False Gods, David Simon, Atul Gawande

Listening to David Simon on Bill Moyer's Journal, one thing stood out among all the many truths Simon spoke: The use of numbers, statistics, has been used in corrupt and damaging ways which have undermined the very purposes of the institutions we created to protect ourselves.

This is made particularly clear in The Wire as it pertains to the way crime statistics have perverted and nearly destroyed police departments and this is true for public schools, which have been similarly damaged by the unintelligent and corrosive use of statistical measures, judging teachers by the tests scores of their students, and it was true during the Viet Nam war where "body counts" were used as evidence we were winning that war, when in fact we were losing it. Robert MacNamara was the epitome of the man who made  a career creating an image of himself as the smartest boy in the room, the man who could prove with mathematical "precision" how we could and would win that war.

One area which would seem immune from the criticism concerning the importance of statistics would be medicine, which is, after all a science, we would like to believe.  Another is finance and economics, which are, after all, in their very essence, numbers games.

But the problem is, numbers are really just dumb tools and they have to do with measuring things. But in order to understand the way things work, you really have to have a qualitative insight, and the quantitative tools cannot by themselves provide that.

The numbers are supposed to protect us from our emotional side, from the subjective, from biases. They are just the facts ma'm. 

Consider two instances of the uses of numbers which have been found to be very persuasive by those who wanted to believe, in a qualitative way, what these numbers were supposed to mean. Both instances arise from New Yorker articles by Atul Gawande.

Gawande, it must be understood, is a very nice man. He is well meaning, bright, earnest and when he is telling a story about an individual  patient, he can be quite moving and effective. That is, he is telling us something which has quality to it. But when he gets out of the operating room and tries to tell us about a whole, complex system based on numbers when he really doesn't understand how they were collected, he unwittingly misleads.

And the President reads Gawande. 

When Gawande strays into territory beyond his immediate experience, beyond the particular experience he has had with a particular patient, he begins to worship the false god of quantitative thinking, of misinterpreted numbers. 

The first instance is his article about a cystic fibrosis clinic which has far better numbers for survival than any other CF clinic in the country.  I forget the exact numbers, but if the average life expectancy at the average cystic fibrosis clinic is 34 years, then this clinic was getting 45 years, numbers like that.  A really impressive difference.  

To his credit, Gawande did not simply read the numbers, but he hopped a plane and visited the clinic to find out what this clinic could teach us about how to improve the quality of care for CF patients.  The numbers, after all, clearly told us this is this is by far the best, the highest quality care for cystic fibrosis in the country. The numbers were undeniable, and could only mean one thing. (Beware numbers which can only mean one thing. Remember, numbers are dumb.)

The patients at this clinic lived ten years longer than anywhere else; they got beyond death in young adulthood to middle age.  Following the head of the clinic, Gawande saw this doctor  examine the record on a patient who had been doing very well on her lung function tests but had over the prior three months deteriorated sharply. Questioning the patient relentlessly, it turned out she had acquired her very first boy friend, and she had moved in with him, and not wanting to gross him out with the "pulmonary toilet" she had previously performed on herself several times a day, she had done less and her lung function tests revealed the difference in her effort. 

The doctor was outraged. What have you done to make this clinic the best CF clinic in the world? You have let us down. You've let yourself down. Sure the coughing and wretching and hacking up secretions from your lungs may disgust your boyfriend, but we're talking about your lung function here. This set of testing makes our clinic look bad. We look like a failure. The patient broke down in sobs and we got no more information from Gawande about whether or not she ever returned to clinic. 

We really didn't need it.  It was pretty obvious that patient was either going to comply with her pulmonary toilet regimen or she would not have the nerve to ever show her face again at that clinic. 

So who benefited? If the patient slinked out of the clinic, never to return again (a distinct possibility, given her humiliation) she'd take her stinking numbers with her and rid the clinic of the stench, but who was served by humiliating her and throwing her off the train?

