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[P]ontifications: Ethical Discussions About the Contemporary and Controversial
Second Amendment Rights: Another Sad Day Scott Anderson, MD
This past 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 perpetuated by individuials that 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. Alabama gun laws? Pathetic. http://www.bradycampaign.org/xshare/bcam/stategunlaws/scorecard/2010releases/AL.pdf Again, who will save us from ourselves? 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 "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 relationship 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 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. Here's an example illustrating why I believe this.
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 providing for their needs and future education? How about when I miss a soccer game to tend to a critically ill woman with 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 when I'm away. 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? 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 assitance 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 meaningful interaction can oftentimes be brief.
A more serious pitfall is when parents place their children in the so-called "double bind." Here, unwittingly, parents send conflicting instructions 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 any 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 a spouse whose occupation takes him or her away for business or duty.
Where is this going? I think I'm trying to say that, despite forgetting the name of my daughter's dance teacher, despite not recognizing my son's soccer coach at Wal- Mart, I'm still a good dad. When my ex was busy building empty relationships with more soccer moms, I was engaged in what the kids were doing. I think that was pretty OK. I knew then and still know now, that one secret to fostering a good relationship with your kids is showing them that you are able to make a real difference in the world by breaking away from the herd now and then. Sure its risky. They may do something radical like give up that beautiful house in the nice subdivision for a hut in Central America 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 ...coming soon
Health Care Reform or Cultural Reform? Scott Anderson, M.D.
A Bizarre and Illogical Healthcare Culture We Have
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 in a system, itself, 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.
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 epicenter 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, I and her Cardiologist 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. Nonetheless, 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.
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. 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, she lost a portion of her small intestine, 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 quality of lives 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 current 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 current 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 appreciate 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.
What Do We Do When Tobacco Costs Significantly Overrun Tax Revenue?
Government Solution: Put Bigger Warning Labels on Cigarette Packaging. Yeah, That'll Work, Alright.
You want reform? Here's a 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 cigarettes, 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 moral compass for the rest of the world, but that hasn't stopped us yet; and we are certainly setting a poor example with the current healthcare system. Living in this Country is an amazing privilege. There is no guarantee that America will even look the same or even be here in 10 years. 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. 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.
You are one voice among millions of voices, and may feel that your opinions don't really matter. However, your voice plus your 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 you, as an individual, 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.
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 disasterous. 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, infirmed, and elderly 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 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. 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. 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 an assisted-living facility, 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 hate. His virtues do not seem to be extolled in 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 (probably) an even 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, Walt is a man living very much in the past, and his surroundings, especially his once homogoneous, 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 immediatekly 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...
Last Updated: February 18, 2010
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