Wednesday, September 30, 2015

What Pope Francis Didn't Say

Everyone loves Pope Francis - engaging, smiling, a man of the people - humble, loving - and a man of peace. Francis possesses a special charisma and "stage presence" unique to his office.  Francis has filled his recent visit to The United States with pleas for peace, for ending poverty, for the caring of the young, the sick, and the old.  He, in other words, echoes the hopes of humanity.  Who can possibly be opposed to any of these pleas and hopes!

But words are not actions - and some words lack specifics.  The very controversial Pope Pius XII, whose papacy spanned the era of Nazi Germany and World War II, also prayed and preached for peace and love.  What he did not do, and why "controversial" is applied to his papacy, is that he failed to name names.  He never directly condemned Hitler's policies, nor Mussolini's.  He never denounced the Nazi perpetrators of the mass murders and human extermination that occurred during his papacy. His words may have made a difference, above all since many of the perpetrators were Catholic.

A general damning of war, human suffering and poverty- that's easy.  What's difficult is directing such condemnation at those actually known to be at the root of human suffering.   Like Pius, Francis has failed in this regard.  As Pius failed with Hitler and Mussolini, so Francis is failing with Assad, with Khamenei, with Al Quaeda, with ISIS - and with all others responsible for the terrorism, murder, and genocide that plagues humanity today.  Francis urges us to care for and to empathize with the teems of migrants desperate to find security and stability in Europe, but castigates no one responsible for this extraordinary display of despair.  It is a noticeable silence.

The world knows the power of papal speech.  Words matter.  And the words of a pope, particularly such a beloved and charismatic pope, carry great moral weight.  As we listen to his words, we must also listen to his silence.

Thursday, September 17, 2015

How To Pronounce "Los Angeles"

Ilan Stavans's recent op-ed article in the New York Times (Sep 17)  discusses the American TV reporter Vanessa Ruiz's (an anchor for 12 News, Phoenix Arizona) insistence on pronouncing words and names that have a Spanish derivation in the Spanish manner.  So, for example, her name RUIZ would be pronounced not as an anglicized ROO-iz, but in the Latino style  Rrroo-ISS (with a rolled "r").

When Latino names and terms are pronounced by reporters or anchors with Latino backgrounds, they often assume that such names are preferably voiced in the Latino style.  I hope they checked with the persons involved, because he/she may prefer the anglicized version rather than the Latino.   I have never heard Senator Ted Cruz or Senator Marco Rubio pronounce their names using Hispanic rolled "r's".   Their names are always anglicized when spoken to an American audience, which I feel rather confident in saying is the usage they prefer.

I once made the mistake of Italianizing a patient's surname, believing it would be the preferable form of address.  I was dead wrong -- immediately corrected by the patient, who went on to pronounce his name using his preferred anglicized style.

My name,  STEEG,  is of German origin and in Germany is pronounced SHTEHG.  I certainly do not prefer this to the anglicized form (rhymes with "league") and would resent an assumption that the German form is proper when used in the setting of an American conversation or discourse.

Stavans concludes his op-ed piece with the following: "Ms. Ruiz's use of Spanish pronunciations reflects the new social reality in which Shakespeare's tongue must adapt."


The names of people and places should be pronounced according to the wishes of those bearing those names or living in those places. The American city is Los AN-gel-ess, not Los AN-hel-ess, and the American state is Mon-TAN-ah, not Mon-Tahn-ya!  Spanish derivation - yes.  Spanish pronunciation - no.

Sunday, September 13, 2015

Malpractice - Myth or Reality

A recent NY Times Op-Ed piece entitled "Legislative Malpractice" prompted a number of contrary Letters-to-the Editor.  These included critiques of juries of lay people who, the writer, averred, do not possess the proper credentials to adequately judge complex medical cases.  Another noted that defending malpractice suits costs the health care system "hundreds of millions of dollars each year," and many are without merit.  Myths or reality?

