An Incomplete Memory

I had the most interesting and instructive experience yesterday.

I was driving back from visiting a friend who was rehabbing from a severely broken left femur that required surgery a month ago.

I was listening to THINK, the KERA program with interviews of authors, journalists, and researchers. The guest was Casey Gerald. His autobiography, They’re Will Be No Miracles Here!, tells of being raised by an ex Ohio State football player cocaine addict and a bipolar often absent mother. Nevertheless after high school in Oak Cliff he attended Yale and got an MBA from Harvard.
I did not get his name as I drove but heard him tell of his father Rod at OSU. When the host, Krys Boyd, repeated his name I was suddenly thrust back in time.

One fall many years ago I was watching football on TV. Ohio State was playing an opponent whose name I can’t remember. What I do remember is that the quarterback for OSU was Rod Gerald. (Now when I look him up I see that he was the quarterback for the 1976 and 1977 seasons and led OSU to an Orange Bowl victory in 1977.}

Early in the next year after that football season I was returning from someplace south of Dallas. I went to the Home Depot on Interstate 20 in South Dallas to buy I know not what. What I do remember is asking a store employee for help. I was surprised when I looked at his name tag. On it was written Rod Gerald. I said to him that another Rod Gerald played football at Ohio State. Sheepishly he admitted that he was the same Rod Gerald and had left OSU involuntarily. I do not remember anything more of what he said – was it academic? (I think so) or disciplinary? (I can find no record of Rod Gerald leaving OSU).

So I saw Rod Gerald play football on TV and then saw him a few months later in a Home Depot in Dallas. It was such an odd coincidence I’ve never forgotten it. That I am sure of.

What I don’t remember is the year it happened, why I went to Home Depot, Where I went before or after, or anything else Rod Gerald said to me. That it occurred in 1977 seems earlier than I would have thought because my hazy recollection is that my wife, Cherry, was with me. We were not married until 1979. But we were dating in 1977 so that date is possibly correct. She has no memory of this event but then she wasn’t watching football then.
Maybe there was another Rod Gerald or Rod Jerrell that played later at OSU but I can find no record and that seems unlikely.

My vivid memory of a chance encounter is incomplete but no less real to me and is as accurate as I can recount.

Does this remind you of a recent tale of a vivid memory that has been savaged for its incompleteness? A reference to that memory in a recent adolescent rant by the President in Mississippi comes to mind.

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I didn’t leave medicine. Medicine left me.

I just came from sitting with a friend in the Baylor Emergency Department.  It reminds me how much medicine has changed since I entered it 50+ years ago. Finishing my training in 1972 I was scheduled to leave for Stanford medical Center and a residency in nuclear medicine. However literally at the 11th hour I decided that leaving my two young daughters in Dallas, even though her mother and I were divorced, was something that I could not do. And so several fellow residents at the VA hospital and a Methodist Hospital began forming a medical group that would be located at the nascent Medical City Dallas Hospital, being built by Trammell Crow and Bob Wright. Putting that group together as the Dallas Diagnostic Association is the most memorable job I have ever had.

DDA original nineWe started from nothing and ended up two years later with the best single specialty group in Dallas. Creating the group was fun and being part of it was inspiring. Until the second generation doctors were recruited to join the DDA we were a creative group, willing to take risk.  As one of them later said “we took it away from you.” The fun ended, I left and spent the remainder of my career practicing more or less alone.

Now medicine is corporate, doctors have jobs, and more time is spent filling out forms than treating patients. A good example is the Ebola crisis which occurred at Presbyterian Hospital several years ago. The whole epidemic of Ebola in Dallas could have been prevented had a simple question been asked of the alpha case. “Have you traveled anyplace overseas recently?” But it wasn’t and several people died. Interestingly my 88-year-old friend in the Baylor Emergency Department from a fall was asked that very question, probably as a result of the Ebola episode. But for the three hours we were in the ER waiting for a room, at least five people (none doctors) entered and asked her the same questions about her medicine, her Medicare, did she have an advanced directive, etc.?  Apparently collecting information is valued but sharing it is not. We are wedded to technology and the doctor-patient relationship is mostly of historical interest now.

When I was practicing at the DDA and solo, before medicine changed I was a diagnostician. Patients came with a myriad of problems and my job was to sort them out, identify them, and either prescribe or refer them for appropriate treatment.

