rosary beads, we sincerely hope you overcome your fear and ignorance (if you're against stem cell research), and try to learn instead of believing everything your preacher spoon feeds you. Ignoring and failing to appreciate alternate views = arrested development. If God truly made us in his own image, then he allowed us to have our own thoughts and free will. He also allowed us to be tolerant of others. We must acknowledge that there is one planet, and one creator. It seems quite implausible that a loving God would create a belief system that fosters hate and intolerance for both innocent people and Science; but that's just my perspective.
The DISCLOSE Act: Understanding the Concept-The Good (And Bad) of Increasing Transparency
OpenCongress SummaryThis is the Democrats' response to the Supreme Courts' recent Citizens United v. FEC ruling. It seeks to increase transparency of corporate and special-interest money in national political campaigns. It would require organizations involved in political campaigning to disclose the identity of the large donors, and to reveal their identities in any political ads they fund. It would also bar foreign corporations, government contractors and TARP recipients from making political expenditures. Notably, the bill would exempt all long-standing, non-profit organizations with more than 500,000 members from having to disclose their donor lists.Official Summary6/24/2010--Passed House amended. Democracy is Strengthened by Casting Light on Spending in Elections Act or DISCLOSE Act - Title I: Regulation of Certain Political Spending -
(Sec. 101)Amends the Federal Election Campaign Act of 1971 (FECA) to prohibit:
(1) independent expenditures and payments for electioneering communications by government contractors if the value of the contract is at least $10 million; (2) recipients of assistance under the Troubled Asset Relief Program (TARP) of the Emergency Economic Stabilization Act of 2008 (EESA) from making any contribution to any political party, committee, or candidate for public office, or to any person for any political purpose or use, or from making any independent expenditure or disbursing any funds for an electioneering communication; and (3) persons who enter into negotiations for an oil or gas exploration, development, or production lease under the Outer Continental Shelf Lands Act from making any contribution to any political party, committee, or candidate for public office or to any person for any political purpose or use, or from making any independent expenditure or disbursing any funds for an electioneering communication. (Sec. 102)Applies the ban on contributions and expenditures by foreign nationals to foreign-controlled domestic corporations. Requires the highest ranking official of a corporation, before making any contribution, donation, expenditure, independent expenditure, or disbursement for an electioneering communication in connection with a federal election, to file a certification with the Federal Election Commission (FEC), if this has not been done already, that the corporation is not prohibited from carrying out such activity. Declares that nothing prohibits any domestic corporation from establishing, administering, and soliciting contributions to a separate segregated fund, so long as:
(1) none of the amounts in the fund are provided by any prohibited foreign national; and (2) no such foreign national has the power to direct, dictate, or control the fund. Declares that nothing prohibits any domestic corporation from making a contribution or donation in connection with a state or local election to the extent permitted under state or local law, so long as no foreign national has the power to direct, dictate, or control such contribution or donation. Declares that nothing prohibits any domestic corporation from carrying out certain activities, so long as: (1) none of the amounts used to carry out such activities are provided by any prohibited foreign national; and (2) no prohibited foreign national has the power to direct, dictate, or control such activity. (Sec. 103)Treats as contributions:
(1) any payments by any person (except a candidate, a candidate's authorized committee, or a political committee of a political party) for coordinated communications; and (2) political party communications made on behalf of candidates if made under the control or direction of a candidate or a candidate's authorized committee. Defines "coordinated communication" as: (1) a publicly distributed or disseminated communication referring to a candidate or an opponent of such candidate which is made during a specified election period in cooperation, consultation, or concert with, or at the request or suggestion of, a candidate, a candidate's authorized committee, or a political committee of a political party; or (2) any communication that republishes, disseminates, or distributes, in whole or in part, any broadcast or any written, graphic, or other form of campaign material prepared by a candidate, a candidate's authorized committee, or their agents. Excludes from the meaning of "coordinated communication": (1) a communication appearing in a news story, commentary, or editorial distributed through the facilities of any broadcasting station, newspaper, magazine, or other periodical publication, unless such facilities are owned or controlled by any political party, political committee, or candidate; or (2) a communication which constitutes a candidate debate or forum.` Repeals the prohibition against contributions by individuals age 17 or younger. (Sec. 105)Prohibits a communication which is disseminated through the Internet from being treated as a form of general public political advertising unless the communication was placed for a fee on another person's website. Title II: Promoting Effective Disclosure of Campaign-Related Activity - Subtitle A: Treatment of Independent Expenditures and Electioneering Communications Made by All Persons -
(Sec. 201)Revises the definition of independent expenditure to mean, in part, an expenditure that, when taken as a whole, expressly advocates the election or defeat of a clearly identified candidate, or is the functional equivalent of express advocacy. Requires any person making independent expenditures exceeding $10,000 to:
(1) file a report electronically within 24 hours; and (2) file a new report electronically each time the person makes or contracts to make independent expenditures in an aggregate amount equal to or greater than $10,000 (or $1,000, if less than 20 days before an election) with respect to the same election. (Sec. 202)Increases from 60 days to 120 days the period before a general election during which a communication shall be considered an electioneering communication.
(Sec. 203)Requires mandatory electronic filing by persons making independent expenditures or electioneering communications exceeding $10,000 at any time. Subtitle B: Expanded Requirements for Corporations and Other Organizations -
(Sec. 211)Requires corporations, labor organizations, tax-exempt charitable organizations, and political organizations other than political committees (covered organizations) to include specified additional information in reports on independent expenditures of at least $10,000, including certain actual or deemed transfers of money to other persons, but excluding amounts paid from separate segregated funds as well as amounts designated for specified campaign-related activities. Requires certain additional information in electioneering communication reports. Prescribes special rules for transfers aggregating at least $50,000 between covered organizations treated as transfers between affiliates, including transfers to affiliated tax-exempt charitable organizations.
(Sec. 212)Sets forth special rules for the use of general treasury funds by covered organizations for campaign-related activity, including both designated and unrestricted donor payments to an organization. Authorizes mutually agreed restrictions on the use of donated funds for campaign-related activity between a covered organization and a person who does not want his or her identity disclosed in a significant funder statement or a Top 5 Funders list. Prescribes special rules for transfers aggregating at least $50,000 between covered organizations treated as transfers between affiliates, including transfers to affiliated tax-exempt charitable organizations.
(Sec. 213)Authorizes covered organizations to make optional use of a separate Campaign-Related Activity Account for making disbursements for campaign-related activity. Requires such an Account to be reduced by the amount of organization revenues attributable to donations or payments from a person other than the covered organization who has an agreement with the organization that it will not use such donations or payments for campaign related activity.
(Sec. 214)Requires any electioneering communication transmitted through radio or television which is paid for by a political committee (including a political committee of a political party), other than a political committee which receives or accepts contributions or donations which do not comply with the contribution limits or source prohibitions of FECA, to include an audio statement identifying the name of the political committee responsible. Prescribes additional information to be included in certain radio or television electioneering communications by persons (including significant funders of campaign-related communications of a covered organization) other than a candidate, a candidate's authorized committee, or a political committee of a political party. Prescribes a format for the individual disclosure statement.
(Sec. 215)Indexes certain amounts under FECA. Subtitle C: Reporting Requirements for Registered Lobbyists -
(Sec. 221)Amends the Lobbying Disclosure Act of 1995 to require registered lobbyists to report information on independent expenditures or electioneering communications of at least $1,000 to the Secretary of the Senate and the Clerk of the House of Representatives. Title III: Disclosure by Covered Organizations of Information on Campaign Related Activity -
(Sec. 301)Requires covered organizations to disclose to shareholders, members, or donors information on disbursements for campaign-related activity. Requires a covered organization that maintains an Internet site to post on it a hyperlink from its homepage to the location on the FEC website containing information required to be reported with respect to public independent expenditures, including disbursements for electioneering communications. Title IV: Other Provisions -
(Sec. 401)Authorizes judicial review of the provisions of this Act by the U.S. District Court for the District of Columbia, and on appeal by the Court of Appeals for the District of Columbia Circuit. Grants Members of Congress the right to:
(1) bring an action to challenge the constitutionality of a provision of this Act; or (2) intervene in any action challenging the constitutionality of a provision of this Act, either in support of or opposition to the position of a party to the case. (Sec. 402)Declares that nothing in this Act shall be construed to affect any provision of law, rule, or regulation which waives a requirement to disclose information relating to any person in any case in which there is a reasonable probability that the information disclosure would subject the person to threats, harassments, or reprisals.
Opinion: Transparency in campaign finance should be critical to the electorate's ability to make a more informed decision on election day. Americans need to know how much foreign money is being spent on American candidates only to ultimately further competing economies, and how much money is being pumped into the campaign coffers of leaders pandering to special interests- yes, even NRA-friendly candidates by the "non-partisan" gun rights group. However, the NRA threw another political tantrum and the (not unexpected) carve-outs were made for their group.
In a statement from the NRA Institute for Legislative Action (NRA-ILA), the following was offered:
"There are those who say the NRA should put the Second Amendment at risk over a First Amendment principle. That’s easy to say—unless you have a sworn duty to protect the Second Amendment above all else, as we do."
Wait a minute. The Second Amendment above all else? Sworn duty? The Constitution was not designed to be a hierarchy of Amendments. NRA: your ignorance is showing again.
When the NRA receives a special exemption, and even the mere threat by big business of running election ads, as noted in Marcos Chaman and Ethan Kaplan's Iceberg Theory of Campaign Contributions, will suffice to carry the day anyway, this proposed legislation is already gutted beyond repair. Nice try, though.
WWJD: Liberal or Conservative?
-Scott Anderson, MD
 With the recent mid-term primaries, I had cause to ponder the religiously-charged political musings of the local, Morgan County populace. My take is that this community lies to the very right side of the Right-Wing bell-shaped curve. Evangelical, conservative, intolerant, fearful, exclusive, self-absorbed, judgemental, self-rightous, hypocritical bigots. Just my opinion. Hope its not true, but here's the argument:
Morgan County: Roughly 85% Republican, 15% Democrat. Morality: Publically proper, privately bereft. Unconcerned about the poor and disenfranchised except as they relate to increased taxation of the well-to-do. Highly invested in the social clubs they call churches. Disingenuous and contrived. Overly-concerned about others' personal choices, abortion and stem cell research yet oblivious to the planet at-large, futile wars, and the killing of innocent people around the world. Proud of their missionary trips. Always attempting to convert the unconverted in far-off lands, but never failing to leave them in poverty and starvation. Indifferent to America's rural and inner-city disenfranchised. Heaven-bound with a bold, pious, and unwavering certainty. Always praying and quoting. Often judging. Seldom helping. Rarely sacrificing. For sure, no real mitigating effect on adverse statistics such as crime and divorce.
