Posts Tagged ‘Philosophy’

OUTFOXED

June 30, 2014

A recent Fox News show claimed Minnesota was the first state to allow Sharia Law.  The reasoning included Somali cab drivers at MSP Airport, who refused to transport people who carried alcohol and a Muslim cashier at Walmart, who refused to handle bacon.  The latter was re-assigned.  The former?  Well, if a cab driver doesn’t want to take me, there are a lot of other cab drivers who would be more than happy to jump the queue.  We all must decide whether we are willing to take the financial consequences of our beliefs.

Assuming this is true, and given Fox, I would have liked to see this for myself, these are scare tactics, NOT news.  Sharia Law says that a nonbeliever must be put to death after first being allowed to convert to Islam and refusing.  I have been to Minnesota well over forty times, I have spent more than 300 nights in the state, and I haven’t even seen a mosque.  Fox plays on American fears of Muslims, the 25% who believe Mr. Obama is a Muslim (as if it mattered if he were), and Muslim beliefs.  Let’s look at a few of those beliefs: eschewing alcohol (like Mormons), not eating pork (like Jews), praying in hundreds (which every large Church does during its service).  Fox omits saying Islam requires charity outside of taxes, limits loan interest, which we would do well to adopt, believes in prayer as a time to reflect upon one’s life (doubt many do that), and fasting to remember how the poor feel. I respect these tenets, just as I respect many in Judaism and Christianity.  There is a lot of good in religion.  The Holy Books have beautiful passages.  The idea is good; the execution often is too good, using a different meaning of “execution”.

In other words, Fox News was cherry picking, and the cherries weren’t ripe to begin with.

Let me demolish the argument right now by going back to 1960, before most of the anchors were born.  John F. Kennedy was seeking to be the first Catholic President of the US.  Back then, people then said that if Kennedy were elected, the Pope would be making American policy.  Yes, I remember that.  We also know that the Pope did not make American policy.

Now, we have over 60 million Catholics in the US, our vice-president is one, and I didn’t hear anybody’s saying that an Argentinian (good heavens, a LATIN-AMERICAN) would order, from ITALY, of all places, Mr. Biden or 20% of our population what to do.  Fox missed the boat on that one.  Indeed, in the process of googling this, I saw a picture of women whose hair was covered, and thought they were Muslims.  They were NUNS. Why is it fine for a nun to cover her hair but not a Muslim woman who desires to do so?

This particular clip upset some.  One said the Somalis should “become Americans.”  What is that?  I think she meant waving the flag (even if you don’t look at it when the national anthem is played), have a yellow ribbon on your car (but never have served), go to a Christian Church every Sunday (but deny people who love each other the right to marry).  We have the right to believe what we wish in this country, no matter how detestable it may be.  They believe life begins at conception, have no idea how the fetus develops, but do not care about the baby’s welfare after birth, especially if a person of color.  The Declaration of Independence said all men are created equal, but didn’t say “physically equal”: some have bad genes and really rotten luck.  As a doctor, I saw many with horrific conditions, some preventable, most not.  How do we handle them?  By dismantling safety nets?

What is an American? Somebody who believes what Fox News says, or somebody who thinks about what they say and disagrees?  Somebody who believes food stamps should be outlawed because of an abuse story, yet thinks guns should be available despite very deadly countable daily abuse?  Food stamps have less fraud than Medicare. Illegal gun sales are common, not just anecdotes.

What is an American?  Somebody who thinks America right or wrong, but tosses litter out the window, or puts a box of kittens out in the desert?  Somebody who obeys laws they don’t like, or grazes cattle on public land without paying?  What is an American?  Is it prayer at public events, Christian prayer, that is, insulting non-Christians and non-believers, like me?  Who is “big government” we love to hate?  Do we hate ourselves?  WE ARE THE GOVERNMENT.  Would we demand government tell a Somali cab driver whom he should carry?  He has the right to refuse to serve a person.  Or do rights belong only to “native born” Americans?

Does being an American mean we need to start speaking and writing English better?  I’d welcome that.  Is it knowing American history?  Then why didn’t we learn from Vietnam and not attack another country in a part of the world that we have little understanding of?

Jews eat Kosher; their diets forbid pork, so I don’t see a problem with a Muslim who doesn’t want to touch pork.  I am vegetarian and don’t want to touch meat. The Native American Church is allowed to use peyote, otherwise illegal.  The Catholic Church uses wine, alcohol, in its services, forbidden by Islam.  Ironically, “blue laws,” which restrict the sale of alcohol on Sundays, affect me, although I neither abuse alcohol nor am a believer.  I have to obey religious doctrine in buying alcohol on Sunday.

How is a Somali’s refusal to transport alcohol Sharia Law?  Do we have Jewish, Catholic or Mormon Law in this country?  No, we have religious beliefs of many types, and we try to accommodate those beliefs.  The NCAA doesn’t make BYU play tournament games on Sunday.  Jews don’t work on their holy days, and we allow that.  Catholics celebrate Holy Week, most of of us Christmas.  Sharia Law?  No.  Are there women who wear the Hijab here?  Yes. Sikhs wear head coverings.  So do nuns.  What’s wrong with that?  At the last funeral I attended, the number of people wearing jeans appalled me.  And we worry about covering hair?  I’m ex-Navy, and I soon learned when one did and did not cover.  One salutes only when covered, not otherwise.  Sounds like covering the head is special.

People have strong beliefs.  I have mine, too, that one may read in the nearly three hundred posts here on the blog.  Some are perhaps irrational; others may appear to be but are not.  Decide for yourself this belief of mine:  Fox News promotes hatred and fear, is biased, too often appears in public places, and violates the interpretation of the First Amendment. There are limits to “free speech,” and Fox has crossed them.  If I am wrong on that, correct me.  Then try to convince me Fox is “fair and balanced.”

If my wife wears a cover in Minnesota, it is to protect against mosquitoes, not Sharia Law.

 

24 x 7

June 21, 2014

Recently, I read a post about how the children of the ‘70s survived, despite all the problems they encountered: recalled toys, like lawn darts; not wearing seat belts; no helmets; and leaving kids unattended. Lawn darts caused a few injuries and one death; 12 high school and college students die annually from football, but a lot more play football than threw lawn darts.  It might not have been unreasonable to ban them.  Given football’s propensity to cause brain damage, I think the game must change, a tall order in this country.

We don’t need helicopter parents, not letting their children discover the world for themselves.  Kids need to experiment.  But some experiments we know aren’t a good idea, and we don’t want kids repeating them.  Diving into unknown water is one of those.  Not wearing a seatbelt is another.  I remember when cars didn’t have seat belts; people who first encountered seat belts in cars thought they were weird, like we were going to go flying.  On holiday weekends, we saw in the paper numbers of dead (hundreds) from motor vehicle accidents.  Since 1960, the absolute death rate has fallen, despite a near doubling of population.  The actual death rate per 100,000 is half of what it once was.  Seat belts are the major reason.

