A More Perfect Union

I enjoy studying the perspective of our little blog clutch even if I don't always agree. Reading and rereading one of our local friends blog post on government I realize that I have a very different take on the matter.
My government does not trust me. I have never taken a penny that didn’t belong to me. I try to live an ethical life. My days are filled with regulations and oversights that mostly make my job a lot less pleasant. On those days when I become most frustrated with this state of affairs, I retire to our ample home library and seek out one particular case of books. Seven shelves floor to ceiling in a four foot section of the collection. Every one of the books in this section reminds me why all these annoying regulations are absolutely necessary. This section is on the excesses of medicine, religion, and business (and government). Many are more than excesses - they are evil. Not all are the Nazi doctor evil. Some are the Tuskegee experiment kind of evil. Poor black men exposed to Syphilis when it could be treated so that American doctors could watch the natural history of the disease. An evil exposed during the lifetimes of most who read this. The main difference is that the perpetrators of Tuskegee weren’t hanged at Nuremberg. Faces and names of people harmed by medical experiments run by people who cared nothing for the humans they mistreated in order to conduct their research. People like Henrietta Lacks. Cancer cells harvested without her permission or knowledge became the first sustainable culture line of human cells (HeLa) and led to some of the greatest achievements in modern medicine and our understanding of cell biology ( I once worked in a lab that used this line of cells in its research. The donor’s name was misidentified as Helen Lane for decades.) Billions have been made on patented cell products derived from her cells, while her family cannot afford medical care and mostly live in poverty. Henrietta’s own cells experimentally injected into healthy poor prisoners and women without their knowledge.

Ground water contaminated drilling for natural gas. Gasoline refined from oil purchased at lower prices before the troubles in Libya, is being sold at inflated prices because of the increased price of oil. No doubt more record breaking quarterly earnings are in store for big oil. The disparity between the salaries of workers and their executives has grown exponentially. Pharma shifting sales of questionable products overseas at the first sign of trouble.

Actions conducted by men and women who did not think themselves greedy or evil. And so I am required to provide informed consent to my patients. Expected to document the reasoning for my actions. Required to respect their autonomy. Not because of my profession’s ethical codes but because of government. My government does not trust me. History provides abundant reasons why it can’t afford to. This nation was founded in order to form a more perfect union. Not a perfect one. Just better than religion, science, business, and professionals could be trusted to create without we the people asking a lot of hard questions and looking over their shoulders. Our security is costly. Social safety nets are expensive. Just like liberty and justice and national defense. Business, and special interests do not care a damn about we the people. For that we only have the annoying, distrusting, and expensive hand of we the people. Weaken that at our peril. Our government is wildly imperfect - except in comparison with any of our other institutions. Science can provide the needed answers to many of our questions, but democracy protects the people.


The Ontological Argument: the Mystic Pizza

Imagine the perfect pepperoni pizza. Huge and tasty. Perfect in every way. Infinite in it's crusty goodness. No pizza could be greater or more pure. So, having savory imaginings of this Pie of Ages, one must conclude without doubt that this most perfect of pizzas exists for it must if it is perfect. It must also be accessible because a pie that is not tasted and enjoyed would not be perfect since taste is a huge component of pizzary perfection. It cannot be metaphorical or hypothetical since neither would be perfectly satisfying and to think such a thing is simply foolish.

Don't ask me to explain such an obvious thing to you for without years of philosophy you won't understand. No, because we know that such logic exercises in setting the absolute limits of The Pie that is also related to Pi must result in an actual extant uberpie. By assigning perfection to the pizza construct we ensure that it has slammed into corporeal reality as we have defined perfection as to require existence and accessible tastiness. Now abandon your foolish notions of the fact that those hoping for the existence of the Truly Special Delivery get to arbitrarily define perfection and that this definition need not coincide with anything we know objectively. In fact there is only one way that such an uberpie Kant exist... One must, if logical, faithfully await that knock on the door by the great cosmic pizza delivery man. And of course keep in mind that a perfect pizza would be free...

