Our New England Schoolmarms Strike Again

In one of the few rulings by the Supreme Court that has made sense in recent memory, the self-proclaimed Third Branch of American Government ruled last week that a local ban on the keeping and bearing of firearms by the law-abiding, tax-paying residents of the District of Columbia was, in fact, unconstitutional. Duh. Not surprisingly, the academic medical community, much too busy to work to save American Healthcare from destruction by the insurance industry, and complicit in its destruction by the forces of socialism, came out against the ruling in an editorial in the most recent New England Journal of Medicine.

http://content.nejm.org/cgi/content/full/NEJMe0805629

If the sentiments expressed in the article were not so deeply-felt and so dangerous to our way of life, they would be almost laughable. It betrays the Technocratic mindset of so many in power in today's academic institutions - that somehow it is up to them to save us from ourselves. Epidemiological experiment? Hilarious. Liberty must be so incredibly irritating to these braniacs. It is so...untidy. Their silence was deafening as we the people (apparently their helpless, hapless wards) were subjected to other "epidemiological experiments" at the hands of the Highest Court - "Law enforcement officials can not be held responsible for defending people in their homes"; "Your personal property can be seized through imminent domain not only for the good of a community but also for the good of a more profitable tenant".

Where is the outrage at the New England Journal when people are attacked and out-gunned by criminals in their own homes? Where is their scientific input on the true causes of inner city violence, crime, and illiteracy - namely, the irresponsibility and even participation of those communities in those problems? Where is their backing of Bill Cosby when he addresses matters such as these? There is absolutely no doubt that those problems are at the root of the issue, but still the New England Journal remains silent. Well, silent at least until something occurs that offends them personally. Their fear of law-abiding citizens owning the firearms to protect themselves is legendary. They've always sided with the criminals in that regard. In their world, the law-abiding, ignorant sheep are supposed to look to the increasingly impotent government for everything, and remain victims of circumstance. This ruling was a slap in the face.

Their statement shows how utterly despicable and irresponsible they have become. They care nothing for the residents of Washington D.C., or any other city, town, or rural area in the country. If they did, they would use their power as the leadership of a (previously) highly-respected medical publication to educate our most vulnerable citizens about how to work and fight their way out of illness. They instead use their power to push their ultra-liberal agenda using the mantle of medical expertise to hide their true intentions. Their ridiculous opinion is thus given artificial credibility. What cowards. They know that their beliefs are losing traction, so they must package them as the "advice of the experts".

The New England Journal of Medicine thus continues to lose much of its credibility, hijacked, like so many of the great institutions of our nation by the socialist parentalism of the academic community. They are not welcome to speak for me. They should be ashamed.

Delayed Gratification - Numbers Don't Lie

I'm a little bitter. I admit that. It is difficult to be in my mid-thirties and still struggling, still living not unlike a college student. I am tired of Ramen, you know? To make it worse, I am constantly confronted with those who chose other career fields and whose lives seem so much better than mine. I see trips to Europe, new cars, big houses - all for the people that, according to our guidance counselors - "weren't going to be able to make it without a college education". I know how this sounds - jealous. Guilty as charged, I guess, but more than anything - disappointed. I'm disappointed that my work seems like it is never going to pay off. I'm disappointed that the future seems to look more bleak all the time. Most of all, I am disappointed that people are so wrong and bitter toward me for what they apparently imagine my life to be like.

Doctors are all super-wealthy. Isn't that the common notion? I suppose all professions suffer at least to some degree from the false perceptions of those outside the loop. Medicine is no exception. At least once each week, a patient that is either bitter enough or socially clueless enough to be completely honest about his feelings accuses me (usually with veiled sarcasm or in the guise of a jest) of doing extremely well for myself in my chosen career field.

Physicians have traditionally felt uncomfortable addressing this subject. I think there are a few reasons for this. One reason I feel uneasy denying this misconception is that I don't want to be further accused of whining. I guess I feel like "If this guy already thinks I'm a spoiled doctor, it'll just make things worse if he thinks I am also ungrateful for the giant imaginary fortune I am amassing". The second thought that usually creeps into my mind is the thought that if (a) he thinks all good doctors are filthy rich, and (b) I admit to continuing to live very modestly, then (c) I must be a pretty lousy doctor. Suspicion of false riches is bad enough - an accusation of professional failure is downright intolerable. Finally, and most pathetically of all, I continue to hold out hope against all evidence that someday, in the distant future, I may actually begin to reap some of the rewards from the lifetime of study and hard academic work it took to become a doctor. I would hate to jinx that. Almost all doctors are at least a little superstitious.

