“They’re tryin’ to wash us away.”

Naomi Klein Saying No Is Not Enough                           Randy Newman Louisiana 1927

The term “shock doctrine” describes the quite brutal tactic of systematically using the public’s disorientation following collective shock-wars, coups, terrorist attacks, market crashes, or natural disasters-to push through radical pro-corporate measures, often called “shock therapy.”

(Trump’s) goal is all-out war on the public sphere and the public interest, whether in the form of antipollution regulations or programs for the hungry. In their place will be unfettered power and freedom for corporations.

We don’t go into a state of shock when something big and bad happens; it has to be something big and bad that we do not yet understand. A state of shock is what results when a gap opens up between events and our initial ability to explain them. When we find ourselves in that position, without a story, without our moorings, a great many people become vulnerable to authority figures telling us to fear one another and relinquish our rights for the greater good.

Neoliberalism is shorthand for an economic project that vilifies the public sphere and anything that’s not either the workings of the market or the decisions of individual consumers.

The primary tools of this project are all too familiar: privatization of the public sphere, deregulation of the corporate sphere, and low taxes paid for by cuts to public services, and all of this locked in under corporate-friendly trade deals.

Neoliberalism is a very profitable set of ideas, which is why I am always a little hesitant to describe it as an ideology. What it really is, at its core, is a rationale for greed.



$2.125 million per dose : The Most Expensive Drug in the World

Since retiring I have not read much of the medical literature. However, one publication I still subscribe to is The Medical Letter on Drugs and Therapeutics. It is a twice monthly newsletter that as you would suspect reviews recently released medications and occasionally reviews the treatment of a particular illness.

The July 29, 2019, issue features Zolgensma – One-Time Gene Therapy for Spinal Muscular Atrophy. It describes a revolutionary gene therapy for the treatment of children less than two years old with this debilitating and often fatal illness. It involves the infusion of a manufactured gene carried by a virus into nerve cells, resulting in the synthesis of the missing protein needed for neuro-muscular function. It appears to be one of the first of many “gene therapies,” that are in the pipeline. The FDA estimates that 10 to 20 of these remarkable therapies will be approved annually by 2025.

The Medical Letter said that Zolgensma is approved for intravenous infusion for one dose in children less than two years old. The cost is $2.125 million. That amount jumped out at me and led to a search for more information. The website medicalxpress.com on August 8 reported that approval of Zolgensma was based on manipulated data. However, the FDA and Novartis, the company selling Zolgensma, agreed that the therapy was safe and effective and should stay on the market.

I was curious to find the source of funding for the development of Zolgensma. The website keionline.org reports that “The NIH RePORTer database lists nearly a half billion in grants, when the search term “Spinal Muscular Atrophy” is used…” Almost $150 million in NIH grants have been awarded to three United States investigators. I was surprised to see that one of the investigators is Jerry Mendell, a neurologist at Ohio State University, who was one of my classmates at UT Southwestern Medical School.  From www.latestly.com: Jerry Mendell, a doctor involved in the trial said, “The level of efficacy, delivered as a single, one-time therapy, is truly remarkable and provides a level of unprecedented hope for families.”

Still my interpretation of that information is that charitable donations and NIH grants have funded the research. So why $2.125 million for a single treatment?

The industry argument is that it takes billions to shepherd a drug through the FDA to get approval. They also remind critics that the cost of unsuccessful drugs must be borne by those that do reach the marketplace. But still in my reading I found no one who suggested that much of that cost is borne by charitable donations and taxpayers. Am I mistaken? If I am not what is the return on our investment as taxpayers?

Another suggestion that has not gained much traction is a one-time prize for drug development. The price could be on a cost plus basis, assuming that the true costs of development and approval could be fairly arrived at. Then a prize of say $2 billion would be awarded by the FDA (and lesser amounts could be awarded by other governments) and then the drug would be sold at an affordable price.

Women and Desire: Three Women tell their stories

My wife is in a book club with ten or twelve other women. Each is responsible for choosing a monthly book to read and share. Three Women by Lisa Taddeo was suggested to Cherry and she is considering it for her selection. I often read the books. I just finished Three Women.