Helmets save lives, too.  Recently in my city, an 18 year-old girl hit her head after falling off a skateboard.  She got back on, a little while later was short of breath, collapsed and died.  This was almost certainly due to an epidural hematoma, with the classic lucid interval, and could have been prevented by a helmet.  Anecdote?  Sure.  But data support helmet safety.

Second hand smoke may not have caused cancer yet in the generation born in the ‘70s, but they are still young.  Wait until they become 50 or 60, and some who never smoked die from lung cancer.

The issue is not that you got away with it, and therefore it was safe.  That is Challenger-type of thinking. Challenger was unsafe to fly at the ground temperature it was at.  We had plenty of evidence to suggest that, but no catastrophe had occurred, so launch was allowed.  The issue is probability.  The probability I will die in a motor vehicle accident is very low.  But I can make it lower by wearing a seat belt, which then makes the airbag useful.  The probability I will get cancer from second hand smoke is low, but I can make it less by not being around it.   Smokers can live long lives and non-smokers can die young, but the probability is against such an occurrence.

I continued to write that in my youth, we had 3 TV channels, not hundreds.  We did not have Nancy Grace, Fox News, or Keith Olbermann.  Last year, after the Asiana crash at San Francisco, we had extensive coverage, where experts were continuously asked to offer opinions about something about which they had limited facts.  “Dead air” is an ironic killer in 24 x 7 news, and it has to be filled, but if the filler is conjecture, and if it is repeated often enough, the conjecture becomes treated as fact.  Politicians have known that for decades.

If child abduction and murder by strangers were 26 times higher than it is now, we would have a national campaign to protect children.  Come to think of it, we do.  And it works.  The problem is that a child is 26 times more likely to die in an auto crash and 20 times more likely to die at the hands of a family member than a stranger.  But 24 x 7 coverage of an Amber Alert overplays the idea that children are always in imminent danger, when they aren’t.

The idea that we are just seconds away from death at any moment, “It could happen tomorrow” on The Weather Channel, the idea that but for a super hero or a first responder, our lives could be snuffed out in a second, is wrong.  We need counts of deaths, we need proof of dangers, if we can determine such, and they must be peer-reviewed.  Mike to The Weather Channel:  the most dangerous weather system on Earth is a stalled high pressure system.  Heat-related fatalities comprise a plurality of weather related deaths in the US, drought is the cause of more than half of all worldwide weather-related deaths.  Showing storm chasers near electrical storms does not help teach people that lightning annually kills more people here than hurricanes, even with Katrina’s toll factored in.

Such 24 x 7 coverage often pits two “experts” against each other in the name of equal time, whether or not the science is equal.  Climate change is an example. Or, it asks multiple experts to speculate, when speculation may be outright wrong, either because the facts aren’t clear or the reasoning isn’t.  In a country with over 300 million people, there are daily tragedies.  Indeed, each of us in our own lives has tragedy strike numerous times. On an average day, most of us have things happen that we don’t like.  It is probability, and low probability outcomes with large numbers of events lead to a significant expected value of these uncommon outcomes.

There is significant news every day.  It would be nice if it were reported and then left alone until further information becomes available.  Breaking news is not helpful if it glues people to the TV screen, with experts trying to comment upon things they can’t effectively comment upon.  It is akin to diagnosing a patient based upon what they write in a letter or say over the phone.  A good doctor will use extreme caution here.  A good journalist should, too.

 

 

 

STUDENT-ATHLETES

June 17, 2014

At the recent Track and Field championship in Eugene, I heard numerous announcements and saw commercials on the big screen about “student athletes”. I don’t like big screen ads during competition, since it is distracting, and I doubt the money generated goes to help students in financial difficulty or to pay grad students better,

It appears the NCAA is pushing the term “Student athlete” vigorously, as former UCLA basketball star Ed O’Bannon is suing them about not receiving compensation for the NCAA’s use of pictures of former “student athletes”.  He was joined by Oscar Robertson, who puts Mr. O’Bannon in lofty company.  O’Bannon was one of the few who succeeded professionally in his sport.  He led UCLA to the NCAA basketball championship in 1995.  He was drafted 9th but played only 2 years in the NBA and 8 years in Europe.  He now sells cars in Las Vegas.  He disappeared, but his reappearance now may be the most important thing he does in his life: change the sham that college football and basketball are played by “student athletes.”

Universities generate $4.5 billion from football and basketball alone, enough to cancel 190,000  student loans of $24K, the average for Oregon.  Or pay grad students better.  Or pay the players who actually do the work, not those who benefit from such work.  Alabama’s football coach makes $5.5 million; Arizona’s basketball coach $2 million, and he is far from the best paid.  The median salary of an associate (tenured) professor of physics is $70,000.   In Eugene, Matthew Knight Arena cost $227 million, a 2002 “facelift” at Autzen Stadium was $20 million.  The NCAA generates nearly $1 billion, mostly from the “March Madness” basketball tournament.  I heard numerous times 89 championships and 450,000 “student athletes,” with 90% of the revenue returning to the schools.  Why would the NCAA be saying what per cent goes back to the schools, unless they felt they were under fire?

So, $100,000,000 remains, and I write the number, because seeing it is often useful. The $4,500,000,000 ($4.5 billion) is one-seventh of what America spends on the NIH, which I think does a lot more good for people, but I might be wrong.  Sports are perhaps more important than finding cures for diseases like Alzheimer’s.

The issue the NCAA doesn’t appear to understand, or at least doesn’t want to admit, is that football and basketball are different:  athletes and coaches involved in these sports are not the same as athletes and coaches in other sports.  John Calipari at Kentucky has well over a $35 million package for the rest of the decade.  An assistant football coach makes 6 figures, one has made a million; an assistant track and field coach makes about $20-40K.  Look it up.  I did.

The question for the NCAA is this: how much should men’s basketball and football players be paid?  It isn’t “whether” but “how much?”  These players are abusing their young bodies, not mentally mature, and vulnerable to being used.  They often do not finish college, taking a slim chance they will have a pro career, that in the case of even O’Bannon was short. The probability a college football player’s playing professionally is 2%; basketball is 1%.  OK, 1.2%.  The probability of graduating without a degree and without playing a professional sport is a minimum 15-30 times higher, approaching 70% in some places. These players are not going to find good jobs, their joints worse than mine, and I am 3 times older.  Football brain damage isn’t even being factored in here.