Then there was Jesus, the genuine. A radical with a contemporary and logical message. Worked on the sabbath. Hung out with 12 single male sinners, prostitutes and criminals. Eschewed the establishment and status quo. Blazed a new trail. Marched to a different drumbeat. Hated injustice. Didn't hold grudges. Preached tolerance and inclusiveness. Loved sinners. Hated hypocrites. Gave up his very life for the cause.
Was Jesus Right or Left? Conservative or Liberal? Whose political party would he join today if he had to pick just one? The party of the rich or the poor? The party of the saved or the party of the sinners? The party of the tolerant or the intolerant? The party of equality or the party of elitism? Obviously this is a silly argument. Jesus is sovereign. He is neither Left nor Right, Liberal nor Conservative. Maybe we should remember his example when it comes to contemporary politics instead of languishing in an eternal governmental stalemate.
History has shown us that divisiveness is disagreeable to this Nation. Recall that the Confederacy's short experiment in this regard ended historically at the Appomattox Courthouse 9 April 1865. However, it took the Southern Baptist Convention until the mid to late 1990's to denounce its own racist history. Indeed, even in the 1960's, the SBC appeared to condone racial discrimination, with a minority of the organization's churches having African American citizens among their ranks. Given the opportunity to change its name to the more inclusive "North American Baptist Convention" in 2005, the proposal was soundly defeated by the old guard.
Even today, the SBC, as penned by its Ethics and Religious Liberty Commission in the organization's naiive and simplistic "Fifteen Principles for Successful Healthcare Reform" sec. 12, would limit protection from discrimination to people in only three categories: those with disabilities, those with pre-existing conditions, and, finally, those of a particular age. Interestingly, sec. 12 does not denounce discrimination based on gender, race, or religion. Therefore, the SBC's stand on discrimination is non-inclusive of protected classes and, as such, is unconstitutional. Don't take my word for it, though. Go to this link and check it yourself: http://www.sbc.net/ and also:
 This Commission also opines in sec. 13 that the primary motivator for medical research and development is profit: "America leads the world in the development of new medicines, treatments, and medical devices because American companies are allowed a reasonable profit on massive investments in the field of medical research. If they are denied the possibility of a reasonable profit on their massive outlays of investment capital, they will not engage in such activity (bold added for emphasis)." Good to know that the SBC has its finger on the pulse of American scientific research. Again, history shows us that modern American Pharma is pretty good at one thing: Inventing different versions of the same medicine. Did we really need multiple permutations of "the little purple pill" to decrease our stomach acid? Currently there are approximately seven (7) drugs that, ostensibly, perform exactly the same function, none being measurably better than the rest. So we have competition, millions of dollars invested in R&D, but with no significant benefit after the original PPI drug, Omeprazole (Prilosec), was introduced in 1988. Since then, and over a span of 20 years, at least 6 other "me,too" drugs were synthesized and brought to market. The motivation was profit. The overall positive effect to society: negligible. This story is repeated time and again in the pharmaceutical industry today. However, the novel, society-impacting discoveries like penicillin, vaccinations, and, simply, the germ theory of disease were not based on profit, but, rather, on the inherent desire to make a difference. Lister had a simple theory about carbolic acid that had, essentially zero associated cost for R&D. Without his rather basic discovery we might still be operating in dirty rooms with soiled instruments held by unwashed and un-gloved hands. Modern Medicine continues to work and, to some extent, rest on its laurels, but often fails to observe or listen. Finally, sec. 14., "Reduce Waste and Fraud," suggests that "Appropriate measures be taken to eliminate waste and to hold accountable those who engage in fraud." To me, there is no greater waste in Medicine than the synthesis of redundant compounds as remedies for the relatively trifling afflictions that would be better served with lifestyle changes than expensive scientific "discoveries." Yes, even our scientists have become lazy, trading innovation and novelty for profits. When it comes to waste and fraud, we really need to look at what we are doing to the poor people we're trying to keep alive that probably weren't meant to be. That's fraud and waste: promising people life at the cost of increased pain and suffering. Promising cures for the incurable. Hospitalizing people just because we can. This heaven thing: is it real to you? Why do so many Christians seem so afraid of going there? Why do so many "Christians" act like, well, like this guy says they act?
Was profit Jesus' motivation for healing? Did his fleeting "worldly" affiliations affect his over-arching mission? We all know the answers to these questions. The motivation was agape love; and love transcends everything. Think about that the next time you go to the polls and make potentially world-changing decisions. Be informed and be true to your conscience. As you can see from the SBC position statement on healthcare reform, doing your own research can bring to light many hidden truths, and uncover as many lies and inconsistencies. If you cannot reconcile your dogma, then you are justified in questioning its authority. By the way, I think Jesus would have been a liberal; but that's just my opinion.
Fooling the Fools: Pandering to a Misinformed Electorate Paves Way to Victory in November for Republicans
-Scott Anderson, MD
"Self-made men […] are the men who owe little or nothing to birth, relationship, friendly surroundings; to wealth inherited or to early approved means of education; who are what they are, without the aid of any of the favoring conditions by which other men usually rise in the world and achieve great results." -Frederick Douglass
June 2, 2010
Mid-term primary elections yesterday were, sadly, predictable in Alabama, especially when it came to the gubernatorial race. I was up bright and early to cast my vote. The night before, I was putting up signs hoping to influence a few folks in Morgan County, AL regarding their choices. It has been said that politics, religion, and personal finances are sensitive matters, not proper to speak of at social functions or dinner parties. And I'm sure a few people perusing this site might think it irregular to speak of these things as often as I do. However, there's a method to my madness.
This is about to sound down right insulting to many of you. Those who are the most ashamed will be the most irate. Its only logical. We humans tend to know when we're wrong even though we seldom admit it. If this digs at your conscience, then,perhaps some introspection is in order.
As many of you know, I have supported Artur Davis since I found out he was running for Governor. I did not support him because of his party affiliation. I did not support him because of his color or religion. I did not support him based on his vote on healthcare reform (which, incidentally, I personally disagreed with), because he was my neighbor, personal friend, or co-worker. I supported him because I believed he was the most intelligent and capable candidate going forward. Period.
I could connect with most of his voting record in Congress. I could respect that he seems to favor exertion to opportunity; that he was the type of self-made man Frederick Douglass spoke of. A Harvard Law School graduate, he rose from the ranks of the disenfranchised, and is a true American success story-a man to look up to, and, in many ways, a model for our children. However, what I believe to be a beacon for character, was, concomitantly and, ironically, a hindrance to a campaign in an extremely conservative State.
Congressman Davis' vote on healthcare reform in The House likely turned out to be his undoing, especially in districts that favored the recently passed legislation. His campaign, like so many Alabama Spring storms, swept wildly through some Counties with fury and passion, while leaving others seemingly untouched. He tried to be electable, and, in so doing, ironically did not make it to the radar screens of thousands of Alabamians. The ultra-conservative, Bible-thumping, evangelical right wing pachyderms could not have planned a more perfect strategy for the ultimate victory in November, as Ron Sparks, the opposing candidate bankrolled largely by a loan that appeared to defy all customary lending standards, and the only other candidate the Party could muster, is virtually unelectable, with his gambling-based economic platform in a State that wouldn't collectively say "bingo" unless it was referring to a farmer's dog.
It has been argued by many Monday morning quarterbacks that Davis did not consider the needs of his constituents by eschewing health care reform in its present state. I respectfully disagree. I believe that he stood up for what he believed in, ignored the race card, and tried to win on his own merits. Jesse Jackson implied that, perhaps, he was not "black enough." That's why JJ will never become a genuinely great leader. Great leaders do not pander to mobs. Great leaders are not bigots or racisits. Great leaders follow their convictions and do what they believe is right for everyone, regarless of race, religion, or affiliation. But, alas, in the State that gave us George Wallace and Roy "above the law" Moore, nothing ceases to amaze me.
In my County, Republican voters out-number Democrat voters by a tremendous margin. In this election, fully 85% voted on the Republican ballot. This is a margin that seems to defy statistics. But, recall, once upon a time this County gave us Supreme Court case no. 534: Norris v. Alabama. Morgan County is no stranger to ill-conceived, systematic and arbitrary decisions. On Wednesday morning, Decatur City workers came to my office and removed Congressman Davis' campaign signs from the property with stealth and quickness. I was going to keep the signs up for a while to proudly show my support, even if it meant being the butt of a few harmless jokes. However, I never got the chance. This seems more like an act that would be promulgated in China, not the United States. I'm sure glad the good Christain folks that seem to run this place follow the Constitution and abhor excessive government intervention in the lives of its private citizens. Good thing I still have a few signs, and the Supreme Court left.
When it comes to informed leadership decisions, Alabama, on its face, appears indolent. The good ol' boys network is alive and well, and pandering seems good enough to carry the day in a State eternally struggling with social, educational and economic woes. Artur Davis did not pander to anyone. And, thus, he lost in Alabama this time. Bad for him; worse for Alabama. We can criticize him all we want for his alleged campaign errors and abandonment of expected political views. However, this should be a lesson to the entire Country: the best leader will neither be left, right, Democrat or Republican, Christian or Muslim, male or female. The best leader will be genuine, and one who leads with conviction.
Admiral James Stockdale once said: "Leadership must be based on goodwill. Goodwill does not mean posturing and, least of all, pandering to the mob. It means obvious and wholehearted commitment to helping followers. We are tired of leaders we fear, tired of leaders we love, and tired of leaders who let us take liberties with them. What we need for leaders are men of the heart who are so helpful that they, in effect, do away with the need of their jobs. But leaders like that are never out of a job, never out of followers. Strange as it sounds, great leaders gain authority by giving it away."
Maybe the next election cycle I'll volunteer a bit more if Congressman Davis decides to run again or, perhaps, something more ambitious.
Fooling the Fools: Pandering to a Misinformed Electorate Paves Way to Victory in November for Republicans-Chapter II: South Carolina
OK. I know this must just be a terrible REM-rebound nightmare. Somebody please wake me up! This can't be happening, can it?