            The book could be subtitled “Women and Desire.” It is a raw open account of the lives of Lina from Indiana, Maggie from North Dakota, and Sloane from Rhode Island.

            When I practiced medicine I experienced rare moments with patients when all pretense and façade was stripped away. We were communicating… words seem inadequate to describe… emotionally naked, soul to soul. It could be my revelation of a part of me, but usually came from my patient – a joy, a sorrow, a regret, a dilemma, a desire. The moment was all-consuming and invariably brought tears to my eyes. Locked in a stare we’d realize we were naked. Then we’d look away and the moment was gone.

            Reading Three Women made me think the author had many such moments with her subjects but also those raw intimate feelings were what the women either experienced or were desperately seeking.

            My cousin Carl sent me a video clip of a comedian whose routine explorers What Do Women Want? It is a question men have been asking with varying degrees of seriousness for a long time. If men give any thought to it, I think it is because of their mothers and their desire/need to please her. And yet there is a resentment of that need. Both the desire and resentment transfer to relations with women.

On the other side, I have always felt that women wanted love and security. If they got both in the same package they were reasonably happy and fulfilled. Settle for love without security and a woman was often on an emotional roller coaster of ups and downs and curves that threatened to throw her off. Settle for security without love and a part of her was either repressed, sublimated, or unfulfilled.

            Three Women is about these three women and their search for love with and without security.

            As the song says, “Woman needs man…that no one can deny.” But here too there is an ambivalence. From this book, I saw the world from a woman’s view and began to feel a glimmer of understanding.

            That it’s a man’s world still rings true in most places. Reading Three Women I felt the suppressed rage at being assigned to this one down position all your life.  And yet this book describes the need, the desperate need, to be with a particular man and yet the fear and agony when he becomes unavailable – either temporarily or permanently.

            The tension between that desire and rage is the driving energy of this fascinating book.

            Billy Crystal said women need a reason to make love, men just need a place. The reasons may be described differently, but underneath they are all about need and desire, love and security.

            There is a lot of graphic sex in this book that may be arousing to some and offensive to others. But that is only a small, albeit important part of their search for love and security. These three women tell us soul to soul of that search. As much as a man can, I understand. I am with them.

Let’s Mess with Texas

Let’s Mess with TEXAS!

Now that the midterm elections are complete it is time to do some rethinking. Thomas Friedman the New York Times columnist and author said in a talk at SMU on election night that in our rapidly changing world it is not time to think in the box or out of the box. It is time to think without a box at all.

So in that spirit let’s return to 1845.


 Before we do that let’s look at the US Constitution.

Specifically Article IV Section 3.

New states may be admitted by the Congress into this union; but no new states shall be formed or erected within the jurisdiction of any other state; nor any state be formed by the junction of two or more states, or parts of states, without the consent of the legislatures of the states concerned as well as of the Congress.

We now have fifty states. The last two states admitted were Alaska and Hawaii in 1959. Puerto Rico is eager to be admitted as the fifty first state. 

Now imagine adding four additional states all at once? Maybe American Samoa, Guam, Puerto Rico, and the U.S. Virgin Islands?

No, not those four protectorates. 

How about West Texas, Dallas/East Texas, Austin/Hill Country, Houston/Coast, and San Antonio/Border/ El Paso?

That will never happen you say. …without the consent … of the Congress.

Congress will never give approval dividing Texas into five states. Au contraire mon ami.

They already have!

Back to 1845. When Texas was struggling as an independent nation it agreed to join the Union as the 28th state. The Joint Resolution for Annexing Texas to the United States approved by Congress on March 1, 1845 states

New States of convenient size not exceeding four in number, in addition to said State of Texas and having sufficient population, may, hereafter by the consent of said State, be formed out of the territory thereof, which shall be entitled to admission under the provisions of the Federal Constitution;

That is settled law. Or at least it is according to Michael Stokes Paulsen and Vasan Kesavan in the University of Texas Law Review in 2004 and in the University of Minnesota Alumni News in 2005 .

In some rather clever grammatical gymnastics they argue convincingly that the last phrase of Article IV Section 3 “without the consent of the legislatures of the states concerned as well as of the Congress” applies to all of the three previous statements because the Founders used semicolons instead of periods.