The concept of “student athlete” works if it is a Dartmouth runner who loves to run but must meet high standards of an Ivy League school.  The runner may perform well enough to be in the 5000 meter finals in Eugene, but he was lapped well before the end. This is a student athlete.  He loves track, but his life work will be something else.  Dartmouth, like all Ivy League schools, does not offer athletic scholarships.  If a university does, it is subsidizing an athlete, not a student.  This to me, a Dartmouth alumnus, is an important distinction.  Only a third of the 450,000 get athletic scholarships; four sports: football, men and women’s basketball, and women’s volleyball, give full rides.  Is that payment?  If it is, then they aren’t primarily students.

Football and basketball players are too often athletes who happen to attend classes.  Their graduation rates approach 70%, better than it was, but a significant number of programs graduate fewer than half. What was their major? I doubt it was physics, chemistry, mathematics, English, or literature.  Many athletes on full athletic scholarships are a farm team for the pros, leaving college when they believe they can turn professional.  To put their faces or names on a shirt, while they are in college, so that the NCAA or the school can make money, is using them as pawns.  This happened to Michigan’s “Fab Five” 20 years ago.

There are student athletes, and there are student athletes.  The NCAA compares both equally, and they are not.  The volleyball coach at the University of Arizona knew full well that successful recruiting and funding of his program depended upon a successful football and basketball program. Eleven of Arizona’s 13 programs listed lost money, including volleyball.  The profits from men’s football and basketball were about $26 million, more than enough to compensate.  Graduation percentages are tricky, and I don’t like the 6 year definition; I got through Dartmouth in 4, and the Dartmouth man who ran the 5000 at the NCAAs will likely do it in 4, too.

I am concerned about big corporations buying advertising, using handsome young men and pretty young women with nice voices to push a toxic agenda, be it chemical, like ExxonMobil, or sport, like the NCAA.  Money talks, it talks too much, and it is time to shut it up. Money could be used to pay for good professors, not coaches, lessen the burden of student debt, develop first rate researchers, writers, educators, and try to lift more poor out of poverty.  Ads? Request retired people like me to help tutor or use our experiences and wisdom.  Bet they wouldn’t cost much on a Jumbotron.   This is the 21st century.  We need educated people to understand the growing complexity of this world. Fox News has a simple answer for everything.  There are few simple answers, and that makes life difficult. Instead of embracing complexity, we pay tens of millions to a coach to help young men put a ball through a metal rim.  If your team wins, you feel better about life. Is escape the point?

When I cared about basketball, O’Bannon was a name to be feared in Arizona.  Now, I wish him every bit of success off the court.  Stay with this cause, sir, for this is where you may make your mark in life.  I bet you never expected that.

 

 

 

NO ANONYMITY WITHOUT RESPONSIBILITY

June 3, 2014

“I can’t find a goddamn parking place in this  f——- town!” we heard, while walking to the Prefontaine Classic.

The middle-aged man walked away from a series of parking meters that were good for 2 hours, not quite long enough to see the event.  On the other hand, had he been willing to walk a few more blocks, he would have been able to park for free.  Had he anticipated the potential problem parking, he might have left home earlier, wherever home was.  He had “skunk anger,” and I quickly recalled my arm, after I had begun to point out parking spots.  Nowadays, it doesn’t take much to set some people off, and with the only restriction on firearm possession these days appearing to be price, I thought it wise to quietly walk away.

Public displays of anger are scary.  I vividly remember a fist fight breaking out over who was next in line at a gas pump during the 1973 oil shock.  I saw a man pummeled in Nairobi once, and stayed far away.  Over the phone, it is too easy to express anger, for one doesn’t see the effect upon the other person.  Sadly, many who receive these nasty calls weren’t involved in setting up the faulty system or designing the flawed product.  Highly paid executives are shielded from much of the difficult work that is “customer service.”

Letters may also be hurtful. Virtually everybody has regretted at some time hitting “send” too soon.  Angry letters require rereading and preferably should sit 24 hours before being sent.  It is remarkable what will be deleted after waiting.  Many such letters I never sent.  Still, angrily written letters have a name and an address; they are not anonymous.

The Internet has brought anonymity to public discourse, which I find both disconcerting and dangerous.  Read the comment section of an online newspaper article.  The comments do not sit for a day before posting, the grammar and spelling are often atrocious, the venom almost visible, the comments close to libelous, and the points often not factual.   Anonymity allows every frustrated individual to write whatever he wants: a free pass for hate mongers, the ne’er do wells, a public voice for those who used to say their indecent words in private, or at least not in my presence.  People I never will meet vent about all sorts of topics, truth being the greatest casualty, the beautiful English language a close second.

Letters to the editor are difficult to get published, because they require knowledge of basic English grammar, which many do not have.  These letters have an approximate 150 word limit, requiring careful thought, not a long-winded exposition.  I find it ironic that many who decry the use of Spanish—a language I wish I could speak fluently—cannot write a decent English sentence.

Online, every time I read one’s advocating physically fighting the government or secession, I wonder why these people don’t have their IP addresses tracked and informed their comments are treasonous. Many say the government is incompetent, rather than taking the small step to say some people who work for the government are incompetent.  Yet, this same “incompetent government” is somehow able to keep secrets about Area 57, currency reform, 9/11, the New World Order, and faked the Moon landings.  The inconsistency of these two concomitantly held viewpoints baffles me.

What I almost never read in diatribes are detailed suggestions how we might fix problems.  Perhaps many of us have given up. Ideas are seldom seriously considered by any organization I’ve sent them to.  Message to those in power: you do not have a monopoly on good ideas; they can come from anywhere, not just your staff or the same people that have been in the public eye for decades, some of whom need to move on.  You might be surprised what we have to offer.

Simplistic suggestions: “Deport all of them,”  “lower taxes,” “repeal Obamacare” are not solutions.  Mandatory national service, encouraging national volunteerism and using the experience of older people are starting points. I have been open to different ideas, so long as they have data, inferences, margin of error, ways of tracking effectiveness, and are well thought out.  My name is visible, and information about me is available.  It’s is clear what I believe, and it is clear that I may be influenced.

I had no idea the jerk I heard—and the man was a jerk, continuously swearing at the top of his lungs in a quiet neighborhood about a city I happen to love—would lead to an article.  It didn’t quite, until I read online in the Green Valley News (Az.) that a Hispanic shot and killed by the Border Control was an unarmed US citizen.  He had a prior record, was stopped and allegedly fled on foot, not at all a physical threat.  He was hauling marijuana, not human flesh.  He broke several laws, no question, but he didn’t deserve death.  I wonder whether those who have decried illegal immigration will speak out against killing our own citizens in these circumstances.  I chose not to read the comments, because I suspected I would read “the man deserved it”, “most of these people are illegal,” “his papers were probably forged”, “we still need a wall”, and of course “this is only one instance,” which in the issue of death happens to be irreversible. Is there no shame?  The Border Patrol has a difficult job, but we cannot use that as an excuse.

