Saturday, December 31, 2011

Keynes, Krugman, and Common Sense

"Keynes Was Right" argues Paul Krugman in his NY Times Op-Ed column of Dec 30. "The boom, not the slump, is the right time for austerity at the Treasury" said Keynes in 1937. His pro-Keynes argument goes on for four half-page columns without once citing any historical or present-day evidence that this concept has ever actually been shown to work! He chides FDR for cutting spending too soon thereby prolonging the recession of the 1930s at a time when the economy was showing signs of improvement. Obama has made the same mistake, Krugman maintains. Now is the time to spend more, buy more debt, etc. to get the economy to improve even more quickly.

Let's assume Krugman and Keynes are correct. Does one just keep buying debt (printing money) as the economy continues to slump? Surely there must be a point at which economists would agree that it may be time to consider the alternative - namely a limit on spending. How does Krugman (or Keynes) know when that point has been reached? He does not inform us. How can one be certain that continued government spending in the 30s would have speeded a recovery? Where are the data that show continued spending is the answer to our current economic issues?

It's all theory. Common sense may teach otherwise. To paraphrase Ecclesiastes: "For everything there is a season - a time to be born and a time to die, a a time to sow and a time to reap, etc." Well perhaps during periods of recession there may be a time to spend and a time to stop spending. I think Moody's agrees.

Tuesday, December 20, 2011

Medical Expenditures - Life v. Death

In a recent essay in the New York Times, Dr. Peter Bach discusses the "worth" of medical care, even if the end result is death.  He cites an example from his medical background of a "middle-aged man" with no reported chronic medical history who appeared in the emergency room with a life-threatening acute illness.  Though close to death, with a grave prognosis, proper treatment was instituted and three weeks later the man left the hospital in apparent good health.  Bach speculates that, had the patient in fact died, many "policy analysts" would have called the expense of those three weeks a "waste of health care dollars."

Bach confuses terminal patients with non-terminal patients is this discussion of costly treatments.  This "middle-aged" man is hardly the same as a very elderly man with a known terminal disease who happens to come to the emergency room with a similar clinical picture.  We all accept the fact that caring for the sick many mean caring for people who may die, but such patients represent a very broad and varying landscape.  The distinguishing factor should not be "people who may die," but "people who may live!"

I have heard no arguments regarding expenditure for saving a life.  The ongoing valid argument concerns expenditure in situations where this probability is, in fact, virtually non-existant.

Wednesday, December 7, 2011

Musings on Today and Tomorrow

How important is it to worry about tomorrow's world?  What are we really trying to accomplish?  Are we trying to preserve the planet as it exists for us?  Have we decided that preserving an environment that pleases us, a way of life that is comfortable and satisfying for us, should continue for eternity?  Since we have developed methods to actually affect how the future planet may evolve, we seem to have declared that the existence we know today is the existence to be preserved forever.

This "preservation complex" seems to be a natural one.  After all, who doesn't want to maintain the planet as a place of comfort for "those who come after us."

Though we seem to be morally committed to creating a "better world" for those who follow us, can the "happiness" of the world we exist in truly predict the "happiness" of the future world?  Larger evolutionary and ecological factors may evoke a different response and the happiness of succeeding generations may differ from our concepts of happiness today.  Future beings will evolve in one form or another irrespective of our attempts at conservation.  Though global warming, for example, may be an unwanted circumstance for extant homo sapiens, it may devolve into the initiation of another way of life  -a way of life quite alien to what exists today.  Maybe a happier life.  Our global warming problem my become their nurturing environment!

The philosopher Derek Parfit has expressed his concern about our "bias toward the future."  He conjectures that the time of human presence on this planet is just be a beginning, with a future that is significantly longer than its past.  We fret, he says, about the probability of future pain without remembering the pain of the distant past.  The pain of the past, he believes, was probably outweighed by the happiness of the past - and so, in all likelihood,  will the pain of the future.

Sunday, November 27, 2011

"Artfully Sheltering" Your Money

The lead article on page one of the New York Times today (Nov 27, 2011) concerned the "Artfully Sheltered" wealth of Ronald S. Lauder, heir to the Estée Lauder fortune.  The piece goes on to describe Mr. Lauder's "shrewd use of the United States tax code" to shelter his substantial income.  Many examples are listed.  Lauder is criticized for generating charitable deductions (which support many worthy enterprises) as just one "facet of a sophisticated tax strategy used to preserve a fortune...."  He is said to have been involved in a "tax-sheltering stock deal so audacious that Congress later enacted a law forbidding the tactic."

What is the message here - the lead story in the Sunday New York Times?  Are readers to find Lauder's financial "shenanigans" intolerable, and regard him as nothing more than an execrable member of the "1%."  What has Lauder done?  Has he broken a law?  Has he been too meager with his benevolent financial assistance?  Has he bilked naive investors of money?  Has he run a Ponzi scheme?  Has he been nefarious in not publicly calling for the elimination of tax loopholes? 

Ronald Lauder is no crook.  The article cites no illegalities.  His actions are the actions just about every one of us would take.  We are all "guilty" of using  loopholes as methods to limit our taxes.  Most of us would opt for ourselves before we opt for the "greater good."  Most all of us are dedicated to preserving our fortunes for ourselves and for our heirs.  When our tax preparers advise us of legal ways to preserve income, we jump at them - gleefully embracing legal tax havens!

Rather than making Lauder seem like the "bad guy," the Times should have emphasized who the real bad guys are - Congress.  Lauder and his wealthy cohorts did not write the tax codes.  Lauder is doing what every red-blooded American seems to do - finding legal ways to preserve his wealth.  If we want Lauder, etc. to start paying more taxes, it is up to us to close those tax gaps!  If we don't want wealth to be perpetuated for fear of advancing a plutocracy, perhaps we should eliminate the ease with which this is accomplished.  "Occupy Wall Street" should be "Occupy Washington" (with the appropriate acronym "Ow!")

It is wrong to crucify the wealthy for legally-acquired wealth.  It is wrong to crucify the wealthy for  attempts to legally retain and pass on their wealth.  We would all do the same.  It is we, the people - the "99%" and the "1%" - who bear the responsibility to change a system we feel is not equitable - and to do so thoughtfully and legally

Thursday, November 17, 2011

Israel - A State or a "Jewish" State

"His Majesty's Government views with favour the establishment in Palestine of a national home for the Jewish people  and will use their best endeavours to facilitate the achievement of this object, it being clearly understood that nothing shall be done which may prejudice the civil and religious rights of existing non-Jewish communities in Palestine, or the rights and political status enjoyed by Jews in any other country."

These are the words of the 1917 Balfour Declaration.  "Jewish Homeland in Palestine" was also the term used in the original 1897 Zionist Declaration at Basel.

Does "Jewish Homeland in Palestine" imply a "Jewish State?"  Should Israel be regarded as "The State of Israel" or "The Jewish State of Israel?"  A series of articles in the current issue of Foreign Affairs addresses this issue.

With a significant growth in Israeli Jewish ethnocentrism,  questions have been raised as to how non-Jewish Israelis could not be considered as "second class" in a Jewish State.   Is it not difficult for  such a citizen to relate to the strikingly Jewish symbols of the Israeli state - its flag, its seal, its national anthem?  Is it possible for a Jewish state to be governed by a non-Jewish prime minister?  Is it possible for a future Jewish state to have, a citizenry which is only 50% ethnically Jewish?  (It is now less than 80% Jewish.)  It was interesting to read that neither Jordan nor Egypt, though recognizing Israel, acknowledges Israel as a Jewish state.

To us Jews Israel is unique and our relationship to Israel is unique.  Many Jews (if not most) draw a very thin line, or perhaps no line at all, between Israel and Judaism.  We are ethnically and historically and religiously forever joined at the hip!  I can think of no other extant 5000-year-old people-land connection.  As Jews, in our hearts, Israel is and always will be The Jewish State!

But that's us.  And we are not the world!

When I was a boy Christmas was celebrated in my public elementary school every year.  I learned all the carols which were to be sung at "assemblies."  Jewish holidays were unrecognized and, for the most part, unfamiliar to our teachers.  Weekly "assemblies" started with a hymn (Abide With Me) or The Lord's Prayer (which, of course, I still can sing and recite.)  I can't say that it bothered me very much at the time, but it certainly made me regard my standing as very different from that of the overwhelming majority of my fellow students.  They were part of the "real America," whereas I was a member of a sort of "subset of America." Things are clearly quite different today.  P.S. 22 of 1945 is not P.S. 22 of 2011!  Though "Christian" is a very important concept in the history of the United States, the exclusive teaching of Christian customs and liturgy is no longer permitted.

Right or wrong, the terms  "Jewish State," "Muslim State," "Christian Republic," or "Buddhist Republic" - even "Gallic State" or "Anglo-Saxon State" - imply an ethnic or religious affiliation contained within that "state" associating it with a particular religion or ethnic identity which may be incompatible with the views of a significant minority of its citizenry.