New states may be admitted by the Congress into this union;  ① but no new states shall be formed or erected within the jurisdiction of any other state; ② nor any state be formed by the junction of two or more states,③ or parts of states, without the consent of the legislatures of the states concerned as well as of the Congress.

Trust me!  You’ll have to read the articles if you want more.

https://www.law.umn.edu/sites/law.umn.edu/files/alumninews-2005-spring.pdf page 21


So the US Constitution allows it and Congress approved it. What else is left to do?

All that is needed to make the states of 1) Dallas-East Texas. 2) West Texas-Panhandle,3) San Antonio-Border-El Paso. 4) Houston-Piney Woods- Coastal, and 5) Austin-Central Texas a reality is approval by the Texas Legislature. (“With” the consent of the legislatures of the states concerned as well as of the Congress.)

According to worldpopulationreview.com the current population of Texas is 28.7 million (up from 25.1 million in 2010) and the United States population is 327.6 million. So Texas has about 8 % of the US population but only 2% of representation in the Senate. I know, I know – the Senate was constructed by our Founders to balance out state representation, unlike the House of Representatives which was and is based on population (and gerrymandering!) Dividing into 5 states would give our population about 9% of the Senate votes.

How do you think that might split politically? My guestimate is shown in color on the map. I placed it beside the recent statewide Senate results.

2018 U.S. Senate results Cruz vs. O’Rourke

I think West Texas/ Panhandle would definitely be RED and the border area San Antonio to El Paso definitely BLUE but less certain are Austin/Hill country, Dallas/East Texas, and Houston/Coast. I favor BLUE, PURPLE, PURPLE but you could argue PURPLE, RED, RED. But I think the future favors BLUE, PURPLE, PURPLE.  

Regardless of the mix just imagine Texas with 10 Senators! Mitch McConnell and Chuck Schumer would not know what to do with all those Stetsons and Cowboy Hats!

So Texas Legislature GET BUSY!

Will Texas Become Turkana?

Turkana is the driest hottest county in Kenya. We have visited there on several occasions and have been struck by the friendliness of these hardy people who live in a challenging environment of high temperatures, low rainfall, and ever present food insecurity. As I read about the most recent dire predictions of our threatened environment I wonder of Turkana’s challenges could become our own in the future? Certainly we have more resources and infrastructure than they do but we are spending less on preserving what we have and ever more on well MORE!  You’ll see below that 90% of our citizens are unaware of the danger to our environment and civilization.   As William Butler Yeats predicted in the Second Coming, “Things fall apart; the centre cannot hold; Mere anarchy is loosed upon the world.” So when I think of Texas’ future, most likely after I am gone, I see Turkana. It is not a pretty picture.

Lodwar Airport Turkana

Scientists and the fossil fuel industry know that global warming is 1) true and 2) a likely human catastrophe threatening our very survival.

They have known for 40 years 1 and yet Exxon and other oil companies have used disinformation and outright lies to spread uncertainty in the public. 2   Why? Short term profits AKA GREED!

Dick Cheney
Lee Raymond

The UN report in October 2018 says we are running out of time. They target a temperature rise of 1.5 C⁰ (2.7⁰ F)  that is likely to be exceeded in the next decade. CO emissions now 40 billion tons annually must be halved by 2030 and reduced to near zero by 2050. According to the I. P.C.C. (even 1.5 C⁰ of warming “is likely to be disastrous. Island states like Mauritius (where our daughter and husband honeymooned) fear they will be underwater in the near future of nothing is done, which seems likely.3


The current US administration predicts that global temperatures will rise by almost  4⁰ Celcius.

Which was used as a justification for rolling back EPA regulations for cars and truck that would reduce emissions by 6 billion tons over the life of the vehicle. Their reasoning if this is the scenario, who cares about 6 billion tons? 3

For Texas: 4

“North Texas (will be) one of the worst-affected places in the country.” Amir Jina University of Chicago

  • More record-setting heat in North Texas is a virtual certainty. 
  • North Texas will have longer and more severe droughts with profound economic impacts,
  • Rainfall patterns will become more extreme
  • Hailstorms and tornadoes may become more concentrated and less predictable.
  • North Texas economy is predicted to decrease by 10-20%

There are several contrarian websites that debunk climate change. Some of them sight reputable scientists but all seem to have a right leaning prejudice against Al Gore, the UN, and the threat of one world government. They favor business as usual – low taxes, low regulation, and limited government. To me they are not unbiased or persuasive.