Anonymity is used by cowards.  My name is on my posts and letters; I don’t hide behind “Blueheeler2”. Stating comments in public requires thought. I suggest we edit these sites, in order to make some of the comments readable, shorter, and enforce common decency.  We used to, and violent threats online ought to be investigated.  They have led to shootings, which takes me full circle.

Some say anonymity is the price we pay for the Internet.  I say we shouldn’t pay it. If WordPress wants to edit me, fine.

Please, however, don’t have your editors make grammatical mistakes in their comments.  That annoys me no end, but I will try to be polite in my letter to you.

 

Michael S. Smith, MD MS (Stat.)

 

 

 

 

WHERE’S THE BEEF?

May 30, 2014

Twenty years ago, medical director of a hospital, I took a call from a woman who wanted to know how many Abdominal Aortic Aneurysms (AAA) her husband’s surgeon had repaired the prior year at our facility.  She asked a good question, because the surgery is difficult, fraught with risk, even when done electively, which in this instance it would be.  Too often, it is done after the aorta ruptures.  My cousin’s husband died of a ruptured AAA; I have dealt with the issue emergently, and it is difficult to control the bleeding while simultaneously repairing the vessel.

I didn’t know the answer.  Therefore, I had no idea her husband’s chances of survival, how long he would likely be hospitalized, or his condition six months later.  We didn’t track that.  It took me four years to get the hospital to track outcomes from cardiac surgery, after I exploded one night in the ICU saying that I had been consulted 26 times in 270 open heart cases in one year.  Consulting a neurologist after a heart case usually doesn’t bode well.

I mention this, because AAA is one of the outcome measurements Leapfrog uses in determining how well a hospital performs.  So is Aortic Valvular Replacement.  The Tucson hospitals that used Leapfrog scored no better than “C”; one scored “D”.  Some of these hospitals had marketed themselves as being “one of America’s top 100 hospitals.”  It seemed that they were not quite as good as they thought they were.

Leapfrog tracked drug errors, too, and no hospital in Tucson scored better than “C”.  On 2 May 2002, I met with administrators at University Hospital in Tucson to outline my reporting program to reduce medical errors.  A year earlier, I had met with their cardiac surgery program to help track outcomes better.  I can’t believe I was so naive to think that I, who had practiced, been an administrator, had a Master’s in statistics, and 2 months earlier had written an op-ed on an error reporting system we needed in medicine would take on Big Hospitals.  Capitals mine.

Both groups wanted to know, in an unfriendly tone, who I was.  Being from the same city was a minus; had I been from outside, I might have had more credibility.  It would have helped if I were good-looking, exuded charisma, and showed glossy paper with colorful bar graphs, rather than having sound ideas and a quiet demeanor.

Needless to say, the cardiac surgery program wasn’t interested, and I was assured, that second of May, that University Hospital had “one of the best safety records in the country.”  They gave me no data.  They wanted to know what software I would use. I didn’t need software; I needed reports of errors in order to understand them better.  Unfortunately, computers and charisma mattered more to them.

Leapfrog was initiated by a group who had the smarts, the looks, the networking ability, and the leadership skills I lacked.  My ideas were ahead of theirs.  In 1974, I was counting outcomes in medicine when I was an intern.  I was selecting my surgeon to do carotid surgery in the mid-1980s, based upon his outcomes.  I raised concerns about our cardiac surgery program in 1990.  I wasn’t surprised that hospitals were graded “C.”

Every member of my immediate, now small family, has suffered from a medical error.  People make mistakes.  I accept that.  People should learn from them, too, which they often don’t.  For years, we had lousy data and lousy tracking systems.  No, we had no data and no tracking systems.  We hadn’t a clue, and we let Big Medicine, called the Joint Commission, dictate what hospital quality was.  I met with the Joint Commission, too, on 14 August 2001, in Chicago, at my expense.  They were quite interested, so they said, but I never heard again from them.  No e-mails, no calls, no response to my written requests, nothing.

It takes 30 seconds to compose and send an e-mail saying one is not interested.  They weren’t  too busy.  They were rude, arrogant, and wrong, as wrong as Condoleezza Rice had been 8 days earlier and the Bush administration would be four weeks later.  The only difference is a lot more people die from medical errors every year than died on 9/11.  We just don’t know how many.  Our estimates are bad, and the margin of error of those estimates is seldom given.  That violates a basic rule of statistics.

We should be tracking outcomes of common procedures in medicine.  When I broke my hip in an accident, the surgeon had no idea I had done well until I wrote him.  I fractured my fifth metacarpal, had a cast for four weeks, and told that alcoholics often took off their casts with no sequelae.  When I was told I needed two additional weeks of the cast (which did not change the angulation of my metacarpal), the comment my father made was “that is what your doctor learned to do where he trained.”

“Why?” I asked, “don’t we know whether somebody with a broken metacarpal even needs a cast?  Why don’t we know the optimal time? Do metacarpals heal depending upon geography?”  This is not a rare injury.  If we don’t need a cast, wouldn’t that save money and time?  How many other conditions don’t we know the results?  Perhaps some shouldn’t do certain procedures, like colonoscopy, lumbar punctures, bronchoscopy or angioplasty.  How many of these have you done, doctor?  And what happened to the patients?

We physicians like to say we are scientifically trained, and non-physicians don’t have data to show they make a difference.  Where are the numbers?  What should they be?  And what are we doing to achieve those numbers?   Too many ideologues argue using rhetorical questions, which I find annoying.  A statistician’s job is to ask questions.  Ours are good questions, answered with data, uncertainty and appropriate inferences.

We don’t need high speed computers to measure outcomes.  Pen and paper work just fine, with a lot of curiosity, and an open mind.

 

TIME TO LEARN FROM THEIR SILENCE

May 23, 2014

I hiked the other day with a group, including a man who had driven to the trailhead with a “Disabled Veteran” license plate on his vehicle.  He was the lead hiker and set a good pace. He was probably my age, give or take a few years, and we started talking, since this was an aerobic hike—fast, but not so fast that we couldn’t talk.

When I mentioned I was a retired physician, he said a corpsman saved his life.  I didn’t have to ask where.  I knew it was Vietnam.  Corpsman=military=my age=Vietnam.  He didn’t say what happened, only that he ended up in Yokosuka, Japan, for 5 weeks before being sent back home.  He is a Marine (note the tense, for Marines consider themselves for the rest of their lives as a Marine), and we talked about ships, sailors, and generalities.

We did not talk about what happened to him.  He mentioned Hue (“Way” is the pronunciation, for this household word in 1968), and I was polite enough not to inquire further.  I had a pretty good idea what happened to the Marines in Hue, and it was ugly, awful, and part of the devastation we inflicted on many of our countrymen and their families plus another country and their people that year.

This man lived; 58,000 Americans died, as well as least three million Vietnamese, probably a lot more. Cambodia and Laos were subsequently sources of many more deaths.  This man wasn’t killed but wounded, and when one starts tallying the wounded, we are in eight figure range—more than ten million.  Americans never trusted the government quite the same again after Vietnam.

