Tuesday, February 17, 2015

Obama, The Crusades and Islamic Fundamentalism

"Humanity has been grappling with these questions throughout human history, and lest we get on our high horse and think this is unique to some other place, remember that during the Crusades and the Inquisition, people committed terrible deeds in the name of Christ. In our home country, slavery and Jim Crow all too often was justified in the name of Christ."

This recent comment by President Obama, attempting to somehow minimize the horrors of 21st Century Islamic fundamentalism by comparing them to the Crusades and other historical evils perpetrated in the "name of Christ," is inappropriate to say the least.  Lecturing Americans and other members of Western civilization about "getting on our high horse" when being outraged at the indescribably unspeakable acts of beheadings and immolations of conscious human beings in the 21st Century, is disgraceful.

First of all, drawing immoral equivalents never minimizes the immorality of an act.  The immorality may be equivalent, but using such equivalents to somehow explain or minimize an outrage is just wrong!  

Secondly, it is a poor historian who attempts to compare acts committed during the 11th century, 15th century, 19th century, or for that matter, during  Biblical times, or the times of the Neanderthals with the acts of brutality committed today.  The cruelty of human beings never disappears, but today's world will not abide the hacking and burning to death of human beings.  The Crusades were then - this is now!  Humans may have wantonly slaughtered humans back then (they even burned people at the stake!) but to say that the acts of Biblical Hebrews, or 11th Century crusading Christians, or 15th Century Spanish inquisitors, or club-wielding cavemen can be used to somehow minimize the barbarously brutal acts of 21st Century Islamic fundamentalists, is a contemptible use of history and an unfortunate example of deplorable moral leadership.

Monday, February 16, 2015

Gay Rights and God - This World and the Next

"Do not lie with a male as one lies with a woman; it is an abhorrence. (Lev 18:22)
"But you must keep My laws and My rules, and you must not do any of those abhorrent things...."(Lev 18:26)
"All who do any of those abhorrent things -- such persons shall be cut off from their people..." (Lv 18:29)

So God admonishes his people in the Bible.  If you are a true Bible-believer and that the Bible is the word of God - the "word" about homosexuality (just male homosexuality, by the way) is quite clear - God is against it.  It is an "abhorrence."  

The Bible, however, does not constitute the laws of the United States.  Follow it to the letter if you are so inclined, but do not impose it on others.  No "sharia" law here.  You must respect the legal rights of your fellow citizens.

Homosexuality is genetic - but even if it were not - even if it were a choice - all of us are free to live as we please so long as we cause no harm to others.  Gay marriage hurts no one.  No government should have the right to limit the values and lifestyles of consenting adults whose activities injure no one.  Whom one loves, whom one is intimate with, whom one wishes to marry are not its business.  

The Declaration of Independence's endows us with certain "inalienable rights."  Freedom of sexual association between consenting adults, including freedom to marry whom you wish is such a right, and though the Declaration is not a system of laws, it is a system expounding the basic principles of freedom upon which this nation was founded.

Legalizing gay marriage will injure no one.  Individuals have every right to view it unfavorably, but no rights to legally prevent it. If you share the opinions attributed to God in Leviticus, so be it - but you must agree that only God can decide how gays will be "cut off from their people" - not you.  God has no legal representation in this world - maybe in the world to come (as some would believe), but not in these United States!

Tuesday, February 3, 2015

Miracles in Medicine - Not Everyday Events

"You can't make up a story like T.F.'s  She arrived in the St. Francis ER with a ruptured aorta.  If that weren't bad enough, she immediately went into cardiac arrest.  Doctors knew they only had seconds to react.  They opened her chest and massaged her heart, miraculously they brought T. back right there in the Emergency Room.  They continued with extensive cardiothoracic surgery in the operating room to repair the aorta.  They saved T's life......................."

This message, under the headline "This is NOT Science Fiction," comprised the body of a full-page ad (undoubtedly extremely expensive) on the back page of the Science Section of the NY Times on February 3, extolling the virtues of St. Francis Hospital, The Heart Center, in Roslyn, NY.

