Essays on América

Physicians and US Health Care 2019

Posted on Updated on

T

Every undisclosed payment, free sample or all-expenses-paid trip is an attempt to manipulate. And whenever clinicians or researchers take the bait, it’s patients who are put at risk”. R Pearl Forbes Dec 10 2018

There is ample and well documented evidence of the way drug and medical equipment manufacturers co-opt and groom both physicians and the public. (1) For physicians the evidence is all around us. Physicians accept:

Gifts that influence medical decisions or practice.: :

Meals, and samples from attentive, attractive drug ‘reps’.

Subsidized Continuing Medical ‘ Education’ ( read grooming!)

Subsidized or free medical meetings

Free samples of costly drugs to promote later sales.

Physicians are not quite innocent in accepting such freebies; we know there is a payment due, but fail to make the obvious conclusion: Don’t accept the bribe!

ProPublica Dr B gave overly favorable reviews for Swiss drug company Roche but failed to disclose $3 million in direct payments from the company since 2014, claiming the lapses were “Unintentional”!

Brigham and Women’s Hospital in Boston revealed that Piero Anversa, a high-profile physician and cardiac stem-cell researcher, had falsified and/or fabricated data in at least 31 medical journal publications.

Tito Fojo, MD, PhD in The John Conley Lecture found that “the last 71 chemotherapy agents receiving FDA approval extend life by an average of only months—time often spent in pain, isolated from friends and family.” (2)

Misleading Direct To Consumer TV ads largely pay for ‘free’ TV. They are often so misleading as to be absurd; but they work! When an ad claims that a drug, “significantly increases the chance of living longer” What does that mean? Nothing! Another ad can state that a medication ‘can improve (symptoms) ‘ up to 75 %’ That must mean-75%-100 % may see no improvment! ( Step right up Ladies and Gentlemen! See the two headed woman grow another body!)

Medical trials funded by drug companies are 30% more likely to show their drugs are safe and effective compared to independently funded studies, according toa consortium of medical and statistical experts (the Cochrane Coalition.)

Is there something physicians could do? Various new Oaths have been written:

I swear to fulfill, to the best of my ability and judgment, this covenant:

Hippocratic Oath: Modern Version
Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University  (Good, but anachronistic in 2019)

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of over treatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

“The original oath is redolent of a covenant, a solemn and binding treaty,” writes Dr. David Graham in JAMA, the Journal of the American Medical Association (12/13/00). “By contrast, many modern oaths have a bland, generalized air of ‘best wishes’ about them, being near-meaningless formalities devoid of any influence on how medicine is truly practiced” Probably modern oaths are written by a committee or by congress! (Sorry.My rant…Ed)

I agree the modern oaths are not much improvement in the 21st Century. We live in a new era, the equivalent of the time when the printing press and cheap paper appeared; what followed then was constructive chaos because information, and commuication only available to the few, became available to the many. Isn’t that what is happening today on a much wider scale? A world wide scale? It is as true of medical information as everything else. Therefore even if we physicians may refute or ignore the assertion that we are complicit in the prohibitive cost of US Health Care, we should realize that is irrelevant; we are no longer in charge. Who is? Our world with almost unlimited access to information formerly confined to the elite of medicine: to us. If we think we are in charge we could read Marcia Angel’s book; and if we still want to be the alpha wolf of medical care, simply going on line and looking up any disease, condition, medication or treatment option should abuse us of that illusion. Is there reason to reconsider the ethical practice of medicine? Even by drug companies? Yes!

If so, physicians should do that both individually, and collectively through professional organizations. We cannot absolve ourselves from being complicit by saying “ I myself wasn’t paid millions.” Rather, we could consider this: “I sold myself far more reasonably, like most of my colleagues! Still, I am not altogether innocent; I realized there would be some kind of payment due, but failed to make the obvious conclusion: Don’t!:”

I graduated under the old oath, from the University of Minnesota School of Medicine in 1954 and have been grateful every day of my life. There is no more privileged, challenging, joyous, or fulfilling work. Some things do not change! Not yet at least…

We should consider an Oath something like this which:Recognizes that patients have more access to information and therefore are more able to participate in medical decisions about their health and health care, and reads as follows:

I PromiseTo:

Conduct myself in the most rational and far sighted way I can, avoiding careless, thoughtless, or self serving prescription of medications or procedures that may harm the biosphere, or the health of my

patient or the bioshphere, or the wider community.

Honor traditional, rational and moral standards of medical ethics but willingly discuss and render my opinion about those I feel are unwise or harmful.

Refuse nominally free continuing medical education (grooming) through enticements.

Honor my patient as I do myself, being always willing to take time to explain the reasons for my opinions and always ready to listen and consider respectfully my patient’s ideas, concerns, objections and wishes.

Honor my patient’s right to choose among the various options for treatment or nontreatment.