Thinking objectively (not easy) it may prove more constructive if ethnic and/or religious references were omitted from the names and identities of states, since such recognition would tend to promote exclusivity on the one hand, and exclusion on the other.  History is replete with nation-states, but the concept of a true nation-state is very questionable today.  I strongly believe in Israel as the home of the Jewish people and as a state that should be culturally and historically Jewish.  But, perhaps illogically, to include the subtitle "The Jewish State" is somewhat difficult to accept.

Saturday, November 5, 2011

Abortion - The Ineffective Pro-Choice Arguments

The abortion wars continue.  A recent article in the respected New England Journal of Medicine addresses the issue of "The Supply Side Economics of Abortion."  It points out that attempts to limit pregnancy terminations are now being accomplished by making it more difficult for such facilities to set up shop (the supply side.)  Up to now, difficulties in obtaining abortions were effected primarily on the "demand side," - waiting periods, parental consent, counseling, etc.  Regulations, citing safety issues, are now mandating space requirements for abortion clinics that make it far more expensive to construct them.  Additionally, a number of states (Missouri, Virginia, Arizona) are requiring facilities performing abortions to update to "hospital status," or that the carrying out of abortions be restricted to physicians only.  (In many facilities they are performed by fully qualified nurse practitioners or physician-assistants.)  These are the "supply side" issues discussed.

Yes, attempts to restrict or eliminate abortion continue - and always will.  Yes abortion has always been with us, and will most likely continue to be with us in the future.  But be sure to understand the motivation of "pro-lifers."  Realize that no argument exists that will budge them from their point of view - their belief in what constitutes a human life.  Arguments - that abortion, legal or not, will always be part of our civilization, or that an increase in "back room" abortions will result in an increase in significant morbidity and mortality, or that giving birth to "unwanted" children will only result in a greater number of ill-cared for and abandoned children - are destined to fall on deaf ears.  Justifying the procedure as being a woman's prerogative will not work.  As a nine-month old fetus is hardly considered merely a part of the mother's body, so, too, the newly created product of conception.

The conviction that the preservation of innocent life is a moral imperative will eternally close the mind of the believer to such arguments.  No true believer will ever consent to the "murder" of a human being in order to accomplish, or in order to prevent, any foreseeable incident.  One does not "kill" a human being that was created as a result of rape or incest. One does not "kill" a human being because it may be economically advantageous, etc.  It is important to always remember that to a "pro-lifer" a product of conception exists as a human being (has the same DNA) from the moment of fertilization to birth, infancy and beyond.  This moral imperative is permanently moored in the "pro-lifer."

Those of us who are pro-choice must invariably stay aware of the powerlessness of our arguments.

Monday, October 31, 2011

Occupy Wall Street v. Indian Fasting

I would like to highlight some of Bill Keller's op-ed piece, Beyond Occupy, which appeared in the New York times on October 31.

Mr. Keller, writing from New Delhi, attempted to interview the" contemporary Indian 'Ghandi'", Anna Hazare.  Mr. Hazare, as you may know, had been on a recent hunger strike in order to exert pressure on the Indian government to institute reforms.  These fasts have apparently resulted in a number of successful results.  Keller points out that Hazare's Indian campaign is hardly anti-capitalism.  Hazare's aim, says Keller, "is to stop a political class from usurping the fruits of capitalism."  A Hazare spokesman (Hazare himself has taken a "vow of silence") is quoted as indicating "we're not anti-capitalism.  We're pro-integrity."  Hazare's spokesman called the Occupy Wall Street movement "engaging," but lacking in a destination!  "We had a destination," he said.

Keller summarizes his column a follows:  "I'm prepared to celebrate when the Occupiers - like the lone hunger artist of India - accomplish something more than organizing their own campsite cleanup, demonstrating their tolerance for tear gas, and distracting the conversation a little from the Tea Party.  So far the main achievement of Occupy Wall Street is showing up."

Wednesday, October 26, 2011

Wealth Distribution - How "Poor" is "Poor?"

Occupy Wall Street!  Re-distribute wealth!  OK, it's clear that inequality in wealth exists in America (as it does in all "developed" countries.)  If we genuinely want to create more equality in wealth-distribution in the United States, how do we do this?  Not by taxation.  Lets assume Billionaire Bill, with accumulated wealth of $30 billion earns (with outstanding advice and insight) 20% on his investments.  That calculates to $6 billion.  Even if we tax him at 80%, it still leaves Bill with $1.2 billion to add to his $30 billion.  One can't create equality by taxation initiatives.  We can try to narrow the gap by putting a ceiling on income and wealth.  Laws can be instituted to limit wages to some multiple of a calculated "poverty wage" in the country.  Assuming a base poverty-level income of $20,000, maximum income could be restricted to a multiple of 20 x $20,000, or $400,000, a difference of $160,000.  Needless to say this is a generalized illustration; there would be modifying factors.

But consider the implications.  If this formula were in place, one would anticipate that the lowest income level would rise by re-distribution.  But as it rises, of course, the upper level would continue to rise by a factor of 20.  A new base of $40,000 would result in a ceiling of $800,000, or inequality that has now reached $760,000.  As the level rises, so does the difference between the extremes of income.  Now, since money begets money, the richer will get richer.  Yes, the "poor"will also get richer, but the difference in the extremes will continue.

Are today's "underprivileged" "99%" so much worse off than the "privileged" "1%?"

Let's examine the "poor households" in the United States:  43% own a home, 73% own a car or truck, 31% own two or more cars, 80% have air-conditioning, 37% have a dishwasher, 97% have a color TV, 55% have two or more color TVs, 63% have cable or satellite TV,  etc. (1) Not too shoddy.  The poor American (as defined by the government) reports that his family is not hungry and has the funds to meet essential needs and access to quality medical care.  While life is not opulent, dire poverty, as we often imagine it, exists only rarely in the United States.

Another interesting statistic:  Housing space per capita (in square feet): US - 721,  US poor - 439, High income countries (UK, France, Germany, Japan) - 377, Low income countries (Egypt, Philippines, Morocco) - 95, Very low income countries (India, China, Nigeria) - 66.  By the way, this comparison of US poor is to "average," not "poor," populations of the listed countries. (2)

Yes, poverty exists in America, but although some 12% of Americans are classified as "poor" very few actually lack essential resources. Yes, disparity exists....and, I believe, always will.  As long as there is equality of opportunity, there will be inequality of success,  as defined by income or by any other criteria.   Should we somehow place a financial limit on wealth disparity?  Will such a system be better for America?  Could it be worse?  Are the "poor"really "poverty-stricken" in the true sense of this condition?  Inequality is not the same as inequity.

Sources:  1. US Census Bureau, American Housing Survey for the US 2003,2005.  US Dept of Energy 2001. 
               2. UN Center for Human Settlements and World Bank, 1993.  US Dept of Energy, 2007.

Wednesday, October 19, 2011

Opting Out v. Opting In

How do you feel about "opting out" as opposed to "opting in?"  This recently became a subject of interest in the Republican presidential debates.  Gov. Rick Perry defended his signing of a bill passed by the Texas legislature requiring all girls of a certain age to be vaccinated against HPV (human papilloma virus).  HPV can be precursor to cancer of the cervix.  His argument, when challenged by those who maintained that this was government interfering with a decision that should be left to families, was that the legislation included an "opt out" clause, allowing unwilling families to do just that - opt out.

What about this "opting out" choice?  It seems to me that for any organization (government, business, health facility, etc.) the "opt out" option clearly favors the organization rather than the individual.   "Opting in" is  an intentional choice.  "Opting out" is a default choice.  Very different!  It is much easier to not respond than to respond.  Businesses are well aware of that fact - especially book clubs and magazine subscription services.  "We will send you this book if we don't hear from you by...." is quite a contrast from "Once we receive your order, we will send you this book." There are obvious reasons why the default option rather than the intentional choice option is offered.

"Opt-out" (default) choices have a ring of speciousness about them.   When a choice is in the offing, doesn't an "opt-in" (intentional) choice seem far more equitable?

Friday, October 14, 2011

History Does Not Repeat Itself

History does not repeat itself. We can learn from historical events, but we cannot use them to predict future occurrences. And that is because yesterday is never the same as today and today is never the same as tomorrow. Things change. Facts affecting events change. Players participating in events change. Situations affecting events are ever changing. Change fuels the world and does not permit the retrospective analysis of history to be the sole decider in decision making. Such an analysis can serve only as a background for decisions affecting today.

Has history helped us avoid conflict? Is the world a better place because of the lessons of history? I think we would all agree that the answers to both questions are a resounding "no!"

History seems to cycle rather consistently. That is the one, if only, true historical fact. Wars, man-made disasters, non man-made disasters, financial crises, crises of thoughts and ideas - ever constant, but never the same.

Programs instituted to stem the depression of the '30s cannot be the answer to our present financial debacle. Early 20th century is not early 21st century: trading in the stock market is different, corporate management is different, the value of currency is different, the population is different, the people in control are different. The world is different.

Ahmadinejdad's antisemitism is not Hitler's antisemitism: the situation is different, the world is different, weapons are different, spread of information is different, the organization of countries is different, the population is different, the people in control are different.

