Republican Chutzpah

Keep your government hands off my Social Security!

There is a word which, as far as I know, is best defined by an example:  Chutzpah is defined by the man who murders both his parents and begs the court for mercy on the grounds he is now an orphan.

The Republicans in their debate last night displayed much chutzpah--they do everything they can to kill government and then complain the damn government just does not work.

They beat that mule to death and then they complain he just won't plow the fields.

Of course, the two federal government programs which most Americans, even Republicans who hate government, love and will simply not tolerate doing without are Social Security and Medicare. The Republican party has been trying to kill both programs since the Democrats delivered these babies squealing and squirming, Social Security sometime in the 1930's and Medicare in 1965, and both times the Republicans screamed "socialism!" and pointed to these as the first signs of the coming apocalypse.  

Every year since their births,  Republicans tried to kill them by a thousand cuts, tried to "privatize" Social Security and Medicare and Dr. Ben Carson is still trying.

Every Republican on that stage last night will tell you Social Security is on life support and in danger of immediate collapse--Chris Christie confidently told us it will be insolvent in 3 to 5 years, when, in fact, it's just fine until 2033 and other government accounts keep borrowing from it.  But, of course, if you use a number like 3 to 5, it sounds like you really know what you are talking about. 

Rand Paul tells a little bit of truth, saying there are only 3 workers to support every 1 retiree, that the program was put in place when people only were expected to live until age 68, so carrying them from age 65 was easy enough. He says we have to raise the retirement age to some undetermined age, but most people are talking 67.  Probably not unreasonable, but the fact is there is a much easier solution which the Republicans will not touch any sooner than they would touch a high voltage wire: simply make the rich pay more, i.e. "raise the cap."

Now this involves some math, so don't expect any of those Republicans to get it, but here it is:  Currently, everyone pays into Social Security through their paychecks and they are taxed on their income up to $118,500, which is "the cap" on how much of your income can be taxed to support Social Security. After that, you do not pay any more. So if you make $40K, or $80K or $100K you are paying into the system. But if you make $500,000 or $100,000 you stop paying on all income above  $118,500. 

Now, how much pain would it cause a guy making $1,000,000 to pay tax on say, income up to $800,000?  If the rate is X, then he might pay, say $1,000 more a year in payroll taxes. 

Of course, for the really rich, who escape the higher tax rates by income which is not payroll income, none of this matters. 

If some adjustment to the "cap" on taxable income were made, Social Security would be fine until the 22nd century. 

So who would not be for this? 

You guess it: The Republicans.

And why would they resist such an easy fix to avoid the coming apocalypse? I'll leave you to draw your own conclusions.  

Here's a multiple choice test: 
They are unwilling to raise the cap because:
A. They are trying to protect the middle class.
B. They are owned by the super rich who do not want to pay a dime more in any tax
C. They are brain dead.

Hint: It's not "A"

Children with Type 1 Diabetes at School

What is the role of the public (or private) school when it comes to children who have diseases which require or may require care at school, during the school day?

What is the obligation of a public school system to provide not only the greatest good for the greatest number but to provide special care for children with special needs?

An article in the New York Times Science Tuesday recounts the story of an eight year old child with type 1 diabetes who was told he could not be admitted to a private school and could not go to the public school in his neighborhood because he had type 1 diabetes. 

The mother, an oncologist, said it was all she could do not to "give the finger" to the principals of the schools in question.

There are questions of principle, of public policy here, but also practical questions and solutions.

As for the practical questions, there are simple solutions:
1/ Every state could pass a law indemnifying school staff from any legal responsibility, any lawsuit in connection with administrating care to a diabetic child or to any child with a medical problem. This would make "good Samaritans" of any staff member and remove the excuse that I can't do it because it would expose me to liability.
2/ School staff could be sent to a central training day and get the basics (which are very simple) in dealing with kids with type 1 diabetes.
3/ School boards and local governments could nullify school policies which say children cannot  give themselves needed medicines for diabetes or asthma--which is something these children do at home all the time.  Or, if the legislators are too thick to understand how much sense this makes, they can vote the funds to have a responsible adult, not necessarily a nurse, present at school for children who take medications.

As for the principle: I have not heard both sides of this argument and would very much like to hear it, but I wonder whether school systems should be given the responsibility/ burden of care for kids who have a whole spectrum of "special needs."

On the other hand, in a nation where we more or less force women to work, it is a problem that a mother who has a diabetic child or a child with asthma or seizures should be unable to place her child in a school because the adults at the school are scared to death of having to deal with a sick child.

On the other hand, public schools, as they were originally conceived, had nothing to do with anything but teaching kids how to read and write and calculate. Now they are the centers for free lunches, before and after school programs, parenting surrogates for parents who are either over burdened or inadequate.  