Yes, it can. Only this time, not in sophisticated Alabama-style. South Carolina Republicans: I'm sure there's a perfectly logical explanation for this.
America: Poor Stewardhip on Steroids
"One of the most tragic events of our time is that we know more than ever before the
pains and sufferings of the world, and yet are less and less able to respond to them."
-Henri J.M. Nouwen
 April 20th. The Day that changed history as we know it in the Gulf of Mexico and, perhaps, the world as a whole. The Deepwater Horizon, an ultra-modern, state-of-the-art, semi-submersible drilling rig steadied by GPS-guided, computer-controlled, treble-redundant thrusters, exploded and sunk two days later off the coast of Louisiana in 5000 feet of water.
The photo above shows the rig prior to the disaster. This thing was an incredible engineering marvel, was it not? The menacing, hole-boring, cement-spewing hunk of a pontoon-boat gave new meaning to the term "Drill, baby, drill," moving from place to place tapping more and more sub-sea black gold for its greedy caretakers. If you really consider the logistics, it seems to be an impossible feat: Build a big, floating platform that displaces more water than an aircraft carrier, somehow get it to the optimal location, keep it rock-steady for months, and drill thousands of feet below the ocean's surface with minimal environmental impact ...Never mind, it appears that it is, in fact, impossible. Transocean: Better make that totally submersible.
Deepwater Horizon
 Here's the after-picture: An ever-expanding oil slick whose epicenter lies at or near 28.73667 N and 88.38716 W. The Deepwater Horizon's position? Roughly, the same place-just about, give-or-take, 5000 feet below the water's oily facade. Estimates of the daily output volume of the spill are, of course, still somewhat speculative. However, many experts collectively place the ocean's daily dose of the toxic hydrocarbons to be, ostensibly, between a quarter-million to one million gallons per day spilled into this highly sensitive environment.
Ironically, the day of the disaster, several BP executives were on board celebrating its safety record. They lived. Eleven workers perished. After the disaster, the expected congressional hearings commenced.
28.73667N 88.38717W
  Each executive was predictably circumspect. The owner, the leaseholder, the giant oil contractor-all playing the blame game. In the end, all we will have is more blame, more denial, more expense, and a more polluted aquarium. Big businesses, protected by our right "honest" leaders and gigantic insurers (or, incredibly, themselves), are, yet again, virtually unassailable. We are, indeed, a nation brainwashed by the corrupt and greedy. In America, there really isn't anything we can't pacify with lies and a whole lot of money.
Do you swear to tell the truth...?
 Perhaps, instead of first worrying about how the tragedy will affect this year's beach vacation or property values like so many selfish Americans, we could concentrate on the impact to the real victim of this calamity: the world's largest biome. Maybe we could work on that first, then change, in overarching fashion, the way we treat our planet, and, probably last, think about dipping our feet in the surf at Gulf Shores or Destin.
 Once again, this is another wake-up call to a very sleepy nation and an increasingly somnolent planet. If the world events presently occuring
do not keep us up at night; if they do not chill us, as a nation, to our very core, what hope do we have left?
Our thoughts and prayers go out to the families and friends who lost loved-ones in this disaster. DONATE NOW: http://www.gulfaid.org/
Desperation: Can't We Do Better Than This?
Second Amendment Rights: Another Sad Day
Scott Anderson, MD
"Every gun that is made, every warship launched, every rocket fired, signifies in the final sense a theft from those who hunger and are not fed, those who are cold and are not clothed."
-Dwight D. Eisenhower
On Friday, February 12th, 2010, a female neuroscientist with a Harvard Ph.D. shot 6 people at the University of Alabama-Huntsville. Three were killed, 2 critically injured. A week or so before, a 9th-grader shot and killed a fellow student at Discovery Middle School, not far from UAH. What do these things have in common? Guns: the great equalizer. As the old expression goes "God made men, but Sam Colt made them equal."
Indeed, whether in the hands of the sociopath, intelligent scientist or misguided adolescent, guns kill all too easily. Unfortunately, we never know who will use them responsibly and who won't. Therein lies a very significant problem. How will we know? The answer is, we won't.
I love the Constitution. It is a blueprint for our rights and freedoms as Americans. Unfortunately, our Second Amendment right to bear arms needs an overhaul. Initially, the Amendment was drafted to provide for a "well-regulated militia," and was designed for the following:
As any enlightened person can see, the construct of the original Amendment does not apply today, and has not applied for decades. Individual, armed citizens cannot deter an undemocratic government, repel foreign invasion or suppress insurrection. Obviously, slave control no longer applies (nor should it have ever). Law enforcement I get. A natural right of self-defense, not so much; and unless average citizens can arm themselves like our current military, our little guns will not thwart a corrupt government nor keep foreign agressors at bay. Studies show that, no matter what the weapon, any person that sets out to do harm to another has the advantage already-the element of surprise. This is a tremendous advantage, indeed. The element of surprise is a much more powerful weapon than the unused gun of a would-be victim. Gun rights proponents cite that their weapons are a deterrent to crime. However, this has never been borne out in the literature. In fact, just the opposite is true. Most guns in the U.S. are actually used to kill ourselves. Indeed, suicides make up the majority of gun-related deaths. Of course, there are plenty of homicides as well, and the greatest percentages of gun-related crimes are committed by individuials who either borrow or steal other people's weapons. This especially applies to children and adolescents. Child Access Prevention (CAP) laws have been designed to limit the access of children to firearms by imposing criminal liability on adults who allow negligent access to firearms. Seems logical and reasonable in a country where we can't be responsible with our guns anyway. However, despite having cities where you can't even buy a cold beer, Alabama has no such law on the books. In Alabama it is illegal to drive with a blindfold, play dominoes on Sunday, and purchase bears for the purpose of wrestling (seriously). Making adults criminally responsible should children gain access to their firearms? Gee, we think we'll just stay with the ban on bear wrestling. Why aren't guns illegal? Quite simply, greed and politics (just like everything else that's bad about us). Americans have a love affair with their guns. Some statistics say that between 40 to 60 million Americans own guns, and the NRA is a very strong political force. "Guns don't kill people, people kill people" sayeth the NRA crazies*. So far, as of February 14th, 2010 over 13,000 people have been shot in the United States already. America is one of the most armed nations, and has one of the highest murder rates in the developed world. Its obvious we can't play nice with our guns.
So the Second Amendment allows us to play with our guns, and sometimes (ok, a lot of times) innocent people are killed. The NRA and many other people believe that guns should never be illegal. They believe that, even if many innocent people die every year because of guns, it's not the law's fault; its not the gun's fault; it's the fault of the individual person who pulls the trigger. Yet, paradoxically, when it comes right down to it, most of the folks that support keeping laws intact that allow us to possess and shoot guns, are the same people that would support a law reversing Roe v. Wade-the political Right, correct? I do think there's a lot to reconcile here.
If we maintain that current gun laws aren't permissive for killing people, then we must also view abortion laws in the same light because, logically, a permissive law alone cannot kill. Nobody has to shoot another person, and nobody has to kill a baby. So why, then, all the fuss over this stuff? Logically, both laws are permissive for death to occur. If a child accidentally kills himself with his dad's rifle, we say it's a shame, but we don't really hold anyone morally accountable the way we tend to hold the mother of the unborn child morally accountable. Why? To me its about choice and actually the same. Gun owners choose to fight for their rights despite the accidents, suicides, and epidemic school shootings. They seem to be in a blissful state of ignorance regarding their toys-no matter how many kids and other innocent people they end up killing every year. In 2009, there were roughly 9,500 abortions-down 11% from 10,600 the year before. Meanwhile, on average, over 30,000 people are killed from firearms every year. I guess the Right Wing, evangelical "moral majority" can somehow justify this figure. The math says that, in order of priority to prevent the most deaths, we should outlaw tobacco, alcohol, and firearms before we ever tackle the abortion issue. Some might feel otherwise. However, seems to me that an 11% drop in the number of abortions in just one year is significant enough to show that something good is happening. Maybe its because effective education might actually be beneficial. Perhaps the figure will be lower next year. I hope so. Remember, there's a difference between pro-life and anti-abortion, just like there's a difference between pro-choice and pro-abortion. Lots of slippery-slope stuff here, but do we customarily go around calling pro-gun folks "pro-death" or "anti-life"? Maybe we should, as guns easily cause more deaths than abortions. I find it amusing that gun owners criticize and judge those who advocate for or support the pro-choice movement. After all, isn't the Second Amendment a "pro-choice" amendment? Gun advocates do not want their choice to own firearms taken away, despite the deaths caused by guns each year. Perplexing.
Those of you maintaining the "they'd-do-it-anyway" philosophy about mandating bans on anything are probably right. After all, making prostitution illegal hasn't even made a dent in the world's oldest profession. But here's the thing. Make abortion a crime and women will still do it, only the mothers are more likely to die or endure greater medical complications secondary to shoddy, "back-alley" procedures. Furthermore, will unwanted fetuses just grow up to be unwanted, unloved, and abused children who turn in to damaged adults? Make gun ownership a crime, and the bad people will continue to get the guns they need to kill other bad people or kill animals they don't need to kill. I agree. So the bad people keep killing each other off, but I doubt that the average deer hunter or weekend sport shooter would ever be desperate enough to be willing to do jail time. Truthfully, many of us can have a good time and fulfilling lives without shooting or killing things, and many of us hate abortion. If I were king, things would certainly be different. I submit that we just need to think and live our lives perhaps a tad bit further below the surface. It can be pretty interesting down here sometimes.
The surface is where the blissfully ignorant live. They talk a lot about their stuff: about their cars, their clubs, their baubles, their golf games and their guns. They also have predictably myopic opinions. Rarely do they stop to ponder why things are the way they are or what the downstream consequenses of their actions might be. They tend to compartmentalize issues and problems, taking a NIMBY ("not in my backyard") philosophy about things that are difficult for them to reconcile psychologically; so they seek distractions. They live in their gated communities, join their fraternal organizations, think happy, superficial thoughts, and pretend that the rest of the world doesn't really exist until something personally threatens them or their families. I could give numerous examples.
Let's face it. Most of the gun owners in America are full of contrived concern over gun-related tragedies, but would never give up their firearms-even if it meant saving children or stopping thousands of preventable gun-related accidents and deaths. Why? Because the average gun-owning demographic, the conserative, middle class, white, male, evangelical, Protestant "Christian" could really not care less about a 16 year old black kid in a Detroit slum being killed, or an 8-year old hispanic girl paralyzed by a bullet from a drive-by shooting in East L.A., or even a whole school in Colorado where 34 individuals were shot and where twelve students and one teacher died. Unless it is directly impacting them, in their minds, it really doesn't exist. Seriously, it really doesn't. You won't convince me otherwise, because the evidence to the contrary is really overwhelming.