Eventually I'd like to discuss the loss of prestige, professional pride, respect, and sanity felt by so many of my peers. Today, though, I would like to partially tackle the false rumor that today's family doctors make a fortune.

Insurance is the obvious target, and probably is, in fact, the biggest contributor to the decline. They have made a very comfortable profit for years by frightening people into paying a middle-man for a vital service. Following Medicare's lead, they have worked to prevent physicians from working together to bargain for better rates while doing the exact same thing themselves, creating an uneven playing field. This has had a negative effect on all specialties, but has hit the already-lowest-paid primary care practitioners the hardest.

The increasing medical school debt to income ratio is another element of the decline. During a period in which medical school costs have shot up drastically, physician salaries have remained flat. For a neurosurgeon making $400K/year this is frustrating - for the primary care physician it can be devastating. It is estimated that family physicians pay up to 20% of their post-tax income for medical school loan repayment.

http://www.amsa.org/meded/AAFP.pdf?bcsi_scan_F72174411F520D17=0&bcsi_scan_filename=AAFP.pdf

This amounts to a game of catch-up for the primary care doctor, with the deck stacked against him. The average starting salary for a family physician is $120,000. A salary of $120,000 seems like a fortune to a poor kid - it did to me, at least. And perhaps it would be, except for all the hands dipping into it. At a salary of $120K, the doctor is in a fairly high tax bracket, even under today's much lower taxation levels. After taxes, the physician has about $92,300 left. The typical physician owes between $150,000 to $200,000 in school debt. The payment on that debt will be approximately $1500-$2000, even with very low interest rates, and will take the doctor 15-25 years to pay off. Take home pay? Around $71,000. And we mustn't forget about malpractice insurance, which will run at least $10K/year. After all is said and done, the physician takes home about $60,000 a year - about half of what he started with. And considering that most physicians work between 50 and 60 hours a week, that comes out to just over...are you ready?...just over $21 per hour. Just over $21/hour after 11 years of education.

Compare that with a nurse, who goes to school for 2 to 4 years, and can expect to make $50/hour before taxes, a construction laborer who makes about $18-20/hour plus overtime, an engineer...you get the picture. It will take the family doc in the scenario above about half his career just to catch up with the lifetime earnings of the laborer with a high school education and no school debt, who has been taking home $20-25K each year.

So please forgive me if I'm a little bitter. I had hoped that I would be able to enjoy some of the fruits of my many labors before retirement. But don't dare accuse me of being a "rich doctor". I just may hit you in the face.

Environmentalism - the Art of Compulsory Conservation

The world is a dirty, disgusting place. I become increasingly aware of that daily. My childish naivete yields to an increasing realization that it is more and more difficult to find any honor, any integrity, any transparency. I have become more suspicious and cynical. I feel that I've had to. You can't trust anything. And so, when I read this story from the Wall Street Journal about Richard Sandor, the so-called "Father of Carbon Credits", I felt that my suspicions about the Enviro-Banshees were at least partially confirmed.

http://online.wsj.com/article/SB120535230851631199.html?mod=%2528_pageid_%2529_topbox

Let me explain how it works, for those of you who (like me) didn't really quite get how this shell game operates. With the government's assistance, or better yet at the insistence of foreign powers (See Kyoto Treaty), arbitrary caps are set on how much carbon (in the form of CO2, especially) can be emitted by a particular company. If they fail to meet those standards, then they must buy additional carbon credits to avoid penalty - ultimately from Dr. Sandor and his cronies at the Chicago Climate Exchange. If a company does well and emits less than the standard, then they have some "carbon credits" which they can sell to a needy company to bring them into compliance. Either way, the Chicago Climate Exchange makes lots of money - either through the creation and subsequent direct sale of this new arbitrary and previously worthless currency, or through fees on the carbon trades between companies. It gets better. The caps get progressively lowered so that fewer and fewer companies are able to win, requiring them to go groveling with greater frequency to the economists, politicians, and academics at the Exchange, kissing the ring and begging enviro-indulgences. And it doesn't end in Chicago - the same bunch of mega-rich All Stars have identical trading centers across the world. Quite a racket, eh? They appear to be off to a champion start. The Exchange was opened in 2003. Dr. Richard Sandor made an estimated $260 million last year alone.

Biography of Dr. Richard Sandor:

http://www.milkeninstitute.org/about/about.taf?function=detail&Level1=ProStaff&Level2=Bio&ID=37&cat=Staff

Dr. Sandor is a recent convert to the worship of Mother Gaia, but appears to have always gravitated toward green of a different sort, at least generally. He was one of the original proponents of applying the futures market concept to interest rates. He was also instrumental in a past environmental "cap and trade" futures trading scheme similar to today's carbon trading, but during the last much over-heralded Apocalypse of the Universe, the Acid Rain scare of the 1980s.