Polio vaccines were given at school. I remember vividly, because I fainted getting mine at age 7 and they had to call my grandmother (who happened to be visiting) to take me home. Nobody talked about canceling polio immunizations because I fainted at school and scared Hell out of the adults.

I have a patient who has a child with congenital brain malformations who has grand mal seizures in school and she is indignant that the principal at her child's school does not want to provide a nurse to administer his medications and emergency care if he needs it.  She has threatened to sue.  

To some extent, this is a matter of line drawing: How serious/life threatening is the illness? How much of a burden would it be?  

Surely, most people would agree a student in a hospital bed on IV's and a respirator would be more of a burden than any school should be asked to bear. But what if he could sit in a wheel chair? What if he didn't need the IV? Suppose he was not on a respirator but on portable oxygen? At what point does that child cross the line from being totally dependent and an unreasonable burden  to being simply a kid with "special needs?"

Is a child with Oppositional Defiant Personality Disorder a kid who the school should have to deal with? Does that kid have to be kept in classes with "normal" kids when he is disruptive?

Then there is the educational aspect to school. Remember education?

When I was in seventh grade, age 13, I used to have lunch every day with a kid who sat alone, all by himself at a big cafeteria table. Nobody would go near him. I sat down with him because he was sitting alone at that cafeteria table every day. The whole empty table and this kid alone. So I sat down across from him. He eventually looked up at me and I could see why nobody had chosen his table, even though the school was overcrowded and cafeteria tables were at a premium. He had a very large head and a nasty looking scar ran from the vertex of his head down his forehead and across to one ear.  His lips were a peculiar blue color and his eyes seemed to go in different directions and his nose ran constantly.  When he ate, his fingers could not manage a fork, not enough manual dexterity, so he forced his spaghetti in with his fingers. Not appetizing.

The first few days he said nothing to me. I wasn't sure he knew I was there, although I thought I had seen one eye flicker up in my direction once. The third day he said, "You've been here before." And I introduced myself. He told me he was not supposed to be alive. The doctors told his parents he wouldn't make it to the fourth grade, but here he was in junior high school. He had had heart and brain surgery.  

I ate with him every day that semester, but then never saw him again. He just disappeared. Maybe he died. Maybe he left school. 
I can't remember what we talked about but I know we talked.  
Other kids would glance over and look at me, eating with the freak kid, but for reasons I cannot fathom to this day, at a time when I very much cared what other kids thought of me, about my "reputation" I was drawn to this outcast.  

For some reason, it didn't bother me to think I might be ostracized for being at this kid's table. And your cafeteria table, who you got to eat with, was a big deal in junior high; it determined to some extent, who was in and who was not cool.  
And I definitely wanted to be cool. Even as a boy, I cared about my hair, my clothes, who my friends were, who thought I was cool. 
I had never read "The Hunchback of Notre Dame" or "Beauty and the Beast" and there was no "Shrek." That whole narrative of literature had no yet been popularized. 

But for whatever reason, in the case of this kid, I said, "Shove it." I'm eating with him.

Somehow, I think that experience was part of my education. Don't know exactly what I got out of it. Don't know if he got anything out of my companionship, but as far as I could tell, I was the only kid at that school of 1500 kids who ever said a word to him.

It was part of my education.

When the Police Throw the First Punch

https://www.youtube.com/watch?v=4tRsrmMUTcw



This morning CNN actually came close to having an interesting discussion.

The occasion was a video from a South Carolina classroom in which a policeman was shown ejecting a student from her chair in a nifty maneuver which catapulted her skyward as if she were being ejected from an airplane, landing her on the floor with his knee in her back.

Harry Hauck, the CNN cop in residence sighed and, once again, said with a weary impatience:  "She refused to obey the policeman's order."

Professor Hill, CNN's resident reasonable man said, "Let's take this reducto ab absurdum: If the policeman had ordered her to get out of the chair and she refused and he had pulled his gun out and shot her, then we both, I hope, would agree, the policeman has used unreasonable force. Do you agree? And if you agree that refusal to obey a policeman's command does not justify that level of violent response from the policeman, then you will agree we have to then assess what level of violence we can consider reasonable."

Faced with this basic college seminar proposition, Retired policeman Hauck was struck dumb, really speechless, momentarily. Eventually, he said, "Well, if you call a policeman into the room, you are asking for him to act." 

This is all complicated by the fact this happened in school and in some way may be connected to the feelings parents have about teachers or any other adult striking their children. We stopped corporal punishment in schools ages ago.

What retired policeman Hauck was saying is police are volatile, explosive, pull-the-trigger sort of people, and when you are the teacher and you request a confrontation, stand back. Once a policeman gives you an order, you are like a soldier in the Army, you disobey at your own peril.

Or, if you get pulled over by a policeman, don't provoke him or your life may not matter. 


Apparently, the standard issue TASER shocking devices have been an effort to allow policeman to not just shoot everybody, but allow for something less than lethal force for every jaywalker.