To argue against this premise means that your are unschooled in the art of logic and lack sufficient education. Still not convinced of the superior logic? You aren't the first. To (greatly) paraphrase Bertrand Russell 'though it seems obviously flawed it's hard to articulate a specific reason why this is a load of crap' - no wait! Maybe we can. Let's imagine a perfect load of crap. No need, what could exceed the ontological argument in that regard...

Thought for the Day

Hell is unconstitutional under the Eighth and Fourteenth Amendments to the United States Constitution.


The Alternative Rag

Mac's lyric response deserves a proper one in return. So for you Mac - with your twisted (a trait I am glad to share...) love of the rhyme, here is something a bit different from my usual rhyme. It started because of a letter to the editor about a new bill to remove parental protections in Oregon for parents who let their children die of medical neglect because of faith-healing. The writer was concerned that this would be a slippery slope used to eventually outlaw all kinds of what I call alternatives to care. So in response here is my ode to alternative care. The amystic must fight mysticism where ever one finds it and fight against pre-scientific thinking in its many guises. With proper apologies to Steely Dan, the following 'alternative lyrics' should be matched with the melody from "Rikki don't loose that number". (It doesn't rhyme but neither does the source.) I know there's an extra stanza but I had to cut 3 more out already.
Hear you left the practice, that’s ok
but choosing an alternative to real care is a big step
I guess you kind of scared yourself, judging by your call
But with facts you may have a change of heart

Reiki’s just another woo blunder
plain water cures nothing but your thirst
twisting your spine’s a really good way to hurt yourself
Reiki’s just another woo blunder
science-based care, not Asian needles
is the only one that can actually make you better
so you live to go home

Don’t know how to make it more plain
Stickin needles won’t help unless it’s carrying meds to a vein
A week of water or herbs and a colds sure to go away
but of course it would have anyway

Reiki’s just another woo blunder
plain water cures nothing but your thirst
twisting your spine’s a really good way to hurt yourself
Reiki’s just another woo blunder
science-based care, not Asian needles
is the only one that can actually make you better
so you live to go home

your spine is out of alignment or is it in the wrong house
hard to keep all this straight since it changes daily
say we’re being mean if we ask for proof
they can make anything other than your cash go away

Reiki’s just another woo blunder
plain water cures nothing but your thirst
twisting your spine’s a really good way to hurt yourself
Reiki’s just another woo blunder
science-based care, not Asian needles
is the only one that can actually make you better
so you live to go home

Claim to tell what ails you from the bumps on your head
I’d add a few if some sense it would imprint
It might make your neurons restart

Reiki’s just another woo blunder
plain water cures nothing but your thirst
twisting your spine’s a really good way to hurt yourself
Reiki’s just another woo blunder
science-based care, not Asian needles
is the only one that can actually make you better
so you live to go home



Ode to the Cure (my 200th post)

An insatiable maw consuming 18% of our GNP;
that it cannot go on screams out like a banshee;
and though we spend twice as much as the very next;
we live not as long and lag behind more than 30 in most respects.

Blame for this state is enough to go around the globe a dozen times;
That it is the fault of another, each special interest quickly chimes;
Patients blame the docs who blame the insurers who blame the feds;
and don’t forget the neocons who claim any fix will make us all Reds.

We can blow up the world more than a thousand times;
We can move an army to destroy a regime for both real or imagined crimes;
We can endlessly debate which path or no leads to heaven;
But we can’t vaccinate all kids or provide simple care for at least 1 in 7.

Suggesting that universal coverage might be a fair start;
Has self-serving pols rattling china on their tea cart;
Some moron can try be be coy by suggesting we must all buy a gun;
A family an illness away from bankruptcy may not be ready to join in his fun;

Legislators are quick with a resonating sound byte;
but sadly they don't really have a dog in this fight;
they pass rules all the time that they don't have to employ;
requiring them to abide by what we get might be a sound ploy.