1978 in DDA office

However, one of my regrets is that intellectual medicine takes a backseat to procedural medicine. Payment for thinking continues to be undervalued and thus underused. Three unusual cases come to mind that I diagnosed that probably saved lives -a case of *malaria in a college student returning from Mali (Timbuktu) that had not been diagnosed at the UCLA Medical Center;  a case of  *coarctation of the aorta in a young woman who had almost died in childbirth; and an *insulinoma in a middle-aged woman who was having fainting spells. The malaria was treated with medication. The coarctation of the aorta and the insulinoma were treated surgically.

Taking complex medical problems, finding the right diagnosis, and prescribing the correct treatment was the most satisfying medical job I ever had. That may still occur in medical schools but even they are now driven by the profit motive. Technology trumps a history and physical.

I grieve for my former profession.

 

*Malaria is one of the most common diseases in the world, carried by the Anopheles mosquito. The malaria parasite injected into the body by the mosquito causes fracture of red blood cells, fever, and untreated organ failure and death. One of the biggest prizes in public health is a way to prevent malaria, especially in Third World countries.

*Coarctation of the aorta is a congenital malformation that constricts the aorta just below the blood vessels that supply the arms. It results in high blood pressure in the arms and very low blood pressure in the legs and abdomen. How she was able to carry an infant to term with such low blood supply is amazing.

*An insulinoma, or beta cell tumor of the pancreas is an insulin secreting benign tumor resulting in excess of blood insulin driving the blood sugar down and causing people to become weak and faint.

 

Drugs, Choice, and the “Free Market”

I went to see my allergist yesterday. One of the treatments she prescribed was Dymista. It is a nasal spray containing an antihistamine (Astelin) and a corticosteroid (Fluticasone). I have been using these separately with some success but the combination simplifies their use. She gave me a couple of samples that will last me 2 to 3 weeks. She mentioned that my insurance might not pay for it. However, since I generally buy my own medication I was not too concerned about insurance. That is until I looked up the price from the wholesaler that I use and found that Dymista is $175 for 30 doses. If used twice a day, like she prescribed, that is a little over two weeks of medication.

I am all for modern medicine and I think many of the drugs we take have improved health and prolonged life but I for one think Big Pharma has taken advantage of us. And the government has been impotent in curbing their rampant greed.

If you bought Dymista at Walmart, which is the cheapest price I found on GoodRx.com, it would cost $188. Its ingredients Astelin ($30) and Fluticasone($15) cost about $45 for the same amount.

Mylan Pharmaceuticals is charging four times as much to combine the two drugs into one formulation. It is much like charging $3 dollars for a cup of coffee and a dollar for cream and then charging $17 for coffee with cream.

This is an example of the “free market” that conservatives think solve all economic ills. If regulators would get out of the way and just let the market decide we would all be better off.

What never seems to come up is why regulations are necessary in the first place. The term “government overreach” is a favorite term of conservatives but what they fail to understand and acknowledge is that the overreach began with players in the market, pushing the legal and moral limits for power and profit. Regulations are a reaction to wrongdoing in the marketplace to try to serve the “common good.”

Until we as a society decide that pharmaceutical price gouging cannot be tolerated the Mylan Pharmaceutical’ s of the world will continue to manipulate and take advantage of consumers for their bottom line benefit.

In a review of William Cavanaugh’s book Being Consumed: Economics and Christian Desire, Alex Abecina says, “Cavanaugh contends that the so-called ‘free-market’, having been detached from objectively good ends, actually leaves consumers vulnerable to economic enslavement under an advertising saturated society, controlled and surveyed by a small handful of transnational corporations. This small but powerful sector possesses the research and marketing ‘know-how’ to produce artificially created consumer desires that are capable of dictating our choices for us.”

Freedom in a “free market” involves freedom to make informed choices, taking into account ethical concerns of fairness and the common good. Absent those parameters the “free market” is just about greed.

Healthcare: Public or Private?

Amid all the hullabaloo about repealing the Affordable Care Act a little noticed meeting took place in Dallas in June.