From today’s NYTimes

Whistling past the climate crisis. In The Washington Post, Max Boot, a former climate-change skeptic, issues a mea culpa.“I’ve owned up to the danger. Why haven’t other conservatives?” he asks. His answer is that Republicans remain beholden to both ideology and to industries whose profit lies in ignoring the problem. “It is a tragedy for the entire planet that America’s governing party is impervious to science and reason.” 5

In The Times, Paul Krugman focuses on the financial incentives of the anti-science crowd: “Money is still the main answer: Almost all prominent climate deniers are on the fossil-fuel take.” 6

Can this greedy world be saved? Unlikely. We are short term oriented, pleasure seeking, selfish hedonists and that is going to do us in. To change would require a cataclysmic shift in our values, goals, and behavior. It would require a servant leader to motivate us to change. In my opinion FDR was the last leader with the moral capital to force change and he’s not available.

Politicians and citizens alike will say:

“Why didn’t somebody tell us?

BZZZZZZ Wrong question! Thank you for playing.The correct question is


References and notes

1 The climatologist James Hansen testified before Congress about the dangers of human-caused climate change thirty years ago.

Exxon, the world’s largest oil company, understood that its product was contributing to climate change a decade before Hansen testified. In July, 1977, James F. Black, one of Exxon’s senior scientists, said “There is general scientific agreement that the most likely manner in which mankind is influencing the global climate is through carbon-dioxide release from the burning of fossil fuels.”

In 1978, speaking to the company’s executives, Black estimated that a doubling of the carbon-dioxide concentration in the atmosphere would increase average global temperatures by between two and three degrees Celsius (5.4 degrees Fahrenheit), and as much as ten degrees Celsius (eighteen degrees Fahrenheit) at the poles.

By 1982, they had concluded that even the company’s earlier estimates were probably too low. In a private corporate primer, they wrote that heading off global warming and “potentially catastrophic events” would “require major reductions in fossil fuel combustion.”

            How Extreme Weather Is Shrinking the  Planet, The New Yorker, November 26, 2018

Turkana Village Houses

2 On a December morning in 1997 at the Kyoto Convention Center, after a long night of negotiation, the developed nations reached a tentative accord on climate change. An American lobbyist, who had been coordinating much of the opposition to the accord, turned to me and said,“I can’t wait to get back to Washington, where we’ve got this under control.”He was right.

On January 29, 2001, Lee Raymond, Exxon CEO, visited his old friend Vice-President Dick Cheney, Cheney helped persuade Bush to abandon his campaign promise to treat carbon dioxide as a pollutant.

Within the year, Frank Luntz, a Republican consultant for Bush, produced an internal memo, “Voters believe that there is no consensus about global warming within the scientific community, Should the public come to believe that the scientific issues are settled, their views about global warming will change accordingly. Therefore,you need to continue to make the lack of scientific certainty a primary issue in the debate.”

Downtown Lodwar Turkana

The strategy of muddling the public’s impression of climate science has proved to be highly effective. In 2017, polls found that almost ninety per cent of Americans did not know that there was a scientific consensus on global warming. 


Turkana Countryside

7 The extra heat that we trap near the planet every day is equivalent to the heat from four hundred thousand bombs the size of the one that was dropped on Hiroshima.

As a result, in the past thirty years we’ve seen all twenty of the hottest years ever recorded. The melting of ice caps and glaciers and the rising levels of our oceans and seas, initially predicted for the end of the century, have occurred decades early. 

This past May, a team of scientists from the University of Illinois reported that there was a thirty-five-per-cent chance that, because of unexpectedly high economic growth rates, the U.N.’s “worst-case scenario” for global warming was too optimistic. 