Condemn  and Reject  Direct to Consumer Advertising by drug companies, manufacturers of medical hardware or devices; and by physicians or other healers.

Refuse payment for unmerited ‘research’ and speaker fees; where these may be justifiable, I may accept only after independent peer review and a commitment to total transparency.

Always take into consideration whatever effect my practice may have on the environmental, medical, biological, and economic aspects of medical care.

Alwaysbe ready discuss and to adjust my fees according to my patient’s request, regardless of any presumed ability to pay.

Respect the ethical guideline of medical care, Primum non nocere, First Do No Harm, while carefully taking into consideration my patient’s personal needs choices, and wishes.

Hold my patient’s medical history, diagnoses, and treatment to be privileged communications between us only, unless my patient directs me to act otherwise, or when consulting with a medical colleague about a difficult case, where the consultation is also a priveleged communicaion.

(1) Among the best reading on the subject are:

The Truth About Drug Companies by Marcia Angel, MD. For many years she was editor of the New England Journal Of Medicine. (ISBN 9780375760945)

Overtreated by Shannon Brownlee (ISBN: 9781596917293)

Selling Sickness Ray Moynihan, Alan Cassels (ISBN-13: 978-1560258568)

Mistreated: Why We Think We’re Getting Good Healthcare—And Why We’re Usually Wrong,”by Robert Pearl MD (ISBN-13: 9781610397650)

(2) JAMA Otolaryngol Head Neck Surg. 2014;140(12):1225-1236.

(3) No doubt freedom of speech could be claimed in defense, and yet Direct to Consumer Advertising is like shooting an automatic weapon into a crowd. Freedom to kill with an automatic weapon is the same sort of crime as killing through dishonest and deceptive advertising. One is killing for its own sake, the other is killing for profit. Neither is protected free speech!)



A Letter From Richard Steele*

Posted on Updated on

 

I realize, dear reader, that it has been more than 300 years since I last penned an edition of The Tattler; and that the United States, didn’t exist back then. But over the years I have always followed events assiduously. The cybernet is limitless, and allows me to reach you now in America ( I should say in the USA, because America refers to an entire hemisphere, right? My bad as you Yanks say.) What seems to be happening there stirs up my quiet conscience and dormant public spirit.

Over the centuries, I have resisted reacting to crude and violent uncivil rage, like the kind that is everywhere around you in the Colonies. (Sorry, as ‘you guys‘ say in  that gender warped way) , it is tempting for me to ignore that Revolution. But I take comfort that language is still something we share; more or less. Bet you don’t know what lucubrations are!

It is specifically the chronic reports of the death of a prominent political pretender to high US office that forces me to comment. I do so with reticence and some embarrasment, because I am rather a coward; I will not name that candidate, in order to avoid being economically destroyed by those, not excluding government, who by comparison to me, commnand unlimited funds, and unlimited time to prosecute!

Although I am still in England, America has a long reach; who knows what  a bity of my old DNA permit, or 23 & me turn up; I must think as a US citizen should. The average person there, facing your system of justice, can neither expect the speedy trial promised by your constitution, nor pay a multimillion cost of defense in the case of an abusive opponent having unlimited funds. The choice is bankruptcy, or a plea of guilty, deviously termed ‘a ‘bargain’, in exchange for an unjust result; it’s a legal kind of blackmail or coersion. Moreover, today,  in an atmosphere of national outrage, certain defendants  can face ugly threats from enraged or uncaged partisans.

That is why, dear readers, to face US justice, ‘ain’t me, babe,‘ in your parlance; so I rely on you to supply the name, which should be easy, since the news of the  most recent death is echoing across the cyberworld ceaselessly, like joyless monotonous waves on an ocean beach. 

The candidate first died in Nov 2008; and again in Nov 2016, but  still appears everywhere, claiming to be alive; to have been alive for many decades; saying a far flung conspiracy exists to lie and decieve.  With due respect, because the eminent candidate  clearly merits that,  I urge acceptance of the dead state bravely and wisely; though the legs and arms may still appear to perform animal functions, the art is not there; the candidate is gone. I hope these lucubrations  help to make that more apparent.  

*

Adapted from The Tattler No.1 April 12, 1709.

Illegal Criminal Child Aliens

Posted on Updated on

The subjects are jailed minor boys and girls awaiting deportation, hearing or trial. The facility where they are kept is among the best, both physically and operationally. It is an older but well maintained juvenile detention facility, with a large gymnasium, an astro-turf sports field and an extensive library. There are many opportunities provided by volunteer groups, and various departments at a nearby College…For example, the art department promotes inmate art works; the results are visible inside and outside: sculptures, mosaics, and murals, created by juvenile inmates: The facility is uncrowded; local inmates are housed separately from the illegal alien children — all, by definition are under age 18– The subjects of these brief interviews are confined to a secure facility because they have a violent or criminal past, or both. They speak, read and understand their primary language fairly well but their ability in English is very limited.