Some facts:

1.  Researchers at Harvard School of Public Health have found that 97% of malpractice suits were meritorious.  There is little "frivolous litigation" in malpractice suits.
2.  The Institute of Medicine has estimated that 98,000 patients die each year as a result of preventable medical errors and hundreds of thousands more suffer nonfatal injuries.  Other estimates are as high as 210,000-400,000 such deaths each year (Journal of Patient Safety 2013).  Despite these numbers, malpractice suits comprise only 3% of all tort caseload.  Only 30% result in a lawsuit.  There are, then, far more instances of documented malpractice than there are malpractice lawsuits.
3.  No more than 0.5% of malpractice payments resulted in an award of $1 million or more.
4.  Despite the non-possession of "proper credentials" by jurors, a 2006 study discovered that juries found for the  plaintiffs only 21% of the time.  (By the way, "improperly credentialed" juries are also asked to decide complex financial issues, contracts, and other forms of very involved civil litigation.)
5.  Medical negligence compensation accounts for only 0.3% of national healthcare costs.
6.  So called defensive-medicine expenditures (ordering "unnecessary tests" to counter potential malpractice suits) do not result in a significant cost increase compared to total health expenditures.
7.  Malpractice premiums, which are primarily driven by the general economic insurance cycle rather than by large malpractice awards, cost a typical physician just 3.2% of total revenue - far less than his/her rent.
8.  Since 1987 medical costs have increased by 113%, while malpractice insurance has increased by just 52%.
9.  Some states have adopted "collateral-source offsets" - costs covered by health insurance not recoverable by malpractice plaintiffs.  With increased insurance coverage, greater "offsets" are expected, resulting in lower total indemnity payouts.

Last fact:

Many so-called malpractice issues are clearly more myth than reality.  Competent physicians, who know what they are doing and how to do it, need have no malpractice qualms!

Thursday, September 3, 2015

The Kentucky Clerk and Dred Scott

Kim Davis, the Rowan County (Kentucky) clerk of courts is denying marriage licenses to same-sex couples, doing so, as she has stated, on "God's authority."  Ms. Davis, whose deeply religious convictions oppose such marriages, is clearly in violation of the Supreme Court's landmark ruling in Obergefell v. Hodges whereby the constitutional right to same-sex marriage was affirmed based on the Fourteenth Amendment.

Ms. Davis's legal advisors have argued that, in fact, the decisions not to uphold Supreme Court rulings without supporting legislation has precedence in the famous Dred Scott case.

And, as a matter of fact, Davis's legal team has a point.

To review, Dred Scott, was a slave in the service of John Emerson, a member of the US military, who moved from Missouri (a slave state) to Illinois and Wisconsin (free states) in 1834.  Though Emerson eventually returned to Missouri, Scott maintained that his residence in a free state had freed him from slavery bonds.  The case finally worked its way up to the Supreme Court.  In 1857, Chief Justice Roger Taney, writing for a 7-2 majority, ruled that Scott had no standing to sue in a federal court since people of African descent (slaves) were constitutionally not citizens of the United States. He concluded that the Declaration of Independence was never intended to pertain to slaves.  Slaves, he continued, being, in fact, property, remained so in whatever state their owners may reside.

The Dred Scott decision helped launch the Civil War, and became what is considered the worst Court decision in U.S. history.

Northern courts and politicians rejected "Scott"as binding. The Ohio Supreme Court ruled that any slave coming into the state with his master’s consent, even as a sojourner, became free and could not be reenslaved upon returning to a slave state; the New York Court of Appeals handed down a similar ruling in Lemmon v. The People (1860). In several states, legislatures resolved to prohibit slavery in any form from crossing onto their soil and enacted legislation freeing slaves passing within their borders.  Abraham Lincoln, himself, did not follow this ruling. With his Emancipation Proclamation  he claimed the executive right to free slaves in the rebellious states.

So, in fact, the "law of the land," was not followed in Northern jurisdictions.  The case remained "the law of the land" until "overturned" by the passage of the Fourteenth Amendment following the Civil War.


Wednesday, August 26, 2015

"Anchor Babies and Tourist Babies"

The latest controversial issue raised by Donald Trump is the "anchor baby" - which I believe he defines as a baby born to a mother who entered the United States for the sole purpose of insuring that her infant is born in the United States, thereby guaranteeing her child United States citizenship, by virtue of the 14th Amendment.   Trump is questioning the interpretation of the 14th Amendment.