The man didn’t talk about the war, and neither did my late brother, who served in Da Nang.  When we start talking about the numbers of people who were indirectly affected by the war, the number is immense.

Only non-combatants like me, who served on a ship that was near Vietnam, but 6 months after “Frequent Wind,” the exodus, talk about our military service.  The guys who were the grunts, the hiker with me called himself one, remain silent.  Almost all of them do.  They don’t brag about their service, and even John Kerry didn’t throw his military record into Bush’s face in 2004, only his medals, about 30 years earlier.  A lot of men who fought in World War II remained silent for years…or forever.  The Republicans at the 2004 convention who wore bandaids, deriding Kerry’s service, were among the most shameful behavior I have ever seen.

This silence should tell everybody how bad war is.  It is so bad that people who have witnessed the tragedies stay silent.  Such is likely is a protective mechanism, but may come with a cost, perhaps PTSD.  The man was a good hiker, and we got up to the top of Spencer Butte and down in about 3 hours, a decent time, although he could have pushed the pace had he wanted.  Four days prior, he and I were part of a group that hiked up Rooster Rock, north of Eugene, 2300 feet vertical, and he was good.  He didn’t mention his military service that day.  It took a second hike with me to mention what he did.

Perhaps the men who start or continue these wars, many of whom have never served in the uniform of this country abroad might think a bit more about the cost.  No, I am not talking about the kept off budget “Emergency Authorizations” during the Bush administration, which were barely challenged by any American, let alone in Congress.  That’s just money; when Republicans spent it, we were patriotic, when the Democrats did it, there was howling about budget deficits.

No, I am talking about the cost to a CIB (combat infantry badge) veteran, disabled, who doesn’t talk about it, and the men who died and will never talk again.  What did they see that kept them silent?  What did they see that their families didn’t even know?  What is this cost?  Well, of course, there is life insurance, but that is a monetary cost.  I’m talking about other costs, something Wall Street, bankers, a good share of politicians, and too many Americans don’t think of and never will, unless it affects them.  To them, unless there is a dollar cost, they aren’t interested.  Health insurance costs money, so many don’t like the country’s spending money on it.  The fact that people feel relieved to have such insurance, and that is a fact, is unknown to them.  Wilderness is board feet of timber, cubic feet of water, a place where they should be able to mine.  The value of what I see, feel, and do in wilderness has no monetary value, so these people ignore it.

Wars are at times necessary, but in my lifetime, Vietnam, Iraq, and Afghanistan were all unnecessary, fought under false pretenses, and run by old men. When I hear jingoistic phrases and see flag waving that make war romantic and patriotic, I wonder why almost nobody asks, “Why do veterans not talk about what they saw?”  I am profoundly saddened, puzzled, angry when people discover that war does bad things to people that we try to sanitize, so the public won’t be offended.  Why were only 16% of us against invading Iraq?  I saw what was going to happen, wasn’t it obvious?  It was to me.

I wonder why we still hear men push to go to war with Syria, Iran, and Russia.  I wonder, of course, where the money is going to come from, since the Republican-led Congress, and that includes the Senate, since they are running that for all practical purposes, wants to cut spending.  I wonder why we act surprised when the VA isn’t helping veterans.  This happens with every war.  That costs money we don’t have.  Why didn’t these guys die or go elsewhere?  A significant number are homeless.  They served, then were thrown away, like old furniture.

When we go to war, we are going to change the lives of every individual who serves in harm’s way.  People will die, families will change, and money will be spent.  The first two have incalculable cost.  The third we try to ignore.  If we go to war, we need to have a national discussion on this, without Fox News, Karl Rove and jingoistic “leaders” calling the shots.  We need to discuss what exactly what it is that makes this particular war so necessary., because thought and negotiation must be expended, before lives and treasure.  Lives are treasure that we cannot put a dollar value on, regardless of what the actuaries and the lawyers say.

Nothing short of the survival of the country should be a cause for war.

 

SITKA SPRUCES

May 15, 2014

It’s only a few hundred yards.  The air feels the same, the elevation barely changes, and the ground feels the same.  To any human hiking west, towards the ocean, the woods and the trees are the same.

But they aren’t.

In this short distance, giant Douglas Firs in the old growth Siuslaw National Forest give way to Sitka Spruce, equally large, so much so that not far north of me is one 550 years old, 15 meters, (50 ft) in diameter, and nearly 50 meters (160 ft) in circumference, 70 meters (230 ft) tall.  A kilometer further inland—maybe only a few hundred meters—there are no Sitkas.

By "Big Tree," 550 years old.  The cave underneath once had a log from a fallen tree, that helped this tree grow.  It was called a "nurse log."

By “Big Tree,” 550 years old. The cave underneath once had a log from a fallen tree, that helped this tree grow. It was called a “nurse log.”

In this transitional zone, there are slight changes in the atmosphere and the soil sufficient to change the climate of the forest enough, allowing one type of tree to thrive and to displace another.  I don’t notice it, but the trees do.  Like the Redwoods south of here in northern California, Sitka Spruce can live only a few miles from the coast.  Any further inland, and the air, the soil, everything changes so that these trees can’t survive, but others can.

It’s a lesson we need to learn.  We are more like these trees than we think.

 

Douglas Fir, with 1.3 meter (4 foot) walking stick for comparison.

Douglas Fir, with 1.3 meter (4 foot) walking stick for comparison.

IMG_0585

Indeed, when one looks at what the human body can tolerate, our cells, too, live in a microclimate that is just right.  Drop the partial pressure of oxygen in the air suddenly by a third, and we die. Change the sodium concentration in our blood 15%, and we are in trouble.  Change the potassium 30%, we die.  Change the calcium 10%, and we can’t think clearly.  Put 50 cc blood suddenly in our head, outside the dura mater, and we die.  Put a few cc in the medulla, and we die.  Change our body temperature 4 C in either direction, and we die.

We are like Sitka Spruce.  Given the ideal climate, we thrive.  Change that climate too much, and we can’t.

Let’s think about the planet as a whole.  We are dependent not only upon the lower portion of the atmosphere but upon the upper portion of the soil, plant life, and pollinators, most of which we call bees.  I wonder if that is taught in Common Core.  It should be.  We think trees are immobile.  So are we, when we consider our habitable zone not the distance from the ocean, but the Earth itself.  If the planet is destroyed, I am as immobile as a Sitka Spruce.