 One never knows, in such circumstances, what is exaggeration or lies, but I have been doing similar interviews for a number of years, and in time one becomes more able to evaluate them. These, of course, were children; yet they were far more frank, open and expressive, less manipulative,  than many adults.

Considering the alleged situation in their country of origin, and the unique opportunities available in the facility ( the jail),  one might think they would be happy, or at least feel fortunate. But they are not, despite nourishing food, shelter, medical care, training in English, access to books and both video and classroom teaching.Why unhappy?

First, they are children, and moreover, teens, who by some law of nature are often unhappy and unhinged. Second, they are not free where they are. As Children their views are short-sighted and self focused; as humans they value freedom. It should not be surprising that they don’t like the strange food; but they hate worse the confinement. They want out; even if they go back to a situation that was dangerous or intolerable, it would be a place where they might Try Again to return. The reader may note that most had somehow had access to enough money to hire a coyote. Why? I cannot say, but wonder whether if criminal or drug activities were responsible, directly or  indirectly. Their individual stories are moving. Here are condensed versions of a few.
Male Age 16, El Salvador Crossed on foot TX in 2014 at age 14; coyote $7k paid by parents. However, after crossing had no further assistance. Lived on street, Las Vegas; arrested for theft. Sleepless, wants sleep med and pain med for back problem. We spoke at some length about the dangers of using addictive medications for sleep or chronic pain, both best treated by being active physically! I doubt he wanted to hear such stuff, though; he didn’t seem impressed.
Male Age 17, Honduras Coyote paid $ 10k by family, 5k deposit, 5k due on arrival. Arrived age 14. Reached a relative in Las Vegas but later arrested after caught in robbery. Says he may be sent back, but will return, and is taking classes in English. The food is terrible in the USA, but the country is great!
Male age 17, El Salvador Crossed the border at San Diego asking for asylum. Sent to Oregon, placed in a shelter; but fell in with folk who lived on the street. Was arrested for theft and assault. Allowed that the request for asylum was not really valid; it was just a door that he opened. If he is sent back he will come again, this time without a claim for asylum… will cross some way, probably on foot. ‘ Better illegal here than legal there.’
Male Age 16, Honduras
Dad paid for coyote, but when he got here dad sent word: ‘Good Luck, you are on your own’. Lived on the street. Arrested for assault. Expects release soon, wants to go back to Honduras because he has family there who are not without economic advantages. I asked: drug business? Yes. ‘Better  a rich  criminal there than poor and illegal here’.
Male Age 16, Mexico Was a ‘mule’ for marijuana smuggling; entered into Arizona on foot, but was immediately caught. Sent to Phoenix. Expects to be deported.  However, in Sonora, his home, he doubts he will be able to avoid going back to being a mule. Why? Realistically there is no other choice
Male age 17, Honduras Caught while crossing near Houston; has family somewhere in US but they did not respond to attempts to locate them. Seems a bright kid, communicative, but didn’t know who his namesake, Roosevelt, was. I told him briefly about two presidents by that name. both, and he plans to look them up in the library and ask the English teacher to comment.
Female Age 14, Mexico Coyote crossed border AZ in a car trunk. Placed on bus to Las Vegas. Arrested prostitution and theft.  Jailed then transferred here. Is awaiting hearing, pending transfer motion. On zoloft and resperidol not sure what it is or why. C/O tooth problem. Whether released or sent back home thinks she will return one way or another, this time with some English. She understands she has no skills and no advantages except  quite a few years ahead for profiting from her looks. I expressed surprise that plan in place at her age, but she looked at me sideways, and commented that she lives in the real world where people have to deal not with ideas but with facts; besides, she said,  ‘I have a good connections in Vegas.’

Male Age 16, Honduras Crossed on foot to reach his uncle here. But the uncle was unable to take him in. Lived on street; theft, prostitution, drug abuse. Arrested states he was ‘beat up’ and remanded to Foster care. Has HIV, probable source uncle? Hep C?He doesn’t know. On medication now. I asked him about his unusual first name. He said it was from a famous poet; he knew nothing else, but says he likes poetry. I suggested he try to look up two poems that may have something to do with his unusual  last name. The first is by Oscar Wilde:

Le Jardin
The lily’s withered chalice falls
Around its rod of dusty gold,
And from the beech-trees on the wold
The last wood-pigeon coos and calls.

The gaudy leonine sunflower
Hangs black and barren on its stalk,
And down the windy garden walk
The dead leaves scatter, – hour by hour.

Pale privet-petals white as milk
Are blown into a snowy mass:
The roses lie upon the grass
Like little shreds of crimson silk.