At least in that case, the numbers reflected what was actually happening, i.e. a loss of lung function which resulted from a loss of effort. But the loss of lung function might be a price that woman was willing to pay, even if it meant she would die at age 40 instead of 45. Is it better to die a virgin at 45 with great numbers or to have lived and loved and die 5 years earlier?

I could think of numbers which didn't even tell you what you thought they did: I signed death certificates for years while covering for other doctors who signed out their patients over the weekend by telling me Mrs. Smith might die over the weekend and I should sign the death certificate. With what diagnosis? Oh, I don't know. She's got a lot lot of things racing to be the cause of death, uterine cancer, heart failure, diabetes. Pick one and sign your name. So I picked one out, more or less at random and that diagnosis became her cause of death and got entered into the stream of information emanating from death certificates.  And then you read about "leading cause of death" or how many people die from heart failure and you know they are based on garbage in/ garbage out systems of collecting those numbers.

The more famous New Yorker article was the piece about the Texas communities, where one town had a hospital which billed the highest rates of Medicare cost in the country while a neighboring town was at the low end of the scale. Gawande tells us that by "every measurement of quality of care" the high cost hospital was no better than the low cost hospital. And he flies to Texas, has dinner with doctors from the high cost place and they "admit" they have probably been bilking the system, doing procedures which fattened their own wallets but did not much improve the health of the patients. And Gawande accepted their confessional as an admission of guilt by five doctors on behalf of the hundreds of doctors who were not at the dinner.

Of course, this plays to the longstanding suspicion about doctors doing unnecessary things to enrich themselves.

But the sad fact is, there are no good "measurements of quality" in medicine, or if there are any, they are very limited and you certainly could not judge differences between the two hospitals without looking much more carefully at individual patients. You'd have to do chart review and ward rounds at both places for months to get a sense for whether there was any real qualitative difference. That is, you'd have to be scrounging around the wards, and not just looking at numbers.

That's what Howard "Bunny" Colvin is talking about when he says statistics ruined policing in Baltimore. Used to be the cop sat on the stoop with the ladies in the neighborhood, and when there was a shooting, the cop had people who considered him a friend and told him who and what and wherefore. That quality of the cop on the beat could not be measured by arrest statistics. 

That is the difference between teaching kids probablity theory by tricking them into thinking they are not learning, when you show them the probabilities which govern the dice game of craps. How do you capture the creativity of a the classroom teacher to sizes up the psychology of his students and finds a way to sneak some learning into them?   In The  Wire, the teacher has the choice of teaching his students what they want to learn or teaching them nothing in a doomed effort to teach to the test. The test results generate statistics. Real learning in the classroom does not.

Juking the stats means lieutenants make majors and majors make colonels and it's great for career advancement and for running for re election but it's terrible for school children, teachers, doctors, clinics and for most important institutions in this country.

Our addiction to the manipulation of dumb numbers has corroded our society from within. It's why we are no longer the best in health care; it's a small part of the reason our schools are failing to do as well as they might otherwise.

We have gotten way stupid in our attempt to look smarter by quoting numbers.  Until you understand how numbers are collected, you are as dumb as the numbers themselves. And I use that word "dumb" advisedly, in the sense of dumb as in unable to speak. Numbers do not speak. Someone has to speak for them.

But we are Number One. Oh, yes. Now there's a number you can believe in.

Harold Bloom, Shakespeare et al

"The English are not just Americans who talk funny. They are really different from us."

--Duncan Gordon


Harold Bloom, The Sterling Professor of Literature and Whatever at Yale reviews a book about English anti-Semitism in the New York Times Book Review, focusing on the place and importance of Shylock and Fagin, the Jew. The editors of the Times tell us Mr. Bloom is "The most prominent--and the most formidable--literary critic and commentator in America today."

I, regrettably, have to argue the irrelevancy of Professor Bloom, and by extension, the aging editors at the Times, and possibly the ensconced faculty at Yale, and the faculties of most universities, and while we are at it, let's include the voters of the Academy of Motion Pictures, the voters for the Emmy awards and most other judges of what is important and notable in forging opinion and values in this country of 300 million souls.