Slogans echoing a reference to a past occurrence, such a "Don't forget Munich!" (vis-a-vis the Iran issue) should serve only to remind us of the event, but never to intend for us to respond to today's issue as we feel we should have to yesterday's. Remember history. Learn from history. But do not become a prisoner of history! The world of today "resembles" but does not "mirror" the world of the past.

Saturday, September 24, 2011

Should We Control Aging?

A recent New York Times article described a scientific battle being waged between researchers studying the aging process and how to control it. Why is science dedicated to the lengthening of life by prolonging it "artificially" instead of concentrating its efforts on allowing life to reach its limit "naturally" by controlling the conditions (diseases, disasters, etc.) that tend to end it prematurely. Why do we bother with uncovering the aging process?

Stemming the aging process would give one the opportunity to live forever, and to live forever without the effects of biological aging! One could have the appearance and the energy of a 30-year old (pick your age) "forever!" Would you opt for this - or opt out of this?

Every living thing undergoes an aging process. There are evolutionary and cultural memes that support this reality. Aging isn't always pretty; as a matter of act it's often quite ugly. It can be emotionally ugly and physically ugly. It is often, if not generally, unwelcome.

We should clearly attempt to make the process less difficult to accept. But should we really be in the business of trying to stop it altogether? I don't know - maybe we should. Perhaps a world where biological aging no longer occurs would be an improvement. Using the evolutionary principle, I guess it would have to be considered an inevitability in the unceasing process of biological alteration. There is no stopping science in its constant drive to answer the never-ending questions about our natural world.

As for me, I'd opt not to tamper with our current march towards the senior years. Aging seems not only purposeful - but has its poetry. However, in its teleologic eternal efforts to understand, science has no bounds and should have none. It may trample on poetry in the process -- but new poetry always follows.

Wednesday, September 21, 2011

The Troy Davis Case - What's Right and What's Wrong

Troy Davis was executed by the State of Georgia on September 21, 2011. Davis was indicted for murdering a police officer in 1989 and convicted of this crime in 1991. He was sentenced to be executed ten years ago. Between sentencing and execution his attorneys had numerous appeals and reviews by various jurisdictions including the Georgia Supreme Court, The United States District Court, The United States 11th Circuit Court of Appeals and the United States Supreme Court, and a at least two special review panels. I counted 11 reviews during the past 10 years.

There had been multiple appeals for new trials and for more evidentiary hearings from notables that include Pope Benedict, former president Jimmy Carter, former FBI director William Sessions, and even Al Sharpton.

First of all, no judge and no court decisions should be influenced by external pressure, whether it comes from Al Sharpton or even Pope Benedict. If the purpose of the demonstrations was for new trials or new hearings, these appeals were in keeping with what actually occurred. There were multiple new judiciary and evidentiary hearings - none of which apparently led to an overturning of the original conviction and sentencing.

None of the notables were present in the courtroom. None of the notables were present for evidentiary argument during the many appeals. I wasn't there, and I would contend that none of the readers of this entry were there.

I am not arguing for the death penalty. I am very opposed to the death penalty. But I firmly support our judicial process, which I believe to be as fair and unprejudiced as possible. Davis's case was considered by many courts on a myriad of occasions. And unless we suspect some form of judicial conspiracy among the various levels of review, it is reasonable and right to conform with their decisions.

Were this not a death penalty case, I wonder if anyone would even have heard of it. Unfortunately Georgia (one of 34 states) supports the death penalty - a form of punishment that has been judged to not be "cruel and unusual."

Yes the death penalty is harsh and, to my way of thinking, wrong. Demonstrations against it are in order - as a matter of fact there should be more of them! But to demonstrate and chastise those committed to the law and its interpretation is unreasonable.

We should not be questioning guilt or innocence here. That is not our place. We were not present in the courtrooms. We should, however, be taking a stand against execution even when the evidence for murder is overwhelming; and even for the most callous of murderers.

On the same day that Davis was executed, Lawrence Russell Brewer was executed in Texas. Brewer was convicted of chaining a man to the back of a pickup truck in 1998 and pulling him along a bumpy road to his death. Protestations and demonstrations against his execution were either non-existent or not publicized. Why?

Friday, September 9, 2011

Israel-Palestine. A Public-Relations War

Last night I attended a presentation by a member of AIPAC (American-Israel Political Action Committee) dealing with the Palestinian statehood issue which will shortly be coming up for discussion at the United Nations. Most of you are aware of this matter. It is the latest approach that the Palestinian "government" is taking to strengthen its position vis-a-vis Israel - a position, which the speaker maintained, has no chance of passing because of an assured United States veto as a last resort. There is, however, the strong possibility that the status of Palestine will be upgraded to what is termed "state without membership" - similar to the Vatican, or Switzerland prior to its joining the United Nations.

The speaker went to to discuss other options relating to a Palestine-Israel accord, seeming quite confident that a negotiated settlement will eventually be reached, because, in fact, there is no alternative solution.

I wonder.

At present Israel is losing a public relations battle. Palestinians are gaining ground, gaining sympathy, gaining allies - to the point where an application to the United Nations is actually going to occur! They are winning the war of words, photos, videos, and headlines. They are an "occupied" people who have been "ejected" from their homeland and are existing in "refugee" status in other countries. If it were a decision left to the General Assembly of the UN, Palestine would be granted official statehood and membership. According to the AIPAC speaker, the vast majority of UN members would vote it so.

The Israel-Palestine problem reminds me a little of psychotherapy. After some 60 years, no real change.

Israel has offered many negotiation-points - but to no avail! Has the time come to believe that this just won't work? If I were winning a war of public relations and sitting in the so-called "catbird's seat," why should I negotiate? If the world is moving in my direction, why change tactics? Time? I have all the time in the world? No reason to hurry. It can only get better for me and worse for the other side. And I have a whole group of potential "fifth columnists" ready to jump in and help.

I find it difficult to share AIPAC's optimism regarding a future negotiated settlement given the present circumstances. Somehow Israel must find a way to gain an advantage in this public-relations war. It has to somehow rid itself of its "oppressor" image - an image which, unfortunately, has come to represent the face of Israel to much of the world.

Israel is not an oppressor!
Israel is not an occupier!
Israel is not a slaughterer of civilians

Israel is merely trying to exercise its right to exist. It has been physically attacked numerous times over its period of existence and all Israel has done is to respond - to protect its citizens and its geographical integrity. In being forced to do so Israel has, somehow, taken on the face of oppression. This image must be changed.

Wednesday, August 31, 2011

Shopping for Medical Care

A recent article in the highly-regarded New England Journal of Medicine began with the following sentences: "Most physicians want to deliver 'appropriate' care. Most want to practice 'ethically.'" (N Eng J Med, Aug 18, 2011)

Isn't it interesting how the author divides the medical profession into two groups: Group 1 - those who practice appropriately and ethically and Group 2 - those who apparently do not. The author does not give us any indication as to where the dividing line lies. Is the Group 1/Group 2 ratio around 90/10, or is it closer to 60/40? I hopefully and candidly believe he is alluding to the first ratio rather than the latter.

Today physicians are frequently referred to has "health-care providers" and their patients as "consumers." Merely the use of these terms has, rightly or wrongly, helped move this encounter from "doctor-patient" to "product-shopper." When one "shops" one considers a number of possibilities before purchasing. Hence the "second opinion" and sometimes even "the third (or more) opinion."

Not that there is anything wrong with that!

As some products are better than others, so are some doctors better than others. In calculating the cost of medical care, I have seen no data that speak to the cost of such "shopping." When such costs are discussed, it is assumed that one family practitioner or specialist is no different from another. We physicians know, in fact, that this is far from factual, and so do our patients. And so the "consumer (patient) shops."

But in doing so, our consumer-patient must recognize that this, too, will necessarily add to the general expense of medical care - whether it is governmentally or privately provided. Controlling health care costs is very difficult for a society that will shop for the best and the brightest who deliver appropriate care in an ethical manner!

Monday, August 15, 2011

"Ethical Boundaries" in Multiple Pregnancies

A recent article in the New York Times Magazine discussed the issue of reductions in cases of multiple pregnancies (twins, triplets, etc.) This has become an issue because of the high incidence of such pregnancies when in vitro fertilization is performed - a process necessitating the implantation of multiple eggs into the uterus of the recipient. Physicians seem to have no difficulty in agreeing to reduce a resultant quadruplet or triplet pregnancy to a twin pregnancy, but ethical issues have arisen when the mother expresses the desire to reduce twins to a "singleton." In the past twin pregnancies carried an increased risk to a normal outcome, but this is no longer the case.

Many physicians perfectly willing to perform a routine choice abortion are not amenable to reduce below twins in cases of in vitro pregnancies. One obstetrician was quoted as saying that reduction to singletons "crosses the line between doing a procedure for a medical indication versus one for a social indication." Apparently a standard singleton abortion for a "social indication" is somehow different. Another, after consultation with his staff, similarly decided against such reductions because of the lack of medical justification. One could conclude that such lack of justification is immaterial when considering a routine choice abortion

Isn't it interesting, in our world of "choice," that how a fetus is regarded is dependent on the conditions of his existence. A physician who would readily abort a product of a normal conception, is not willing to abort the product of an in vitro conception because, as one obstetrician put it: "We were in the business to improve pregnancy outcomes" and reductions of twin in-vitro pregnancies "didn't fit the criteria."