The other poem is by Brazilian Eduardo Alves da Costa, fairly easy to understand for Spanish speakers: Essentially: The first night they robbed a flower from our garden. We said nothing. The second night they openly trampled the rest of our flowers. We said nothing. Until the weakest among them entered our house by night and stole our light; and knowing of our fear, ripped our voice from our throats; then we could say nothing.
Jardim

Na primeira noite eles se aproximam
e roubam uma flor
do nosso jardim.
E não dizemos nada.
Na segunda noite, já não se escondem:
pisam as flores,
matam nosso cão,
e não dizemos nada.
Até que um dia,
o mais frágil deles
entra sozinho e nossa casa,
rouba-nos a luz e,
conhecendo nosso medo,
arranca-nos a voz da garganta.
E já não podemos dizer nada.

Comment: These histories pose a problem: they put a face on illegal immigrants even though in this case they are criminals. The last three cases in particular suggest that it is risky to look at them, or to hear them, too closely. The same is often true of all criminals, and illegal immigrants.  While our country cannot open our borders to billions of people from all over the world, we share a hemisphere with many other Americans, North and South; we share a common cultural and ethnic past with people on our borders.
In fact, as always, the USA needs immigrants. If all illegal aliens were to disappear instantly, there would be an economic and social crisis here; in gardening, building, hotel maintenance, restaurant work, and farming, to say the least… and arguably, even in child-bearing! We North Americans are too often unwilling to raise enough children to replace ourselves. That is too great a sacrifice! Houses, cars, travel, education, health care, and entertainment are expensive priorities, and it costs several hundred thousand dollars and tens of thousands of hours to produce and to raise a child conscientiously.

 A child, as often claimed,  is a hostage to fate: a risk.  But without children there is only past. Frankly, it seems possible  that within 20 years we will offer to pay people to immigrate to our big beautiful USA. To relate stories like those above is not meant  to glorify illegal immigrant children; yet, their desperation and decisive, high risk attempt to change their lives is the recurring story of the USA. Unfortunately, many of these  illegal children come from criminal and drug dealing environments, or worse; they bring that with them. Some are MS13 members. But the first illegal immigrants who crossed the atlantic in wooden ships were often undesirables, rebels, or troublemakers. Some were criminals. All are kin to those, criminals or not,  who pay coyotes or cross nations and deserts to reach our beloved land.

 Adults who are illegal immigrants today are people whose journeys are even more hazardous, more sacrificial, than that of most child criminals; yet they also reveal an intense desire to find a better life in the US. As a consequence they create a better North America, and in a wider sense, better Americas.

My son Fred, a master carpenter,  once again  this April, drove from South Dakota to Baja California pulling a trailer full of equipment. He joined a group of Methodists to build small homes. In this case that is not simply  a charitable act; the recipients of homes are limited to people who 1) work 2) have their own a half hectare lot, where they live in very marginal conditions,  and 3) have children who regularly attend  school. I go to build or to work as a translator for Lighting for Literature,  providing small solar lighting units in the homes  of the same kind of families, so schoolchildren have light to study in the evenings.

The clear majority  of such families have a connection with the USA;  it is generally  with a close relative,  usually one who has, during most of a lifetime,  regularly sent money to their relatives to make their  present and future more  promising.  That sort of story of immigrants and cross culture exchange  is as old as time. It is the stuff of progress, and of civilization.

 

 

The Story Of Philosophy By Will Durant

Posted on Updated on

Will Durant became widely known for his early books, especially The Story of Philosophy.Though first published in 1926, by 1933 it was already in its 15th edition; it provided the income stream that allowed the Durant’s to write for the rest of their lives, and is still widely read. What made the subject, philosophy, so popular, for so long? It is clearly written, and contains opinion, commentary, and humor. It was written to be read, understood, and enjoyed. As I open up my old copy again, it seems relevant to us in the 21st century; “Science teaches us how to heal and how to kill; it reduces the death rate retail, then kills us wholesale in war”; The Durant’s argue that only wisdom, as revealed through philosophy– “desire coordinated in the light of experience– can tell us when to heal and when to kill.”

I first read it in 1963, thanks to a newspaper article about the by Jim Bishop that included a brief account the Duran’t  1913 marriage: she was 15 years old; he, her tutor, was 25; yet they obtained approval to marry. She rollerskated to the courthouse; a ring she wore ever after was donated by an attendant; the marriage lasted 68 years until their deaths two weeks apart. She was a collaborator in all of the Durant’s subsequent books, and co-authored the later ones; their commitment and devotion is palpable in the dedication to the 1933 edition of Story of Philosophy which reads:

To My Wife

Grow strong, my comrade… that you may stand

Unshaken when I fall; that I may know

the shattered fragments of my song will come

at last to finer melody in you;

that I may tell my heart that you begin

where passing I leave off, and fathom more.