Here am I, a physician, reading about this truly "miraculous" result - imagine that - a person in cardiac arrest due to a ruptured aorta -  an aorta so destroyed that it required subsequent "extensive" repair - saved in the emergency room with open chest massage!  Wow!!  I won't burden readers with all the questions I would pose as to how this "miracle" was effected.

Such "miracles" are extremely rare.  That's why they're called "miracles."  Don't believe for a second that the next patient with a similar devastating life-threatening emergency is going to have the same "miraculous" result - not at St. Francis - not anywhere.

The public should not evaluate hospitals based on advertised heroics.  Hospitals should be rated by a proper and thorough research of results as well as by appropriate evaluations by recognized authorities.

"Parents Own Their Children!" Do They?

"The state doesn't own your children.  Parents own the children," said Senator Rand Paul when asked about his views of immunizations, which he considered a "question of freedom."

How far does freedom actually extend.  How free are parents to "own their children?"  Parents do not own their children.  Parents are not free to physically abuse their children, they are not free to decide how their children are seated and belted in a moving vehicle, they are not free to decide whether or not their children are to don helmets when biking, parents are not free to leave their children unattended at home or in a car.

Parents are not always a child's best friends!  The government doesn't "own" your children, but it has a vested and moral interest in their welfare and takes on the responsibility of insuring that all children are provided a degree of protection - decisions about which they are too young to make on their own.  A parent, though perhaps free to make decisions concerning his own health and welfare, ( i.e. foregoing certain medications, or smoking) does not have the moral or legal right to subject his minor child to ill health and danger!

There have been many situations where the state has assumed control of a child's care in cases where parental decisions were deemed injurious to minor children.  As a hospital-based pediatric cardiologist, I have witnessed such proceedings, and have testified in such proceedings.

Parents do not own their children.  Minor children are too young to make informed decisions.  Parents, though free to decide their own fates, should not be permitted to put their children at risk in the face of a safe, well documented, and proven preventive or therapeutic practice that protects or overcomes such risks to life and to health.

Monday, January 12, 2015

Peace - The Occasional State Between Conflicts

With every wish for a Happy New Year comes the additional wish for peace.  I'm not sure what most of the world regards as a "state of peace," but if its a world with no major conflicts, peace has not existed for any significant period of time since the beginnings of written history.  If it is a state of the world where most of it is at peace, and only a small part of it is at war - then we are at peace now - after all millions are not dying, only a few thousand here and there.

The history of our world is one of conflicts - wars, threats of war, skirmishes, battles, policies of mutual destruction and standoffs (Cold Wars), riots, terrorism, mass murder, genocide........and more.  Eras of real peace exist only for short periods between these non-peaceful events, which, in fact, provide most of the milestones by which history is studied.

All of civilization's major religions include "peace on earth" as an important, if not the most important tenet (well, maybe not all religions).  All philosophies, whether agnostic, atheistic, or theistic have peace as a central theme.   Despite all the preachings of love peace, etc., etc., etc. - it doesn't happen - it doesn't work. If God does exist, then his answer to requests for peace has always been a resounding "No!" All of history's preaching and philosophizing  has not had the intended effect.

Of course there is the age-old argument (specious, of course) that without prayer, etc. conditions would even be worse.  That's like saying the Holocaust could have been worse - we should consider ourselves lucky - after all it could have resulted in the loss of 12 million instead of 6 million Jewish lives.

Our species is not a peaceful one - never has been and, it seems, never will be.  We are battlers, we are constantly at war with one another, whether with weapons or with words.  I believe it is part of the human DNA.  We will continue to pray for peace, and some among us may actually find inner peace - but world peace - it is not who we are.

Remember - the enemy feels strongly that God is on his side. He feels he is in the right!  It is we who are the devils.  It is we who are wrong.

As this is being written, rallies for peace are taking place in Paris in reaction to the recent atrocities committed by radical Muslim terrorists.  How well I remember similar rallies after 9/11.  Think of all the peace rallies that have taken place - and then evaluate their long-term effectiveness.

