The Recollections of Holocaust Survivors

A recent article in a Jewish publication described the sensitive story of an elderly woman's recent return to the German village of her childhood.  The story, though compelling, raises some issues.  Ms. B, a 90-year-old woman, discusses life in her little village, including memories of laws restricting Jewish participation in certain professions and government positions. She described how it felt to be "forced from her home." Ms. B emigrated to the United States in 1934.  At the time she was only 10 years old.  I would have to question the recollections of a 90-year-old about the effects of laws on Jewish life in her village during her very early childhood, especially in those initial days of the Third Reich.

Though it is true that restrictive participation of Jews in various professions and activities, and some "unlawful" acts of vandalism did exist to some degree prior to Ms. B.'s emigration in 1934, the very repressive Nuremberg laws, actually banning Jews from certain aspects of public and professional life (1935), and the restriction of schools that Jewish children could attend, did not come into force until after her departure.  Anti-Jewish riots and physical brutality first became a major issue with the events of Kristallnacht in 1938.  I am not aware of any national policy in Germany to forcibly remove Jews from their homes in 1933-1934.

As the Holocaust recedes into history, eye-witness recollections understandably become more vague.  Present-day survivors, now in their late 80's and 90's were very young in 1933-1934.  Jews who emigrated out of Germany as early as 1934-1935 were, indeed, very fortunate.

Religion Is Part of Our History - by Ordinance!

We are all familiar with the Constitution's "Establishment Clause," as outlined in the First Amendment of the Bill of Rights - passed by Congress in 1787 and ratified by the states in 1791.  This amendment is cited as the basis for our present policy of total separation of church and state -  basically prohibiting religion from having any place at all in the public schools.  However, the Constitution's wording is clear  only in prohibiting the federal government from passing laws establishing some form of religion - nothing more, really.   The prohibition of inclusion of religion in a public school's curriculum or  public school's activities is the result of the Supreme Court's interpretation of that amendment.

I was surprised to discover that there is actually a federal ordinance that encourages religion as necessary for "good government." I thought my readers, like me, may not have been aware of this document.  The document cited is the Northwest Ordinance, passed by Congress in 1787, the same year as the Constitution, and intended to apply to the territories being settled in what was then considered "The Northwest."

As a supporter of the "wall of separation" between religious and civic activities, I must concede that it seems the "founding fathers" had considered religion an important as well as a necessary building block for "good government" and "happiness."

Here are the pertinent citings:

Amendment 1 of the Constitution
Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.

Article 3 of the Northwest Ordinance
Religion, morality, and knowledge, being necessary to good government and the happiness of mankind, schools and the means of education shall forever be encouraged. 

Medial Malpractice Claims - How Can They Be Reduced

Nicholas Bakalar (NY Times Science Section Apr 30) reports that a study published in the British Medical Journal Quality and Safety, concluded that diagnostic errors are the "most common cause of paid claims for malpractice."  Researchers reported that these claims resulted in 28.6 percent of malpractice payments, more than errors resulting from various forms of therapy, or the combined total of payments for errors in obstetrical care, medication error, monitoring mistakes, anesthesia complications combined.

I feel certain that some of these awards may have been made in cases where there, in fact, was no diagnostic error, or that the error played no significant role in the eventual outcome.  But I am also certain that there may have been other serious errors which never were brought to a lawyer's attention.  In any event, the number is what it is - and should be addressed.

Diagnosis is the result of algorithmic evaluation of data by the physician.  A physician begins his diagnostic journey with a detailed history and physical examination.  Progressing algorithmically, he then pursues additional data by requesting various diagnostic tests or procedures.  These may raise the possibility of a number of diagnostic probabilities leading to further, more involved diagnostic plans.  Eventually(and quickly one would hope) he arrives at the actual diagnosis, or the most likely diagnosis.

A computerized form of such appropriate diagnostic methodology will significantly reduce the possibility of physician diagnostic error.  Most physicians are not the "Dr. House," or some other amazing diagnostic genius, depicted of various TV dramas.  Physicians are human - they consistently make mistakes.  Development of this technology should significantly decrease diagnostic errors - especially where major diagnostic dilemmas exist.

But no technology will be able to correct improper input.  The physician who does not take an accurate history, or who does not detect an abnormal pulse, or who does not hear an abnormal heart sound, or who evaluates the size of a person's liver incorrectly will not input correct information.

 "Garbage in - Garbage out!"

Gender Attributes - Is There a Distinction?

In "The Tangle of the Sexes" (NY Times Sunday Review, Apr 21) Carothers and Reis argue that men and women are "less different than we like to think."  The implication is that  the sexes belong to the same taxon (sort of like "species") and any noticeable difference between the sexes such as in emotional reactions, scientific abilities, social support manifestations, or intimacy are really just "dimensional" and that there are no real gender differences. We are all basically from the same species-specific gene pool and any distinctions are not sex-related.

The authors evaluated 122 attributes from more than 13,000 individuals and found that "one conclusion stood out:  instead of dividing into two groups, men and women overlapped considerably on attributes" such as those given above as examples.