The Durant’s introductory assertion was that we, society, lack wisdom, which they see as the realm of philosophy. They decry epistemology, as an analytic approach or scientification of philosophy. An opening paragraph titled To the Reader suggests that:

‘epistemology has kidnapped modern philosophy’.

‘the knowledge-process … (is) the business of science,

‘philosophy (is) interpretation of … experience rather than (its) analytic description’ ‘Analysis belongs to science, and gives us knowledge, while

‘philosophy must provide a synthesis… wisdom.’

A subsequent and more extensive introduction expands on these assertions. “… to seize the value and perspective of passing things, and …pull ourselves up out of the maelstrom of daily circumstance we need to know that “Science is analytical description, (while) philosophy is synthetic interpretation. The philosopher ‘tries to put together that great universe-watch that science has taken apart”.

Why did Durant write a philosophy book directed to the unschooled citizen? Why call it a Story? He began, early in the last century, to contribute to the Little Blue Book series 2, pamphlets for the common worker; in time he collected many of his writings on philosophy as the basis for his book. Like the Blue Books The Story of Philosophy is not dumbed down. It reflects the conviction that the common working person is both capable and interested in knowledge of all sorts. The material was chosen and written, not to amuse, but to inform and uplift; not to disdain but to honor the desire and ability of the common worker to grasp any idea or subject. More accurately, to satisfy the hunger of the ordinary worker for knowledge. Durant, like most of the writers, and many of that time, was a socialist in what was, perhaps, the Golden Age of American Socialism, which flourished until the depression was ended by WWII; then Soviet Style Communism whose world conquering goal, prevailed, betrayed American Socialism. One could  hope that the past is, indeed, only history.

little blue book series

little blue books, worlds-famous-books

 

The Durant’s argue that if we break philosophy down like scientists, into– logic: ideal method in thought; esthetics: ideal form; ethics: ideal conduct; Politics: ideal organization; and Metaphysics: ultimate reality… “ it becomes dismembered, loses it’s beauty and joy. That is found by studying philosophers. We have had the same experiences they had but we did not suck those experiences dry of their secret and subtle meanings. So let us listen, ready to forgive errors, and eager to learn.”The subject material for the little blue books suggests that the common citizen is interested and capable of reading and understanding the world of thought and literature:

Ready or not, Social Media is here now, vital and alive, making Old Media of books, magazines, and TV of interest in retrospect. Talk Radio was probably a herald of our time, but less interactive than social media. Social Media, in most countries, is egalitarian, and available to a limitless number of individuals whose collective voice can become very loud even though each one by itself is– pipsqueak– unless it goes ‘viral”. Thanks to the cyber age, information — or misinformation– once again is available almost everywhere.  Once again, it cannot be controlled wherever a degree of liberty prevails. The information offered is not always rational, reasonable, or accurate; it is often fake or false. It is disruptive except where it can it be controlled by severe privation, poverty, and ruthless suppression. Talk with anyone who has spent some  unregulated time speaking with ordinary Cubans and that becomes apparent. People are allowed one kg of rice, one kg of beans, and one serving of chicken monthly. While the island is surrounded by the Caribbean full of fish, only shoreline fishing is permitted because boats are a means of escape. Private businesses, like taxis, are allowed, but strictly GPS tracked, and half the income must be given to the government. The net result, in the words of a taxi driver: ‘We are on an island prison.’ On the other hand, the divisiveness and chaos we see in much of our relatively free world is also apparent.  Yet if history is any guide, this new chaotic period will be– gradually– followed by significant progress in the affairs of humankind.

This is not the first time humanity has gone through this kind of radical change. When paper and printing became widely available, no longer was information controlled mainly by church, monarchy or wealth; one result was pamphleteering. Much that was written by pamphleteers was deceptive, abusive, or simply false. There was no way to put the genie back in the bottle. All this was beyond the control of any government where liberty persisted; the British, for example, tried to suppress pamphleteers it by requiring prior approval before publication… John Milton wrote his essay Aereopagtica to argue for freedom of the press. In time the explosion of information – and misinformation–led to a relative impotence, and downfall, of Monarchy and Church, and arguably, to the American Revolution, which was born in the maelstrom of pamphleteering.

Is it reasonable to question whether humanity will survive our own technology? Arguably, the history of the world-wide chaos at the birth of the 21st century is already being written in an imaginary book where the first section is titled The Story of Creation: Book One is The Age of Agriculture. It begins with the creation of farming and husbandry, at the expense of hunter-gathering, promoting stable communities, and ultimately cities, property, geometry, mathematics, commerce, architecture, rule of law, science, art, and technology. Book Two is The age of Information. Humankind creates technology which creates change, which makes access to information instant and ubiquitous, which then changes human life! The sudden access to information leads to chaos, which in turn, and over time, creates change in human behavior. The imagined book’s introduction includes a reference to Genesis to state the general theme: knowledge– information– is power; and power is something humans do not manage well. God forbids it, but of course, humanity chooses the devil of knowledge or technology and liberty over a heavenly dictatorship. When the forbidden fruit of the Tree of knowledge is eaten, God becomes enraged and expels Adam and Eve from Eden. Now, millenia later, billions of tiny fleshy knowing gods suffer from an overload of knowledge: A sort of Infomania/dynia.