The pertinent part of the amendment read as follows:

Section. 1. All persons born or naturalized in the United States and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside.

This has been interpreted by some to exclude children of non-citizens or non-resident aliens since these children are not "subject to the jurisdiction" of the United States as they are children of citizens of other countries.  In fact current immigration law specifies that a baby born on American soil to a member of the foreign service of another country or a foreign military prisoner is not an American citizen by birth.  Congress can, however, grant citizenship for such excluded persons on a case-by-case basis.

Let's assume that, in fact, the 14th Amendment actually does permit any infant born on U.S. soil to be eligible for automatic U.S. citizenship.   In fact many of these babies, also referred to as "tourist babies," are  not born to "illegal aliens," but to foreign women with tourist visas - often owners of U.S. real estate - who are among the privileged class in their countries, and wish to insure U.S. citizenship for their offspring.

Isn't there something wrong with this concept?  Isn't there something "not right" when pregnant citizens of other countries enter the U.S. for the sole purpose of giving birth to "an American baby?"

By the way, know that the United States is one of the few countries that has such "jus soli" (by right of the soil) citizenship rights.  The vast majority of other countries do not.  Some of examples of "non-birthright" states include Australia, United Kingdom, Germany, Israel, Saudi Arabia, Czech Republic, Japan, Austria, Belgium, Switzerland, Norway, Sweden, Finland, Denmark, France, Greece, Spain, Italy.......and quite a few more.


Wednesday, August 12, 2015

Pounds and Ounces in Prevention and Cures

We're all well aware of the old adage that "an ounce of prevention is worth a pound of cure."  Well, as it turns out - not so!  Margot Sanger-Katz, in a recent New York Times article (Aug 7), has written how the opposite is true.  Turns out, in fact, that "you have to give a lot of people those ounces of prevention to end up with one person who's getting that pound of cure."  As an example, according to the New England Journal of Medicine, 2500 women would have to be screened over 10 years for a single breast cancer death to be avoided.

Prevention is not cheap.  Obamacare mandates prevention coverage.  More and more subscribers are  confirming the status of their general health by taking advantage of these screening options, consequently increasing health care costs.  Providing people with more preventive measures is satisfying and usually reassuring, but expensive and rarely productive.

Early discovery of diseases using preventive screening techniques may result in a longer life - but at a not insignificant expense.  Early intervention for an asymptomatic latent condition results in increased physician visits, increased diagnostic testing,  increased need for the preventive medication, and, of course, an increase in cost. The disease is almost never cured, but its process is prolonged, and death may be delayed.    However, as one survives this condition to live on to an advanced age, the occurrence of other diseases such as Alzheimer's, or other costly illnesses, increases greatly.

Staying healthy is not cheap.  A lot of health care dollars are spent on prevention and a prolonged life.  Preventing diseases is good, new treatments are good.  But none of this occurs without significant cost.

It takes dollars of prevention for one cent of cure!

Thursday, August 6, 2015

Discussing Livers and Hearts Over Lunch

So much of what one says in a private tête-à-tête is dissimilar from what one would otherwise say.

The recent videos of officials from Planned Parenthood discussing the distribution of fetal parts, between bites of salad during a private lunch,  is not a reason to critique the issue or to defund a program.  One may understandably be opposed to late-term abortions or the use of fetal tissue in research efforts to advance medical science, but such a conclusion should not be based on private "intra-professional" conversations.

Physicians often discuss patient-related issues or disease-related issues over coffee or lunch.  Yes, we take bites of hamburgers while discussing illnesses, and may even chuckle or laugh during the conversation as we talk about an unusual situation that may have come up - not always using "appropriate language."  Operating rooms and diagnostic labs are filled with, what some might term,  rather irreverent banter.  It is the nature of our "business."  It is in the nature of any "business" to speak "informally" when "businesss" matters are tossed around among close colleagues.

Saucy collegial conversations regarding medical issues are very common.  One should not use such surreptitiously recorded conversations as a tool to promote or condemn a point of view.