None of this is said with any sense of triumph or joy--My father, who was closer to Mr. Bloom's generation and who grew up blocks from where Mr. Bloom spent his formative years, reading Shakespeare with the same intensity, loved the Bard and found him just a relevant as Mr. Bloom does. The power, the violence, the depths of emotion and the capacity for betrayal, passion and the personal connection to daily life experience rang out to my father just as vibrantly as they have for Professor Bloom.

But not for me. Shakespeare's language was as remote as Middle English for me and not worth the trouble. The stories, powerful in their own time, could not be as artfully interlaced as today's editing and cutting back and forth in time and place can so effortlessly accomplish. Shakespeare, no doubt would have envied the freedom wrought by the capacity for film editing.

Dickens I could sink into and get lost, as a child. Totally absorbed in Oliver Twist and David Copperfield, these were the only books which could immobilize me during my hyperkinetic youth. The language, the characters were living friends of mine, when I was ten, eleven years old.

But no more: Dickens no long seems worth the time, the characters too cartoonish, too unidimensional.

That I cannot read and re-read Dickens as I once did may be my own failing: Maybe, it's the loss of neurons and synapses on my part. But these works, wonderful as they were in their time and for generations which followed, no longer compare in importance, power or artistry to what's out there now.

Compare Oliver Twist to The Wire. (You knew I'd get to The Wire.)

Does Fagin the Jew really approach the odious mother of Namond? Here is a mother whose income is provided by the slinging of drugs on the corner by "The Game." First, it's her husband, Wey Bey, who is an important part of the "Muscle" in a drug organization, who provides for her.

And when Wey Bey, is imprisoned, she is relentless in pushing her son to grow into a soldier and to stay out of school and to stay on the corner. She spends her days on the phone, talking to unseen friends, making arrangements for parties, for trips to New York to catch Broadway shows. When she hangs up, she lambasts her son, Namond, for not being hard enough, for not being man enough to do his duty, which is to provide for her.

And oh, is she a master manipulator, first telling Namond how undeserving and worthless he is, then lavishing pricey retro sports jerseys on him, as if to say, I love you after all. The classic abuser who beats his wife, saying it's only because he's so in love with her, this mother sings the same song--I love you so much, but you disappointment me so, I lose control. Stunned, surveying his cornucopia, Namond asks why. I will not send you out in public in anything less than the princely threads which are your birthright. It isn't long before she flips again, systematically destroying every vestige of self respect to which Namond clings. Ultimately, Namond is only rescued through the astonishing intervention of Wey Bey himself, who wrests control of his son from his mother.

In one of the most extraordinary scenes in Western literature, the mother confronts Wey Bey in the visiting room of the Jessup maximum security prison where Wey Bey will spend the rest of his life. She upbraids Wey Bey for enabling her son to evade his duties as a soldier in the drug trade. Wey Bey asks her what is so essential about the path she has planned for her son. She replies, truthfully and unashamedly, she depends on the income from the corner. But she also asserts the role of the soldier in the game is the essence of what it means to grow up, to be a man, to stand tall. She insists Wey Bey has shown his worth his whole life by being hard and loyal to the rules of the game and to the organization which supports it.

And Wey Bey, whom we have known through four seasons of the story, as remorseless an executioner as any, a man who carried out orders without questioning, who has instructed others the hard thing to do sometimes is to not ask the obvious question, but just to do what you are told to do, to kill and not ask why. This man who has managed to get through his unforgiving world by not asking questions, looks across the table in the prison's visiting room, into the eyes of the mother of his child and asks, in his own idiom, words to the effect, "And who would do what I did, if he had any other choice?"

He has asked the one question which must be the one question which could destroy him as he lives out what remains of his life in prison. He asks it unblinkingly, without wasting emotion, in fact with just a flicker of a smile, as if the answer is so obvious, it's hardly worth discussing.