Dr. Tom Price, the Secretary of Health and Human Services and former Georgia Congressman, met with eight Dallas doctors. How they were chosen is uncertain but the mix was representative of one of the things wrong with healthcare in America. Six of the doctors were male and represented surgical subspecialties or anesthesia. Two members were female and were family practitioners. The minimalizing of primary care input into the debate is regrettable.

The HHS website reported on the meeting that it was very long on complaints but very short on suggested solutions. Sort of like the majority party in Congress.

I have contended for some time that if I gave anybody a magic wand and said “Fix healthcare in America.” That person would be unable to come up with a solution acceptable to all.

President Obama reportedly said,” If we were starting from scratch, a single payer system would make sense.” But we aren’t starting from scratch. Our health insurance system evolved as a way to give workers benefits without raising wages. Then unions fought for it and it became an expectation. Then President Nixon introduced the Health Maintenance Organization Act of 1973 and the “BUSINESS” of Medicine was off and running. And thus we have large hospital organizations that one doctor said are really only construction companies funded by sick patients. It is hard to pass a hospital these days without a crane in the sky signaling more building. And those buildings must be utilized and thus the other thing difficult to escape is advertising billboards on major thoroughfares. Did you know the United States is only one of two industrialized country that allows direct advertising of prescription pharmaceuticals to consumers? (New Zealand is the other)  “Ask your doctor…”   has become as ubiquitous as “This Bud’s for you.”

Say what you will Big Pharma, Big Insurance, and Big Hospitals are not going away. I have always believed that single payer with its lower administrative overhead and universal coverage was the best solution in a perfect world. And it still may be the solution America ultimately comes to. But what do we do about all those health insurance executives and employees?

Consider this before you answer. According to CMS (the agency that administers Medicare/Medicaid) there is roughly one Medicare/Medicaid employee for every 21,800 insured lives. For Health Insurance Companies there is one employee for every 340 insured lives. In other words a CMC employee handles 64 times as many lives as does an employee of private insurance. Score one for single payer.

But are we going to put over 500,000 people out of work? I think not. So is there another way to consider? Many students of healthcare policy advocate for a system like Switzerland’s which utilizes private insurance. Although it is the second or third costliest of the industrialized nations it is still 6% lower as a percentage of GDP than the U.S. (17.3 % for U.S. and 11.5% for Switzerland). So a Swiss system might save 6% of our GDP, a significant amount. So what are the tradeoffs to an annual saving of upward of a trillion dollars? The tradeoffs are: 1) Coverage is mandatory. 2) The Government defines the basic minimum policy that must be offered. 3) The Government controls prices for hospitals and doctors.  And 4) although now only a Swiss healthcare proposal, Government negotiation of drug prices will produce further savings.

For conservatives the “G” word is anathema. But they must face the facts that no profit driven system for healthcare has ever worked without some control on usage and pricing. Somebody has to decide how we use these resources. The doctors who met with Price want unfettered ability to treat and charge what they like. I did too when I was in practice. But we are only a small part of one of our nation’s obligations to its citizens: to promote the general welfare. To solve the problem of healthcare we are all going to have to give up something. If we can agree on that then maybe a compromised solution will be possible.

Should we obey governments that are bad? Robert Jeffress says Yes

 Jeffress: God gives Trump authority to take out Kim
Robert Jeffress

Dallas pastor Robert Jeffress, one of President Donald Trump’s evangelical advisers, released a statement Tuesday saying the president has the moral authority to “take out” North Korean leader Kim Jong Un. “When it comes to how we should deal with evildoers, the Bible, in the book of Romans, is very clear: God has endowed rulers full power to use whatever means necessary — including war — to stop evil,” Jeffress said. “In the case of North Korea, God has given Trump authority to take out Kim Jong Un.” Jeffress said in a phone interview that he was prompted to make the statement after Trump said that if North Korea’s threats to the United States continue, Pyongyang will be “met with fire and fury like the world has never seen.” The biblical passage Romans 13 gives the government authority to deal with evildoers, Jeffress said. “That gives the government the authority to do whatever, whether it’s assassination, capital punishment or evil punishment to quell the actions of evildoers like Kim Jong Un,” he said. Jeffress knows his comments on North Korea could be considered controversial, even among fellow evangelicals. “Some Christians, perhaps younger Christians, have to think this through,” he said. “It’s antithetical to some of the mushy rhetoric you hear from some circles today. Frankly, it’s because they are not well taught in the scriptures.”                                        From Dallas Morning News 8/9/17  by SARAH PULLIAM BAILEY, THE WASHINGTON POST

Is Jeffress right? Are we obligated to follow Hitler or Stalin or Putin?