Somehow an abortion intended to reduce a twin to a singleton in an in vitro pregnancy is said to bring on a new "ethical boundary." Is there really an ethical boundary between a woman choosing to abort a single normal pregnancy and a woman choosing to abort one of a normal twin pregnancy conceived in vitro?

It is altogether possible that with future medical advances, triplets, or perhaps even quadruplets could have an outcome no different from that of a singleton or a twin. What then?
When the medical indications disappear, will the physicians quoted above refuse to reduce four to two or three to two if it be solely for "social reasons?"

It seems to me that the choice to abort either belongs to the woman, or it does not. It is black or white - there can be no gray. A woman choosing to abort or reduce a twin pregnancy, or a triplet pregnancy should be regarded no differently from one choosing a routine abortion of a single pregnancy, no matter the manner of conception. The existence of a product of conception is being terminated in both cases. Why should it make any difference whether it be one, or two, or three, or four, or what the style of conception was?

The so-called ethical boundary can not be conditional on the "style" of conception or on the number of fetuses contained in the uterus. The ethical boundary, if it exists at all, must continue to lie between "pro-choice" and "pro-life."

Tuesday, August 2, 2011

The "Nanny State", Taxes, and "Bad Behavior"

In a recent New York Times article, food columnist Mark Bittman advocated a tax on " bad food." He argues that such a tax would result in "billions of dollars annually" which he feels should be used to support the consumption of "healthy food." He also advocates that the taxes take the form of an excise tax, not a sales tax, in that the former are included in the price, whereas the latter are added at the check-out counter. There is little doubt that such tax manipulation would have some of Bittman's desired effects, but of course the burden would primarily be borne by low-income families and individuals - those who must carefully watch their dollars - whereas the rest of us would hardly bat an eye at the Bittman-estimated extra $1.44 per six-pack of Pepsi.

This raises two interesting issues - the rise of the "nanny state" and the taxing of "bad" behavior or "bad" habits, or "bad" foods as a means of generating government revenue.

The "nanny state" dictates behavior. Usually, via some form of tax, it strongly discourages certain behavior which is considered generally harmful to a person's health and welfare, thereby having a major negative economic impact on society. In its race to do so, however, it treads on individual rights that are not directly detrimental to others.

One could argue that the government, as the major underwriter of health care and general welfare, has not only the right, but the fiscal responsibility to impose "good behavior," "good nutrition," etc. on its citizens for the benefit of the country's interests and security. By virtue of its capacity as the principal provider of health care, the government acquires the right to impose regulations on how a citizen's health care should be managed. Should this be the case, the government ("nanny state") could influence not only our nutritional behavior, but the scheduling of mammograms, colonoscopies, genetic evaluations, etc. and other preventive initiatives.

Governments always need money. Our representatives are constantly searching for new revenue sources. So why not tax "bad behavior," "bad food," etc. as a means of raising dollars? This is a tax plan which is targeted to eliminate itself. If one actually terminates the taxable "bad behavior," etc. then the tax dollars would disappear! If these dollars are dedicated solely to eliminating the taxable "bad behavior," and this behavior is, in fact, eradicated, then we have a beneficial outcome. On the other hand, government may become dependent on these " behavior" taxes as a source of general income - income that was originally intended for a dedicated purpose, but in time of fiscal need, may be "borrowed" to meet pressing obligations.

Should taxes be punitive and be levied as a means of raising income? If certain behavior is deemed "bad for the nation" then shouldn't it be eliminated rather than taxed, and participation in such behavior be a misdemeanor or a felony? Bad food shouldn't be taxed - it should be removed. Cigarettes shouldn't be taxed - they should be illegal.

Where should a society draw the line between individual rights that have no direct effect on others, and societal rights imposed on all members for the general welfare.

Wednesday, July 20, 2011

Smoking and Individual Rights

Earlier this year the New York City Council passed a law banning smoking in open areas such as beaches and parks. Evidence for physical harm to non-smokers from secondary smoke exposure in such areas, is very tenuous at best, according to the New England Journal of Medicine.(1) There may be dangers to those under constant exposure, such as waiters, though not to the occasional bystander. But there are reasons other than those of health, cited by the advocates of this new regulation. Additional disturbing aspects of public smoking, such as cigarette litter and the "nuisance" caused by tobacco smoke have also been cited.

The Journal considers that "in the absence of direct health risks to others, bans on smoking in parks and beaches raises the questions about acceptable limits for government to impose on conduct."(1) This advances the issue as to how far a society should go in restricting the rights of individuals to participate in non-harmful behavior to others - behavior that can be considered no more than a nuisance. Robert Rabin, legal scholar and former program director for the Robert Wood Johnson Foundation's Tobacco Policy Research and Evaluation Program, has questioned another very basic issue - how extensive a restriction, even on known self-destructive behavior, should a society impose?

If smoking is to be legal - if individuals do indeed possess the "right" to what could be considered "self-destructive" behavior - in what public (or even private spaces, such as one's own apartment) should such behavior still be allowed?

1. Colgrove et al. Nowhere left to hide? The banishment of smoking from public spaces. NEngJMed 2011;364:25.

Wednesday, June 29, 2011

Conan O'Brien Speaks

Came across this recent quote from a commencement address at Dartmouth given by Conan O'Brien. In it he is referring to George H.W. Bush.

"Before I begin, I must point out that behind me sits a highly admired president of the United States and decorated war hero while I, a cable television talk show host have been chosen to stand here and impart wisdom. I pray I never witness a more damning example of what is wrong with America today."

With these few words I believe O'Brien truly has "imparted wisdom." Would that more would follow this example.

Saturday, June 11, 2011

The Hamas Charter - Read and Reflect

I recently had the opportunity to review the 1988 Hamas Charter. It is a document that is not very different from Hitler"s "Mein Kampf" or the infamous "Protocols of The Elders of Zion." For those with questions as to why Israel is, shall I say, somewhat "apprehensive" about negotiating with this organization, I have pasted a part of Article Seven as well as all of Article Twenty-Two below - just to provide a small taste of what Israel is dealing with.

Article Seven - The Universality of Hamas (last paragraph)

The prophet, prayer and peace be upon him, said:The time will not come until Muslims will fight the Jews (and kill them); until the Jews hide behind rocks and trees, which will cry: O Muslim! there is a Jew hiding behind me, come on and kill him! This will not apply to the Gharqad, which is a Jewish tree (cited by Bukhari and Muslim).

Article Twenty-Two: The Powers which Support the Enemy
The enemies have been scheming for a long time, and they have consolidated their schemes, in order to achieve what they have achieved. They took advantage of key elements in unfolding events, and accumulated a huge and influential material wealth which they put to the service of implementing their dream. This wealth [permitted them to] take over control of the world media such as news agencies, the press, publication houses, broadcasting and the like. [They also used this] wealth to stir revolutions in various parts of the globe in order to fulfill their interests and pick the fruits. They stood behind the French and the Communist Revolutions and behind most of the revolutions we hear about here and there. They also used the money to establish clandestine organizations which are spreading around the world, in order to destroy societies and carry out Zionist interests. Such organizations are: the Freemasons, Rotary Clubs, Lions Clubs, B’nai B’rith and the like. All of them are destructive spying organizations. They also used the money to take over control of the Imperialist states and made them colonize many countries in order to exploit the wealth of those countries and spread their corruption therein.
As regards local and world wars, it has come to pass and no one objects, that they stood behind World War I, so as to wipe out the Islamic Caliphate. They collected material gains and took control of many sources of wealth. They obtained the Balfour Declaration and established the League of Nations in order to rule the world by means of that organization. They also stood behind World War II, where they collected immense benefits from trading with war materials and prepared for the establishment of their state. They inspired the establishment of the United Nations and the Security Council to replace the League of Nations, in order to rule the world by their intermediary. There was no war that broke out anywhere without their fingerprints on it: “…As often as they light a fire for war, Allah extinguishes it. Their efforts are for corruption in the land and Allah loves not corrupters.” Sura V (Al-Ma’ida—the Tablespread), verse 64 The forces of Imperialism in both the Capitalist West and the Communist East support the enemy with all their might, in material and human terms, taking turns between themselves. When Islam appears, all the forces of Unbelief unite to confront it, because the Community of Unbelief is one. “Oh ye who believe! Take not for intimates others than your own folk, who would spare no pain to ruin you. Hatred is revealed by [the utterance of] their mouth, but that which their breasts hide is greater. We have made plain for you the revelations if you will understand.” Sura III, (Al-Imran), verse 118 It is not in vain that the verse ends with God’s saying: “If you will understand.”

Monday, May 30, 2011

Medical Care - Payment and Practice

There has been a major change in how medicine is being practiced in the United States - at least in the state of Maine. The New York Times described how Maine's physicians have seemingly moved further to the "left" politically as the manner of medical practice changes in the state. With the number of female physicians now approaching 50% - women who wish to combine medicine with mothering are opting for salaried hospital positions with defined hours, instead of opening practices. This refashioning of how medicine is being practiced is occurring nationwide, I believe. More and more physicians, male as well as female, are opting for a lifestyle-alteration, allowing more time for family and fun. As a general rule, such salaried positions are not as remunerative as are incomes from private practice - one way that will help in controlling soaring medical costs.