It's a moment of such layered meaning and revelation to be truly breath taking. Nothing in Shakespeare or Dickens can even approach it.

It is a moment in American literature which could not have occurred in British literature, at least not in seventeenth or nineteenth century British literature, because the Brits really revel in mystery, magic, the other worldly, the super worldly. They cannot separate religion from government, for Chrissake.

But Americans create their best literature when they look the real world unflinchingly in the eye. They do not need to pull a magic sword from an enchanted stone, nor do they need a Hogwarts, when they have the Mississippi.

Huck Finn looks across the raft at Jim, the slave, who Huck has been taught by everything the South holds dear, the proper action is to return Jim to slavery, but Huck looks into himself and knows he cannot do that to Jim, no matter how appalled he may be by Jim's outrageous desire to be free. And Huck accepts he'll go to Hell for it. Match that Dickens.

But now we have The Wire. And, strangely, it is the product of a committee--The Wire is literature which is a collaborative effort. There are different writers for various episodes, actors, directors, cinematographers, all the crew which bring characters and stories to life.

If there is any lesson in all this, it may be there is more power in the creative efforts of a community than in any individual.

I realize, I've just spoken heresy, but there it is.

And I realize, there are individual artists who do not depend on others for their fresh and untainted vision. Bob Dylan is only the most obvious example. The Noble Prize committee will never honor Dylan. But that just fits what we see from the Academy Awards, the Emmy prizes. Winning an award, is of course no achievement. It says something about the powers that be but nothing of the powers of creation which really animate our life on this planet.

There is no surprise those who hand the awards back and forth among themselves have not seen the shift from Shakespeare, Dickens, T.S. Eliot to the new. These are folks who have built careers, reputations, their own relevance on the masters of the past. It's understandable they would be blind to the new, to forces which displace them. Even the members of the Academy of Motion Pictures, the judges of the new collaborative art form are mired in an old literature, an art form which always has an eye on the bottom line. Ditto for the Emmys.

While I'm at it, The Sopranos, Mad Men, Jesus Christ, Superstar, and miniseries like Band of Brothers would all make my list for the new "Canon."

Band of Brothers, like every project involving Stephen Spielberg, is grievously injured by the mandatory descent into maudlin sentimentality, but the fact the scenes which mar the work cannot destroy it, only attests to its overall value. The nauseating scenes of Richard Winters wracked with regret at having to shoot a youth in an SS uniform were almost enough to make one lose faith, but, the series survives it. The scenes between the medic and the French nurse are not quite as much of a turn off, but they dim the luster of an otherwise brilliant work.

Of course, having just extolled the virtues of group effort, it is true, there is virtue to a single point of view and David Webster's Parachute Infantry provides an unsentimental and superior vision of the same experience. Webster's point of view however, is that of the earthworm in the trench and the Band of Brothers series has the virtue of being able to see the same story through different eyes, and to shift focus from the troops in the foxhall to higher levels of command.

Even the overwrought and mostly imaginary episode, "Why We Fight," depicting the liberation of the concentration camp is so powerful, it works beautifully. Strangely, the title is a bit of an oxymoron, given the point made early on in the episode, the soldiers who liberated the camps had no idea what the camps were, and had no interest in the monstrous evil which had been behind the enemy army which was trying to kill them. It was enough the Germans were trying to kill them. They hated the Germans enough to kill them. The "Why" was something that was pasted on later. The discovery of the camps and the evil those camps revealed only added luster to what they had already accomplished, but it had not been a motivator. There was no "Why" there.

But back to Shakespeare and the Brits. Yes, there has been a pervasive anti Semitism rife in British society, a particularly nasty variety because it is oh so genteel.

But, so what? The Brits, like Shakespeare, have become pretty irrelevant. They were made irrelevant by their own self consuming racism, cynicism and selfishness.

No country has ever, to my knowledge, fought a war like the American Civil War to liberate an underclass. Certainly not Britain.

The Brits fought some bloody wars in the name of God (the crusades, to name just one series) Country (you name it) but those were, like most wars, fronts for money and power interests.