On the other hand, as any viewer of The Wire will know, students like the one on CNN have long been a presence in the classroom in inner city schools: "Oppositional  Defiant Personality Disorder" (ODPD) can destroy any hope for learning for forty other students in the classroom.  

In The Wire, a whole cohort of students with ODPD  were pulled from the classroom and grouped together, over the objections of school administrators who were afraid they'd be accused of "tracking" students, which in public schools is a no-no.  

One can only imagine how long these kids would last in a confrontation with police on the street--but you can also imagine these same kids would not "act out" on the street with police, where they might in school, where they feel safer to defy, unless of course a policeman comes into the classroom, because, you know,  if his services are requested, then he can do anything he wants, because he also has Oppositional Defiant Personality Disorder, which is what attracted him to the police force in the first place.

Mr. Hauck pointed out this school had a  policeman on the beat, and that suggests the school had discipline problems and may have had gangs, so the environment may well have been one of intimidation, if not from the police, from at least some students. 

The larger issue about the police, which Chris Cuomo tried to scrupulously avoid is why do we tolerate escalation to lethal force or even sub lethal fracture force from police?  When did "protect and serve" become "pummel and sever?"

On the psych wards,  I saw patients who were oppositional and defiant and they were not shot or TASER'd or thrown out of chairs or windows.  The staff dealt with these "acting out" patients often and they had a plan: Overwhelm with bodies. No one person can oppose for long three or four people who have straight jackets or ropes or restraints. 

This might be a technique the police might emulate. Strength in numbers. Works really well. And you don't have to fracture anybody's spine or skull.

This all goes back to what authority we grant the local police to search and seize, which brings us back to the Supreme Court decision about strip searching.  The Court held police can strip a citizen naked within the confines of a  police station because this may be thought of as an action taken to protect the police in that police station or jail.  What other person, institution or entity in this nation has that kind of power? 

In what way are we different from a "police state" if police have the power to order any citizen, at any time, to get out of a car or chair, to lie down on the ground, or to strip naked and the only justification the policeman needs is that he is a policeman. The citizen has no option but to obey, just as if he or she were in the Army.

Ultimately, police can behave as unbridled monarchs, or thugs, because they are protected right up the chain of command to the Supreme Court.

Once was a time when a Supreme Court insisted police had to inform any person they arrested they had the right to remain silent. The police had to stop what they were doing to show they were aware they were bound by some sort of legal/Constitutional restraint. But not since the Scalia/Alito/Thomas/Roberts/Kennedy court. 

When the Miranda rights case was handed down, there was much bleating about how cops on the beat would be hamstrung by this unworkable intrusion into their practices. 

Oh, how far we've come.

The Select Committee of Ignoramuses

He plays a hero in Congress

I've been trying to dissect out what in particular so infuriated me about the select committee on Benghazi, and I think the buttons they pushed with me go back to watching personal injury lawyers play their cynical, corrupt games with respect to malpractice cases. 

These lawyers typically construct a "story" about what happened and what went wrong with a medical  case that has nothing at all to do with the actual medicine or science but everything to do with histrionics and "creating" a "story" which you can sell to the judge and jury, the "thirteen ignoramuses" of our medical jurisprudence system.

In essence, the conventional wisdom is a bad outcome can always be made the doctor's fault. So they bring some "train wreck" of a case and drop it at your doorstep and you are the one at fault.

Medicine and surgery, as they are judged by physicians and surgeons, are all about process: Did you follow the rules, proceed carefully, as you were trained?  If you did everything you were supposed to do--a pretty heavy burden to begin with--and things go wrong, it's not your fault. 

As one of my residents told me, pulling me aside after a patient with lung cancer filled up with fluid and had a respiratory arrest and then a cardiac arrest and refused to be revived despite all our efforts.  
"Look," he said, pointing his finger in my face, "You didn't give this guy lung cancer. You didn't sock his lungs full of tumor, and you didn't give him sub-pulmonic effusions. You tapped those effusions, as you were taught to do, and he got hypotensive, as patients sometimes will, and he stopped breathing, as people are apt to do under those circumstances and you zapped him and his v tach responded, which was very nice, but it did not last, so he went into V fib and asystole, which patients with all this shit will sometimes do. It's a bitch, but it's not your fault."

Of course, the personal injury malpractice lawyer will not see it that way. He'll read your chart notes and he'll spin a story for the jury that you stuck a big needle into this guy and then he died and it's your fault.

Peter Roskin, the Republican Congressman who did the stunt with the ripping up paper did all that. He is a personal injury lawyer who grew rich from stunts like that, collecting his share of ill gotten gains from such lawsuits.  And he brought all that to the halls of Congress, in an attempt to discredit Hillary Clinton. There was a bad outcome--the Ambassador died. Clinton is like those fat, rich, uncaring doctors who screw up and just go home for the night in their fancy cars to their fancy homes. 