“Like it or not, we will retreat from most of the world’s non-urban shorelines in the not very distant future,” Orrin Pilkey, an expert on sea levels at Duke University, wrote in his book Retreat from a Rising Sea. We can plan now and retreat in a strategic and calculated fashion, or we can worry about it later and retreat in tactical disarray in response to devastating storms. In other words, we can walk away methodically, or we can flee in panic.”

But it’s not clear where to go. As with the rising seas, rising temperatures have begun to narrow the margins of our inhabitation, this time in the hot continental interiors. Nine of the ten deadliest heat waves inhuman history have occurred since 2000. …a heat index of more than a hundred and forty degrees Fahrenheit in June 2018, …temperatures in July in Death Valley, recorded the hottest month ever seen on our planet.

The effects…will be “transformative for all areas of human endeavor—economy, agriculture, military, recreation.”

In late 2017, a study found that, by 2050, if temperatures rise by two degrees a quarter of the earth will experience serious drought and desertification.

All this has played out more or less as scientists warned,albeit faster.

            How Extreme Weather Is Shrinking the Planet, The New Yorker, November 26, 2018

Church and Hut near Lake Turkana 

I’ve seen the future. It is murder.                                                                  Leonard Cohen 

Was America Founded as a Christian Nation?

Christian Nation 2014

We heard John Fea, the Head of the History Department at Messiah College in Pennsylvania at SMU a couple of weeks ago. I decided to read Was America Founded as a Christian Nation?

While the early colonists and founders believed in Providence and that God favored America there are caveats that should give us pause. While most citizens probably believed that they were living in a Christian Nation, early behavior suggests otherwise.

Jamestown was founded in 1608 and mandatory church attendance was required. Conditions were harsh and survival uncertain until slavery was introduced and allowed efficient agricultural production. “Slavery brought wealth to the colony and made it possible for some of the leading lights of the American Revolution to protest against their own enslavement under British tyranny.”

The Puritans came to Massachusetts in 1620. John Winthrop, the first governor wanted to build “a Christian civilization that would stand as a city on a hill.” Only those who could testify to a “conversion experience” were allowed to be church members or to vote. All were required to attend church but most did not adhere to Puritan orthodoxy. Dissenters did not fare well – some were required to leave the community, others were killed. While the Puritans came to the New World for religious liberty they did not grant this to others. “The Puritan approach to Indians living in their midst must be viewed as embarrassing for a society that claimed to be Christian in orientation.” Indian conversion was tried but the Puritans needed land and the Indians were in the way of “destiny.” Violence ensued.

While both sought to follow Christian orthodoxy (proper belief) they failed in orthopraxy (correct practice). Public behavior was not guided by Christian principles.

Fea argues that the American Revolution was a product of the Enlightenment’s values of Toleration and Pluralism more than Christianity. In writings leading up to the Revolution Enlightenment political theory was cited much more than Biblical justification for rebellion from Britain.

There are members of my church who have reacted strongly to “politics from the pulpit.” Any comment remotely secular about the current state of affairs or the political climate from the pulpit is reason for a private meeting with the pastor for corrective instruction.

Fea makes a very convincing case that multiple clergy supported (and a few opposed) the Revolution from the pulpit. They often used creative Biblical exegesis to bend their message the desired way.
An example: John Carmichael, a Presbyterian Minister in Pennsylvania preached that Jesus ”can’t possibly have meant that we should love (our enemies) better than ourselves-that we should put it in the enemy’s power to kill us, when we have it in our power to save our own life, by killing the enemy.”
Loyalists (to England) preached from Romans 13 and 1 Peter 2 to support submission to English authorities regardless of their moral character.
Polities from the pulpit has been present since the early days of America.

The Constitution makes no mention of God. The Declaration of Independence does, but it is not mention Christianity. It may be a theistic document but it is not a Christian document. It is a document of Independence, not a document of values or human rights.