There were British abolitionists, but there was never a British war like our Civil War. And there was never a British Civil Rights movement like ours. They simply never faced internal evil as directly and as thoroughly, in all parts of society, as we did, and as a result, they could not gather the strength we did from such an effort.

And that is where our strength really derives, in all those differences.

It's no accident we have a Kansas white woman and a Kenyan Black man producing the most interesting, if frustrating, political leader in the world.

We are not just Brits who talk funny, thank God.

Gail Collins Anthony Comstock and Margaret Sanger

Thank you Gail Collins, for bringing to my attention the stories of Anthony Comstock and Margaret Sanger.

This is one of those only in America stories which has got to make one feel proud or really weird about being an American.

On the occasion of the 50th anniversary of the FDA's approval of the birth control pill, Gail Collins outlined the battle between these two nineteenth century figures who struggled for the soul and future of American womanhood.

It seems Anthony Comstock, having survived the Civil War as a soldier in a Union regiment, where he was daily offended by the profanity he heard around him in camp, and he devoted his post war life to stamping out smut, and he founded the New York Society for the Suppression of Vice.

You cannot make this stuff up. He was our original Talibund, right here in the United States.

Being politically savvy, he realized he needed some clout, so he got himself appointed to be the guardian of everything handled by the United States Postal Service, which meant that if there had been a Playboy in those days, he could forbid it's transport by the postal service, but since there was no Playboy, he forbid transport of anatomy textbooks with all those lurid, soul destroying pictures of naked female bodies, which represented a profound threat to the moral fiber of future doctors of America.

His post also allowed him to carry a firearm, a cherished right under the Second Ammendment.

Margaret Sanger, a nurse, one of eleven children of a very Catholic mother, had had enough, and decided contraception would be a good idea, no matter what the Pope or Mr. Comstock thought, and she wrote advice to young women and advice to married women columns which, you guessed it, Mr. Comstock thought violated the 1873 law which bore his name.

Ms. Sanger had to flee the country and seek refuge in Europe where they did not have a First Ammendment, so she could be free to speak her mind about contraception. This actually did not turn out to be such a bad thing, because in Europe she heard about diaphragms which were actually more effective than trying to wash away sperm after the act. So, in a sense, we all owe to Comstock a more effective form of contraception, at least for his time.

As a medical student, I was seeking a position as an endocrine fellow and the head of the department of endocrinology at Mount Sinai Hospital in New York City asked me why I wanted to be an endocrinologist. Trying to be bright and socially relevant, I said that the endocrine researchers who had come up with the birth control pill had done more to change the world, more for liberation of women, and more to affect the lives of average citizens than all the politicians and social crusaders up to that point. This was 1972, and I thought I was saying the right thing, which turned out not to be true, apparently, because I didn't get the fellowship. I think the head of the department was looking for me to say somethign about how much I enjoyed working with chemicals in the laboratory and the social significance theme did not play well with her. She probably thought I was a suck up, which I was trying hard to be at the time, or she might have been looking for a test tube rattler, not some wild eyed hippie.

But, apart from the selfish motivations behind my little speach, I acutally believed it then, and I still do now.

People in government make policies. Preachers preach from the pulpit. Activists mobilize marchers. Stephen Speilberg makes movies which captivate people and he can even do projects like Shindler's List and Band of Brothers, which may change some attitudes.

But I recall the words from Jesus Christ Superstar where Jesus tells his advisors, "You have no idea what real power is." They've been urging him to use the power he has over the masses who come to hear him. They advise, "Throw in a little hate for Rome." They tell him, if he uses his power over the masses, he and his Christian disciples will have the power and the glory. And he says, "You have no idea what real power is."

And I agree with him.

Real power was the power to prevent polio. Real power was the power to allow women to choose when and with whom they would make babies.

No war, no change of borders on a map, no amount of money or attention ever changed life on earth for human beings as profoundly as what came out of the biology laboratories.