One things for sure, keep this up and a collapse is near;
Then better hope you need no care for one who is dear;
Tea party nay sayers may celebrate what they claim is for freedom a victory;
but to die from neglect, seems to be for a great nation somewhat contradictory.

As one in medicine’s trenches for a quarter century I know what I speak;
wait much longer and harder will it be to find the care that you seek;
Ignore those who believe the phrase health care reform is a kind of profanity;
To avoid the peril that Einstein reminded defined insanity.

Is there any hope, any direction other than over the edge?
any means to avoid the collapse or a means our bets to hedge?
The answer is yes but the cost will be high, though not in dollars;
The only answer is sure to stir a great chorus of hoots and hollers.

No doubt you have already heard the dire rumors;
We can neither afford nor staff to the levels needed to care for the Boomers;
Not if we persist in our national predilection for acute care late in the game;
Only a shift toward prevention, wellness and early detection will these costs contain.

Bricks and mortar systems are impressive with scanners and the latest high tech toy;
But using robots to cure one while others get nothing, any claim to national greatness must destroy;
The cost of one mechanical heart for a former VP;
could vaccinate thousands of kids from many a working family.

The limits are few on the options for those with means;
but nothing is left to provide the poor with the simplest of health screens;
The rich are told, ‘well here of the list of things that might provide some limited good’;
But to offer the most basic care to the poor a doc must don the cloak of Robin Hood.

Test after test is used to define an insured’s problem in detail;
those without means wait outside an ED to be seen at a pace that would bore a snail;
Clinical judgement and communication has fallen by the wayside on the path to a cure;
Why do one test when three can be had for 10 times the price just to be sure.

Oh yes, a doc will claim that they do too much because they are liable;
but as a real excuse that just isn’t viable;
yes lawyers and suits are a nuisance, that much is sure;
but tort reform isn’t where we’ll find the cure.

The real key to reform is a mindset that must be corrected;
if our rendezvous with disaster is to be deflected;
Less the purview of the doc is the change that is required;
More effort than nothing from the patient is needed lest we remain in red ink mired.

Prevention wellness and optimized care lower cost and improve the quality of care;
But for these the individual not the doc is the one who must the responsibility bear;
The Bard was right when he said that the fault resided in ourselves;
Not as some would claim on a pharmacy’s shelves.

Americans have demanded a system that at ‘goal line D’ gets ever stronger;
So that they can smoke, drink, eat, and veg in front of the TV all the longer;
A life of sloth and neglect requires expensive fixes as is our convention;
Ben Franklin, it turned, out was too conservative by far in the value of prevention.

And it’s not just inattention that has its costs as some choose an alternate who claims to cure with water or prefer some Asian needles;
or crystals or prayer or twists to the spine or the ground carcass of some beetle;
that is your right but should not the failure then be your own?;
not shared with those who prefer the direction that the light of science has shown.

But science is but part for the ability to pour money down a hole with greater precision;
Is not what should drive every health care decision;
It’s more than a question of ‘yes we could’;
But can is not now, nor ever, the same as should.

Everyone dies in the end - a sorry fact from which there can be no buffer;
Medicine blurs the edges between preserving life and extending the time one will suffer;
But for every futile act wasted at the end of one’s time on earth;
solace could come from knowing the savings could help hundreds at the time of their birth.

Why a spiritual nation fears the undiscovered country so much;
is a topic of much interest to those who work closely to death's touch;
for we see every day that there can be far more sinister fates;
than to die whether eternal bliss or the void is what awaits.

We must find a balance far different from what we do today;
more attention to staying well than being rescued is really the only way;
and then we can afford to care for all as befits a great nation;
yet still have enough for acute care just not as our sole fixation.

They say that freedom always comes at a cost and it's socialism we should fear;
but our health care freedom currently runs a tab of two trillion each year;
robbing us of jobs and crippling our industries with insurmountable costs;
but opponents to reform offer nothing but rhetoric while our treasury exhausts.