In case you're wondering about statistics (you know how I love them), our State, Alabama, has been ranked number 2 or 3 in gun-related deaths, despite its standing near the buckle of the Bible belt. Why? Again, inequality. Hard to reconcile, isn't it? Here's an idea that will probably anger you: Maybe its because the "haves" in Alabama don't seem to care much about the "have-nots" killing each other. After all, if it doesn't happen in their backyards, how important could it be? Alabama gun laws? Pathetic. Some things really do never change. http://www.bradycampaign.org/xshare/bcam/stategunlaws/scorecard/2010releases/AL.pdf
Again, who will save us from ourselves? Obviously not the NRA nor organized Southern religion. In fact, when you look at the State of Alabama as a whole, it is really a study in irony and hipocrisy, as religion does not seem to have a mitigating effect on gun violence, drug use, the divorce rate, or other serious social problems that are epidemic in the South. Perhaps instead of following the herd or listening to your preacher, you should eschew the mob mentality, listen to your God and your conscience, and vote for what makes sense-what is truly better for everyone-not just for the folks in your neighborhhods with the money and power. Enlightened people know what is right, are in tune with their conscience, think for themselves, and act on their convictions.
As an interesting aside, there is a place where religion does have a mitigating effect on gun violence and other social ills, however. It's called Utah. Though most conservative evangelicals decry the Mormon religion as being reminiscent of a cult, it certainly is hard to argue with the numbers. Believe their version of Christianity or not, at least the LDS walk the walk. We could learn a lot from them. Even though I am not Mormon, I certainly respect what their churches have accomplished in their communities and the State of Utah. Southern Baptist Convention: Take note.
Join us, the AMA, and several other responsible organizations by signing the NRA's black list: http://www.nrablacklist.com/. Let's help end this national embarassement and stop more school killings.
Other links:
http://ceep.crc.uiuc.edu/pubs/ivpaguide/appendix/patten-sayingno.pdf *Disclaimer: The term "NRA crazies" refers to the delusional, gun-toting members of the NRA that overutilize the expression "guns dont kill people..."et.seq., and truly believe that guns don't kill people, not the National Rifle Association or its associated entities. ResponsiCare, Inc. underscores the fact that NRA membership may not always be comorbid with mental illness...just sometimes.
Teach Your Children Well #1: Time: The Present but Disengaged Parent
"Nothing has a stronger influence psychologically on their environment and especially on their children than the unlived life of the parent." I used to be constantly criticized by my ex-wife about not spending enough time with the kids. Being a physician, indeed, means often spending hours away from your own family to tend to your other "family"-your patients. Many negative behaviors that my children exhibited were attributed to my relative absence from the physical dwelling she considered our "home." During our divorce, "you're never here" was her incessant mantra, and one reason why she felt she deserved custody of our children. Until I recovered some semblance of my premarital self-esteem, she almost had me believing her. It wasn't until we separated that I was able to step back and look at the relationship with my kids with less static in the background.
In my world, logic and reason win out over emotion every time, except when it comes to love. I knew that I loved my kids, but could a "good" dad be away from his kids a lot? Was there any direct correlation between my fitness for duty as a parent and the amount of time I spent with them? What characteristics differentiate a "good" parent from a "bad" parent? My conscience could not rest until these questions were answered. My hypothesis was that each relationship is unique, that each has different emotional demands, and that those demands are dynamic, not static. I then began my research. I knew in my heart that I was a good dad, but in a divorce you often have to prove you are a good dad. During a divorce, parents are placed in the vexing situation of having their character attacked by a former ally and confidant. Here we have a relationship where, prior to the falling out, both parties would have been readily complimentary of one another to others, even if contrived. However, no matter how civil or amicable the spin, make no mistake; divorce is war. The relationship has taken an adversarial turn, and now each party predictably seeks to extoll and magnify their own attributes, while even more greatly magnifying the other party's faults or perceived shortcomings to others. Divorce would try my soul. Was I a "summer soldier," a "sunshine patriot," or did I have the real stuff to get through this and keep my long-term relationship with my children intact?
Nothing is quite so demeaning as being accused of being a bad parent. I once accused a child's mother of being a bad mom because she had a string of boyfriends in and out of her household and once allowed her depressed and suicidal son to take a gun and go hunting. She thought it would make him feel better. Bad choice on the mom's part in my opinion; but who am I to judge her as a parent? I called her a bad mom to her face and she left the practice. In retrospect, I would have left as well. I had the invitation and opportunity to help her and her son, but I refused to try to learn the family dynamics and let my unrefined, immature, and predjudicial moral values and emotions get in the way before even trying. Its amazing how owning mistakes ultimately makes you a better person. Lesson learned-big time!
Everyone thinks their parenting is superior, especially during a divorce. All parents have their own, sometimes novel, but usually average and redundant ideas about parenting. We all tend to offer them up to others so freely, as if our experiences are somehow superior or universalizable, never thinking that, perhaps, we may not have earned the right to set the moral compass for the rest of the population.
I tend to follow the principles of situational ethics (see Fletcher) as they pertain to parenting. In other words, I sometimes set aside certain established "moral" principles in the interest of the greater good, nurturing a relationship based on agape love, not rules or regulations. Notions such as "being with your family is the most important thing" or "family comes first" are illusory in the world of agape and situational ethics.
When my son was three, he had to have his tonsils out. Ten days later we were riding in the minivan and a huge amount of blood started gushing from his mouth. He was hemorrhaging from a post-tonsillectomy bleed. Knowing the consequences, I sped up, broke the speed limit, drove dangerously, ran every red light and whisked him in the front door of the emergency room ahead of every one else. The most important thing to me at that time was saving my son's life, and, at that moment, I didn't really care that I had broken laws and even endangered others in order to do it. Somehow, I don't think the God I worship was too angry about not following the rules, exactly. Its situational ethics; and, whether anyone reading this wants to believe it or not, we have all been in these types of situations. We just tend to grade them differently, largely based on our cultural and moral biases. So I'm a hero for that, right? Am I just as much of a hero when I'm away from my kids at work providing for their needs and future education? How about when I miss a soccer game to tend to a critically ill woman with a heart attack? Will my kids ever forgive me? I think so, because I've taught them empathy and compassion, and they've seen that played out by example.
Sometimes I've even taken my kids to work-around sick people. OMG! Is it proper to take a 5-year old to the hospital with you on rounds? In my world, sure, if it teaches compassion and empathy for others. Even if they're exposed to nasty germs, you say? Maybe, unless the magnitude of any potential illness outweighs the actual lesson they learned while they were there. Should what I do for a living be a mystery to them? I don't think so if it gives them a greater understanding and respect for what I do and where I'm at when I'm away. I want them to know that what I do is largely glorified on TV and in the media, and that being a real doctor means more than wearing a white coat, being well-to-do, and being seemingly entitled to a better life than others.
Are the dads deployed in the military for months at a time fighting for our freedom bad dads? Hell, no; and they should be respected just as much as stay-at-home-dads, if not more. Businessmen who spend 5 days a week traveling for their jobs? Same deal. How about stay-at-home parents? Are they superior parents? Sometimes, but then again, maybe not. Are single moms better at raising children than single dads? Studies say...no. In fact, custodial mothers are almost three times more likely to be in poverty, work less, require more public assistance and have more problems with their children. Children raised without a father are more likely to have emotional and psychological problems, and are more likely to be incarcerated. Research says that dads, even busy ones, are critically important to their children's development.
Effective parenting is not borne out of mere presence. It is a dynamic and nimble interaction between parent and child with the free expression of needs, desires, reservations and aspirations. A couple that I have much respect for raised very caring, intelligent, and well-adjusted daughters. Both were arguably "unavailable" by many parent's standards, one being a pilot, another a physician. Both extremely busy. Both away from home a lot. Still, the time that they spent with their daughters was of tremendous quality; and, despite their parent's demanding occupations, the girls did incredibly well-both in college, both successful.
I aspire to the Parenting for Everyone philosophy (see Simon Soloveychik). This philosphy opines that the success or failure of upbringing is directly related to how much a parent truly believes in the child's goodness. The goal is to impart in the child a lifelong yearning for happiness. It is also to impart a desire, not to learn what society (a.k.a. the herd) says is "good" or "bad," but to raise consientiousness, so that a child will act out of altruism rather than coersion, duty, or selfishness.
How do we do all of that? Listen to our kids, and make everyday events life lessons. When they "annoy" or "bother" us, they're really, in their own way, trying desperately to convey an important message. It is critical that we as parents listen to that message, no matter how bothersome or seemingly meaningless. Their messages might be presented in a slightly different format, but they are no less important. Listening to your children tells them that they are important to you. Interacting in ways they can understand makes you more valuable to them.
One of the greatest parenting pitfalls is to spend lots of time with the children, but never really spend intense, quality face-time with them. How many people passively parent and then dole out punishment like a drill seargent when the kids "annoy" them? Most misbehavior has to do with children not having a firm understanding of their boundaries, often due to parental inconsistencies in expectations, discipline and reward. When your children are trying to communicate with you, don't order them back to play. They're pulling at your leg for a reason. Play is natural for a child. If they stop playing, they probably want to communicate something to you, or simply want your undivided attention, if just for a momemt. If they ask you to play, go and play with them. In their world, "play" means problem-solving, research, and interaction, and they are craving your guidance and participation. Presence without meaningful interaction does not necessarily equal good parenting, and such valuable interaction isn't necessarily proportional to the amount of time spent with a child.
A more serious pitfall is when parents place their children in the so-called "double bind." Here, unwittingly, parents send conflicting messages to their children-messages that indicate to the child that they are in a no-win situation. Believe it or not, saying something as "innocent" as "go and play" or "leave your sister alone" may be very damaging. In the example, "go and play," it is not natural to mandate that a child do something that, by its very nature, is based on spontaneity. If the child is not playing, there is a good reason for it, and we should not demand that inherently spontaneous actions ever take place. Likewise, telling a child to leave his constantly-antagonizing sister alone represents a dilemma for which the child cannot emotionally resolve. If he leaves her alone, she will continue to pick on him. If he doesn't leave her alone, he will be punished by his parent. If this sounds far-fetched, you may be surprised to know that the repetition of such actions has been scientifically linked to maladaptive behavior and schizophrenia in adults. Ever go to the store and buy your child two shirts and question why she wears one over the other just because you like one better? That sends mixed signals, and in kid world, mixed signals may mess them up for good.