Portsmouth Police Save Town from Bus

In a scene straight out of Alice's Restaurant, the Portsmouth Police mobilized all its resources to save this seaside town from the next big terrorist attack.

It all began when a passenger on a Portland, Maine to New York City Greyhound overheard another passenger, speaking on a cell phone and she heard "There's a bomb on this bus." Now, I wasn't on the bus at the time, but if news reports are to be believed (and I realize what I'm asking here) the guy on the phone was speaking Swahili. I'm not sure if there's a Swahili sentence that sounds like, "There's a bomb on this bus" which actually means, "This bus is a bummer, " or "I hope I can get a bagel in Portsmouth, but it is New Hampshire. I'm not sure they even know what a bagel is in New Hampshire," or words to that effect.

So the concerned citizen, being aware of the Times Square attempt, calls 9-11 and the Portsmouth SWAT team surrounds the bus and the news media swarms and we are all watching events unfold from our computers at the hospital and the patients are watching on their bedside TV's, everyone wondering if we are going to be the next Times Square, and a town which doesn't even shrug when President Obama walks down the street during primary season, and people actually walk the other way rather than having to talk to John McCain or Mitt Romney because they get tired of all the attention, suddenly everyone is all a twitter about getting national attention.

But it's more than national attention we are worried about. We don't want our town blown up.

And we recognize that right after New York City, we are a very high value target.

North Church on Market Square was where Daniel Webster hung out and even George Washington slept there right there in the front pew. So there would be big time symbolism blowing up Portsmouth.

They clear out all the restaurants and bars and they seal off the downtown parking garage so nobody can drive home and everyone just has to watch and wait and wonder if we are next in the war on terrorism, or actually that was last year's tag, the effort to contain radical fundamentalism.

That's us, right there on the vanguard.

But, it was not to be. No bomb.

Not to feel too bad for the police, because in the sweep they did reel in two potential threats to domestic security. The first was some guy from Maine who "pulled away" from a police officer leading him away from the bus and was charged with resisting arrested after they "Tazed" him twice for the crime of riding on a Greyhound bus and being unpleasant about having to leave it with his hands held above his head.

The other guy, I have never met, but I liked him just from the reports. This guy is Black, and from Brooklyn, which must make New Hampshire pretty terrifying, but he also had a guilty conscience because he knew he had paper on him, an arrest warrant for riding his bicycle on the sidewalk and for smoking blunt. (It was not clear where he had been accused of these heinous deeds, but I'm doubtful it was Portsmouth because they are pretty laid back here about bicycles on sidewalks, as long as you don't run over any tourists.)

Now, I'm from New Hampshire, so I'm not sure what blunt is, but from the context I imagine it's something that's bad for your health. But no, that would be tobacco. So maybe it's something not bad for your health but illegal, like marijuana. Whatever, the guy knew he was in trouble, but unlike the guy from Maine, he was very pleasant and apologized a lot, so actually the police did not Taze him and simply charged him with giving a false name.

That, you might suspect, is a rare charge in Portsmouth, where giving a false name would not help much because the policeman probably went to high school with you, unless you are from Brooklyn.

But Portsmouth is actually a town accustomed to tourists and people from out of state. So the police are trained, they were at pains to emphasize, to deal with all sorts of different people, except for people from Massachusetts, who tend to be frequently unpleasant and pretty obnoxious.

Brooklyn, we are okay with.

Where was I?

Oh, two arrests, no bomb, The North Church saved. The Portsmouth Brewery unscathed.

And the police got to use all the SWAT team stuff they'd had not unfolded since it was bought.

Money and Medical Care

Glycemic control is deteriorating.
Beta-cell function is decreasing.
It's time to rethink what a single agent can do for your patients with type 2 diabetes
It's time for Byetta.
      --Junk mail 




Now there's an advertisement  my eyes skipped over. It's just one of those many fliers I get daily, one of those ads which infiltrate the medical journals,  like the New England Journal of Medicine. They are ubiquitous now. I hardly even notice any more.