Should we consider our health as an island that to a greater sphere need not connect?
Or in this was Donne once again correct?
The individual must be responsible for their own destiny as this is the answer not another;
and try to get in the habit of remembering that your clinician is not your mother...


Happy Valentine's Day

To all who happen by and all the ships at sea. I hope you spent or are spending your evening with someone you love.


Sophomoric Friday!


Let's get out the vote!

Design for art fountain installation.


The Defeasibility Defense

Over at 'Proving the Negative' there was an interesting discussion about defeasibility of beliefs - what would it take to get you to change your mind. If nothing is the answer then 'you're just being pig headed and we should waste no more time on you' was sort of the gist of it. The original post was in reference to believers of various sorts but the local catholic apologist showed up and countered that nonbelievers could be equally pig headed. Possibly true, though skeptics are aided by the old axiom that 'extraordinary claims require extraordinary evidence.' A comment was made that it was not reasonable to expect a god to jump through hoops and do tricks implying that expectations of proof had to be deferential in some way.

It got me thinking. What, if anything, could get me to believe in the supernatural? Specifically gods. Hmm. It's really a tough one because of the extraordinary claims part. One thing is for certain - I'm a pretty naturalistic and objectivist thinker. The common methods of spiritual actualization have absolutely no chance of changing my mind. I'm too into cognitive bias and dissonance work to buy any personal experience no matter how vivid. I know too many pharmocologic and neurochemical ways of achieving these kinds of responses to not be extremely dubious of claims that result. Remember I'm the guy that had the near death experience that seemed perfectly physiologic to me despite matching all the common descriptors that people talk about. Oxygen deprivation and random neuron firing makes for some pretty wild experiences.

Some might say I'm ignoring the obvious or missing the point, but to me, one of the arguments against religion is its expectation, no outright insistence, that personal perspectives and feelings are the route to enlightenment. I see too much cognitive bias (and sometimes nefarious actions) in individual witnessing of all kinds to put any stock in it. I know it works for a lot of people, but it's not for me.

For me, the proof would have to be something along the lines of what sagely Carl Sagan put in his book Contact. Proof for me would have to be woven into the fabric of creation and the holy texts. Amongst all the begatting there could have been some reference to gravitation, or atomic structure, or DNA, etc. Lots of opportunities to put things in that would be obvious to future readers. A lot of people try that sort of thing but it's less compelling than my horoscope so not too helpful. Please do not mention creationism as an example of this for it is just the opposite.

It would have to be something that was unambiguous and scientifically reproducible. It would have to be a shared scientific experience. I like Sagan's idea - after you run Pi for awhile it traces out a perfect circle. That would be something that would make even old Pliny take notice. So, from that perspective, I think my position is reasonably defeasible at least from a deist perspective. But maybe that perfect circle would be too much of a hoop to expect...


Does Science Presuppose Naturalism?

No. Good science follows from the evidence. It’s a method to seek objective facts that support or discount explanations for events. That science has become associated with naturalism is used as a slam by some philosophers. If you say that it doesn't presuppose naturalism they count that as a victory. But only if we fail to drop the other shoe. The elephant in the room for the theist philosopher is the question ‘why has science become associated with naturalism?’ Why is it that our most objective methodology for proving cause and effect has become associated with naturalism? Why is it that our best method for overcoming human cognitive bias is so closely associated with naturalism? Could it be that it’s because all of the evidence, all the objective facts point to naturalism? If not then where is the evidence for theism? Mere argument and insistence are not evidence no matter how eloquently or slyly delivered. People do not now believe that evolution is true because Darwin argued the point eloquently. It is believed because enormous mountains of evidence, some from disciplines that did not exist in Darwin’s time, supports the truth of it. Because in 150 years, no factual data has ever been unearthed that disputes it.