Ah, yes, back to the good parent-bad parent rant. When it comes to spousal (or ex-spousal) criticism of parenting fitness, our ego defense mechanisms always have a way of telling on us! Are we vilifying our temporarily absent spouses because we're genuinely concerned about the kids, or because we're just tired of watching them and they're late for their babysitting shift? To some people this projection is really obvious and easy to pick up on. However, if one is unaware that this is occuring, it can often lead to false guilt and the undermining of self-esteem in spouses whose occupations take them away for work.
Where is this going? I think I'm trying to say that, despite forgetting the name of my daughter's dance teacher or, perhaps not immediately recognizing my son's soccer coach at Wal-Mart, I'm still a good dad. I don't need to bond with those people, I need to bond with my kids. It angers me when people actually are afforded the luxury of spending quality time with their kids, but forfeit that bonding opportunity. When my "stay-at-home" ex felt the need to place our children in daycare at 15 months of age despite my objection, and later was busy building empty relationships with more "over-worked" moms that "needed a break" from their kids, I was very engaged in what the kids were doing while still providing all of their financial support. I think that was pretty OK and, frankly, pretty normal. Did those poor moms really need a break from their very young children? Apparently they thought so. I can't imagine how stressful it must be to spend time bonding with your toddler all day long. Besides, watching children takes so much time away from shopping and the spa. Those unfortunate, overworked moms! I personally thought their behavior was more than a bit selfish, but that's just my opinion. After all, I never felt like I needed to hire a babysitter to take care of my 20-30 sick patients at work every day so that I could "have a break", and I'm not even related to those people!
Its no surprise, therefore, that I have very little respect for people that say they need a break from their kids. I seriously hope my children never emulate their selfishness and sense of entitlement, and I hope my son doesn't emulate their wimpy, pushover husbands' permissive behaviors. One of the reasons I'm divorced today is because I didn't buy into my ex-wife's parenting style and the over-scheduling of my kids, nor did I buy in to the amount of alleged "difficulty" she had taking care of them. After all, what's so difficult about putting your kids in daycare or preschool? All it meant was that I had to pay more money so that she could transfer her responsibilities to total strangers. As usual, everyone lost but her. In retrospect, though, perhaps it was a blessing in disguise. I guess I'd rather have someone, if even a stranger, paying attention to them instead of a disengaged parent.
Ah, you poor, misguided soccer moms. You expect your kids to be geniouses and sports heros. You enjoin the entirety of their waking hours to organized activites so that they can be everything you wanted to be, but couldn't, and wonder why they grow up maladjusted. We need to stop living our lives vicariously through our children. We need to allow them to embrace their true gifts and talents. I guarantee, they will make their desires known to us. If my kids want to play sports, that's great. They'll tell me. If my son decides that he wants to be a ballet dancer and my daughter a hockey player, cool. I'll support that. The best any parent can do for their children is to cultivate their natural interests and to love them unconditionally. I'd like to share a really neat article from Psychology Today, which further illustrates some of the dangers of the over-scheduled child:
Here's a message for all the parents that force their kids to do things that they have no desire to do: Stop! You're hurting them. (And for the moms that force their kids to dress seductively, cake on makeup, and prance around at kiddie beauty pageants: there is something particularly worrisome about you). Perhaps if you got in touch with your psychopathology and actually did something (yes, something yourself) that your children could be proud of, you wouldn't have to ride their coattails in your selfish and vicarious pursuit of success or illusory notariety. After all, when they grow up, you'll unfortunately still be you. What will you do then? There is a really good chance that your kid won't go pro or get to the olympics. Then what? Higher education should never be a "back-up plan." What if you spent as much time coaching them in academics as you spent at the ballfield? Oh, yeah. That's no fun (for you).
One secret to fostering a good relationship with your kids is showing them love without strings attached, making quality time, and demonstrating to them, by your own actions and achievements, that they are able to make a real difference in the world by breaking away from the crowd now and then. Sure it may seem risky. They may do something radical like exchanging that beautiful house in the nice subdivision for a hut in Central America working for the Peace Corps someday. However, my yardstick for measuring success is a bit different than most folks. My kids will have succeeded if I can recognize them apart from the herd when they grow up.
Teach Your Children Well #2: Hate the Herd I was playing the piano one night and my 8-year old son came up to me and said with a very serious and somewhat sad look "Dad, how did you get popular?" I immediately stopped playing, temporarily paralyzed by the shock of the moment. At the same time I was mortified and ecstatic. Humbled and proud. I smiled big, trying to keep my composure. "Me, popular?" I was, after all, one of the most unpopular kids in my little town growing up. Because I was the son of disenfranchised parents, born into poverty, I had to learn most things the hard way. I didn't have the "proper" social training or emotional equipment to negotiate my childhood like a lot of other kids. My parents never forced me to do, well, anything. I had no chores, no rehearsals or practices, no regular bed time. Church: optional. Discipline: seldom. I could pretty much come and go as I pleased.
To outsiders, I guess, my parents might have been classified as bona fide "white trash". My dad was a nearly illiterate high school dropout and factory laborer, my mom a humble homemaker without even a driver's license. We lived with my grandmother during most of my childhood in a former iron mining company house on leased mining company land in the Upper Peninsula of Michigan. We were apparently too poor to afford a house of our own. My mom dreamed of owning a mobile home and going to Disneyland someday-dreams that were destined to be unrealized in a family where replacing a broken water heater might require a bank loan...more to come.
Health Care Reform or Cultural Reform? A Bizarre, Illogical and Greedy Healthcare Culture We Have Scott Anderson, M.D.
"We do not have a money problem in America. We have a values and priorities problem."
— Marian Wright Edelman We, along with the majority of the country, absolutely believe that healthcare reform is imperative to help increase quality, comprehensive care and decrease the needless waste and spending in a healthcare system that, by many standards, lags behind several industrialized countries in terms of overall health outcomes, longevity, quality of life, and other important metrics. However, the current ideas behind healthcare reform must absolutely be supplanted by a new and, perhaps, radical paradigm; one where the people, not the government, drive the healthcare system to better itself.
We believe, as President Obama, the late Sen. Edward Kennedy, and others, that healthcare reform is long overdue in this nation of plenty, where approximately 50 million Americans are uninsured or under-insured, and those fortunate enough to have insurance or who participate in government programs such as Medicare or Medicaid must negotiate the truly arcane world of third-party payor systems just to get their valid and reasonable problems addressed and their claims paid in an efficient and timely manner. The currently "functional" third-party payor system is very broken itself, yet many would like to cling to this confusing, backward, and antiquated reimbursement model that essentially rewards doctors and other health providers for failure, and, enables a type of "caste system" of medical specialties which encourages the best and brightest medical students to avoid Primary Care completely and enter much more lucrative specialties which, inexplicably, the nation has deemed more important, and which third-party payors reward at significantly higher reimbursement rates. Please allow me to explain further.
Our children are, arguably, our country's most valuable resource. It is important to nurture and teach them to be future thinkers, stakeholders, and leaders in our society. To that end, many resources must be utilized, including educational and healthcare resources. What most people do know is that our teachers are grossly over-worked and under-paid for the responsibilities that lie before them each and every day. I am particularly concerned about their plight, as I have children enrolled in a system which doesn't always reward the best and brightest educators for the work that they do. What many people don't know is that Family Physicians and Pediatricians, each responsible for the healthcare and preventive services of the majority of this country's children, are two of the lowest-paid medical specialties that exist. Yet, some specialties dealing primarily with our aging population earn 3 to 4 times (or more) than primary care providers, sometimes for working many fewer hours and having much smaller patient loads. Is there anything more important than our children, our future?
We agree that specialists are important, and we absolutely need their services. Yet the disparities in benefits, income and social burdens are continually driving bright students away from primary care into specialties that offer lucrative financial rewards and better lifestyles. Many of these specialists focus their work on America's aging population, such as Cardiologists and Radiologists who perform more studies and high-tech procedures on the elderly than other specialties. We have an aging population, with an average lifespan continually increasing. In fact, the group over age 85 is the most rapidly-expanding portion of our population! That's not necessarily a bad thing, as it proves that Medicine continues to increase our years on this planet; but much of the time it comes at a great cost in terms of human and financial resources. Part of this issue has to do with expectations of our healthcare system to extend life further and further without evidence that doing so is beneficial in the long run. Sometimes, in reality, we attempt to extend life so far, that we deliver individuals to places they never were meant (or wanted) to be. Who's to blame? Greedy doctors and hospitals? Guilt-ridden family members? The unfortunate, ill-informed patients? Usually a combination of these things is to blame. For the most part, we spend the majority of a person's aggregate healthcare expenses in the last 6-12 months of their lives, sometimes lives that are so miserable or of such poor quality as to not even be considered "lives" at all. We spend millions of dollars on treatments for conditions which offer very little chance of survival or which increase pain and suffering, as the inevitability of mortality marches steadily forward. We, as individuals, often think nothing of it, and even expect our healthcare system to support these types of oft-futile and economically wasteful practices. The following is a real case from my own practice. Everyone involved seemed to have very genuine and lofty intentions, and everyone technically seemed to do the right thing, yet something went terribly wrong. See if you can appreciate it, too.
First, Do No Harm
-Hippocrates
A very nice elderly lady in her 80's found herself in the hands of several capable doctors after she started to have some abdominal and pelvic pain. I was one of her doctors. Some initial tests were performed, but, ultimately, those tests did not really point us in the right direction. More tests were performed in an attempt to locate the cause of her discomfort and relieve her longstanding pain. After undergoing an ultrasound of the abdomen and pelvis, it was discovered that this lady had a large cystic mass in her pelvis near one of her ovaries. Of course, given the limitations of today's Medicine, it could not be reliably ascertained whether or not this was a benign mass or an agressive malignancy. One doctor on the medical team opined that the pain was emanating from the mass, despite having the knowlege that ovarian pain is sometimes poorly localized, and that ovarian cancer rarely causes significant pain before leading to incurable spread of the disease. Nonetheless, we had a patient, and that patient was in pain. We were trained to relieve pain, and now we had a target to focus on.