Change the acidity of the ocean 25%, warm it just 1 C. (1.8 F.), and coral bleaches and dies.  Oh, that has already happened.  The ocean’s pH has fallen by 0.1 unit.  To most, this is meaningless, but do the math, yes, the nerdy math, by taking the negative log [H+], and you will understand I am right.  Increase the average monthly temperature 1 C., only one-third a per cent, and we call it warm.  Is every day 1 C. warmer?  No.  Some days might be even cooler, maybe 5 C.  Increase the change to plus 2 C. and we call it a hot month.  Change it 3 C., and we have record warmth.  One per cent increase in temperature is record warmth.  In Tucson, the annual change since 1980 has been about 1.5 C (2.7 F). I noticed it 25 years ago. People like warm winters, even when it is 90 in February and winter rainfall is a third of what it once was.  I am not a Sitka Spruce.  I moved. The desert plants cannot move.  If they can adapt, they stay; if not, they die.  We’ve seen a lot of death in the Sonoran Desert.

Decrease rain 10%, and it’s a dry year.  Decrease it 20%, and we are in drought.    Decrease it 30%, which has happened in Tucson for the last decade, and you have…..silence.  Nature doesn’t say right or wrong, only allows organisms adaptable to local conditions.  Change the conditions, change the organisms.  The desert is still there but is no longer the same.

Our habitat is a small planet in a perfect orbit around the right star.  We thrive.  Or we used to, before several things happened.  We became too plentiful, and our resource use is unsustainable.  When there are too many people, governing becomes more difficult and less gets done.   We aren’t acting.  The Western Antarctic Ice Sheet is going to melt, and sea rise will eventually increase 3 meters, or 10 feet.  There goes Pacific Islands, Bangladesh….and Florida.

The Chambers of Commerce are going to have a hard time with the last.

Nature isn’t out to kill us.  Nature, biology, physics, and chemistry have no conscience.  They are.  Change the habitat, and Sitka Spruces—or humans—will disappear. The oceans are rising; there is absolutely no doubt about that:  the two causes are glacial melt and expansion of warm water.  No political rhetoric will change that fact, nor will any change the fact that increasing carbon dioxide will acidify the oceans.  It already has.  The Earth will stay in heat balance, regardless what happens in Brussels, Washington, Moscow, or Beijing.  If there is more heat, it will be balanced by storms, for a hurricane is a heat exchanger.  The Tea Party may say it isn’t happening, but they have no evidence.  Nature doesn’t hear “hoax;” changes have consequences.  We know some; we don’t know all.

Sitka Spruces use soil and air.  Eventually, they succumb, to root rot, to wind, and perhaps to excessive rain on certain slopes. They give back during their life, sequestering carbon and producing oxygen.  When they die and fall to the forest floor, they are recycled into new trees.  For thousands of years, they have born, lived, and died, in tune with their environment.  Walk among these giant trees, and you see all parts of the life cycle.  It is a cathedral of life, for from a dead tree springs new life.

It is the way of the world that was set into motion.  It is fair to argue what set the world into motion.  I happen to believe in The Big Bang and evolution.  To me, the evidence is compelling.

It is neither fair nor right to argue that changing the conditions of the world will not affect what life forms will exist.  It will; it has. Denial is short-sighted, stupid, and sad, not just what we have done, but that we never tried to fix it.  We didn’t try and fail.  We didn’t even try.

Nature, however, will not judge.  There will be only consequences.  They are already here.

 

IMG_0700

Nurse log that actually never died. Not only do the trees (the 3 on the right, although the center is did) get their nutrients from the downed tree, they were original branches. I have never seen this before.

Douglas Fir on the right; The Sisters in the distance.  Oregon Coastal Range, but 30 straight line miles (50 km) from the ocean.

Douglas Fir on the right; The Sisters in the distance. Oregon Coastal Range, but 30 straight line miles (50 km) from the ocean.

IMG_0618

Another example of the size of a Douglas Fir. Notice the deep grooves in the bark. This tree probably germinated during the reign of Queen Elizabeth of England–the first one (1558-1603).

HOW ABOUT MISTER SMITH, OR EVEN SIR?

May 12, 2014

“Dr. Smith, lay to the bridge.”

John, my hall mate back aft on the O3 level, cringed, and then let loose with a few epithets.  He and I had the two aft staterooms separated from the rest of “Officer’s Country” by a door.  It was colder there when it was cold, like off Korea in March, and it was hotter there when it was hot, like in the Philippines in June.  But we were mostly left alone, had an exit door aft, with a good view of the ship’s wake, when we weren’t working.

The numbering system for decks started with the Main Deck, then 2,3,4 going below or down.  Going topside or up, it was O1, O2, O3, to the uppermost deck, our bridge on the O4 level.

John cringed, because “lay to the xxx,” was used only to call enlisted personnel. “Your presence is requested to xxx”  was for officers.  Put succinctly, it was a breach of etiquette. The Navy was polite.  As coarse as the day-to-day language was, contributing to my current curse word vocabulary well into three figures, there was politeness.  I had to salute senior officers once a day on board, but only if I were covered, or wore a hat.  At sea, hats were not required, although most of us wore ball caps.  Navy men never salute uncovered.  Covers were not allowed in sick bay; they were required on the bridge.  In port, in uniform, one was always covered outside.  I learned these rules fast; I had to.

Coming aboard, one saluted twice, once aft, where the colors (flag) flew, and once to the officer of the deck, concomitantly saying, “request permission to come aboard.”  The procedure was reversed when one disembarked.  One needed an ID ready, too.  Ashore, one saluted any senior officer, holding it until the salute was returned. We called senior officers “Sir,” but on board, the executive officer was “XO,” the Captain was “Captain,” or plain “Cap’n”.  He didn’t mind.  When the Captain appeared, the first person spotting him said, “Attention on deck,” and we all jumped up.  The Captain would say “at ease,” and we would sit down.  This was formal stuff.  When the XO appeared in Sick Bay, I stood up.  It showed respect.

In correspondence with junior officers or enlisted men, we wrote, “Your attention is directed to xxx.”  To senior officers, we wrote, “Your attention is invited to xxx.” To this day, I take that and three other things with me from the Navy: short hair, my shirt buttons lined up with my pants zipper, and use of the word “Sir.”

I mention all of this, because the other day at the local pharmacy, where I get my medications, I stood inside the privacy line, painted on the floor.  Privacy is a big deal these days, except everybody knows everything about me, so I don’t really believe in it.  I may not see a prescription, but even with bad ears I hear what people are getting.  In any case, I was chided with a “Get back behind the privacy line.”

Gee, sorry that I am old, new in town, and honestly didn’t see the line, since the letters were faded.  I got half my medicines, since one was still not ready, five days after I dropped off the prescription, another problem with today’s “just in time inventory.”   I decided to return the next day.  As I left, I heard , “Thank you, Michael,” and cringed.

I don’t like strangers, especially the young, calling me by my first name, and I don’t like it when people on the phone with whom I speak ask me how I want to be called.  You call people Mr., Mrs., Dr., or Ms.  It is default.  You don’t ask, you do it, and you ought to know that.  I still call the former head of neurology where I trained “Doctor.”  He is in his 80s, and he has always been “Doctor” to me.  The past Executive Director of the Medical Society always called me “Doctor,” although we spoke on a lot of issues as friends.  It’s a sign of respect.