Now I am not claiming to have any sort of special knowledge about the environment. I will tell you that as someone who is trained to read and interpret scientific studies as part of my job, I believe that there appear to be some serious flaws in the methods, results, and conclusions of those studies. The thing that bothers me about the scenario I describe above, however, is that it simply looks bad. Allow me to explain.

If a doctor accepts a pen or a dinner from a pharmaceutical representative, he is increasingly accused of being in the tank, or at least of questionable, if not unethical conduct. This is because people are very suspicious of doctors and drug companies right now. Part of that is medicine's fault for not being more critical and discerning when dealing with our partners in healthcare, the pharmaceutical companies. Part of it is the fault of over-zealous attorneys who exaggerate the problem in order to personally profit. And part of it is simply misinformation and ignorance on the part of those who make the accusations. What is the end result? I have to consider carefully how what I do with respect to pharmaceutical reps will look to the public.

I believe that there are those well-meaning souls who truly believe with every fiber of their being that our planet is perched on the edge of ruin because of man-made pollution. I respect that. I disagree, but I don't condemn them for their beliefs. But in the same way a physician has to be wary of the image he presents to the public, the growing and strengthening environmental movement should use extreme caution before making bedfellows of the kinds of people I now find are at the heart of the movement to mandate cap and trade for all industries. They, along with the ultimate self-servers, Albert Gore, Inc., are causing the environmental "Movement" to appear less of a cause and more of a cash cow for a few wealthy industrialists and Technocrats.

It is clear to me that until assurances can be made that we are not all simply being duped by Sandor's pals into funding their (and their great grandchildrens') retirements in the name of Environmental Protection, it is my duty as a responsible American and taxpayer to be resistant to the idea of making these carbon limits mandatory.

Independence Day Self-Examination

First, I would like to wish everyone who reads my blog a very happy Independence Day. The fact that I can sit here writing my unvarnished opinion on all these matters is truly a miracle, especially when you consider the series of events that had to occur in order for this to come to be.

Consider, for a moment, what was involved in that statement, the Declaration of Independence. In fact, you don't have to look much further than the title of the document itself. What does it mean to "Declare one's Independence"? One part of it is easy - we Americans have mastered it. It means, in part, to declare that you will no longer answer to authority. The first Americans stated plainly that they would rather suffer grievous loss - even die - rather than to continue to pay homage to a distant, foreign, and almost tyrannical ruler. Amazing. This collection of farmers and merchants (actually only about one third of the total population actually supported the Revolution) declared for the first time since Spartacus that they would no longer bow to the authority of their masters. No doubt many of them assumed that they would soon share Spartacus' fate.


But there is another, often overlooked element to a declaration of one's independence. Independence does not make one free from obligation, responsibility, duty, or toil. A person who is independent is simply not dependent on another. Somehow, over time, we've forgotten this critical element of our Liberty. We are great at refusing to pay homage - we are less great at actually being self-sufficient - independent if you will.


In fact, as a people, we are more dependent than ever. We depend on others for our food, for our fuel, for our security, for our retirement needs, for our health care, and even, in some cases, for our shelter. Our most basic human needs are being assumed by the Collective. I wonder, with shame, if the men who so bravely signed a defiant letter to the most powerful king on the planet at the time could have possibly foreseen a nation so socialistic, so weak, so...well...dependent. Would they be proud of us? Would they be proud of me? Would they be proud of you? Would they even recognize us? Or would they repudiate us in disgust for our failure to keep the Revolution alive?


The Revolution continues. In truth it never really ended. Even when the seeds of our Republic were sown, there were already those who felt that without a strong central government, the sheep could not survive. But that is not what I believe. I believe that there will always be a nucleus - often quiet, as now - who believe that it is the individual's responsibility and right to be truly free and responsible. I literally hope and pray that those people will rise up and reclaim what is rightfully ours - our precious, dearly-bought, God-given Liberty.


I invite each of you to examine yourselves, as I am doing this Independence Day. I beg you to measure yourselves against the bravery, selflessness, and long-sightedness of those original Patriots who first articulated our precious beliefs. And try to make our Fathers proud of you. I pray that you all have a safe, happy, and blessed day. May God Almighty bless our dear Republic, and may we continue the Revolutionary Struggle against tyranny in all its forms. Amen.