Initially, it was decided to draw tumor markers. Good news! Tumor markers were not supportive of a malignancy. Serial ultrasounds were performed out of an abundance of caution, and these continued to show no change in the size of the mass over time. More good news! However, The patient continued to have pain. Surgery was then contemplated. In an attempt to seek confirmatory evidence to justify taking such a course of action, one of the doctors on the team decided that the patient could likely withstand surgery, as one year earlier this octonegerian had survived open-heart surgery. Furthermore, her Cardiologist and I had "cleared" her for surgery in the past. Thus, a decision was made to operate-not surprising, given that surgical types often live by the mantra "A chance to cut is a chance to cure." On its face, the decision seemed quite sound. However, the morning of the surgery, the specialist performing the surgery quickly realized that he was in over his head.
A relatively "simple" diagnostic laparoscopic "band-aid" procedure rapidly evolved into an exploratory laparotomy due to difficulties maneuvering around massive adhesions and scar tissue from previous surgeries. In fact, even upon opening the abdominal cavity in traditional fashion, no cystic mass could even be identified through all of the adhesions and scar tissue. Thus, the procedure was aborted. The woman was recovering from this surgery when she was noted to have green dischage from one of her surgical incisions. She developed increasing pain and drainage. Follow-up CT scan with contrast revealed that the patient's small bowel was inadvertently nicked during the prior surgery, creating a perforation which led to peritonitis-a life-threatening abdominal infection.
A second surgeon brought the patient back to the operating room, and the section of injured small bowel was resected. During that time, aided by the second surgeon, the doctor who performed the original procedure was able to locate the large cyst. However, it could only be partially removed due to its location. Frozen sections were sent during the surgery. These showed completely benign tissue. Due to peritonitis, however, another procedure was required in order to place a central venous catheter for IV antibiotics. The surgery was completed. However, the patient's problems were just beginning.
After the operation(s), she was tranferred to the ICU. Due to blood loss, the patient became profoundly anemic, requiring blood transfusions. An Infectious Disease expert was consulted. Expensive, top-shelf, broad-spectrum antibiotics were initiated to fight her severe infection. Cultures further proved that she had a concomitant fungal infection. Therefore, powerful antifungal agents were started. She then developed relative dehydration and acute renal (kidney) failure. This required further treatment. Because of the severity of her illness and inability to properly utilize nutrients, fluids, and electrolytes, she became severely malnourished. This required total parenteral nutrition (TPN) or total intravenous feeding.
Secondary to massive fluid shifts during her illness and surgery, her otherwise compensated cardiac function started to decline, and she developed congestive heart failure. This required Cardiology consultation and more procedures, including an echocardiogram. She eventually began to recover from a cardiac standpoint. However, she subsequently developed shortness of breath, fever and chills. These symptoms triggered a chest x-ray which showed pleural effusions (fluid between the lungs and chest cavity) and pneumonia. Because of the severity of her symptoms, a Pulmonologist (lung specialist) was consulted and a CT scan of the chest with contrast was performed to rule out a pulmonary embolus (blood clot in the lung). This study was negative, and, only at that time during the patient's hospitalization was the decision made to place her on medication that would help prevent blood clots. However, it was too late. She had developed some swelling in her left arm and, on the advice of a new specialist, a doppler (ultrasound) study was performed on her left arm which, indeed showed a deep venous thrombosis (blood clot). Worried that this clot could potentially travel to her lungs, the patient was started on anticoagulation with Fragmin, a relatively expensive medication and Coumadin (an oral blood-thinner).
Our patient eventually recovered enough to go home. However, she was so weak, she needed the assistance of a home-health agency. During routine monitoring, her nurses discovered that her blood was too "thin"-dangerously so, and she required at least one visit to the Emergency room to reverse her Coumadin with vitamin K to prevent massive internal bleeding. When was I called to help manage this case? After she got out of the hospital. For real. After all of this, I'm not even sure if we ever found out the real reason for her belly pain. However, we sure did lots to take her mind off of it!
Why is this case on our website? Because it actually happened, and because cases like this occur quite commonly under the current "advanced" American health care system. Oh, and because its really not that exciting (except for the patient) when you think of the big picture. As health care providers, we see these types of decisions played out nearly every day in hospitals and extended care facilities throughout the United States. Sadly, our health care system, with its arguably bizarre culture, twisted ethics, and arcane third-party reimbursement system, has allowed both patients and providers to become so insulated and uncoupled from the downstream consequences of their actions, that they, all too often, view these cases as simply unfortunate occurences and not the jaw-dropping, shocking events they really are. In summary, a nice lady with abdominal pain was subjected to significant pain and suffering, lost a portion of her small intestine, and many doctors and a hospital made a lot of money which was ultimately paid for by all of us as she has Medicare, and she still has unresolved problems. If we were to ask every person involved in this woman's care, including the hospital administrator, they would justify their actions. However, is this person really better off for all of the suffering and expense?
Therefore, the questions ultimately come down to ones like these: What's one year of a wretched, painful life worth? Why are we so uncomfortable with death and dying when we seem to be embracing more than ever as a culture the concept of a living God and a real afterlife? Why do we invest so comparatively little in our children when they represent the greatest chance to make this country into a great nation that is respected around the world? Why do we pay the people that prevent illness far less than the people who fix problems after they've progressed too far? Would there be fewer problems if we spent more on prevention? Would our qualities of life be better? Could we really, truly, embrace the circle of life, the value of our youth and the concept of diminishing returns on the millions that we agressively treat at the very end of life, knowing that they are simply and naturally completing that circle? For meaningful reform to take place, these very questions must be answered and acted upon. It won't be easy, but we must finally answer these and other controversial queries and move forward as a nation with real solutions. I believe these solutions start at home.
We absolutely must teach our children to think critically and independently so that, unlike many purportedly "functional" and "upstanding," though narrow-minded and morally bereft leaders of our communities and States, they will challenge the status quo, question corruptive and unethical practices, and embrace new ideas and paradigms. While many of our so-called leaders greedily and ignorantly cling to their antiquated, corrupted, and comfortable notions so that they and their equally corrupt constituents can remain fat and happy, our children, hopefully, will be there to ask "why do things have to stay this way if they don't make sense anymore, or if they're just plain wrong?" We think the current administration is asking just those questions, and some of our esteemed political and healthcare leaders are more than a little concerned. No matter how educated you are, or how intelligent you think you are, some things just don't add up; and the majority of our healthcare policy maladies can't be cured by a corrupted political system with its never-ending flow of special interest money. Our present leaders won't be around in a few years to even care about the mess they've created for our children when they, then, will be old enough to be the beneficiaries of the selfish, ignorant, and greedy decisions our leaders have made. These issues notwithstanding, we must educate the population to start thinking critically about the consequences of their actions and the potential strain on an already over-burdened healthcare system.
You want reform? Here's another thought. Currently, approximately 96 Billion (thats right, Billion, with a "B") dollars are spent annually on smoking-related illness. Just banning cigarettes alone would eventually wipe out a large portion of the healthcare costs in the budget over a relatively short time. In business, we would do just that-cut a line item from the budget that is costly AND is unnecessary. Win! However, this is not the way things are done in healthcare world. We inexplicably ignore such seemingly low-hanging fruit and attempt to tweak and spin the fatally flawed current system. Lets all just pretend that smoking-related illness doesn't even exist. That is, in effect, the message our government is sending by not outlawing smoking. Imagine if every smoker in this country decided to take their lives back and quit on their own? The tobacco industry would be crippled. The people, not the elected leaders on the take or the tobacco lobbyists and executives, would truly be in charge. How can we ever get to the heart of real healthcare reform when we cannot even stop government-sanctioned drug abuse? Don't expect that the contrived governmental concerns about the harms of tobacco, like putting bigger warning labels on cigarette packaging, will ever lead to meaningful anti-tobacco legislation. Economically, our country, to large extent, has become beholden to big tobacco. Ironically, our leaders want to improve healthcare, but fully sanction a product that has been deemed a public health menace since the early 1960's. Unfortunately, as long as the money keeps changing hands in Washington, this national embarassment will continue. The saddest thing is that six million children in this country currently under the age of 18 will eventually die of smoking-related illness, and will never realize their full potential. What will it take to save us from ourselves?
We, as individuals, must work to fix the problems inherent to the current healthcare system now, and we are simply irresponsible if we just sit back and allow others to "take care of it." Remember, if you're not involved, if you're completely disconnected from the process, you cannot expect that things will ever get better. Let's quit blaming others and own up to some of our own responsibilities as beneficiaries of healthcare services and American citizens. Maybe we could actually try to be healthy. Eat healthier. Exercise more. Throw the cigarettes and other garbage in our lives away. Get help for our psychological and emotional problems. Set a good example for our children as well as our friends and neighbors. Get away from the entitlement mentality and actually do something-anything.
The United States has no inherent right to serve as the political, moral, or cultural compass for the rest of the world, but that hasn't stopped us from trying; and we are certainly setting a poor example with the current healthcare system. Living in this Country is an amazing privilege, but there is no guarantee that America will even look the same or even be here in 10 years-especially if terrorists get enough enriched uranium in their hands. Other Countries are racing ahead of us in manufacturing and technology, and we, admittedly, have difficulty keeping up. Many of our schools can't even compare to those in China and India, and such countries are taking increasing financial ownership of The United States. Currently, we're in a bit of a catch-22 with China. Do we continue our excessive consumption of high-quality but cheap merchandise, or continue the tariff route with our Asian friends? The latter will force us to pay higher prices for many of our goods. Will we be willing to pay? If we anger Hu jintau enough, will he make things rough on the U.S.? If so, how rough? Trade protectionsim in our future? Tough situation. One thing's for sure, we have a huge trade deficit with China, and that didn't happen by accident. We want their cool electronic stuff and clothing, and most of the exports they want from us are things to fortify their infrastructure and make bigger factories to send us more stuff to get hooked on. We are China's #1 trade partner. The next highest non-Asian trade partner is Germany, but we still beat them by a 3:1 ratio and a difference of about $200 billion. We're only number 4 on their import list, right under Japan, South Korea, and Taiwan. Just because we're Americans doesn't guarantee us the right to the best of everything, especially when we often don't work hard enough to deserve the best. Sadly, its that mentality that has caused America to lose its edge as the star on the world stage; and, even worse, it has caused us to be hated by many nations who have grown weary of America's prideful culture. We cannot rest on the achievements of those who came before us forever. We extoll America's greatness, but, with each passing year, we have less evidence to back that up, and other countries are watching with great intent. But I digress...