So the i.genie is out of the bottle; it consists of the internet, browsers, email, skype, twitter, Facebook, robotics, artificial intelligence, etc.Any image, any idea, any lie,  can spread in minutes around the globe. Meanwhile Old Media flails, fumes, and fails: newspapers shrink to the size of circulars, living on snippets of local news, stale national news, and remunerative specious ads.  ‘Breaking News’ becomes stale, dull, repetitive, and uniform while talking heads become simply entertainers on the order of professional wrestlers or football players– but far less fun to watch. There is no place, no way, to hide information any more. The gadfly of social media suggests that some of our revered leaders, and TV and media moguls, are serial sexual predators, liars, violent scofflaws and drug users, who professionally foist biased political views on us.  Social media make live raw unfiltered information instantly available to almost anyone, anywhere. The current tsunami of information and misinformation predictably brings chaos, both internal and societal. We are unable to evaluate, filter and sort it all. And until we adapt, or create new ways of dealing with it we are likely to remain factionalized, frustrated, fragile, and furious.

Perhaps it is worthwhile to take a long view; perhaps, to read some dead philosophers The Durant book is a good start. It’s in paperback at Amazon for $9.66.. It offers a chance to catch up with the U S unschooled working people of 100 years ago. Each of Durant’s nine chapters is devoted to a ‘Western’ philosopher, and the last to three North Americans. Of course there have been more since the ’30s, but any philosophy that has survived a few centuries may have something worth hearing. Each chapter opens with a brief historical context and a summary life story of the philosopher. For the curious there are many references. Durant does not shy away from difficult material; he expands and makes personal comments often. He wants the reader to meet the philosopher, hoping for an exchange that is both memorable and enjoyable.

1The Story of Philosophy, 412 pp, focuses on the West, and excludes Asia. But the first volume of their 12 volume History of Civilization is devoted to Eastern Philosophy and History. Caution: 1150 pp. Both are free PDFs on-line. But to read these huge books on-line would leave no time for Critter, Glitter, Fritter, and to some extent, email, Siri and Browser!

2 These staple-bound books, were a project of Emanuel Haldeman-Julius (1889-1951), a socialist reformer and newspaper publisher. The Amherst College Archives , and Cal State Northridge hold large collections. However I don’t know of any place to buy them now. The over- riding principle was that the common worker was capable and interested in every aspect of knowledge. The books were pocket sized; the topics were very diverse: # 1 was the Rubiyat of Omar Khayyam, with a critical essay by Clarence Darrow. Other Titles included Oscar Wilde, Poems; Voltaire, Essays; Thomas Paine, Age of Reason; Guy de Maupassant, Short Stories ; Edgar Allen Poe Tales of Mystery; Margaret Sanger, What Every Girl Should Know; Honore de Balzac, Short Stories; Henrik Ibsen, Ghosts; Henry Thoreau, On Walking, Mark (sic) and Engels, Communist Manifesto; Ralph Emerson, Essays; Leo Tolstoy, Essays; Arthur Schopenhauer, Essays; Marcus Aurelius, Meditations; Walt Whitman, Poems; The Care of the Baby: A mother’s book by a mother ( # 81), Smith, Common Faults in Writing English (#82) ; Georg Brandes, On Reading (#86); Jesus Christ, Sermon on the Mount; Wood, Julius Caesar; John Mill, Subjection of Women (#177); Henry James, Daisy Miller; Anatole France, The Majesty of Justice #198; By 1944 more than 1800 little blue books were published. Scattered throughout are the philosophers, many written by Durant, like # 19, The Story of Frederik Nietzsche’s Philosophy; #39 The Story of Aristotle’s Philosophy; The Trial and Death of Socrates (# 94) , and The Republic of Plato # 157; .

3 You may also want to consider the Durant’s 12 volume History. They are written in the same easy style but on a grand scale richly researched and documented. I read them when I was drafted into the US Navy, placed on a Seaplane tender –(AVP 49 for antisubmarine warfare, now obsolete). We plowed the Pacific back and forth at 13 knots when weather allowed, leaving plenty of time to digest these big tomes. But that was so long ago I don’t remember much. The 12 volumes still accuse me silently and sullenly from my bookshelf.