Must be somebody's fault. We can usually vilify some authority who had responsibility for his care.  

This is the same man who calls climate change, "Junk Science."

The wonder is, he probably thinks he actually knows something about science and something about responsibility.

He goes to bed at night having convinced himself he is a hero.

October in New Hampshire

Route 88 Exeter Road, Hampton Falls

I brought my camera along on my Saturday morning bike ride through Hampton Falls to Exeter. I've only been in New Hampshire 7 years, so I've not got inured to the fall colors or the seacoast, and even though we are past peak leaf peeping season, the colors are still vivid and changing. The sugar maples and beach trees are yellow and orange and the next wave of leaf changes is coming. 

Ice Pond, Hampton

We have two Norway maples in our backyard, those forbidden trees, illegal to buy, transport or plant in the Live Free or Die state, and their leaves are supposed to turn from maroon to bright red, but this year their leaves have simply curled up at the edges and turned a sickly tan and haven't even bothered to fall off the branches yet.

No matter, the sugar maples behind them are all ablaze. 

Dearborn Road, Hampton

The air is clear and there is the occasional whiff of wood or leaves burning, which brings back memories of childhood.  It is still legal to burn your leaves in Hampton, New Hampshire, although my neighbors do not do that much. They tend to rake them or blow them with machines and then deposit them among the trees in their backyards. Since most people around here have at least an acre lot, and the majority have larger lots, there is plenty of room for leaves and compost piles. The town dump (recycling center) is only 2 miles away and they take bags of leaves. 

Where I lived in Maryland you'd have three fire trucks and a police car at your door if you tried to burn leaves and you'd be lectured by all your neighbors about how you'd just contributed to global warming and air pollution by leaf burning. Somehow, that doesn't seem to be a problem in leaf country.

Plaice Cove, New Hampshire 

Hampton, New Hampshire 

Fall is beautiful in the East, from North Carolina to Maine, but I'll take Fall in New Hampshire any day. It feels brooding, full of portent and every year this time, I read the paragraph with which Grace Metalious opened Peyton Place, and I feel New Hampshire has a special claim to Fall, even though she is talking about a special sort of Fall, Indian Summer:

Hampton Falls 

"In northern New England, Indian summer puts up a scarlet-tipped hand to hold winter back for a little while. She brings with her the time of the last warm spell, an uncharted season which lives until Winter moves in with its backbone of ice and accoutrements of leafless trees and hard frozen ground. Those grown old, who have had the youth bled from them by the jagged edged winds of winter, know sorrowfully that Indian summer is a sham to be met with hard-eyed cynicism But the young wait anxiously, scanning the chill autumn skies for a sign of her coming. And sometimes the old, against all the warnings of better judgment, wait with the young and hopeful, their tired, winter eyes turned heavenward to seek the first traces of a false softening."

Towle Farm Road, Hampton

There is so much going in those sentences. We know what this splendid season is heralding. Snow blowers are flying out of the stores. After last winter, even I bought one. We know it is coming, like the invasion at Normandy; we just don't know when.  We are prepared, and we can feel its rumblings, and knowing that autumn will not last, that is is temporary and simply a staging platform for what is to come, invests this time of year with an urgency, a live now for tomorrow...It's like second semester senior year in high school, the last party before graduation and launching into the hard world to follow.

There's a lot going on now.

Lawrence Lessig: Sine Qua Non

Professor Lessig

Professor Lawrence Lessig has taken leave from Harvard Law school to "run" for President.
Of course, he is not really running for President because anyone who is actually running for President behaves as if he wants to win and serve as President.
The professor is doing what professors like to do: He is generating discussion, trying out ideas, examining thought, but he is not concerned with the practical, real world consequences of those ideas.

In this sense, he is like my other favorite professor of public policy, Paul Krugman, the former Princeton, now CCNY economist, who once remarked he did not want to become part of the government because then he would have to deal with the practical implications of putting into action his ideas.

Professor Lessig spoke at a recent Hampton Democrats Picnic, a backyard affair attended by surrogates for the Democratic Presidential candidates and by Lincoln Chafee (who is running for President for reasons I have yet to fathom) and about  fifty local citizens.  

He is a masterful speaker, the best of the day, with the possible exception of Hillary Clinton's surrogate, the Congress woman from the 1st Congressional district o of Connecticut (which includes New Haven.)  But while every candidate or the surrogate covered a broad range of concerns from immigration to healthcare to terrorism, Professor Lessig hewed to the single issue he says is necessary to address before any other business of government can proceed: Campaign financing, the idea that our Congress is up for bidding, is bought and sold and every member of the legislative branch spends most of his or her day soliciting bribes from people with enough money to make a difference.  The system of allowing Congressmen and Senators to phone for money is nothing less than a system of sanctified corruption and until we have a Congress which serves its constituents rather than its patrons, we have no sort of democracy at all. Or, as my grandfather was so fond of saying: We have the best Congress money can buy.