Back on the healthcare front, there are increasing numbers of people going to countries like India and South America for cheaper procedures and similar, if not better, outcomes. We are rapidly moving to a healthcare system based on free-market principles. The formerly occult prices of our healthcare goods and services are no longer a mystery to more and more individuals. Are our healthcare services market-ready to be "shopped" by consumers looking for better values? They had better be. Though there will unlikely be an adverse balance of trade for healthcare goods and services between the U.S. and other countries any time soon, the scales are being tipped more every year. While most would think that medical travelers seek cheap and fast medical attention, some facts in a May 2008 McKinsey and Company report regarding medical tourism indicated otherwise. The report states that 40% of medical travelers seek advanced technology, while 32% seek better healthcare. Another 15% seek faster medical services while only 9% of travelers seek lower costs as their primary consideration. Hold on. Forty-percent seeking advanced technology? Thirty-two percent looking for better healthcare? As a U.S. physician, that gets my attention. Medical tourism is projected to be $100 billion industry by 2012. Will healthcare reform entice more and more insurers to outsource medical care overseas if their members are willing to go? If I was a greedy enough company I might, and I could sell that idea to any company wanting to trim its bottom line. Healthcare as an industry can be effectively globalized just like anything else. It already has. About 1/4 of all of the doctors in training programs are foreign-born. Certainly that must mean that there is a shortage of Americans wanting to go into Medicine. Wrong. Why is there a shortage of physicians? Partially because america has a longstanding and entrenched elitist mentality regarding medical training, and the obstacles are currently too great for solid, but not outstanding undergraduates. There is also some entrenched nepotism in many training programs that many schools would not acknowledge. Too often in America, Medicine is considered the golden ticket to a lifestyle on the right side of the curve, and many enter Medicine, not to serve, but to indulge a lifestyle; hence the shortage of primary care physicians-especially in rural areas. The biggest reason is that there are not enough medical schools or available slots in the current schools, nor are there enough residency positions. After all, we wouldn't want just anyone becoming a doctor. How would we ever feel special?
 We cannot have healthcare reform without an ample supply of well-trained doctors. However, for many medical school candidates, Primary Care isn't considered prestigious enough. If I was in it for lifestyle, I wouldn't have picked Family Medicine, that's for damned sure. My position in class afforded me the chance to do anything almost anywhere. I was told by a surgeon trying to court me to a postgraduate program during one of my rotations that I was "wasting my life" by going into Primary Care. I actually see it differently. Sure, it would be nice to worry less about paying the bills, and it would be cool to live in a mansion or own my own jet. However, I think my soul would have eventually been lost in the process. I actually flirted with the idea for a while, but it wasn't in me. Besides, I think its cool to turn a bunch of nebulous symptoms into a diagnosis. I like the thrill of the chase. Primary Care is to the superspecialist as hunting is to dining in a 5-star restaurant. The specialists usually get their cases delivered to them. They work in nice, clean, sometimes sterile environments. We see people off the street and have to distill "I'm tired" into terminal cancer, pregnancy, depression, or, most of the time, nothing at all, and do it in 15 minutes. Specialists seem to talk more about their stock portfolios than interesting patients in the doctor's lounge, as if that's their real calling and Medicine is simply the means to achieving wealth. I once completely silenced an entire doctor's lounge by announcing that I really liked my Hyundai Elantra after the Radiologist was bragging on his new Audi. The Radiologist was speechless. I was, of course, amused. The fact that we even have to have a special "lounge" to brag about our new houses, cars, boats, and golf clubs is kind of crazy, given the fact that we all have enough money to pay for our own lunches. I don't do doctor's lounges much anymore unless I'm desperate and don't have enough spare cash for lunch. But, the doctor's lounge must exist to indulge our need for elitism, I guess.
The point I'm circuitously trying to make is this: We will soon have many more patients to care for with, roughly, the same amount of doctors. If this trend continues, we won't be able to prevent anything, because we'll be too busy trying to cure everything that's already been allowed to happen. Granted, my days will be easier. "I'm tired" will turn in to end-stage renal failure, which I can diagnose with simple tests. However, that's not the point of healthcare reform, after all. We must not only reform how the bills are paid, but must also reform the culture of Medicine in general. We need to educate the public about what Primary Care really stands for, and must not be viewed simply as "gatekeepers," but rather as pilots, shepherds, or stewards. Our role in guiding patients through an incredibly complex system needs to be recognized, and we need to get more diverse candidates into the schools, not just the privileged doctor's kids wanting to maintain a lifestyle.
Why all of this reform and "globalization" talk? Because, quite simply, America cannot survive alone on this planet. The healthcare system is just one symptom of an indolent, but no less serious cultural disease in the U.S. We are, individually, one voice among millions of voices, and may feel that our opinions don't really matter. However, our voices plus our friends', neighbors', and family's voices, connected to the leaders that have been chosen by us to hear those voices, will make a difference. That is why we, as individuals and as constituents, are so important. Call your Congessman, Senator or other elected leaders. Send a letter. Participate in a rally or town meeting. Read the Constitution. Make an attempt to understand how our government and healthcare system really works, why it is broken, and how we, collectively, can fix it. If you just sit there, you'll never be part of the solution. If you really care about meaningful reform, then ask our leaders the difficult, important questions, and hold their feet to the fire until you are satisfied with the answers. They work for us. Don't ever forget that; and don't ever forget you're part of one, connected world.
Even in an imperfect system, many difficulties can be overcome by inspiring enough involved, intelligent, caring people to demand better of our leaders. If we all just sit and wait for things to happen, we deserve exactly what's coming to us, and that could be disastrous. If we really care, we will be agents of change, even if in our own lives, families, and neighborhoods. Allow your good efforts to be known, and this country, with its potential wealth of human capital, will change one citizen at a time.
Devalue the Delta
Scott Anderson, M.D.
Sometimes, I think the least our patients can do is recognize the importance of the service we're performing and value it, at minimum, as much as their vanity, entertainment or quest to keep up with the material possessions of their neighbors. However, that probably won't happen any time soon. In general, we really don't value health. Seriously, I know people talk about it a lot, but we really do not value our native, baseline status. Why? Because people can only perceive the delta (the mathematical and scientific term for "change"). No perceived change has no perceived value.
Our perception is our reality, regardless of the scientific or logical validity of such perception. We do not perceive the healthy state, therefore it appears to lack value. Instead, we perceive the state of illness, the delta. The greater the perceived departure from normal, the greater the perceived value. The flaw in this thinking, of course, is that, in reality, the healthy state has immense value compared to the state of illness, because with it brings happiness, productivity, and a person's full capacity to enjoy life.
Are We As Smart As Wolves?
Scott Anderson, M.D.
In a non-human habitat where natural selection exists, the sickest animals are left behind so as not to threaten the existence of the entire group. In the human world, where, to large extent, natural selection has been obliterated, the people with the least ability to sustain themselves get the greatest assistance at the expense of the the rest of the population (the 80-20 rule). Imagine an injured, dying wolf. Will the rest of the pack stand by it's side, or will the group leave the injured wolf behind? In a habitat governed by natural selection, the sickest animals and the poorest hunters, the animals of least value to the group, will die and the genetically superior animals will thrive. In America, the least productive citizens, the poor, uneducated, irresponsible, institutionalized, and infirmed are given a disproportionate share of society's resources, and we artificially select who will live, die, or propagate. In our society, the poorest hunters are often the fattest. In a natural environment, the poorest hunters are the leanest or dead. This is by no means a judgement regarding the propriety of our societal values; simply an observation. We can learn a lot from a pack of wolves as author Twyman. L. Towery references in his book "The Wisom of Wolves." This is a recommended read. Here is the highly-cited introduction:
by Twyman Towery The attitude of the wolf can be summed up simply: it is a constant visualization of success. The collective wisdom of wolves has been progressively programmed into their genetic makeup throughout the centuries. Wolves have mastered the technique of focusing their energies toward the activities that will lead to the accomplishment of their goals. Wolves do not aimlessly run around their intended victims, yipping and yapping. They have a strategic plan and execute it through constant communication. When the moment of truth arrives, each understands his role and understands exactly what the pack expects of him. The wolf does not depend on luck. The cohesion, teamwork and training of the pack determines whether the pack lives or dies. There is a silly maxim in some organizations that everyone, to be a valuable member, must aspire to be the leader. This is personified by the misguided CEO who says he only hires people who say they want to take his job. Evidently, this is supposed to ensure that the person has ambition, courage, spunk, honesty, drive - whatever. In reality, it is simply a contrived situation, with the interviewee jumping through the boss's hoops. It sends warnings of competition and one-upmanship throughout the organization rather than signals of cooperation, teamwork and loyalty. Everyone does not strive to be the leader in the wolf pack. Some are consummate hunters or caregivers or jokesters, but each seems to gravitate to the role he does best. This is not to say there are not challenges to authority, position and status - there are. But each wolf's role begins emerging from playtime as a pup and refines itself through the rest of its years. The wolf's attitude is always based upon the question, "What is best for the pack?" This is in marked contrast to us humans, who will often sabotage our organizations, families or businesses, if we do not get what we want. Wolves are seldom truly threatened by other animals. By constantly engaging their senses and skills, they are practically unassailable. They are masters of planning for the moment of opportunity to present itself, and when it does, they are ready to act. Because of training, preparation, planning, communication and a preference for action, the wolf's expectation is always to be victorious. While in actuality this is true only 10 percent of the time or less, the wolf's attitude is always that success will come-and it does. (End citation) Wolf Credo
If we continue on our current path, I imagine a civilization where our healthy traits will eventually be "bred out," and we will become extinct from our well-meaning, but misguided attempts to combat illusory problems that threaten the weakest individuals, but not the species or the planet. Thinking like a global "pack" is not on the radar screens of most people. Maybe that's why our world is in the dire predicament it finds itself in today. Why worry about tomorrow? We (and by "we," I mean human beings) won't be there anyway. Now let's all go to our happy places and pretend what's happening really isn't. It's what we humans do best.
The Chimera of Adult Credibility
Scott Anderson, M.D.