The Hyper-sensitive Beefcake - and Other Children's Moral Tales

I've never really liked Governor Jesse Ventura. Which is odd, because there are several things about him - at least the Cliff's notes version of him - that I should have liked. We are both veterans - he is a former Navy SEAL and I am a former Marine. We are both small-government guys. We both like underdog political candidates because we think they are, in theory, good for the system. Then I heard him on Fox News this morning on the way to work, and it all became a little more clear for me.

"Fox and Friends" is sort of a goofy show. I know that. And the blogosphere is all lit up with complaints about them. But that is just their shtick - they are silly. I can appreciate that. If Iran shot all their nukes at us, I probably wouldn't turn to Steve, Gretchen, and Brian for their reportage. But if I'm looking for something kind of light in the morning on the way to work, and still want to know the headlines, they are a good choice for me. So it is in that context that I heard the wrestler this morning.

I had always assumed that Minnesotans voted for Jesse out of a sense of their own masculine inadequacy - sort of a Stockholm syndrome thing. But it turns out from listening to him this morning that he was actually a good choice, because he may be the biggest liberal, conspiracy-theorist clown in the whole state. I was stunned to hear him suggesting 9-11-01 as an "inside job" wouldn't surprise him, and using his past as an Underwater Demolition Team (UDT) member as some sort of credential for this conclusion. His statement was that his government had lied to him so many times in the past that they'd lost all credibility.

The thing that really gave me a clue into his personality, however, was what he did next. I preface this with a little story. In the Marines, we were all brothers of a sort. And although we were supposed to refer to each other as Rank and Name (example: PFC Smith), in privacy, we would "break the rules" and call each other by our nick names. There were those, however, like a certain Sergeant I remember, who were so empty inside and so dependent on their rank for their self-worth that they required everybody to call them by their rank and name.

He (Jesse) stopped the interview to ask them, in his characteristic "'-roid voice",

"Do you call all former Governors by their first name, or is it just me?"

Are you kidding me??? Ummmm. Aren't you that jack-ass that used to dress up in a fur stole and tights and prance around before your wrestling matches? I'm sure that he would play it off as a joke, but I heard something a little too familiar in that. You might be able to fool a lot of people, JESSE, but you can't fool a fellow Vet. At least not all of us. I know where you were coming from. You are just a scared little boy in that beefy, steroid-laced body. Take away your little titles and you fall apart, don't you?

The morals of this story are (1) that you can't trust your government, no matter what, (2) that former SEALs are experts on how 100-story skyscrapers are supposed to fall, on architecture, on physics, on aerodynamics, on meteorology, and on rules of etiquette, (3) don't ever criticize a main-streamer. Not so much a free-thinker as much as just one more authoritarian schoolmarm who knows what others are supposed to do because he is a know-it-all.