Except when I stop to think about it. It's like greasy fingerprints smudged on the walls of your old house; you just don't see the blight after a while.  But it's just one of those things which signifies a much larger neglect. We just don't care any more whether or not medical information presented to doctors is true or not. All that matters is whether or not the company makes money.

Like the fiber industry and the calcium industry, all the snake oils the FDA used to guard against, things which don't work, or things which may actually do more harm than good, like any of dozens of new medications brought on line monthly. The important thing is getting the image out there, the words out there, a kind of background buzz so the names are familiar. And after a while, doctors, especially newly minted doctors lose the capacity to critically appraise drugs, or new therapies; they just numbly write the prescriptions.

I saw a TV ad the other day saying if you were a good mother you'd be sure to feed your kids Fruit Loops cereal because they are a wonderful source of fiber. Fruit Loops ! How much is wrong with this picture? I cannot even begin to count the ways--simply too depressing. Fruit loops. Michelle Obama where are you now? Obesity in America. Fiber. Ye gads. Have you no shame? 



The profit motive, we are constantly told, is a force of good, the best way to encourage the creative energies of American industry and what makes our medical care system the best in the world, the envy of other nations.


Not that any of that is actually true: We no longer have the best system in the world, if we ever did, and we are certainly not the envy of the world. We simply have more glitter and more energy, but we are using that energy to chase after dollars.

So we have local magazines putting out those Best Doctors in Washington, DC or Best Doctors in New York, and you can hardly tell the magazines "ratings" from the advertisements for plastic surgeons, urologists and heart surgeons.

We hear radio ads for doctors. On TV and we see doctors who have their own TV shows advertising themselves while trying to become the new wizard of Oz, the new Oprah. 

Self promotion is no longer suspect, it's admired. It's marketing. It's good.


When I was an intern in the emergency room, years ago, in New York City,  a fifteen year old East Harlem mother brought her three year old daughter with her into the exam room. The mother had a cough and a fever and she brought her daughter in with her because there was nobody to take care of her at home. They spent their days togehter, watching TV.


When I stepped into the exam room, the daughter said, "I seen you on TV."


Apparently, they watched a lot of soap operas with doctors.


I smiled at the mother and expected her to correct her daughter but to my amazement, she said, "Yes, we saw you."


The awful truth dawned on me. These two, the mother and child, did not understand the soap opera was just commercial fiction. To them, it was on TV; it was as real as anything else in their lives.


Now, of course, doctors and magazine buyers are supposed to be more sophisticated than that, but over time, you stop seeing distinctions.


It's like that scene from the last page of Animal Farm, where the animals are looking through the windows into the farmhouse and the pigs are having dinner with the human beings and the animals on the outside look from pig to human and from human to pig, all around the table, and they cannot distinguish pig from human being.

Drill, baby, drill: What me Worry?

Of course, President Obama must be ruing his own timing endorsing off shore drilling, but then again, he never made "Drill, baby, drill," his anthem. He, as he has done too often, caved in, and tried to mollify critics. So he said we have to do everything at once. We are coming to the end of  our tether; we can't afford to dismiss any option.

Sarah Palin, however adopted this mantra as the emblem of her own tough mindedness.  In her vice presidential debate she noted this idea had come to her from rallies, where the chant from her demented supporters came to her and she liked it.  

So, as in so many other areas, Ms. Palin did not originate the idea, but once she saw the effect it could have on the crowd, she gave it to them. 

We've heard what President Obama says now--no more drilling until we can be sure this won't happen again.

Since we can never be sure, that sort of tells the tale.

Actually, the first time off shore drilling befouled coastline was back in 1969, if my internet search is correct--on the California coast.  Then there was the Exxon Valdez, but that was not offshore drilling. But, deep water drilling, it turns out, frequently contaminates ocean water and beaches--happens in Nigeria all the time.  But of course, as they say in Baltimore, that's not a zip code that counts.

Ms. Palin will have to edify us now. 

Still think it's a good idea, Sarah?