But wait a minute - what have we really learned here.  We have learned that there is more overlap than there is distinction.  This, however, proves nothing about whether significant distinction exists in areas that do not overlap.  If we were to compare the attributes of rocket scientists with those of ordinary workers, I feel certain there would be considerable overlap in most of them.  It's not the overlap - it's the distinction that matters!  It's the distinction we notice - not the commonality.

Men and women are genetically distinct.  It is not reasonable to believe that the only difference this yields is one of gender.  Though the overlap of similarities is obviously huge, both physically and attitudinally, one cannot conclude that no distinctions of significance exist at the non-overlapping points on the curve.

Remember - 90% of human DNA has commonality with that of a chimpanzee.  It's the differences that that make us distinct - not the similarities.

Aesop's Future

A quote  from a piece by Edward Hoagland which appeared in the Sunday Review Section of the March 24, 2013 edition of the New York Times.  Entitled "Pity Earth's Creatures" Hoagland bemoans the potential future loss of Aesop's animal metaphors as we, as Hoagland puts it, "shred our habitat."

Mostly that's over......The tortoise and the hare, the lion saved by the mouse, the monkey who would be king, the dog in the manger, the dog and his shadow, the country mouse and the city mouse, the wolf in sheep's clothing, the raven and the crow, the heron and the fish, the peacock and the crane.  From where will we draw replacement similes and language?.........Hogging the spotlight, playing possum, resembling a deer in the headlights, being buffaloed or played like a fish.  Will the clarity of what is said hold?  A "tiger, a "turtle," a "toad."  After the oceans have been vacuumed of protein and people are eating farmed tilapia and caked algae, will Aesop's platform of markers remain?

"Three Cheers for the Bloomberg Ban" - What??

In "Three Cheers for the Nanny State" (NY Times Mar 25) Sarah Conly argues for the Bloomberg Ban on large-size sugary drinks.  The argument is that the general public is just too uninformed or is just not able to fully research the data, or that we, as human beings, all suffer from the bias that bad things just won't happen to us.  In other words, we, as a species, are incapable of making proper, well analyzed decisions affecting our health and welfare.

One has to wonder if we are capable of deciding who to marry, what professions to pursue,  or when to seek medical help etc. - or are these decisions also best left in the hands of a more sophisticated and knowledgable party.    I am certain that such decisions may also affect the general health and welfare.

Though, admittedly, many drinkers of these large-sized sodas will remain quite healthy, Conly proceeds to equate a ban on these drinks to government-imposed bans on excessive highway speed.  After all, she says, many of us are capable of "safe driving" at 90 mph, so why should we "safe drivers" be limited.  It could also be argued that a ban on excessive alcohol intake, or a ban on cell phone use is a similar infringement on individual rights.  After all there are many who can drive very safely with excessive alcohol blood levels, and many who may drive with, perhaps, even greater caution when using a hand-held device.  Those bans are in place for the greater good, so why not ban large sugary drinks?

But there is a great difference between banning acts that affect others and banning activities that affect only the concerned individual.  We do not ban individuals from smoking - only in places where it affects the health of others.   The limitations on drivers clearly affect the health and welfare of those who share their vehicles and their roadways.

Children comprise a separate category.  It is assumed that children cannot be aware of certain dangers and are unable to make appropriate judgements.  The government does have the right as well as the duty to protect them from undue injury in the event that the parents neglect to do so.  Government may ban the sale of cigarettes to children - and even the sale of large-size sugary drinks to children.

But not to an adult.  Unless a large number of purchasers are not just drinking these sodas themselves, but are forcing others to drink them, they should not be banned.

An afternote.  With the ban now in place,  it is the duty of the banning agency to scientifically evaluate the data to determine whether or not this ban has achieved the desired result.  This is not as easy as it sounds.  Controlling variables is such a study will be difficult.

Non-Indicated Medical Diagnostic Procedures - Who Should Pay?

A recent article in the Science Section of the New York Times examined a very prevalent and difficult problem for physicians, namely the right of a patient to "manage" his own diagnostic evaluation, in opposition to the opinions of his physician (Working Together on Costs, February 26.)   The article maintained that patients often "do not want their doctors to take cost into account.............even if those (more expensive) options were only slightly better than the cheaper alternatives."

The issue, unfortunately, frequently results in a physician complying with a patient's request and ordering a potentially expensive diagnostic procedure (e.g. MRI, ultrasound, etc.) even if he feels it is not indicated - "adjusting" the medical record accordingly.  Though, as the article maintains, it is the patient who bears major responsibility for this added cost to medical care, one cannot overlook the physician's complicity.  The doctor often rationalizes that if "I don't order the test, Mr. X will find another physician who will."

Medical insurance should not cover non-indicated procedures.  A patient, however, should not be denied the right to "purchase" a test.   If, in fact, he insists on a non-indicated MRI, he should have the freedom to "buy" one.  Perhaps there could be a new form of insurance policy, priced accordingly, for individuals who are interested in having the option of purchasing such highly-priced, non-indicated diagnostic procedures.