Ever wonder why children seem to make friends more easily than adults? Quite simply, they haven't had a chance to be corrupted by the world or their parent's emotional and psychological baggage yet. If you grow up with intolerance to others' culture, views, or opinions, you may develop those same tendencies and become ego-centric and insular. Some of these tendencies transcend generations. The belief that everyone shares the same "everything" with you is central to early stages of develpment (see Piaget). As a child, you assume everyone has, or should have, the same belief system as you. As such, it is easier to enter into relationships, and easier to forgive. However, at between ages 7-12, it is normal to eliminate egocentrism in the Piagetian so-called "preoperational phase" of development. We begin to consider the opinions of others as valid or invalid alternatives to our own. Anything that may interfere with normal stages of development such as abuse, agression, and strong moral biases may cause permanent disturbances in the developmental process such that adults may lack appropriate consideration for others' opinions, empathy, or higher-level coping skills. When we develop maladaptive tendencies, other factors may take hold, including preemptive responses to illusory threats. Dr. Nayef Al-Rodhan, a highly published author, in the uber-intellectual, but very worthwhile read Sustainable History and the Dignity of Man, cites one basic key concept that should be considered by anyone studying human behavior and our current world order:
"Aggression is prompted by survival instincts in situations where basic needs are not met. History has shown repeatedly that humankind is capable of unthinkable brutality and injustice. This is often a result of what I call fear(survival)-induced pre-emptive aggression, which may occur no matter how calm the situation appears, although it is not necessarily inevitable. Moreover, where there is injustice that is perceived as posing a threat to survival, humankind will do whatever necessary to survive and be free. In such instances, “might” (military or otherwise) may not prevail or be the optimal solution. Since we cannot rely on human beings to be moral, anarchy and situations of near-anarchy should be prevented at all costs. The sense of fear that such circumstances engender in people will result in fear(survival)-induced pre-emptive aggression, brutality and injustice, and these eventualities must be prepared for. Even in nonanarchic situations, survival instincts are very powerful and may be incited instantaneously. The risk of aggression and brutality needs to be minimised through confidence-building measures and inclusiveness."(see “emotional amoral egoism” by Nayef R.F. Al-Rodhan) (End citation).
This concept circles me around to a story I call The Baby and the Bum. The love of my life sent me this in an e-mail. In the story, a young mother comes face-to-face with her faith. Perceptions, many times, are not realities. No matter what your religion, you will appreciate the message this story sends:
The Baby and the Bum Author Unknown
We were the only family with children in the restaurant. I sat Erik in a high chair and noticed everyone was quietly sitting and talking. Suddenly, Erik squealed with glee and said, 'Hi.' He pounded his fat baby hands on the high chair tray. His eyes were crinkled in laughter and his mouth was bared in a toothless grin, as he wriggled and giggled with merriment.
I looked around and saw the source of his merriment. It was a man whose pants were baggy with a zipper at half-mast and his toes poked out of would-be shoes. His shirt was dirty and his hair was uncombed and unwashed. His whiskers were too short to be called a beard and his nose was so varicose it looked like a road map.
We were too far from him to smell, but I was sure he smelled. His hands waved and flapped on loose wrists. 'Hi there, baby; hi there, big boy. I see ya, buster,' the man said to Erik.
My husband and I exchanged looks, 'What do we do?'
Erik continued to laugh and answer, 'Hi.'
Everyone in the restaurant noticed and looked at us and then at the man. The old geezer was creating a nuisance with my beautiful baby. Our meal came and the man began shouting from across the room, 'Do ya patty cake? Do you know peek-a-boo? Hey, look, he knows peek- a-boo.'
Nobody thought the old man was cute. He was obviously drunk.
My husband and I were embarrassed. We ate in silence; all except for Erik, who was running through his repertoire for the admiring skid-row bum, who in turn, reciprocated with his cute comments.
We finally got through the meal and headed for the door. My husband went to pay the check and told me to meet him in the parking lot. The old man sat poised between me and the door. 'Lord, just let me out of here before he speaks to me or Erik,' I prayed. As I drew closer to the man, I turned my back trying to sidestep him and avoid any air he might be breathing. As I did, Erik leaned over my arm, reaching with both arms in a baby's 'pick-me-up' position. Before I could stop him, Erik had propelled himself from my arms to the man.
Suddenly a very old smelly man and a very young baby consummated their love and kinship. Erik in an act of total trust, love, and submission laid his tiny head upon the man's ragged shoulder. The man's eyes closed, and I saw tears hover beneath his lashes. His aged hands full of grime, pain, and hard labor, cradled my baby's bottom and stroked his back. No two beings have ever loved so deeply for so short a time.
I stood awestruck. The old man rocked and cradled Erik in his arms and his eyes opened and set squarely on mine. He said in a firm commanding voice, 'You take care of this baby.'
Somehow I managed, 'I will,' from a throat that contained a stone.
He pried Erik from his chest, lovingly and longingly, as though he were in pain. I received my baby, and the man said, 'God bless you, ma'am, you've given me my Christmas gift.'
I said nothing more than a muttered thanks. With Erik in my arms, I ran for the car. My husband was wondering why I was crying and holding Erik so tightly, and why I was saying, 'My God, my God, forgive me.'
I had just witnessed Christ's love shown through the innocence of a tiny child who saw no sin, who made no judgment; a child who saw a soul, and a mother who saw a suit of clothes. I was a Christian who was blind, holding a child who was not. I felt it was God asking, 'Are you willing to share your son for a moment?' when He shared His for all eternity. How did God feel when he put his baby in our arms 2000 years ago?
The ragged old man, unwittingly, had reminded me, 'To enter the Kingdom of God, we must become as little children.'
Sometimes, it takes a child to remind us of what is really important. We must always remember who we are, where we came from and, most importantly, how we feel about others. The clothes on your back or the car that you drive or the house that you live in does not define you at all; it is how you treat your fellow man that identifies who you are. (End citation).
In many ways, the more we let our guard down and allow others in, and, paradoxically, the more we embrace certain "immature" stages of development, the more genuine and credible we become. How many adults are able to strip away their vanity and pride enough to allow others really in to their lives? Some of the most fulfilling relationships I have had with people are the ones where I ignored the obvious perception, the outside veneer, and mined the potential, unrealized value on the inside. Our perceptions of Intelligence and ignorance, great beauty and profound homeliness, are all obstacles to good relationships if we are unable to get past our sometimes innate, discriminatory behaviors.
When we show children our falsely-idealized depictions of beauty, intelligence, or morality, and engender them with these ideas, we unwittingly expose them to great harm. This concept is personified by children placing value judgements on people based on society's idealized concepts of normative physical characteristics. In studies, those who appear "ugly" to children are often referred to as "bad." Those who appear "attractive" to children, are more often assigned a value of "good." In the business and political worlds, we search out those with characteristics that perpetuate the illusion of power and success, often with no logic behind such actions. Many organizations have enjoyed early success by embracing this facade, only to fail when the "goods" are not delivered, or when statistics do not support the promise. This social nepotism may lead to undesirable cultural attitudes, corporate, political or otherwise. Some "normal" human behaviors need to be attenuated. We need a paradigm shift in the way children are raised and socialized. We need to teach them how to love others more than themselves. If our preoccupation with self, pride, beauty, and material possesions does not cease, we will fail as individuals, as a culture, and as a world to evolve.
Here's a cool video: http://www.youtube.com/watch_popup?v=iYhCn0jf46U Here's another: http://www.youtube.com/watch_popup?v=7-kSZsvBY-A
If you get it, you get it.
What We Can All Learn from Walt Kowalski Greater love hath no man than this, that a man lay down his life for his friends-John 15:13
Gran Torino is one of my all-time favorite movies. Admittedly, Clint Eastwood has always been one of my favorite actors. However, I'm not sure whether it was his outstanding acting in this movie, the location it was filmed (I lived in Detroit for five years) or whether it was the way I could personally relate to Eastwood's character, Walt Kowalsky, a retired autoworker, that did it for me.
I liked Walt from the very beginning of the movie. He is far from a saint, but he is a genuinely good man. He kind of reminds me of my dad. The movie begins with the gruff, grumpy and stoic Walt Kowalsky greeting family and relatives at his wife's funeral at a local Catholic church. Though Walt is the definition of salt of the earth, he has materialistic douchebags for sons, especially Mitch, with an equally-annoying wife, Karen complete with their dysfunctional, compassionless children. Though his family resides in one of Detroit's wealthy, adjoining suburbs, Walt, who lives in a depressed area of Detroit, is rarely visited by his family, probably because he hates them so much and they know it. Even though the aging Walt is tougher and more independent than guys half his age, Mitch and Karen continue to try to force him from the neighborhood he loves into a retirement community, probably to be consistent with what's expected or what their friends all do with their aging relatives. We don't see his family much in the movie. That's a good thing. They're really, really easy to dislike. His virtues do not seem to be inherited by his children, and a big part of me wonders why a guy like this has such messed up kids. However, my willing suspension of disbelief quickly got me through that part of the movie.
Walt lives simply. He has a very modest, well-kept Highland Park home and two vehicles: a mint '72 Gran Torino and a seemingly older Ford pickup. His Torino is his baby. He parks it in his driveway simply to show it off to the neighborhood. In one scene, he sits drinking beer from a cooler with his dog, Daisy, on the porch admiring the vehicle as he reclines back in all his pride and glory saying "Aint she sweet?" Yes, indeed she is, but Walt is a man living very much in the past, and his surroundings, especially his once homogenous, working-class neighborhood, are changing more quickly than he realizes.
Walt is probably only one of a few, rare people who decided to stay put, despite the growing ethnic diversity of his neighborhood, which has largely been replaced by poor Asian Immigrants; among them the Hmong. There is poverty and lots of gang violence. Next door live Walt's neighbors, the Vang Lors. The main characters are the adolescent siblings, Sue and Thao. They are really quite a peaceful, unobtrusive family, until Thao, who has a terminal self-esteem issue, gets enticed to join a local gang by his cousin, a member of the gang. He is, at first, hesitant, but eventually agrees to an "initiation" whereby, he is challenged to steal Walt's cherry '72 Gran Torino sport. That night, Thao enters Walt's garage, but the hypervigilant former Korean war veteran is immediately aware that there is something amiss. Walt gets his M1 Garand rifle and heads to the garage where he startles the timid Thao causing Walt to fall, giving Thao his exit.
More to come (this is gonna be a long one)...
Last Updated: February 18, 2010
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ResponsiCare, Inc.1802 Presbyterian Drive SE
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Scott Alan Anderson, M.D.
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 ResponsiCare by Scott Anderson, M.D. is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.  http://www.twitter.com
  
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