Should we obey governments that are bad?
Matt Slick

Romans 13:1 says, “Let every person be in subjection to the governing authorities. For there is no authority except from God, and those which exist are established by God.” If this is so, what about the bad governments like the Nazis or the Communist regimes where they killed millions?  If God is the one who sets up governments, are we supposed to obey those bad governments? The answer is no. We are to obey governments unless they violate Scripture.  Acts 5:29 says, “We must obey God rather than men.” Whenever a government violates biblical teaching, Christians are obligated to disobey that government.  For example, if a government were to declare that we should kill all Asians, or immigrants, or people with Down’s syndrome, we should disobey.  Governments are run by people and often become corrupt.  Furthermore, the Bible never tells us to obey governments in contradiction to the revealed word of God. In the Old Testament, God sent the Israelites to destroy different nations.  Technically speaking, we could say that God set up those various governmental systems that he told the Israelites to destroy.  But when systems become ungodly and anti-Christian, they are no longer properly representing God and should not be obeyed. Are we seeing a conflict or a contradiction?  Not at all.   Let’s take, for example, Exodus 20, where we see two commandments: obey your parents and do not murder.  We can see that our parents are the authorities above us, even as governments are, and we should obey them.  But, what should we do it our parents tell us to murder someone? Should we obey?  Of course not.  Obedience to our parents is only proper when it’s consistent with the rest of the Scriptures.  Likewise, submission to the governmental systems is only proper when it is consistent with Scripture. Finally, let’s look at Rom. 13:6-7, “For because of this you also pay taxes, for rulers are servants of God, devoting themselves to this very thing. 7 Render to all what is due them: tax to whom tax is due; custom to whom custom; fear to whom fear; honor to whom honor.”Notice that Paul says that the rulers are servants of God.  This is the context of the submission that is mentioned at the beginning of the chapter.  If these rulers are no longer servants of God, and if they contradict Scripture, they are not to be obeyed.

Matt Slick is the President and Founder of the Christian Apologetics and Research Ministry.

https://carm.org/questions/skeptics-ask/should-we-obey-governments-are-bad

GOD ALONE IS LORD OF THE CONSCIENCE

Westminster Confession of the Presbyterian Church Chapter 20

 

 

 

“Stuck in the sandbox, you must play with the toys you have.”

 

Jon Michael Hill plays Moses and Ryan Hallahan plays Mister in Antoinette Nwandu’s “Pass Over” at Steppenwolf Theatre. (Photo Michael Brosilow)

My friend Lance Sterling sent me this recent musing on the Sun-Times review of the play Pass Over. The Chicago Sun-Times critic has caught a lot of grief for it. Click the link below to read the review.

Pass Over review by Hedy Weiss

Lance’s response

Recently, Hedy Weiss,the famous theater critic for the Chicago – Sun – Times, wrote that we need to avoid white cop stereotyping and pay more attention to black on black violence. The reaction to her veiled racism was swift and brutal. I am one who reacted.

While it is true that there is far more black on black crime than white cop on black citizen crime, the second is more insidious than the first. Blacks kill one another for social reasons not racial ones. Stuffed in the ghettos that whites have created for them, blacks fight with one another over limited resources, like dispossessed people everywhere do. They indulge in life – and – death disputes over drugs, over turf, over illegal business deals, over supremacy (elsewhere called “market share”), over power. There aren’t many other options, but one black has never killed another black because he was a nigger.

White cops do that. And white juries generally acquit them, despite videos and eyewitness accounts. Not surprisingly, white juries convict blacks of all crimes in disproportionate numbers. Surely there is a commentary in the fact that almost half of this country’s 2.3 million prisoners are black. Something is amiss, and blacks know from an early age exactly what it is. Like our president pointed out, “The system is rigged,” just not in ways he supposed.