 

 

TCOYD “Take Care Of Your Diabetes”

Posted on Updated on

 

This is to suggest that when there is a “Take Care Of Your Diabetes” conference nearby it is worthwhile for those with, or at risk of, diabetes; likewise for medical professionals. I attended the TCOYD conference here in March 2018, though I had never done so before; it was offered for about the 6th time in Sacramento, and many hundreds of times in the nation. For professionals at this session the conference cost was $30, and less for others. It was held at the Convention Center, attended by at least a thousand people. There were no openings for walk- inns. The general idea is this: People with an inherited predisposition, or diabetes, or abnormal diabetes screening tests of any sort, are encouraged to do simple things themselves to prevent later problems. Moreover medical providers may discover more about ways technology promotes patient personal involvement in the care of chronic disease; and, I believe, about the direction and future of medicine. Joan Borbon clued me in to TCOYD. We volunteer at a local Student Free Clinic. So I signed up. For me, personally, the whole day was a triple delight.

First, because the general thrust concurs with one I have long practiced: That in chronic disease treatment and prevention, people must be their own principle care-givers and managers. Diabetes is the perfect example. Why? No one can manage the illness without the direct personal understanding and involvement of the diabetic or pre diabetic; no Doctor, Legislator or friend or family member. But technology places the means to do so in the hands of the individual. For example, in diabetes, the personal Blood Glucose Monitor allows people, 24/7, to measure and control their own disease. No more time consuming lab or office visits, days long waits for test results. Moreover, in the forseeable future, access to reasonable, personal technology and information will make self care ever more practical and efficient. In my own little lifetime, it seems to me the most significant development in diabetes care has been the personal BG monitor, which has become acessable, reasonable, and simple to use.

Second, because I, a stubborn, arrogant macho man, ignored my own clear symptoms and family history for at least 15 years before discovering my own diabetes…never listening to my life, never thinking about it.* Maybe signs of diabetes were so easily overlooked because my routine screening tests were always normal; my doctors and I relied on them without another thought. But if we had considered my family history, or even listened to the voice of my body, we could have discovered my type 2 DM much earlier.

Many people with an interest in diabetes attend the conferences over and again, gradually learning more and more about the disease. And yet, while the conferences are very informative, perhaps it's wise to keep some things in mind: 
  1. Even if addressed mainly to the general public, these are medical conferences; they are funded completely by people who want to sell stuff–caveat Emptor — Buyer Beware.
  2. The eloquent and impactful speakers, aided by great media, are partially bought and paid for.
  3. The literature is as skillfully crafted to subtly mislead as are magazine or TV ads.
  4. The booths are staffed with highly trained professional salespeople. Beautiful, engaging people.

Third, The program is varied and relaxed enough to allow for casual unhurried conversation. A personal note: I like to run and sniff the world like an escaped hound dog. But always, even in childhood, Northern California has been the home where I return ever, where my family history and heart and dearest memories also live; as a physician, it’s been my medical home since 1959. Therefore in this broad focused meeting I often met up with old colleagues or friends who share an interest in diabetes. Steve Edelman, who many years ago concieved and organized TCYOD, was a Med student at UCD when it was still on the Davis Campus where I occasionally lectured; Demo Pappagiannis who coached and wrote several papers with me on coccidioidomycosis, was there. There were many other friends, colleagues, and physicians from Kaiser, UCD, Woodland, Davis, and Sacramento. And nurses; perhaps most of all. .

Nurses and P As are the Hands and Heart of medical care. Brooks Smith and I were the first lecturers for the UC Davis Rural Family Nurse Practitioner training program. It was in the Dept of Family Pracitce headed by Hughes Andrews, and managed by Mary Fenley and Leona Judson. Since then,– 45 years ago– it has evolved fast, grown, changed names, and fled the skirts of the Med School into the arms of Nursing. At the conference every local Nurse Practioner and PA I spoke with was a graduate of that particular program.

TCYOD is based in San Diego) at the center of a world of Spanish speaking folk with diabetes and prediabetes. Therefore A Cuidese Su Propio Diabetes– CSPD– is needed. If I were still crazy I would volunteer; but I am less insane now. Maybe someone can use material in Spanish I wrote for diabetics in Colonet, Baja CA. ¡Quizas!

* But during the first years of symptoms I was working day and night 7 days a week, rather doggedly doing My Thing with migrant worker night clinics, and Regional Rural Health which they grew to be, and Salud, an inner city clinic in Broderick, CA. At the same time I worked at UCD to establish an Occupational Medicine Program, and took on many consultant jobs in order to provide for my family, 6 people whom I supported but otherwise mostly left on their own. I was Sick, Out of My Mind. Over time I gradually developed severe bilateral lower extremity neuropathy. As my usual diabetes  tests were normal, neither I nor my doctors explored diabetes further. A neurologist confirmed the neuropathy, but asked: Do you drink? Yes occasionally. Well! He said, Don’t. A podiatrist ordered some $400 shoes. I had had a laminectomy in 1975 for and acute disc with foot drop, with lipiodol studies, so a CT was done. Nada. I ignored some other things: that my neuropathy was better when backpacking – and burning a lot of glucose. That the cold bothered others it didn’t trouble me. That my balance was slaightly off. Only after several years of worsening neuropathy did I order an old fashioned four hour Glucose Tolerance test. Bingo! Ironically, today anyone with a personal blood glucose test kit can do that home alone. I”m happy to say that the neuropathy has receded with control of my disease.. like many people, I detest initialisms and acronyms but they are epidemic;; as they say, It is what it Is. IIWII. So, TVOYD; Listen To Your Body. LTYB; Listen To Yor Family, their words acts, troubles, and History. LTYF; Hear, Think, And Do. HTAD.