He is correct, of course. Like the hedgehog, he knows one big thing. The fox is a very clever animal, and knows many things. The hedgehog is a simple animal and knows only one thing, but he knows that one thing very well.

The problem is, if you are actually asking people to vote for you for President, they will expect you to be more than a designated hitter. 

Anyone who watches "West Wing" has to be impressed by the sheer magnitude of the scope and spectrum of problems faced by the President and his staff daily. If there were ever a case for a liberal arts education, watching "West Wing" should convince us the president should be broadly, which is to say, liberally educated. From science to economics to engineering to psychology to political science to sociology to anthropology, every discipline is relevant to what a President should, ideally know something about. 

In one of the best sequences of this episode of "West Wing," Donna, a campaign worker, has to go around to interview other "candidates" who want to be considered by the voters in the Iowa caucuses: She meets one man who is running because he wants to make it a crime to not carry a gun in America. There is another whom she calls a "refugee from Hootenany" whose main concern seems to be singing folk songs with political messages. This, of course, calls into question who can claim to be considered a serious candidate, who deserves a place behind a podium on the stage at the debate

Clearly, in modern times, we have had men who simply were not smart enough or well educated enough to function effectively as a President, George W. Bush being the prime example. 

Lessig is actually portrayed in an episode in Season 6 where a group from a newly liberated former Soviet republic arrives at the White House, asking for help to write a constitution for their new democracy.  Toby, the show's most cerebral, passionate and opinionated player, tells them they should not want a Constitutional democracy at all; what they should really want is a parliamentary democracy. No, they reply, they want a government with a strong executive leader, like the American government.  A parliamentary systems would dissolve into chaos because the prime minister is not powerful enough to keep the government together. But, Toby points out, a constitution is not enough; what really makes a constitutional government work is the mindset of the citizens who want the government to work, who use the written document as a touchstone and a point of reference from which to begin the discussion, but it is not a guarantee of success. Most constitutional democracies have failed because the president becomes a monarch, Toby says. 

In the show, Lessig is invited to the White House--I can only imagine Professor Lessig approved of his portrayal in the script--and he argues that the Constitution is a living document which allows for government, and even though this former Soviet republic has no tradition of democracy, neither did our country when we first set out. All we needed was a few good men, and this particular former Soviet  republic has a critical mass of that. 

Elsewhere in the episode you see a very principled candidate for President, played by Jimmy Smits, compromise his principles in Iowa by endorsing corn derived alcohol as a gasoline additive, even though it is a billion dollar a year boondoggle which does nothing to benefit the environment or global warming but exists only to feed the accounts of some farmers but mostly big agribusiness. A more  principled  candidate refuses to tell the Iowa farmers what they want to hear and he is booed from the platform and chased from the state. Smits has done his calculation: He cannot do the things which matter most to him if he refuses to do things he doesn't want to do on issues less important to him. You have to pick your fights in politics.

So these are the things real candidates must do--abandon some battles and some constituencies to survive and fight another day.  It can be wrenching:  you sacrifice some troops and allow them to die, lose one battle, so you can win the war.

Professor Lessig has floated the idea that once he accomplished the reform of campaign financing, once he got money out of politics, he could resign the Presidency--our work here is done. 
The problem is, people elect a President for more than that. Even Lincoln who maintained his main job was to save the union had to address many other issues, from commuting and pardoning to appointing men to be government functionaries. The Presidency is broader than any one issue.

Dr. Lessig has only one core principle and he cannot compromise it. 

He can be a professor but not a President.

The Death of Deven Guilford

Deven Guilford: Dead

This morning, on the basement treadmill, I saw some CNN or MSNBC story on the shooting death of a Michigan teenager during a traffic stop, and like most of these stories, you know you don't have all the information you'd like if you were a juror but you can see the cop cam video, and you can hear the now dead kid and the cop and you are told the policeman used his Taser and then shot the boy 7 times, unto death.

What was really intriguing was the two pundits to whom the bimbo reporter posed her inadequate questions.  One was a shaved head retired NYPD detective who kept insisting the boy refused to produce his driver's license and his insurance information and his registration so he was refusing to cooperate with the officer. This constituted a threat to the officer's life--the all purpose excuse for any policeman who draws his weapon and shoots a citizen to death. The boy might have refused to get out of the car because he had a gun and the policeman could only be safe if the kid got out of the car. Anyone who has seen the movie "Fargo" has seen what the police fear--the gun in the car.  

But the policeman clearly had other options, to wit: Back away from the car, and call for help. Surround the car with police and defuse the situation with overwhelming force. Instead, this school yard bully policeman went all cowboy, drags the kid out of the car, wrestles him to the ground and now he's got a fight on his hand and gets his face bloodied.