Peace may come, not with a change in our behavior and attitudes as we know them, not with some awaited messiah, but perhaps with some future engineered alterations in our biological structure, alterations in our chemical and molecular makeup, alterations in our DNA!  This is not happening soon.  Peace is not around the corner.  Peace is not at hand.  There will be no peace in our time.

But yearning for peace will continue.  Yearning for the impossible, or the highly improbable, is what we do. When will we "beat our swords into plowshares and our spears into pruning hooks?" When will we see Utopia?

Yearn if you wish, but expect nothing.  Peace will continue to occur intermittently.   Peace is a manicured lawn left unattended.  The grass will grow wildly and the weeds of war, constantly lurking underground, await sprouting once again.  The lawn requires constant mowing and the weeds constant uprooting - and the cycle continues.

Monday, December 22, 2014

"All Lives Matter"

The ongoing controversies regarding the Ferguson and Staten Island issues of white-on-black police brutality have reached new heights (or maybe the proper word would be "depths).  A current article describes a recent incident at Smith College concerning a campus-wide e-mail circulated by Smith's president, Kathleen McCartney.

Dr. McCartney's e-mail announced her concern, and the concern of the Smith community about not "losing faith in the quest for racial equality, and how you fear for people of color."  It went on to speak about how violence of this nature serves as a reminder of the existence of racial injustice.  The president ended her note with the following:

"We are united in our insistence that all lives matter."

Apparently some Smithies interpreted this phrase as racist.  They argued that it "minimizes the anti-blackness of this current situation."  It was felt that McCartney, in using this phrase, was not sensitive to the problems that specifically befall African-Americans.

McCartney apologized for "drawing attention away from the focus on institutional violence against Black people......" and went on to commit herself to "learning from the lived experiences of people of color....."

We really have a problem when a statement proclaiming the equal value of all human life is considered insensitive and biased - and results in an apology.

Thursday, December 11, 2014

The Usefulness of Medical Data in Managing Disease

Dr. Sandeep Jauhar (Op-Ed NY Times, Dec 11) questions the use of standard accepted medical guidelines in the management of patients.  He is correct in pointing out that there have been such treatment guidelines published by a myriad of medical specialty organizations, outlining what current evidence indicates is the best method of evaluating and treating various conditions.  These organizations have committees of recognized experts in their respective fields who review all available published data that may pertain to a particular disorder/procedure.  Their conclusions are then published in the medical literature - not only as guidelines, but with "guidelines" as to how to evaluate the recommended guidelines.

The "guidelines" to evaluate the guidelines look at the statistical validity of the populations studied:  (A)were multiple populations studied,  (B)were there limited populations studied, or (C)were there only very limited populations studied.  Based on the data analyzed, the experts then classify procedures/treatments according to apparent benefits v. possible risks.  Class I indicates that the data clearly indicates that the procedure/treatment is very beneficial and is highly recommended.  Class II concludes that benefits are not conclusive, may indeed be worthwhile, but suggest additional studies.  Class III is comprised of treatments/procedures that have not been shown to be helpful or may actually be harmful.

Evaluating these criteria, and then following the suggested treatment/procedure outline is what is called evidence-based medicine.  This is the way to manage patients - this is the way to manage disease.  When a treatment/procedure is found to work in a significant majority of people (evidence-based), physicians should use it!  Denying the validity of such recommendations, is to deny the validity of using properly collected statistical data.  On what else can conclusions and recommendations be based?

Dr. Jauhar argues that such "homogenized health care" is not always the best treatment.  Of course not.  There are always times when any one individual will react negatively to a recommended course of therapy, or where it might be contraindicated for one reason or another.  He concludes that personalizing care is better.  Of course it is.  But until individual genomic analysis allows medicine to personalize care (and it is moving in that direction), so called "homogenization" is not to be denigrated.

Remember - what works well for the significant majority of a population will, in the vast majority of instances, work well for you too!  Though you are an individual and have your own personal genetic makeup, your genetic similarities to others is vastly greater than any differences - and you are  far more apt to have the same benefit/risk result to a recommended guideline as your neighbor.