Fun With Drug Testing, Volume 2

The call was routine. At least it should have been. You know the old saying about how "no good deed goes unpunished"? It's true. It wasn't even my case. My comrade at our other clinic was out of town, so his drug test reviews fell to me. Just my luck. The donor had popped positive for methadone. At this point I should make a confession about something. I know less than I probably should about methadone. For example, having never prescribed it myself, I know less than some about its effects on the patient. I have to assume that it has some effect. Otherwise there would seem to be little reason for prescribing it. There are two main reasons for taking methadone - that much I do know - (1) chronic pain that is poorly-treated with more traditional narcotics, and (2) management of opiate addiction. There are those who believe that methadone is as close to a harmless medication as exists. I have found that these people are generally the doctors who prescribe it and the patients who take it. On the other hand, the Department of Transportation forbids its use in drivers. Somewhere in the middle is the probable truth. If the reaction of the drug testing donors is any indication, however, then it probably needs to be better regulated. They display many of the same denial characteristics as those who take the drugs commonly abused. This brings me to my story. The donor was very cordial. I went through my routine with him; he acknowledged the use of methadone. He gave me the prescription number and the name and phone number of the pharmacy where it was filled. I thanked him and hung up. Only one little red flag went up - he had a loudmouth wife in the background. She kept interrupting him and I could tell that she was disappointed with the fact that he wasn't giving me the earful that she wanted to. I called the pharmacy to verify the prescription, and it got interesting. The prescription was six months old. Methadone should not be prescribed for "as needed" use. Whether for pain management or opiate addiction, it should be taken constantly to provide a baseline level. I called him back and asked him about this. It was really a moot point anyway. His job called for him to perform safety-sensitive duties - driving a forklift, working 50 feet or more above ground, etc. His company would not have hired him even if he was taking it appropriately. He tried to explain that he hadn't needed it for a long time, then he began having some acute knee pain so he took a couple. This may have been true - he may have been that boneheaded. Or it may have been a lie. He may have been taking illicit methadone for months. Either way it was not good. I reported the result as "negative" but recommended against his working in safety-sensitive duties. About 30 minutes later, he called me back. Actually his wife called me back. And she was not happy. I was not able to tell her that I couldn't discuss his test results with her because she wouldn't shut up telling me what a sorry S.O.B. I was. Eventually he got back on the phone. She had apparently done a superb job of spurring him into action. He was very believable as a creep. "I've gotta work. You are gonna cause me not to get this job. I'd looove to be sitting up there where you are, bein' the doctor, tellin' people whether they can work or not. But I'm just a construction worker, tryin' to make a livin'..." I imagined him - eight feet tall, massive, but with chronic, crippling back pain and tobacco-stained lips and hands. All the while, I could barely hear the harpie in the background. "You tell him it's your medicine, and you can take it any way you damn well want!" "You tell him he just cost you a job!" "You find out where he is!" Eventually, even I'd had enough. "I'm not going to listen to any more of this. I didn't make your back hurt. I didn't make your knees hurt. I didn't make you take methadone. I didn't tell you to take it wrong. In fact, I didn't even call you positive, although maybe I should have. I just said it wasn't safe for you to do dangerous things while taking methadone. So I think we're done talking now." And that was that. I'm sure that in his mind, I do have a pretty great job. If he only knew what it feels like to be in constant fear and real jeopardy of some dead-end loser taking everything my family has for something like that. I have to content myself with knowing that I may have saved his co-workers from injury due to his inattention while taking massive doses of narcotics. They will never know. All they'll think about is what a jerk the "company doctor" is the next time they lie to me and I call them on it. God, I wish I could escape this sometimes. I'd just take back the $250,000, turn in the license so dearly purchased, and stop being everybody's favorite target.

Health Care: Rights and Responsibilities - Part II

Here is a quick recap of yesterday...

The belief held by many that health care is a right is plagued by some inherent difficulties. Among these are the following:

(1) Health care is difficult to adequately define and as such is difficult to promise to anyone.

(2) Freedom from illness has not traditionally been considered a "right", as health is impossible to guarantee, even under ideal circumstances.

(4) Universal health care, like the partially-socialized plan of today, would suffer from serious inequities in the real world, with a small group paying most of the bill and a different minority reaping most of the benefit.

(5) In order to guarantee this benefit, the government would have to crush the objections of the practitioners - through force if necessary.



It is primarily for these reasons that I do not believe health care is a basic human right. Instead, I believe that it is up to each of us individually. Admittedly, my way is not perfect, and I will discuss these weaknesses of my position today.



If health care is not guaranteed, then what are we to do with the uninsured?

I admit that there is no perfect answer to this question. Almost immediately, though, I am reminded that ours is not a perfect world. Historically, though, these less fortunate citizens were cared for by private citizens and their organizations. I believe strongly that they do a better job of dealing with specific issues than the government does. The government requires, by its nature, a large beauracracy for even the smallest task. This causes the work of the government to be particularly wasteful. A church or civic organization, on the other hand, requires almost no additional manpower, is quick to act, and by acting, strengthens its community in ways the government can not hope to.

What about the children?

Children, due to their vulnerability and their inability to completely care for themselves, must be cared for by others when things go wrong. Continuing to care for all children without other resources under the age of 18, even expanding coverage for them, seems to be the right thing to do. I am a capitalist, but I am not heartless.

By requiring all able-bodied adults to care for themselves, it allows them the opportunity to make conscious decisions about their health, not just their health care. Worrying about one's health and taking proper steps to ensure it should never be the responsibility of some third party. Why would it be? This mindset betrays the worst sort of authoritarian parentalism in our government. If I were a cynic, I might think that the people who want to create this sort of dependency for even the most personal of matters are only trying to create a large segment of the population who will continue to vote for the person or the party who will continue that life-support. If I were a cynic.

The notion that the medically indigent are somehow unwitting victims of circumstance is held only by some of those who have never actually worked with this population. The generations of dependency have caused them to be completely irresponsible, in many cases, making poor lifestyle choices and further increasing their need for health care. It is a vicious cycle. They choose cigarrettes instead of medicine, then complain about the limits on the numbers of medicines they are allowed under the Program. This is ridiculous. I am exhausted, both as a hard-working taxpayer and as a physician. It is high time for us to begin the process of withdrawing benefits - not just for financial reasons, but because it is cruel to continue to convince people that the government can do a better job taking care of them than they themselves can.