There are many photos of the cop after the incident with  battle wounds to his face: I gotta say, I looked more bloodied after most of the roller hockey games I played with my kids, after any high school school wrestling match, or just after running into my bicycle hanging from its rack in my dark garage. 

But the shaved head cop is unyielding. The kid did not obey commands. He got what was coming to him, to anyone who does not obey a policeman on the scene, i.e., sudden death.

There is a black guy, who can hardly get a word in edgewise, the other pundit, who points out:
1/ It is not against the law in Michigan to flash your headlights.
2/ The kid told the cop he had flashed his headlights at the officer's car because the officer had his brights on and the kid was signaling to turn the lights down. The cop explains, during the video, he has new car and the headlights are bright and look like high beams when they are on normal and the kid replies, quite reasonably, "Then you need a new set of lights."  Minutes later, the kid is dead.

What nobody points out is that the cop could be reasonably accused of "entrapment," i.e. he has provoked an act which, had the kid been left alone, the kid would never have done, namely flashing his high beams.

But what is so manifest is the pundit TV  policeman (retired) is determined to defend the cop who fired the 7 shots, no matter what the facts of the case may be. "He felt his life was in danger. The driver did not respond to the policeman's commands."

In the world view of the policeman, he is the sovereign monarch of the road. Any command he issue is reasonable and any citizen must obey. Echos of Sandra Bland, the woman arrested in Texas for changing lanes without signaling, found dead three days later in  jail.

What government official in this so-called democracy of ours has that much power?  
Was the Constitution not written by a group of men who were so sick of local bullies called the King's Men, that they wrote the Bill of Rights to address the specific bullying tactics:  Citizens are protected from Unreasonable Search,  from Unreasonable Seizure (which we see manifest in this cop's actions).  

Stepping back from the details of this particular horror show, I think, at my advanced age, I have seen enough videos to conclude:

1/ The quality of the police on the road is woefully inadequate. You can dress these guys up on fancy uniforms, but they are still the kids from the playground who, if they hadn't gone to the police academy, would have been holding up drug stores and gas stations. In the old days, men became policemen because their fathers had; today it's just as often men with personality problems. 

2/ The restraints on their behavior are inadequate.

3/ We ought to be be re thinking allowing police out of the station house. We might be better off with surveillance cameras deployed than police deployed, and like those traffic cameras which capture you speeding and you get a ticket in the mail, you have lots of cameras and robots to deal with misbehaving citizens. Once you do decide to send out the cops, you send out a team, including a lawyer to apprehend and you video everything. 
The arresting officers are and should always be as much under suspicion as the arrested citizen. Every forceful interaction between authorities and citizens is a situation rife with possibilities for abuse of power. 


Decades ago, when I was a medical intern, another intern tried to put a nasogastric tube through the nose of an uncooperative patient. The intern had been ordered to do this by his resident for a good reason. The patient was thought to have swallowed something toxic and this was an effort to suck that stuff out of his stomach, for his own good. The patient refused, pushed away  the arms of the intern and shouted, "No!" The intern persisted, trying to bat the patient's arms aside, but then another resident intervened, saying, "What you are doing is assault. The patient has refused. You note that in the chart. That's all you can do."

We were all shocked. We had all done similar things against the will and wishes of patients, thinking we were acting for the patients' own good. But that resident got us all thinking and we stopped doing stuff like that. 

It only took an insider to speak up and say "No."

That's what our cops need now.

Patriot Games: The Democrats Shine

 Maybe I just did not notice, but the fact I did not notice says something--I did not see any of the candidates at the Democratic debate wearing lapel American flag pins last night.*

I am so happy about that. 

Worse than no patriotism is phony, dime store patriotism

However you want to think about patriotism, for me, patriotism is phony if it does not involve personal cost, and risk. 

Around April 15th every year, my father would fill out his income tax forms and write his check to the government with a smile. "I'm a closet patriot," he would tell me with a sly smile, in a conspiratorial tone.  "I pay my taxes."  And then he'd add. "And I don't cheat."

For him patriotism meant real sacrifice. Dollars out of his bank account. 

I think it was Ronald Reagan who started the American flag on the lapel thing. Reagan was all about image, all about easy, showy patriotism

Joe Sixpack, who buys a $2 bumper sticker for his F-150 and weeps at the singing of the national anthem before the ball game, thinks he's a patriot.  Nathan Hale he is not.

For my money the real patriot is my neighbor, who lives up the street, and spends her Saturday mornings walking through neighborhoods she does not know, knocking on doors, trying to talk up her candidates, trying to persuade her neighbors. She is no more than 64 inches tall, a wisp of a woman, but she walks all morning and then goes home to man the phone banks in the afternoon.

One day I had a route which overlapped hers and I found myself in a Dogpatch part of Hampton, an unpaved road, an eviscerated deer hanging from a tree branch its antlers touching the ground, its trunk flayed open, flies working on it. In the driveway, a pickup truck with the inevitable gun rack and the , "These Colors Don't Run" bumper sticker. 
I looked this scene over and decided to pass. Wasn't worth trying to convince this guy to vote for Obama.  Not a likely vote for Obama. 