Septic Shock in 2018 Type A Influenza

Posted on

I recently took a friend to the hosipital with severe septic shock from acute influenza. After one day of typical acute flu– sore throat, fever,  headache, tight cough and prostration– she developed most of the characteristic signs of sepsis.  On registering at the emergency department, the symptoms of sepsis were recognized, and she was admitted immediately. Within minutes after appearing at the registration window,  more than two liters of saline were pumped into her through to IV lines; more would follow. After about 10 hours all her vital signs, pulse, temperature, and respiration,  gradually returned to normal, and she was released. The diagnosis and treatment were immediate and effective.

Septic shock can be the result of any overwhelming infection that   causes the body blood  circulation– and therefore multiple organs– to fail. It is seen most often with a bacterial infection, but in this case  was caused by  a virus: type A influenza. When someone comes to the ED with fever over 100, heart rate over 100, and respiratory rate over 20, (an important but often overlookied vital sign!); and in the worst cases,  mental confusion and low blood pressure– it is Sepsis, septic shock requiring  immediate treatment,  just as with heart attack or stroke or poisoning or respiratory failure;  it’s that urgent. Accurate diagnosis and multiple lab tests are  far less urgent than immediate treatment, based on symptoms and findings. Over the next few hours  her lab tests did come back, consistent with influenza, including  a nasal rapid test for type A influenza.

Sepsis  sometimes kills people during the current flu epidemic, or pandemic… It can also kill from influenza pneumonia, or complications of preexisting  heart or respiratory problems, especially in the aged, and  paradoxically, the very young.  Type A flu constantly mutates, changing so much that the  old flu vaccine is little help, precisely because it’s derived from the last few epidemics, while influenza has moved on, evolving and changing ever since. So in this and most epidemics, people are almost all on their own, even after a flu shot, although arguably that immunization does no harm.

With symptoms of influenza, one should go to bed and stay there,  drinking at least a  liter of liquids three times a day, until you are  without fever and well hydrated. If the symptoms of sepsis are suspected, go to the nearest hospital.  Tylenol/ acetaminophen/ ibuprofen/Motrin,  may relieve symptoms some, but aspirin is not advisable. If one get by for 4-5 days, expect gradual  recovery over a few weeks, with  productive wet cough.  Tamiflu (oseltamivir)  helps at the very first.  It’s expensive,  and requires a prescription, unfortunately. Of course the manufacturer suggests it be taken for much longer; in my opinion, that is profitable,  but isn’t as effective as taking it on the very first day. ( I confess. My bias is: ‘follow the money’. )

It is curious that the last great worldwide lethal influenza epidemic took place almost exactly 100 years ago: The pandemic of 1918 killed many  tens of millions,  then a great part of the world  population; deaths were comon among people with ongoing  serious chronic health problems, or malnutrition, when treatment was less effective than it is now, especially treatment of  secondary bacterial infections.

Well, that’s my take on the 2018  flu. But then, thankfully,  I am only an old ex-doctor, ( I love that!)  So you,the reader,  must realize this is just gossip, worth  less than what you pay for it!

Friends of Grays and Fleets

Posted on

 

We’ve been probed, CT’d and MRI’d,

Have suprapubic midline tatoos,

And golden marker seeds inside

To show gamma ray binocular eyes

Where to send high energy rays

to the place where cancer lies

awaiting a deadly dose of Grays.

 

We arrive, our bladders full,

With a Fleet’s clean sigmoid;

Identified, pastic bracleted, we pull

Off our clothes and try to avoid

More exposure of bare buttox

To watchful target cathodes

waiting in cold whiteness.

 

We are cheered by nurse and technician

Who treat us like aged newborn babes

And carefully swaddle us in position.

They leave. The machine wakes, and stirs,

To mufflled beats of rap that plays;

It rotates, stops, starts, and whirs

To shoot off focused gamma rays,

 

Until the prescribed dose is spent;

Then deflates the swaddling wrap,

sighs, and stops, as if content,

and settles down to take a nap.

Our nurse helps us to our feet,

pulls off our wadded sheets,

Then sets it all in order again

For friends of Grays and Fleet’s