Some other ideas:

1) Limit, or eliminate, reimbursement for procedures and treatments for which there is no documented benefit, e.g. routine mammography before age 50, routine colonoscopy after age 75, certain cancer treatments.
2) License nurse practitioners and other similarly trained medical personnel (e.g. physician-assistants) to practice medicine - independently and without supervision by a physician.
There are 158,348 licensed nurse-practitioners in the United States (American College of Nurse Practitioners, 2008). Just imagine the increase in the availability of medical practitioners if even 50% of them would open family practices, supplementing the present number of family practitioners (95,075 in 2009, according to the American Association of Family Practitioners). Nurse practitioners (see Blog July 16, 2008) are perfectly capable of handling the vast majority of medical issues (I would guesstimate some 95%) for which patients visit physicians.
3) Implement a Ryan-Rivlin type plan (such a plan was advocated by the Simpson-Bowles Committee) which would include a limit on Medigap coverage as well as some form of defined-contribution plan for contributors prior to retirement.
4) Raise the eligibility age for Medicare. The Medicare plan did not anticipate life expectancy to reach 80 (77 for men, 82 for women) by 2011. As the number of aged Americans is increasing, the number of employed Americans contributing to the Medicare pool is decreasing.
5) Medicare supports the post-graduate training of physicians with substantial capitation grants to the medical institutions that carry out the training. Eliminate these programs from the general Medicare budget and assign them elsewhere, so that cost for education and cost for care are separated.

Of these, the one that would include no additional significant cost, yet provide meaningful benefit, is the licensing of non-physician personnel to practice medicine. Remember, the EMT that responds to emergencies and the medic treating field injuries in combat - people to whom we entrust out lives - are not physicians! Don't worry about a properly trained nurse practitioner making errors in clinical judgment. They rarely will, believe me! Being a physician is great - we are well-trained, intelligent, and knowledgable. But as competent as we MD's are, there are quite a number of judgement errors for which we've been responsible.

Saturday, May 21, 2011

"The Holocaust" v. Genocide

The Holocaust (with an upper case "H") is unique. Such a phenomenon had not occurred prior to or since the happenings of World War II. Comparisons have often been drawn between this horror and previous and subsequent genocides, which, to my mind, are not only incorrect, but serve to diminish the monstrous events carried out by the Germans against the Jews in the 1930's-1940's.

The Holocaust is unique from a number of perspectives: 1) it was perpetrated against an ethnic group that had lived peacefully in Germany since Roman times, had no political objectives, was very "German" in its daily existence (and was actually assimilating), contributed positively to German society and economic growth, expressed some of the same prejudices against "outsiders" as did the non-Jewish German, and was generally supportive of German customs and ideals, 2) it was devised and outlined in a clinical, economic, deliberate, well-constructed strategy that was to achieve its goal using an efficient, cost-effective methodology, in which "by-products" of the process such as hair, skin, teeth inlays, medical trials, and energy produced by crematorium-generated heat were to be used in a profitable manner, 3) Jews could not avoid it by conversion, surrender, cooperation, or any other means, and 4) it was to eventually include all Jews everywhere in the world, basically without exception

Ethnic cleansings typified by the Rwandan genocide, Armenian genocide, and the Bosnian genocide were hardly the same. They were rooted in long-standing tribal and ethnic disputes which included political differences, religious differences, border disputes, possible fifth-column activities, and dissatisfaction of one group with governmental control of a minority over a majority. In none of these genocides was systematic destruction at the level of the "Holocaust" ever reported.

The term "Holocaust" is not the same as the word "holocaust." "Genocide" is not equivalent to "The Holocaust." Chief Justice John G. Roberts, in an unrelated matter, observed in The New York Times of May 21, 2011 that "while the ultimate results may be the same - a dead body..... - it is the means of getting there that attracts notice."

Friday, May 6, 2011

Tony Kushner - Honor or Dishonor

Tony Kushner was initially "denied" an honorary degree by CUNY because of his perceived political views regarding Israel. Under pressure, according to the New York Times, the CUNY Board then reversed this decision. Benno C. Schmidt, Jr., the CUNY Board chairman was quoted in the New York Times as believing the board had "made a mistake of principle, and not merely of policy." He went on to say "it is not right for the board to consider politics in connection with the award of honorary degrees except in extreme cases not presented by the facts here." Jeffrey Wiesenfeld, the board member who raised objections to Kushner stated, in a letter to the editor, that Kushner's accusation of Israel participating in "ethnic cleansing" "crosses the line."

Was Wiesenfeld wrong in raising this issue? Apparently a sufficient number of board members thought enough of his remarks to postpone Kushner's nomination (they did not "deny" him the honor), and tabled it until more information could be obtained.

The much honored (including a Nobel Prize) South African Bishop Desmond Tutu has been said to have made anti-Zionist remarks, accusing Israel of apartheid, and more! ( He is hardly the only honored personage to whom such remarks have been attributed - there are many!

Before we jump on the Kushner bandwagon and latch on to the concept of the separation of politics from honorary academic acknowledgment, we should remember Schmidt's own cautionary words about "extreme cases". Is Tutu an extreme case? Is Kushner?

Thursday, May 5, 2011

Keeping History In Its Place

Today's edition of the New York Times includes an article about David Barton, whom the Times indicates is using "America's past to remake its future." According to the article, Mr. Barton advocates the fact that the United States was "founded as a Christian nation," and that the First Amendment has been misinterpreted by the Supreme Court. The Amendment, Barton maintains, does "erect a wall of separation between church and state," but the original intent was to insure government non-interference in religious activities, rather than to prevent the use of public spaces for religious activities.

Let us assume, for the moment, that Barton is correct. So what! The whole process of social and political evolution is to move history forward. There is no doubt that Christianity played a large part in the formation of this country, as it did in Europe - but that was then! Certain principles may still apply, but evolutionary forces will always modify them. History serves as a background to the studies of these forces of change - forces which will always be present, and will generally serve to improve rather than to worsen the societies affected. As a matter of fact, what radical Islam is attempting, I believe, is somewhat similar to what Barton is advocating - a return to historic principles with little concern for how societies have evolved!

The same holds true for the church-state issue. He may very well be correct in his interpretation of original intent. But so what! It's over. Events have progressed as our society has evolved into one far different from the one that was founded on these shores by English and Dutch settlers some 400 years ago! What was a principle at that time, has evolved into new principles acceptable to the society that adopted them.

In addition to expounding on the Jeffersonian or Washingtonian writings of the 18th century, one should consider what these giants would be ideating were they around in the 21st century!

History is a wonderful place to start. But it is only a start. Societies evolve, and their principles will necessarily evolve as well in order to adapt to society's changes. This is not to say that there are not certain principles, Judaeo-Christian or otherwise, that will always hold true, but we have to realize that the society of today can never again be the society of yesteryear. Though history can teach us much, it must constantly be considered in light of the present.

We should never become the prisoners of history. Our past can never be our future.

Wednesday, April 13, 2011

Mistakes v. Errors in Judgment

There are two classes of "mistakes." There are factual "mistakes" and then there are "mistakes" that are retrospective judgmental errors. Factual "mistakes" include incorrect mathematical calculations, or spelling errors. Retrospective errors in judgment are a very different form of "mistake;" an error that is not objectively factual, but one seen only subjectively in hindsight.

If, after assessing all known variables, a decision is made to undertake a deliberate action, the result of this action can only be termed "mistaken" retrospectively - never prospectively.

Decisions to marry, decisions to change jobs, decisions to raise taxes, decisions to declare war cannot be considered "mistakes", if elected conscientiously after proper evaluation of the variables involved. Whether these decisions eventuate into retrospective errors in judgment may take many years - even decades - to determine.

Chou En-lai, the former prime minister of China who was highly regarded for his intelligence, reportedly, was once asked his opinion as to the long-term effects of the French Revolution. "Too early to tell," he is said to have replied!

Sunday, March 27, 2011

The Concept of God v. The Existence of God

Can one be religious and a philosopher as well. Only if one can accept the fact that a believer in a god can be unbiased in his philosophy. I believe that this cannot be. To be a god-believer and to be philosophically impartial is not possible. This, of course, also holds true for the confirmed atheist. He, too, can not be impartial and his philosophy therefore is also biased.

But one can hypothesize the possibility of a god or no-god, and argue from this hypothetical base. But one cannot argue the philosophy of life, universe, morality, and more with the pre-existence of an absolute belief one way or the other.

Let me argue morality from the atheistic point of view. Is a moral and ethical code possible without a central belief in a supernatural power? Of course. One can advocate the principle of social Darwinism - that our ethical and moral codes can stem from our needs as human animals to survive as a group, as is the case for many other animal forms who have learned that within their herds or flocks, etc. there are social rules to be followed. Our ethics, morals, and laws can originate from such needs, as can our needs to "explain" what we otherwise cannot explain.