But my co-worker was undeterred, she arrived later, all alone, marched up to the door, rang the bell,  and when the deer slayer ambled over, no doubt scratching his hairy belly, as he stepped out on the porch, she handed the $2 patriot her pamphlets, and doubtless,  batted her baby blues at him and she  said, "Hope to see you at the polls."

"Are you out of your mind?" I asked her, later. "That guy had a shotgun on that pick up truck. You're lucky he didn't hang you up right next to the deer."

"Hey," she said. "This is New Hampshire. Besides, no guts, no glory."

The lady had both. She is my idea of a real patriot.

* [Actually, I just looked at the photos: Martin O'Malley had one, but small, discrete. Bernie Sanders had a lapel pin but I cannot tell if it is a flag or his US Senate pin. He could be forgiven, having described himself as a socialist, you've got to cut him some slack.]

Putin and the Pundits

The Man is Reptilian You Must Admit That 

The other night I watched some pundit on Charlie Rose or The News Hour or some such declaiming how Vladimir Putin had "seized the initiative" in Syria and is "making us look impotent and adrift" and how Russian "prestige" in the middle East is soaring and American "influence" is waning, set adrift by a President of the United States who "looks weak."

Whenever I hear the words "prestige" or "honor" my antennae go up and lights go off in my brain and I think of my father's words.

My father was sitting at the dinner table telling my mother about a meeting where a physician was talking about something to do with Medicare. This doctor had been at a university hospital but left his position to work for the government. It was the early days of Medicare and the program was growing and these federal employees, my father among them, were trying to figure out how to steer the program in the right direction. After the meeting my father asked the doctor why he would quit doing medicine to sit around meetings in dreary government offices and pull a federal employee's salary. The doctor had some explanation which you might expect--he wanted to do more good for more people, something which sounded noble like that. 

But my father persisted: "But you're a physician. You know things. These guys here, these bureaucrats, these government workers, these sociologists, economists, none of them know anything."
"Oh," the doctor replied. "I don't know about that."
"Well, I sure as Hell do," my father replied. "They just make stuff up they want to believe and then they invent numbers to support it. Sometimes they get help from the numbers fabricators but none of it comes close to science."

I always think of that when I hear the "pundit" on TV inveigh against the drift of American foreign policy and how we are losing our leadership role. As if America ever did or could ever have a "leadership role" among the Syrians who are trying to kill each other.

As if some white bread guy sitting at the Brookings Institution or the Heritage Foundation really knows how America "looks" to some Syrian with a grenade launcher in his hands. As if we should care how we "look" to some ISIS maniac. 

We got into Vietnam because of fear, fear that we'd "look" weak to the Commies. Fear that if we didn't fight them in Hanoi, we'd have to fight them in the streets of San Francisco. 

How do these bozo's get on the airwaves? 

PS: It was Maud who first pointed out the resemblance Putin bears to a lizard. Since then, her observation apparently went viral enough that his visage is routinely displayed with his spiritual kin.

Class Notes: Oh, How We've Changed

brag·ga·do·ci·o

ˌbraɡəˈdō(t)SHēˌō/

noun

1. 1. boastful or arrogant behavior.
2.      2. Of or related to Weill Cornell Medical College

Hard along the East River estuary in New York City, stand the hospital and medical school which are my alma maters. Modeled after a papal palace, ensconced  on the chic Upper East Side, modesty has never been a virtue for which anyone there has striven. 
But the arrival of my alumni quarterly magazine brought fresh reminder of the value of that lost virtue--modesty--especially in the dog days of Trump.

Typical of the ability to spin almost anything into bragging rights is this gem among the alumni notices:

"Paul [M] MD, '75, clinical professor of medicine...was featured in a CBC Cares public service announcement televised nationwide and watched by some 75 million viewers during March, Colorectal Cancer Awareness Month. Dr. [M] is a longstanding consultant on health topics to CBS Cares...His appearance follows previous successful televised public awareness programs such as the 'Colonoscopy Sweepstakes,' where winners were given a free vacation in New York City along with a screening colonoscopy."

Well, there is something to tell your grandchildren about.

In prior years,  announcements in the Class Notes section of the quarterly reported publication of a new textbook by some alum or the winning of a Nobel prize, or appointment to the chairmanship of an academic department at some famous medical school, or retirement after a 40 year career tending to the needs of doyens of Park Avenue and the Upper East Side. 
Now it's come to this.

But better, here's another:

Charles [F], MD '89: "After barely surviving the economic downturn of 2008 I eventually sold my LASIK practice in San Diego in 2012 and took a consulting position to set up a LASIK center in Guam."

Now there is something to inspire medical students of today.