Personally, I don't care what people believe in their hearts as long as it respects the rights of others to believe differently. As long as the belief doesn't become an excuse to persecute others. As long as it doesn't require the subjugation or mistreatment of others. As long as it isn't used to dehumanize opponents. But I do care when people try to discount or distort science in defense of their beliefs. When they try to portray science as just another belief system.

On another blog this was quoted (attributed to one or another famous deist) as part of an argument for deism; “ it's that rough, grainy, complicated feel that Christianity has that fits so well with our rough, grainy, complicated world.” This is for all practical purposes one of the most common arguments for deism. Is it compelling? Maybe, if you are looking for support of a preexisting belief. Is it factual? Not even a little. Feelings have far less to do with facts that we might hope. Feelings reflect wants, desires, fears, biases but not necessarily the facts. Feelings are subjective. Facts aren’t. The deist apologist would do well to avoid making the claim that science does not presuppose naturalism. The fact that science does not presuppose naturalism and yet naturalistic explanations are all we get makes the argument from nature all the more compelling.

Philosophical debate or argument can be compelling, logical, thoughtful and at the same time simply untrue. At some point, argument has to give way to facts. For the true skeptic, facts have to exist outside of the frame work of the argument. The notions and existence of the argument cannot be used as proof, though that’s something we see daily in discussions about this sort of thing. These are important personal experiences and drivers but not facts. Personal epiphanies, though important to an individual, are not facts. They are subjective experiences. They are arguments. For many of us, feelings, senses, historical context, etc., simply are not enough to cause us to believe. It's not that we lack imagination or passion - just that we aren't convinced to alter our world view by these things absent proof. Are subjective experiences important to our daily lives? Of course they are. The fact that I like movie X better than movie Y is subjective and of some personal importance. But my love of movie X doesn’t affect gravitation, inertia or thermodynamics. It doesn't bend spacetime.

Science does not presuppose naturalism. Science follows the facts. And the facts are these - the deeper we probe the more compelling becomes the argument for naturalism. A deist may counter that metaphysical explanations defy the methods of science in the same breath used to claim that science does not presuppose naturalism. Maybe so, but the deist arguments often leave out an important part. There are two reasons that this could be the case - one, that science cannot probe the metaphysical realm, or two, that metaphysics has nothing to offer in way of explanation. The truth of it is simple if not comforting: although science does not presuppose naturalism, all of the evidence, all of the facts, unearthed by science to date point to naturalism without exception. For a growing number of us, that's the end of the debate.

ALSO: please take the medical poll at the right, Thx. Oh, and as the Cuttlefish pointed out, there is no default of none of the above (my bad). If no is your experience, please leave a comment to that effect.


On the Right Track

Despite the simian efforts of 'activist tea party judges' to undermine the landmark health care reform legislation, a lot of great work is getting done. I would recommend that everyone be familiar with the following article published in 2008.
In this article, the current head of the Centers for Medicare and Medicaid Services (CMS) outlined a strategy for reform called Triple Aims. The Triple Aims are:
  • Improve the health of the population;
  • Enhance the patient experience of care (including quality, access, and reliability); and
  • Reduce, or at least control, the per capita cost of care.
Implementing key attributes of this strategy is a huge part of the actual reforms that are underway. If these changes come to pass in a big way, the quality of health care in this country could rise dramatically yet at the same time, costs could plummet.

If you read it and have questions let me know, because this kind of thing is where my research is having the greatest impact. It is an exciting time.


Zero Tolerance

A high school freshman took the guts out of a pen, inserted some little plastic balls and shot spit balls at some people in class at Spotsylvania High School in Virginia. Childish - yes. But surprisingly fun as Pliny found when he was a young buck. When I got caught, I was sent to the principles office and told to knock it off. Now, this kid was expelled, arrested and charged with assault. He was 'guilty of using a weapon to harm and intimidate other students'. Part of a national trend toward zero tolerance of weapons and violence.

Pliny is in favor of another zero tolerance policy - zero tolerance toward idiots who cannot understand the difference between shooting spit balls and brandishing an AKM.