I don’t push the issue, but maybe it’s time to.  If you are too polite, you will be given an honor (yes, it is) to call someone people by his or her first name.  One should not put people in an uncomfortable position of asking how they want to be called, which happened with me with AARP.  How about “Mr. Smith”?  It is always in style, never wrong.

Thirty years ago, I flew over to San Diego to attend my Chief’s retirement.  I stayed in my stateroom one last time. I could have called both the Captain and the XO by their first names, for I was a civilian.  I could have called my chief by his first name, too.  But I didn’t.  I never had.  These people were “Captain,” “XO”, and “Chief”.  They were, and they always would be.

I discovered in civilian life that “Sir” is a powerful word showing respect for the office or age, but properly pronounced may be used to show distaste for the individual or task.  I learned the last to more than one lawyer’s chagrin, when he thought he was dealing with an arrogant doctor: my use of “Sir” with the appropriate tone was devastating.

“Sir, could you please step behind the privacy line?  Thank you.”

“Thank you, Mr. Smith. Good-by.”

“Mr. Smith, may I outline the benefits of our program?”

Notice the “Sir,” “please”, “Thank you,” “Mr.” and “may I”. These seven words exude politeness.

Many gun owners have told me that gun ownership will create a polite society.  I disagree.  I didn’t think the 19th century was so polite, the 20th or especially this one, while gun ownership has increased rapidly.  People must be scared of something.  Congress won’t even fund the CDC to find out why.  If we had 25,000 people dying from a new virus every year, you bet the CDC would get money.

Ironically, one of the most polite places where I worked was one where rifles were locked up, we enforced the Uniform Code of Military Justice with Captain’s Mast (non-judicial) more than courts martial, and fights were almost always with fists, even in liberty ports.   I treated a lot of STDs; I honestly can’t remember treating even a knife wound.

But please, dear reader, bear with me, for my memory is no longer good.  I might be mistaken.  But not about gun violence.

 

 

 

THE NEW WORLD

May 8, 2014

“640 K of memory ought to be enough for anybody.”  Bill Gates (1990).

“I’m 55, I don’t need to learn about computers.  I’m too old.”  A friend, 2001

I remember Blockbuster, the blue and yellow signs, shopping for videos along the many aisles, the late fees we tried to avoid, the drop boxes. Blockbuster was sold to Viacom in 1994 for $8.3 billion.  It was auctioned off not long ago for $254 million, a 97% decrease, and the last of its several thousand stores disappeared before this year.  In the space of a quarter century, Blockbuster went from nothing to huge, to nothing.  The building we went to for videos now houses “Beyond Bread,” a thriving, great restaurant.

Blockbuster had a good business plan, and only one thing went wrong:  the world changed.  It became possible to get videos streamed over the Internet.  I watched probably my 2000th video in German today, for free.  I can watch them in other languages, too, if I choose to.  I haven’t used Netflix, although I could. Those who plan for the world’s changing will survive.  They may not get super wealthy, unless they guess right, but to do well one needs only to see the changes and learn to adapt to them, not deny their occurrence.

The Haunted Bookshop was a lovely place in Tucson, with old and new books, a store where one could pick up a good hardcover, find a comfortable chair, read a few pages, and perhaps buy it.  It has been gone for decades.  Checkout, however, was slow, because the clerk  painstakingly wrote down the book’s name and the price.  Big chains, like Barnes and Noble and Borders, appeared, with tens of thousands of books; The Haunted Bookshop didn’t have a prayer.  Then came the Kindle, which my 86 year-old neighbor uses every day.  She doesn’t have to go to a bookstore.  Borders, which began in 1971, had its last profit in 2006.  It is long gone.  Barnes and Noble countered with the Nook, but Amazon had the books and soon had almost everything else people wanted.

Last week, I literally ran to the local REI to buy a micro SD chip with topos for Oregon and Washington.  REI was out of them.  No surprise, many stores have slashed inventory so much that they are often out of stock of the item you want, promising to have it to you in “x business days.” I find that annoying.

I walked out of REI, leaned against its wall and with my smartphone ordered the microchip from Amazon in about 2 minutes, $15 less, sent to my house.  That’s how good Amazon is.  If I want something, I often look there first.  The prices are good, I can get used books for a lot less, which is often all I need, and my information is saved, so it is easy to check out.  I want to shop and buy locally, but if retailers are going to continue to use the B-school model of “just in time inventory,” which isn’t just in time, I will take my business elsewhere.  I, like many, can be an impulse buyer.  If I can’t find it quickly, I order it. Now, had REI had a different B-school approach, and ordered it overnight from Amazon, at higher cost to them, but not me, they would have gotten my purchase.  Nobody tracked my disappointment, nobody learned, and that is a non-survivable model in the new world.  Count on it.

The topos  I got were for my Garmin GPS, a much nicer model than I had planned on,   I bought that online through Cabela’s, because all I had to do for a 60% discount was show up at the store 5 days later, when it arrived.  It takes me 35 minutes to walk to Cabela’s.

There is a lot of resistance to solar from some utility companies, blocking it wherever possible.  The oil industry wants to do the same.  I don’t know whether solar will be the new energy or something else.  I can tell you this:  the world will change, and what energy we will use will change.  I’m not sure how much, only that it will.  Movement by horse was once a given.  Building better buggies was a huge industry.  Then came the automobile.  One would have to be foolish to think the automobile and gasoline will stay forever.

Last night, a man told me that tidal power was impossible to generate in Oregon, because of the coastal geography and the storms.  I simply replied, “Perhaps not yet, but I wouldn’t count it out.”  He countered by saying it would be prohibitively expensive.  I’d be cautious about making those statements in the new world.  For a few dollars, I can buy an 8 x10 mm piece of plastic that holds 8 GB of data, including every 1:24,000 topo map in Oregon and Washington.  For a few hundred, we used to buy encyclopedias, which I haven’t seen in years.

While we have far more instantaneous information at our fingertips, we don’t have the ability to separate the wheat from the chaff, truth from conspiracy fiction. The new world will need critical thinkers and those who can teach the difference.

It is not yet clear to me whether online education will work.  Through my work with one university, that had some class time, degrees were obtained with a lot less work and a lot less knowledge.  I was motivated, I was smart, but I don’t think I could learned as well with home schooling or over the Internet.  I needed somebody, a guide—a great teacher once told me—to personally explain things, give me assignments, so I could figure out the answer for myself.