Gods exist to "explain" what we "cannot explain." The belief in a god helps assuage these needs, particularly our strong need to imbue our bodies with the concept of an everlasting spirit that will continue to exist beyond our deaths, or that will, at some distant point in time be resurrected into a living form. Human society also needs gods to form the idea of absolute good, as well as the concept of absolute evil. These, of course, are concepts which do not, and never have existed. But a future "heaven on earth," represented by the presence of absolute good and the absence of absolute evil, has always been the everlasting unachievable desire.

I am a non-believer, but, that said, I am an ardent supporter of the idea of a god as necessary for a society that exists in the presence of many unknowns. A god provides an ideal for good. A god serves as a concept that helps acknowledge that human thoughts and decisions are not always rational, but emotional as well. A god provides the "missing link" between matter and essence. A god provides strength under duress, and answers where none otherwise exist. God-concepts (religions) have existed, in one form or another, to provide such answers since the beginning of recorded time! I also think that a world without a god-concept would be a rather sterile world; bereft of the very strong human emotion that ties into who we are and what we are. Religion has been a central point of all surviving societies - it clearly seems to be a societal necessity. Religion plays a need in the "public square." It helps punctuate life.

The idea of a god and a heaven provides an everlasting reach for man. But this "reach" which will always exceed man's "grasp" is what helps stimulate us to be the remarkable beings that we are.

Monday, March 21, 2011

The Sacrifice of Youth for the Greater Good

Ancient civilizations were known to indulge in human sacrifice in order to appease the gods. As primitive, and as repugnant, as this policy may appear, perhaps we should analyze it more closely. Those ancient societies, simple as they may have been, were certain that the outcome - a greater good - clearly justified the offering. And the "chosen one" was always a male or female youth. The gods never seemed interested in a mature, or aged individual. What applies to those societies still holds true today.

Let us hypothesize that our society was threatened, but could be saved with the "sacrifice" of one of our young citizens. Would we? Should we? A society that has made the decision to sacrifice one or more of its members in order to achieve the greater good of survival, must, quite naturally, be certain the objective justifies the expense. Is it worth one "sacrificial gift"? Is it worth 100 such "gifts"? Is it worth, perhaps, 1,000 or more "gifts"?

In ancient days, when a "sacrifice" was necessary to save the civilization, the objective was clear and easily justified. But when the objective is unclear, significant questions regarding "sacrifice" must be raised. When intervening in conflagrations around us, it is never without human sacrifice, and any such sacrifice must be deemed significant - whether one soldier dies, or 1,000 soldiers die. Under conditions clearly threatening the survival of our nation, such sacrifice is acceptable. But should our youth be brought home in body bags for "humanitarian" issues such as Darfur, or the slaughter of innocents in Libya, or Egypt, or anywhere else a rebellion occurs? If so, should we intervene in another Tiananman Square, or in the suppression of a future rebellion in Tibet or North Korea, or Russia. I think not. The sacrifice would be far too dear! We choose our benevolent interventions "prudently," don't we.

We intervene in "merciful" causes when it appears it will cost us little in the way of human expense. But such action is never accompanied by a "get out of jail free" card! It had better be deemed truly worthy of the "sacrificial" cost that will surely be required.

Lionel Trilling wrote "good will generates its own problems, that the love of humanity has its own vices and the love of truth its own sensibilities."

Wednesday, March 16, 2011

Update on the Jewish Holiday of Purim

The Jewish holiday of Purim is rapidly approaching. This holiday commemorates the "saving" of the Jewish people from a Persian plot to annihilate them; a plot which was aborted by the famous Queen Esther, a Jew who had hidden her faith, and who was wife to the Persian monarch. When apprised of the plot by her cousin, she announces her faith and denounces the plotter, Haman, to the King, who subsequently has the schemer impaled on a stake of his own design. Additionally, 75,810 Persians were killed as a result of Jewish reprisal.

We learn here that though there were "bad" Persians who threatened the Jews with extermination, no Jewish lives were lost, but over 75,000 Persians (mostly innocent, I'm sure) lost theirs.

We should also recall that it was a later "good" Persian king, Cyrus, who, in the last two verses of the Bible, proclaims "The Lord God of Heaven has given me all the kingdoms of the earth, and has charged me with building Him a House in Jerusalem, which is in Judah. Any one of you of all His people, the Lord his God be with him and let him go up."

Similarly, it seems incumbent on us to remember that in Hitler's Germany there were the "bad" Germans as well as good Germans. And the Germany of 2011 is not the Germany of 1933. We Jews have not held the Persians forever guilty of a perceived plot of annihilation. So must we Jews not hold Germany forever hostage to its history. At some point, in our hearts and minds, Germany will have to be "set free." As a King Cyrus followed a Haman, so can a benevolent Germany follow a tyrannical one.

Tuesday, March 8, 2011

Is a Woman's "Right to Choose" always "Right?"

A couple engages a surrogate mother for implantation and gestation of their fertilized egg. Now, of course, we have two mothers here - the surrogate who is, in fact, providing the environment to bring the embryo to term, and the biological mother who has provided the genetic material to the product of conception. For the purposes of this discussion, lets ignore any legal and contractual issues that may exist, and consider only some moral ones.

Does the surrogate mother now have the moral right to electively abort the fetus she is carrying? After all, it has become, so to say, part of "her body." Or, does she now relinquish "moral" control of this fetus to that of the biological couple, i.e. it is not really part of her body, but belongs to the biological couple.

But if it does belong to the biological couple, does the couple then hold the right to have the fetus aborted? I do not believe than anyone would condone forcing the surrogate, at the donor's demand, to undergo an abortion to which she is opposed. If one agrees with this conclusion, then the final "right to abortion" must lie with the surrogate mother.

Should, then, a woman's right to choose be no different whether it affects her biological fetus or whether it affects a surrogate fetus? Should she legally have he right to abort in both situations? If not, then clearly she no longer has the absolute "right to choose." "Right to choose", then, depends on which products of conceptions are permitted to be removed and which are not - a limited choice.

If one believes that the "right to choose" trumps all, then to choose elective abortion of a surrogate fetus must be endorsed.

But does "the right to choose" really extend to this circumstance? Maybe the legal right does, but how about the moral right?

Monday, February 28, 2011

Are Prostitutes Good for Our Health?

Prostitutes in Nevada, in countering Harry Reid's efforts to outlaw their business in his state, have offered to pay higher taxes in an attempt to mollify the good senator.

Gee, good old "sin" tax. Isn't it great that there are still "bad" guys out there who participate in horrible vices. Where would we be without the smokers, gamblers, lotto players, imbibers, not to mention the "johns" who patronize the tax-paying prostitutes in Nevada. These guys are responsible for supplying a good portion of the income various states acquire to fund activities such as education and health.

Just imagine if the propaganda to eliminate these bad habits succeeded! We'd have to find an alternative tax to replace monies lost with all that good behavior!

Wednesday, February 23, 2011

Darwin v. The Perfect World

Who should survive? The "fittest," as per Darwin - or everybody?

Just think for a minute. What if everybody survives; not just the "fittest." Imagine, cancer under control, no more heart disease, no more diabetes, no more fatal illness. Then there's always organ replacements in case of accidents, deterioration or non-function, etc. Not to mention cosmetic surgery for that everlasting look of youth and fitness. No more hunger, no more poverty! And ultimately, once we discover the molecular genetics of the aging process - no more getting older! Older in "real years", but not in "human years." Imagine - youthful function with youthful looks (you decide what "youth" mean to you) into your once-called "senior years." Age, as we know it, will become irrelevant! Ah Utopia!!

It's coming. No illness, limited tragedy, a true chance for survival for all - fit or unfit. Its what we all want. Or is it?

Well, maybe we'll still have adversities of one sort or another that will be out of our control - climate issues, earthquakes, asteroid bombardment and similar uncontrollable events - including, of course, human-engineered devastation. We may yet approach substituting the "survival of the fittest" dictum by the new "survival of everybody", but will it be mitigated by the natural aggression that is a piece of who we are?

We may all long for this Utopian world, but won't our reach for this "heaven on earth" always be exceeded by our naturally limited grasp? Isn't it a fact that even in our man-made Utopia, the "survival of the fittest" struggle will continue. We all can't have everything we want. We will remain primarily natural aggressive takers rather than tranquil givers or sharers. It's who we are. The Gordon Gekkos of the world will trump the Mother Teresas. But in the end, is that so bad? Darwin will prevail.

Or will he?

Thursday, February 17, 2011

Watson wins at "Jeopardy"

"Computer Wins on 'Jeopardy!'" reports the New York Times in one of its lead articles today (Feb. 17, 2011). I, for one, would have been shocked if Watson the computer hadn't won. Computers, if properly algorithmically programmed, have to be superior in arriving at factual conclusions than are human beings. When a human analyzes a problem, his brain is also employing algorithmic analysis to arrive at a conclusion. Algorithms use appropriate input and go through well defined instructions to calculate results (one or more.) The brain considers all the possibilities when given certain facts and, when all the these facts are evaluated, arrives at the best possible conclusions, in the order of most probable to least probable. We put our brains though this process every day - making decisions based on past-entered input.