When blacks kill blacks for the reasons suggested above, they are behaving like any nation state, like America. Largely segregated among themselves into enclaves, blacks quarrel over the usual issues, all related to power. Like America, they want more power. As the Mafia says, “It’s business.” But it’s not discrimination. It’s trade and economic superiority and jobs, all the causes America fights for. When Trump says he is going “to make America great again,” whites applaud the very objective they dislike in blacks. If blacks had oil, they would be fighting over it. They have drugs and other cultural flotsam, so that is their casus belli. Stuck in the sandbox, you must play with the toys you have.

This problem will be cured when blacks are, if ever, fully integrated into white society. Blacks will compete like whites, equally ruthless but in a more socially approved manner, cutting throats figuratively, not literally. But make no mistake: Their cause is a racial matter. When the white community gets rid of its sense of racial superiority, social equality will follow. Enfranchised, blacks will no longer have a reason to quarrel among themselves. They will compete in the larger society and embrace the methods and tools of that society, as conniving as whites but in a way that whites recognize and approve of. And white cops won’t shoot blacks any more than others. I don’t want to paint too rosy a Pollyanna picture. Cops will always be cops. Like all people with power, they will always be bullies, always except (sic) graft and kickbacks, always shake people down and extort, always use excessive force, and always gorge on doughnuts. But when society stops discriminating against blacks, cops will too.

Statistics will reflect this equality like they now reflect inequality. Blacks constitute about 12% of the population so they should represent roughly 12% of most statistics. We will know progress is being made when our prison population is 12% black instead of 48%; when black drug convictions are 12% of the total drug convictions instead of 80%; when 12% of CEO’s are black; when 12% of those in the top economic 1% are black; when 12% of doctors, lawyers, university professors, and PhD’s are black; and when only 12% of ghetto dwellers are black. At present, none of these statistics applies, which is why black lives don’t matter. Statistics will tell us when they do matter to whites. And at that point, blacks and cops will stop killing blacks.

Lance Sterling

 

 

A message to Pete Sessions about Planned Parenthood

In front of Pete Sessions’ Washington office in April 2017

 

From Congressman Pete Sessions TX32ima@mail.house.gov

 

Dear Dr. David Anderson Haymes,

Thank you for contacting me in support of women’s health services. I appreciate you taking the time to express your thoughts on this deeply personal issue.

Providing access to free and low-cost healthcare is an important part of our healthcare system, particularly in many areas of Texas. Through the Title X Family Planning Program, Congress provides federal funding to millions of low-income women for critically important healthcare services. This funding is a necessity for many of these providers and clinics to keep their doors open. I fully support the funding of more than 13,000 federally-qualified community health centers, which outnumber Planned Parenthood clinics 20 to 1 nationally. These clinics provide not only low-cost access to healthcare for women, but men and children as well.

As you know, policy related to federal funding of abortion is a fundamentally and historically controversial topic. Federal dollars have not been spent on abortions since the first passage of the Hyde Amendment in 1976. I believe that current law should remain intact to protect taxpayers from having their dollars spent on services that violate their moral values.

Again, thank you again for contacting me regarding access to women’s health services. Please continue to keep me updated on the issues that matter to you. If you have any questions or concerns, please contact me at Sessions.LegStaff@mail.house.gov. I look forward to hearing from you in the future.

Sincerely,
Pete Sessions
Member of Congress

From: David Haymes [dahaymes@gmail.com]
Sent: Tuesday, July 18, 2017 8:44 AM
To: ‘Sessions.LegStaff@mail.house.gov’

Subject: A reply to your letter: Planned Parenthood is not the enemy and provides services community health centers do not

Dear Congressman Sessions,

Paul Ryan got 2 Pinocchios for making the same claim you make. The community health centers are not required to see the indigent or offer family planning. The need for Planned Parenthood exists and as you say no Federal funds are used for  abortion services, that account for less than 3% of Planned Parenthood Services. This is a diverse country. Planned Parenthood is not a threat to you or your constituents. Let it rest and get on to bigger issues – taxes, infrastructure, Russian meddling, gerrymandering, healthcare, and our bloated military budget.

David Haymes M.D.

click below to see Ryan’s statements

Ryan disingenuous on Planned Parenthood

From Congressman Pete Sessions TX32ima@mail.house.gov

Thank you for replying. Unfortunately, the mailbox (TX32ima@mail.house.gov) you are responding to does not accept incoming mail.

Too bad. You should open ALL avenues for your constituents to contact you. You should attend the mail box you send from…so you can “LISTEN” to your constituents.