Our founders were a mixed lot. John Witherspoon was the only clergy who signed the Declaration. While a professing Christian he also supported belief in an innate “moral sense” or conscience independent of the Bible or God’s grace that directed humans to virtuous behavior – a decidedly unchristian belief.
Adams, Franklin, Jefferson, and Washington believed in “Providence” but did not profess to be followers of Jesus. Patrick Henry, John Jay and Samuel Adams (here Fea includes Witherspoon as well) are the founders whom are identified as professing Christians. Samuel Adams was a proponent of Puritan Republicanism – the belief borne out by a study of history that “republics survived only when their citizens sacrificed self-interest for the common good and lived upright and moral lives.” He felt that the promotion of religion was the best way to achieve these goals.

Fea concludes by saying that history is complex and often does not give easy answers. In the early nineteenth century Christians believed they were living in a Christian nation. But our founding documents do not identify the United States as a Christian nation and proscribed the mingling of religion and state. But most state constitution did recognize God and Christianity and many required officeholders to be Christian well into the nineteenth century.

So Was America Founded as a Christian Nation?
For me the simple (and thus suspect) answer is unofficially yes but officially no. Has our nation lived up to Christian ideals? Absolutely not. But who among us has?

Christian Nation

Response to a friend

Freedom Abe small
Dear Friend,

Dinner last night was great as usual. But I was disappointed in my response to your question…”like what?”

When I said that electing opposition candidates was good for our country to keep the majority party (now the Republicans) from having total control of our body politic, I thought that was so obvious that I was blindsided by your question and gave two really stupid responses – taxes and Roe v. Wade.

So let me try briefly to give a more measured response assuming that your question was a serious one.

One of the best classes I ever took in school was at North Texas in the summer of 1964. American Government. I wish I could remember the prof‘s name. He was terrific – did a great Sam Rayburn imitation. But one thing he said that has stuck with me all these years is this.

American democracy works best when three near equal forces are in dynamic tension with each other – business, labor, and government. Big Business, Big Labor, and Big Government if you will. If that tension is diminished or absent autocracy, injustice, even fascism can be the result.

Fast forward to now – big Labor no longer exists. While people rail against big government, it has been largely co-opted by BIG Business.

The three greatest threats to our democracy are unlimited money in politics (Think Citizens United – corporations are people, money is speech), gerrymandering by whichever party is in the state house, and voter suppression. Business rules government and labor.

And the more power granted to a single force the more self-serving that force becomes and the less well our democracy serves its ideals of freedom, equality and justice.

Democracy is messy. It is supposed to be messy. You bemoaned the Kavanaugh nomination process as being deplorable, especially the Democrats. No argument here. BUT at least there was a process where opposing positions made their case and slugged it out. For an example of the autocracy I fear, look no further than Merritt Garland – no process, no debate, no hearings. Which is worse? I know which I prefer.

I heard John Fea, an admitted evangelical and history professor at SMU recently. In his book Believe Me he develops 3 choices that Evangelicals made that really are not true to the faith but have had wide appeal.
They chose

Evangelicals have chosen Trump over their faith. Trump raises the specter of fear at every opportunity and it works. I think fear of the OTHER is in our DNA.
Christians are taught to be humble but they have embraced Trump’s drive for Power (Woodward’s book is named Fear because Trump thinks that Power is delivered through fear).
Power is almost always antithetical to freedom, equality, and justice (Power corrupts blah, blah, blah).
Finally Make America Great Again. Fea says Trump supporters hear “Great!” (Nostalgia) The historian hears “Again” (History) and asks when are you talking about? There has never been a time when America was great for all its citizens. Maybe great for you but how about ______? (Fill in the blank)

So my point last night, poorly made, was that by electing more Republicans we allow them to
1) cut Medicare and Social Security
2) emphasize school vouchers over public education
3) ignore climate change and continue to abuse our environment (I agree it’s too late – that battle has been lost)
4) offend our allies jeopardizing relationships that have kept Western peace for over 70 years.
5) praise dictators like Putin, Kim Jun Um, and MSB of Saudi Arabia. (I doubt if Mueller will find Trump colluded with Russia – probably because of lack of opportunity. But doesn’t his denying any election interference strike you as odd?)

So I’ll stop there by giving you the last line of Woodward’s book Fear.

John Dowd, Trump’s lawyer, on resigning gave his real reason for doing so

“Because He’s a Fucking Liar!”

No response is necessary.

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.

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.