Who will have trouble in the new world?  Those who refuse to adapt to the changes, want to turn back the clock to “the good old days,” which weren’t so good.  Back then, we lynched African-Americans, did nothing about child abuse (“blood was thicker than water” approach) thought getting drunk and smoking were cool and chic, woman and blacks need not apply, cars broke down, planes crashed monthly,  In medicine, “The doctor” could do no wrong, except when he (and it was he) did, it was covered up. I remember those days.

Those who want to turn back the clock would force raped women to carry babies, have unwanted, malnourished, unvaccinated, children, teach them that the Bible (substitute any other Holy Book), is the only truth, when I need just one counterexample, and there are many, called contradictions. The clock cannot be turned back.  The world is changing, and its climate is, too.  What is scary to me is not the change, or even the fact that some don’t want the change and won’t believe in it.

No, what scares me is that those people have become so popular and are damn close to running the show.  The world they want to bring back will fail, and it will take humanity with it.

ITALICS MINE

May 6, 2014

April 15, 1994, was a memorable day:  The executives of tobacco companies stood before a congressional hearing, under oath (Italics mine), and said these words, among others:

“Cigarettes may cause lung cancer, heart disease and other health problems, but the evidence is not conclusive.”

At one point during the hearing, Rep. (now Sen.) Wyden presented data from medical groups and a 1989 Surgeon General’s report on the health consequences of smoking, asking each executive if he believed that cigarettes were addictive. Each answered no.  I saw that on TV. (Italics mine.)

“What the anti-tobacco industry wants is prohibition,” said one. “We hear about the addiction and the threat. If cigarettes are too dangerous to be sold, then ban them. Some smokers will obey the law, but many will not. People will be selling cigarettes out of the trunks of cars, cigarettes made by who knows who, made of who knows what.”

I know what: carcinogenic and addictive substances, same as now.

Despite earlier denials, a Philip Morris study that suggested that animals could become addicted to nicotine was suppressed in 1983 and 1985.

Wow, if cigarettes are banned, only outlaws will have cigarettes, and as bad as firearm lack of regulation in our society is, the magnitude of deaths is at least 20-fold more in the case of cigarettes. (Italics mine.)

The executives stated that tobacco companies could control the amount of nicotine in cigarettes, using these blends for flavor.

Or to addict people.  Turns out smoking is not a character flaw, but is an addiction, like high fructose corn syrup, but the latter is for another time.

Pressed by the subcommittee’s chairman, Mr. Waxman, and Representatives Wyden and Synar, (all Democrats), the companies agreed to supply many private company papers, including all the research done by the Philip Morris researcher whose scientific paper on addiction was blocked from publication by company executives.  (Italics mine.)

When one executive said that all products, from cola to Twinkies, had risks associated with them, Mr. Waxman replied, Yes, but the difference between cigarettes and Twinkies is death.”

“How many smokers die each year from cancer?” Mr. Waxman then asked.

“I do not know how many,” was the reply, adding that estimates of death are “generated by computers and are only statistical.”

If computers are banned, then we won’t die, I guess.  (Italics mine.)

Mr. Waxman asked, “Does smoking cause heart disease?”

“It may,” Mr. Johnston said.

“Does it cause lung cancer?”

“It may.”

“Emphysema?

“It may.”

Could the world be flat?

It may.  (Italics mine).

The term “only statistical” underpins science. We stopped the study on the effectiveness of polio vaccination because of statistics proving the vaccine was effective.  I am polio-free today because of that.  I received the Salk vaccine when it was first available; I was in the first cohort who received the Sabin vaccine.  We have confidence intervals stating with high (not complete) confidence that global climate change is occurring.  I have never seen one CI saying that it isn’t.  (Italics mine.)

We didn’t regulate tobacco enough, allowing “market forces” and “getting government out of business” to handle such issues.  The result has been as many deaths from tobacco-related illnesses every year (Italics mine) as the number of Americans who died in World War II.  Stalin said that “One death is a tragedy, one million a statistic.”  Yes, it is a tragedy when it involves a death at 40, or 53, my father-in-law, or my brother.  This should be a national outrage.  Wow, I can make a case for anti-government being in line of Stalinist thinking.  (Italics mine, but reasoning probably faulty.)

The incredibly rich tobacco company executives lied in front of Congress, suppressing evidence that went back decades.

That, Mr. Boehner, and Mr. Cantor, and Mr. Joe Tea Party, is why we need federal regulation.  Without it, people DIE.  (Italics mine.)

We regulate, because left to their own devices, people make a mess of the world.  We learn that early in school when “today, on your break, you will stay quietly in your seats, because a few people abused the privilege by jumping on their desks and screaming.”  You can use whatever you want for what you couldn’t do, but the first seven words in the subordinate clause stay the same throughout our lives. (Italics mine.)

I unsuccessfully tried to regulate medicine.  With no regulations, doctors did piecework and expected to be paid for it.  I remember a few of these doctors.  Those were the “golden days” of medicine, when “Doctor” was “God,” surgeons threw instruments, people cowered, nurses and medical students abused.  I was verbally abused to the point of tears by many doctors and had a retractor slammed on my thumb once.  “The Giants” made mistakes, because they were human.  Their mistakes were covered up, not investigated so we could learn from them. because to rat on a colleague would result in ostracism and no referrals.

My colleagues operated on carotid arteries, with frighteningly bad results, worse than the natural history of the untreated disease.  I counted these and presented the statistics.  I was screamed at and told I had no business to interfere. I was unpopular; however, I did notice that 12 physicians who became my patients never referred their patients to me.  (Italics mine.)  I thought that interesting. We allowed rods and fusion for low back pain, without adequate evidence that they did any good, which with few clear exceptions, they didn’t.

We failed to do what was proven effective to decrease post-operative infections:  inject a specific antibiotic for clean case infections 30-120 minutes before incision.  Easy, right?  In my hospital, we did it 25% of the time, and physicians refused to change.  We couldn’t even mandate the right antibiotic, promoting resistance to stronger antibiotics that some surgeons insisted upon using.  (Italics mine.)

After many years, we finally mandated that only pulmonary physicians, not general internists, could manage ventilators, because the former had better results.  That was strongly resisted, but it was one powerful group against another, not a dweeby neurologist (Italics and individual mine.) trying to change the profession through data and outcomes.

Politically powerful physicians who brought money into the hospital had special treatment.  Facts, outcomes, right or wrong were too often subsidiary.  It had to do with money. (Italics mine.)

My point is simple:.  Every law, every regulation, came because of a reason.  Maybe the law could have been better written, but the fact that there is a law speaks to a reason.  Some person said, “There ought to be a law against…..”

Don’t like regulations?  Neither do I.  Then self-regulated your group, your peers, your city, your country.  Want government out of your life?  Then figure out how 310 million people can each do what he or she wants without upsetting somebody else.  (Italics mine.) Hear that, Mr. Boehner and Mr. Cantor?

I don’t miss second hand smoke.  Nor does my body.  

(Italics mine.)