There was one item which must be inspirational, noted in passing: 
"When I am not working I am introducing my 6 year old daughter (yes, that is right) to the adventures the city has to offer."  

By my back of the envelop (actually hand held calculator) she had that child at age 46, which should tell prospective interventional radiologists what that career path will do to your basic life choices.

But, somehow my favorite:
"I will be moving to a 7,600 square foot building with two fully accredited operating rooms and a full service medical spa."
This alum was, presumably, too modest to say he owns this building, clearly the crowning achievement of his entrepreneurial career.

But he hardly compares to the man who reports (in the 3rd person): 
"After having started 28 new companies over the past twenty years, he is proud to commit most of his entrepreneurial talents to growing his NBI companies located in Montana...He has a new grandson, who will become a physician like both his parents--extending the..dynasty of physicians that started in Toulouse, France, over 100 years ago."

Which left me wondering: This "new" grandson, is he an infant, for whom plans to extend the dynasty are already being laid, or is he a 20 something "new" grandson by marriage or adoption? Not clear. If he is really a new person, i.e., a baby new grandson, I'd say he has a very tough road ahead of him in that family, especially if he is strong musically and wants to become a rock star. 

Well, that's the report from the alma maters, where all the women are strong, all the men good looking and everyone is very much above average.

Knowing What Good Is

One of the best physicians I ever ran across was a man who went to the American University of the Caribbean.  What made him so good?  He read constantly, kept up with all the news in his specialty, infectious disease, which among all the specialties is constantly changing as infectious organisms become resistant to antibiotics and new antibiotics come on line. But more than that, he never failed to take the time to remove the dressing on the wound, which few of his colleagues ever took time to do because time is money and it's such a chore removing dressings and reapplying dressings. He just had that self discipline. If the test of character is what you do when nobody is watching, he passed that one with flying colors, which few of his Harvard educated colleagues did. He stuck with patients, through the hard times, often at his own inconvenience and pain. 

Having said all that, he is the exception. Can you conclude graduates of the American University of the Caribbean are all like him? Not a chance. There simply are not a lot of doctors like him anywhere.  

Decades ago, I thought I could judge other doctors by looking at their training:  If you went to Harvard Medical School, then did your internship at Mass General or one of the other Harvard training hospitals (The Brigham, the Beth Israel) then you were well trained and smart and likely a top notch doctor.  Ditto for graduates of Hopkins and Columbia and Cornell, and for people who trained a big, busy hospitals like The New York Hospital and Memorial Sloan Kettering. Eventually, my world view broadened as I realized not all the smart people were trained on the East Coast, so people who trained at Baylor in Houston or University of Pittsburgh or University of California, San Francisco or University of Washington, Seattle were admitted to the club.  

It was always true there were foolers: Yale, for all the fame of its undergraduate university and Brown and Dartmouth had medical schools which were simply not of the same caliber. 

But the basic idea was you could tell something about the person from the soil in which he or she was grown. Since every physician had to come up through academic centers, from universities, if you could learn the few dozen academic centers, you could establish a hierarchy of quality in your own mind. 

Then came the advent of corporate medicine. Go looking for a job and you find yourself sitting across the desk from a person who had not gone to medical school, who had no idea about this hierarchy and behind that person was a framed diploma from Northern Essex Community College and that person had no idea about judging doctors by the names of their schools. All that mattered to this person is whether or not the doctor had passed his or her licensing exams and maybe his or her board exams, as if anyone who passes these exams is as smart, well trained and well prepared as any other. 

This is the age of "metrics" in which judgments of quality, which were once the provenance of professors of medicine who did rounds with their trainees daily, who quizzed their trainees and read their notes and listened to their presentations, discussions and analyses of cases, now all that evaluation was reduced to "Did he pass his exam?"  

Today, I looked at the training of a new physician who was hired by the corporation which hired me. He was born in Cambodia, graduated from the Saba Univeristy School of Medicine in Saba, the Dutch Caribbean, did his residency in family practice at the Guther Robert Parker Hospital in Sayre, Pennsylvania and he passed his boards in Family Practice.

Is he as well trained as the man who trained at Columbia Presbyterian hospital in New York City where there is a large volume of patients and a huge variety of diseases both common and exotic?  Is it possible to imagine a physician who trains at a small community hospital and sees only a thousand patients over three years with a hundred diseases is as well trained as a man who trained where he saw ten thousand patients and five hundred diseases from the very common to the very exotic?  They both passed the same board exam. Are they not equivalent? 

When systems are designed by people who know only about the design of systems, but not by people who came up through the trenches can they function as well?  This may apply not just to medicine, where doctors who know medicine are no longer included in the process but have been replaced by young MBA's and managers with degrees in system management. This can be applied to the military or to auto manufacturing, I would think.

I do not have the answers, just the questions.  The first is: Have we built dysfunction and low quality into the system?