But a brain can not be as proficient as a computer at this function. A brain is subjected to immaterial input that may interfere with a defined algorithmic undertaking. Fatigue, the subconscious, prejudice, poor memory, and, possibly, our genetic composition, may unduly influence the defined algorithm. After all, "to err is human."

A computer is unaffected by such human traits. Computers, properly programmed, do not err. With relevant input, they will function far better - unaffected by memory issues, emotions, or prejudice. A computer's memory is essentially boundless. The retrieval of required algorithmic facts occurs at almost lightning speed. A computer can, therefore, outperform the human brain! "Jeopardy" has so demonstrated.

I am a physician. A physician's job is to obtain information from a patient using various techniques, then to input the accumulated data into his brain, and finally arrive at a diagnosis via mental algorithmic analysis. But we physicians are human! We err. We err as a consequence of these human variables.

I feel quite certain that a medically sophisticated Watson (Dr. Watson, I presume) will outscore the diagnostic acumen of the physician in the near future, and will become the physician's most valued "partner." Dr. Watson will "outdiagnose" all of us. Not only outdiagnose - but "outmanage" as well, because the management of a medical problem is also an algorithmic conclusion. We physicians won't accept Watson, at first. Like so many advances in medical management, we will have to be dragged to it "kicking and screaming," but eventually accepting it in the end.

But the human brain is still the master at innovation and new ideas in research and development.

And, we still need the flesh and blood providers of medicine to furnish, through their "art," the very important human functions of compassion and concern, which, even today, remain, arguably, the primary content of the doctor-patient interaction, and among the most crucial forms of therapy.

Saturday, February 12, 2011

Myth Trump Reality

I recently attended a lecture on Exodus - you know the second book of the Bible, not the movie. The distinguished professor who was discussing Exodus made it quite clear that there was absolutely no evidence that the events described in the book took place - Jews as slaves in Egypt and their consequent "exodus" which entailed some millions (using biblical references to arrive at this number) of people wandering through the Sinai desert for some 40 years. There is no archeological evidence supporting this. There is no reference to such events, or to Israelites, in any Egyptian documents of the time. These conclusions are shared by a number of other investigators and are not only those of the lecturer. If you are a believer in God and that the Bible is in fact the word of God, then any evidence to the contrary is meaningless to you. This essay will not persuade nor dissuade you one way or the other - nor is that its intention.

Let us assume that these conclusions were true and the lack of evidence for an "exodus" story is truly incontrovertible. Do you believe that Judaism and Christianity would disappear, or their traditions be significantly altered by these facts? If it were proven beyond any reasonable doubt that there never was an exodus, there never existed a Moses - or there never was a manger-birth of a baby to a mother who was a virgin, or there never existed a Jesus as detailed in the New Testament - do you believe that Judaism and/or Christianity would be cast aside?

I doubt it. True of false, the story would go on. True believers would "clarify" these "incontrovertible" truths with words such as "we humans are incapable of understanding the ways of God," or "the absence of evidence can never indicate that it didn't occur," or some other specious arguments too numerous to list.

I will conclude that the entire biblical story is a myth. But what of it? Myths fulfill a human need. We mythologize so as to attribute explanations where none may yet exist; we mythologize to create a credible and honorable history where none may exist. The reality of the "myth" is that the "myth" helps create an acceptable "reality" - even if this "reality" in fact, never existed! Humanity needs its myths much as it needs water to drink and air to breathe!

Other Examples:

We have mythologized Abraham Lincoln.

If you research his life and actions you will find that 1) he did not believe in the equality of races, though he did believe slavery was wrong. 2) the Emancipation Proclamation did not free all the slaves. Slaves in border states and areas of the south not in secession were not required to free their slaves. The Proclamation applied only to areas in secession that came under control of Union forces. Had an uninvaded state of the Confederate States of America decided to rejoin the Union, slavery need not have been abolished. 3) he illegally confined prisoners by abrogating the habeas corpus clause of the Constitution. 4) his purpose for going to war was not to end slavery, but to preserve the Union. As a matter of fact, when reading certain works describing Lincoln and the Civil War, comparisons to George W. Bush and the Iraq War seem totally appropriate.

We have mythologized our Declaration of Independence.

Do you believe the intent truly was "all men are created equal," Were blacks equal, were women equal? Was slavery mentioned? Are you aware that the document cites the following reason for referring to King George as an oppressor: "He has excited domestic insurrections amongst us, and has endeavored to bring on the inhabitants of our frontiers, the merciless Indian savages, whose known rule of warfare, is undistinguished destruction of all ages, sexes and conditions."

Realities are lost in myths. We have a need to ignore the bad in order to uphold the good. Let the myths reign! Long live mythology!

Monday, February 7, 2011

Cold or Cancer - Which

You have a cold. Your son has cancer. The cure for neither is known. Assuming a very limited number of research dollars, where should these dollars be directed - towards the cure for the cold, or the cure for cancer? Given this alternative - who would care about the cold? A "common cold" is irritating, but nothing more (except in some very rare and exceptional situations.)

Why are we so obsessed with minor infectious diseases? We are told about the possibilities of contagion when we use bathrooms, especially those tiny closets that serve as airplane lavatories. We worry about the sneeze and where it may be directed - into the hand or into the sleeve. People have rebuffed hugs with the phrase "I'm just getting over a cold - don't want to get you sick." We worry about grasping handrails in subways.

If the possibility of contracting some mild viral infection is frightening, one should consider never venturing out in public. Or if doing so, take appropriate protection! Worried about grasping a doorknob that some public lavatory user may have previously touched, then worry about shaking the hand of anyone at all. Perhaps the "hand-shaker" had just visited a "sanitary facility," - who knows if he properly "washed his hands." Or maybe he recently coughed into his hand - Hmmm, better not chance it. Maybe it would be best not to converse with someone unless he is at some properly removed distance. After all, talking involves opening one's mouth, the use of tongue against teeth or palate with a resultant torrent of emerging micro-organisms. Watching actors on a stage declaim their lines, spittle cascading as they speak, one must marvel at the consequent lack of illness!

Consider some realities. There are a multitude of people you encounter every day who are close at hand. The vast majority are completely unaware, as you may be, that they, or you, may be harboring a virus that is contagious and that could, in the next day or so, be responsible for causing active disease.

You and others are exchanging bugs with each other all the time. Surprise! You rarely get sick!! Think for moment - you are entitled to 10 "sick-days" at your job - how many is it necessary for you to use each year. Let's imagine that you actually are laid up with a "bad cold" 10 days each year. How astonishingly wonderful this minor "inconvenience" is, considering an exposure to an uncountable number of "bugs" on a daily basis!

Two choices are open to you: 1) if daring to venture out in public, wear appropriate attire (such as gloves, masks, or better yet, Hazmat protective clothing - or 2) stop worrying so much about the tiny possibility of contracting some virulent organism that will cause major damage or inconvenience!

Tuesday, February 1, 2011

Man IS Nature!

Natural products. Man-made products. Green products. Man v. Mother Nature.

We separate ourselves from Nature. We are not part of Nature. What we produce is not considered "natural." But the human being and his output are part of Nature. A plastic bottle is as much a product of Nature as is a tree! A tree has a chemical make-up - so does a plastic bottle. If we break them down into their atomic elements - the only difference would be which elements are used in the tree, which in the bottle, and how they are relate to each other chemically. All these chemical elements are "natural." Yes, one may be defined as "alive," but both are "natural." Somehow if man makes it, it isn't part of nature. If a bird builds a nest, the nest is considered part of nature. If a man builds a house - it is not.

When we separate the world into Mother Nature and everything else, we should accept that this is a specious division. What we are in fact doing, is disconnecting what may be good for man from what may not be so good for man. When man invents an atomic weapon, he is doing nothing more than assembling existing materials into a product. Mother Nature has provided him with the products and the means of assembly. Man can never "fight" Mother Nature because he is, and we are, all part of "her."

Mother Nature doesn't care what happens to the Planet Earth. Neither do giraffes or bacteria, or viruses. It seems that only we humans consciously "care" about the future of our planet. What we really are concerned with is not Mother Earth, but with ourselves! We want to preserve the "natural" so that our life-forms can somehow continue into the infinite future, a future that looks pretty much like the present, with fish and forests, giraffes and gerbils. However, if bacteria or mosquitoes had the right to vote, do you think they would vote as we might as to how this planet should be preserved?

We, as is true for all species everywhere, are dedicated to self-preservation - if necessary at the expense of other living forms. We have arrogated to ourselves the position of Number One. After all, in Genesis God grants humans dominion over all other earthly creatures! And we use this power to assume mastery over our "domain." We have been put by God, or by evolution - take your pick, at the pinnacle of the planet. We have determined the relative worth of all that exists. We have the right to direct Nature. We have the right to assign worth to natural forms. People are more important than dogs - dogs more important than oysters - oysters more important than mosquitoes.

A tree is interfering with the function of an adjacent cell phone tower that is so designed that it can easily be mistaken for a "real" tree. Should the tree or the cell tower be removed, assuming the expense is equal? The tree is "part of nature," the cell tower "is not." We would choose to relocate the cell tower, I presume. We now discover, however, that the tree can cause a lethal form of cancer in children. I think I would be correct in concluding that it would be the tree that would now have to go. We show little regard for the creatures that may be relying on the tree for food or shelter when the lives of children are at stake.

Once the existence of one form threatens the nature of another form - the threatened tries to eliminate the threatening. Have you, in destroying the tree, interfered with Mother Nature? Not to worry - you have not. The birds and the squirrels may not survive and you will. This is not interference with a process - this is part of a process. So is the cell phone tower.

Man is part of Nature. Nature (or God) created Jackson Pollock. Pollock created his art. His work, therefore, is as "natural" as a "directly created" sunset. We should not arrogate to ourselves some extra-natural powers that can somehow affect Mother Nature or disconnect ourselves from her.

Mother Nature couldn't care less about us. We are fragments of nature that may be affected by what we do, but we should not presume to be Nature's focus. Who we are and what we create are all nature's doing. Nature creates the tree and nature creates the cell phone tower. We humans cannot create anything without the elements provided by the natural environment of which we are a part. Natural? Man-made? Its all the same!

Wednesday, January 26, 2011

The Freedom to Hate

Hate - not a nice sounding word, or even an admirable emotion, right? I agree.

But, I do believe in one's legal "right to hate." I am nor discussing the morality of hatred here - but its legality!

Hatred has always existed, and I feel always will - until, of course, in some far-distant future life it can be "genomically" eliminated.

It is not how fiercely we hate someone, or some idea, or some culture, etc. it is how we deal with this feeling that matters. We need not associate with people or things we hate, we need not read literature or newspapers, or listen to the presentation of issues dealing with matters that are hateful to us, and we have the right to fiercely dispute the issue.

Nevertheless, the "right to hate" exists. One has the right to publicly declare one's detestation of Jews, Muslims, gun-owners, or, for that matter, child-molesters. But there are limits. One may not do so in a manner clearly designed to promote violent action.

A recent article in the New York Times discussed the inadvertent (lets assume it really was inadvertent) appearance of a message promoting a book supporting Holocaust-denial e-mailed to the PTA membership-list of a local elementary school. The parent promoting this book has the right to read it, extol it, and promote it - even on this group e-mail - as long as no law was violated. The fact that it somehow was sent to members of this e-mail list is a problem for those responsible for the administration of the site - not the sender's problem. He has the right to non-violently promote hate-material - and one has the right to hate him in return! But it is wrong to subject him to public exhortations such as "evict the Nazi" or to "threatening phone calls", as enumerated in the Times piece.

Hate him - yes. Never associate with him again - positively! Make conscientious oral or written assertions disputing his beliefs - absolutely. But - direct threats deliberately intended to interfere with his daily life and liberty - not permitted!

The United States does not outlaw the publication of hate literature, nor does it restrict use of public hate speech - as long as its intent is not to provoke violence. This "right to hate" speech does not exist in all countries. Germany has outlawed public expressions of anti-Semitism and Holocaust denial. I understand the "why" - but cannot support the "why."

As long as Germany (and other countries) feels the need to legally proscribe such expression, these banned issues, issues that have severely tarnished its history, must still remain firmly embedded in its soul. Hopefully, in the not-too-distant future, when the guilt of Germany's past is finally wrested from its anima, the "freedom to hate" will join other expressions permitted and embodied in the term "free speech."

Tuesday, January 25, 2011

God and Tucson

Many of the conversations, quotes, and writings about the Tucson disaster have mentioned God. It appears that God is to be thanked for the saving of the lives that were spared, especially for the "miraculous" survival of Congresswoman Giffords - who made extraordinary progress following her brain injury. Perhaps he did have a hand in these "miracles."

But did he, then, also have a hand in the actions leading to the six who were killed? Obviously they were not selected for "saving." It seems that we are always ready to thank God for rescuing us from a disaster, but never "blaming" God for the disaster in the first place! Are we implying that God had nothing to do with causing the problem, but only showed up to mitigate it?

Believers "understand" this dichotomy. After all, "who are we to question the ways of the Lord." But should this entire catastrophe be an act of God, must we not also accept the fact that Jared Loughner took these steps as an "agent of the Lord?" If, on the other hand, it was an act that God did not dictate, but could have prevented, he obviously saw no reason to intervene.

I believe I am correct when I paraphrase the Bishop of Tucson who, in his eulogy of Christina-Taylor Green, stated that "God wanted her to be with him." God works in mysterious ways. If he, indeed, did wish Christina to join him, it seems a rather cruel way to get her there. He had the option of having Christina die peacefully in her sleep, but instead chose to have her die violently with a bullet.

Who are we to question the actions of God. We are only human beings - we are not, and never will be privy to God's reasons. His actions are always beyond our comprehension.

Tuesday, January 18, 2011

Abortion and Viability

Life begins at some point. But when? The answer used to be easy - at birth. This interpretation, of course, is no longer accepted by most Americans. Now life is considered to begin at the point of "viability"- that time of intrauterine development at which a fetus can reasonably be expected to survive ex utero. The termination of fetal development prior to viability is permitted by law. The termination of fetal development after viability may be restricted. Roe v. Wade permits abortion only during the first trimester of a pregnancy - before the point of viability.

Now if one defines viability as the time when a fetus can reasonably be expected to survive, one must seriously consider the argument that the "viability age" may at some future date, be moved back into the first trimester. This is especially true, given ongoing advancements in neonatology, as well as more basic research in methods of extra uterine conception and maturation. It is quite imaginable that viability will be possible for a "product of conception" conceived and subsequently "developed" in some form of "test tube" environment from the very onset of fertilization.

Assuming the validity of the above theses, we may be faced with a new ethical dilemma - the fact of viability at the time of conception - the Roman Catholic definition of when life begins.
Will those in favor of abortion under the rules of Roe v. Wade, and opposed to abortion after a fetus has reached viability, now rethink their positions, given this new certainty?

Should all fetuses (or "products of conception") be potentially viable, it logically follows that viability as the benchmark for the "right to be born" is present at conception, and therefore can no longer serve as the criterion for termination at any age. A fetus aged 1 day can be no different from one 8 or 9 months old. Viability can no longer be considered an issue in this matter. I am not discounting the possibility that there may be other criteria to consider - but viability no longer qualifies.

This discourse is not meant to serve as an argument for or against abortion, but is submitted for your reflections as a potential future ethical issue that may require new considerations in the coming decades.

Thursday, January 13, 2011

Guns and Killing in 2011

"Guns don't kill people. People kill people." So the argument goes.

However, one has to accept the logical conclusion that people can't use guns to kill people if there were no guns. For people to kill people using guns, both guns and people have to be present! Now we can't eliminate the people side of the equation, but we can eliminate the guns side of the equation!

Using a similar argument one could say "Cigarettes don't kill people. People kill people." A dormant cigarette kills no one. It is when a person lights one that death may occur. Both cigarettes and people have to be present! Now we can't eliminate the people side of the equation, but we can eliminate the cigarette side of the equation.

Of course any instrument involved in the killing of a person involves not only the instrument, but a person. But it is the presence of the instrument that aggravates a person's ability to cause a death.

Many, if not most, of these "instruments involved in killing" such as planes, cars, swimming pools, etc. cannot reasonably be eliminated if people are to continue to exist contentedly in today's world. The incredibly easy availability of cigarettes and guns, however, can be controlled or eliminated and , arguably, not significantly affect a reasonably contented society.

Though cigarettes, planes, cars, and swimming pools, and the like are potential instruments of death, they are hardly ever used to deliberately kill. They are not instruments specifically designed to cause severe injury or death. They are not "weapons." Guns, on the other hand, are. Guns were invented specifically to inflict injury or death. They are "weapons!" Though they may be used for alternative activities such as target practice, etc. their invention was to inflict injury or death.

The second amendment of the Constitution of the United States gives citizens the "right to bear arms." No one can argue the fact that this amendment relates this "right" to the maintenance of a citizen militia. Whether the "militia" or the "arms" is the prime subject of this amendment remains unclear. Is it not reasonable to assume that, were "the right to bear arms" the major subject of this amendment, the founders would have not felt it necessary to include any reference to a militia therein? Agreeing that the founders were intelligent men, why wouldn't they just have said "The right of citizens to bear arms shall not be infringed" - and end it there?

The Constitution was designed to be amended. That is why the founders initiated the process of amendment in the first place. The "right to bear arms" is not an original article of the Constitution, but is a amendment! Remember, our founders when constructing our Constitution, decided it was "right" to count certain "citizens" as "3/5" of a person in determining the population of a district for representation in the House of Representatives. Yes, this provision was eventually eliminated by a post-Civil War amendment.

There is nothing "absolutely" sacred about our Constitution. There are times when "updating" and "modernizing" are necessary.

Realizing that the Founding Fathers were not absolutely correct in everything they composed (Consider the phrase regarding "savage Indians" in our Declaration of Independence), we should not feel constrained to change what clearly should be changed. A set of principles and laws written in 1787, surely demands occasional reconsideration 214 years later! Does anyone truly believe that Washington, Franklin, Jefferson, Adams, etc. would have included a "right to bear arms/militia" clause were they writing in 2011?