"All Lives Matter"

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

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

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

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

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

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

The Usefulness of Medical Data in Managing Disease

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

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

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

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

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

Government and Ebola

Physicians may not always be unbiased when it comes to issues such as the Affordable Care Act and similar subjects that govern how they work and how their incomes may be affected. The non-medical community may certainly and rightly differ with their points of view.   But when it comes to evaluating the facts regarding science-based health issues, physicians whose medical and scientific expertise is well recognized should be listened to, and their recommendations generally followed.

A recent editorial in the highly regarded New England Journal of Medicine (Nov 20) discusses the matter of Ebola virus and quarantine.  It points out how the 21-day quarantine on health care workers returning to the United States from West Africa is "unfair and unwise, and will impede essential efforts to stop these awful outbreaks....."  Government should listen to the presentation of the facts and not "drive a carpet tack with a sledgehammer."

Facts:
1.  Ebola is transmitted via contact with bodily fluids.
2.  Viral transmission occurs only when the viral load is very high, which is why asymptomatic individuals are not considered contagious.
3.  Fever precedes the contagious stage.
4.  The blood test for Ebola only becomes positive 2-3 days after the onset of fever or symptoms, supporting absence of contagion prior to that time.

It is important to remember that only those individuals caring for Thomas Duncan (the American who died in a Texas hospital from Ebola) at the time of hospitalization, when he had a very high viral load, became infected, while his family members, exposed during the very early start of his illness, were unaffected.

Government officials who ignore the facts and follow their "instincts" in order to achieve what they believe to be "the greater good" for their constituents, must provide the public with some evidence to support these unscientific and unsubstantiated programs which, in fact, are more harmful than helpful.

Is Israel a Democracy?

The meaning of democracy is equality before the law.

How can Israel say that everyone is equal before the law – that you’re equal before the law – when the law defines Judaism as the cultural, national and legislative basis for the state?

These are the words of Yair Lapid, Israeli Finance Minister, as reported in a recent issue of The Jerusalem Post.

Israel isn't going to be a democratic state...so what?

These are the words of American Jewish philanthropist Sheldon Adelson.

I believe they are both saying similar things, though the tenor of the two quotes differs dramatically.  Adelson is rather blunt.  Lapid is more diplomatic.

Can Israel truly be regarded as a democracy?

Israel may be a democracy, but perhaps a "democracy" with certain provisos.  David Kretzmer, a law scholar at Hebrew University has pointed out the peculiarly Israeli dichotomy between nationhood and citizenship.  In Israel these are not interchangeable terms.   You can be an Israeli citizen, but, if not Jewish, you are not a member of the "nation-state of the Jewish people," which, after all, is how Israel defines itself.

Can you imagine a non-Jewish Prime Minister or President?  Could such an official deal with the religious laws and religious officials of the state?

Yes, one man, one vote - but a clearly defined difference among its citizens - some included in the nation-state, some not.

"Klinghoffer Re-visited"

The Metropolitan Opera has posted the libretto of "Death of Klinghoffer" on it web site.  Here is a piece sung by one of the terrorists.  Do you really believe that these words are not anti-Semitic (though, admittedly, they are the ravings of an outraged, angry and hateful terrorist)?  If similar disparaging words had been used to denigrate blacks or Muslims - do you think an opera including such words would have been written, no less performed?

"RAMBO"
You are always complaining Of your suffering
But wherever poor men Are gathered they can
Find Jews getting fat.
You know how to cheat
The simple, exploit
the virgin, pollute
Where you have exploited, Defame those you cheated, And break your own law With idolatry.
America
Is one big Jew.
What did you say?
You are old and ugly.
Not for one day
Will your children miss you. I hear a belly growl;
The voice of your soul.
Go on then, kneel,
Beg me, beg me to permit You something to eat
And a chance for a piss.
I see you cross
Your swollen legs.
Nobody begs?
That was your last chance. Just this once
You can befoul yourselves. You are all wolves,
Wolves without teeth.
You should think of death, But you meditate
On dirty meat,
And your own unclean flesh. Are you English?
Your Balfour Declaration Led to the partition
And the dissolution
Of the Palestinian nation.

Where English is spoken You will find perversion And all kinds of filth Not practised by stealth Late at night,
But on the street
During the day.
You wink at sodomy. You laugh at blasphemy. You give no charity
To the oppressed.
What did your watch cost?
Is it solid gold?
How many mouths could be filled If this were sold.
Your wrists are thick
But I can make
Bigger ones crack.
There. You may have it back. 

Considering a Sexual Encounter? - Bring Along the Required Documents

There has been much written about sexual harassment and rape accusations at colleges.  I thought it would be interesting to share portions of a 44-page document on sexual conduct and misconduct issued by California's Claremont College for its students (as reported in The Weekly Standard  Oct 20)

Effective consent consists of an affirmative, conscious decision by each participant to engage in mutually agreed upon (and the conditions of) sexual activity.  

The Essential Elements of Consent:
1.  Informed and Reciprocal
2.  Freely and Actively Given
3.  Mutually Understandable
4.  Not Indefinite
5.  Not Unlimited

All parties must demonstrate a clear and mutual understanding of the nature and scope of the act to which they are consenting, and a willingness to do the same thing, at the same time, in the same way.

Withdrawal of Consent can be expressed 'no' or can be based on an outward demonstration that conveys that an individual is hesitant, confused, uncertain, or is no longer a mutual participant."

Don't forget to bring signed documents and lawyers along on your next date!

There Is Only One Holocaust - Stop Making Comparisons!

Godwin's law is an observation made by attorney and author Mike Godwin in 1989.  It states: "As an online discussion grows longer, the probability of a comparison involving Nazis or Hitler approaches 1." In other words, Godwin believes that given enough time, all online discussions end up being about Hitler and the Nazis.

In fact the Holocaust, to which these so-called comparisons relate, is, in fact, not subject to comparison.  It is "incomparable!"

Yes, there have been ethnic cleanings.  Yes, there have been mass killings.  Yes, there have been atrocities of significant magnitude throughout ancient and recent history.  Yes, there has been slavery.  Yes, there has been the forced movement of peoples from their traditional homes.  Yes, there have been outrageous examples of discrimination.  And even more.

But there has been only one Holocaust.  Unique.  Incomparable.  Defined by what it represented.

It is mass killings. It is ethnic cleansing.  It is slavery.  It is forced movement of peoples.  It is the utmost form of discrimination.  It is all of these and much more.  It is a cold, calculated, engineered affair.  It is extermination as a business, in part analogous to pest control, - efficient, cost-conscious, scientific, and yes open to competitive bidding.  It was unique in the evaluation and commercial uses of its byproducts.  Products of the ovens were converted to energy.  Corpses were provided to medical schools.  Gold from teeth was extracted and melted down.  Skin and hair was re-cycled.  People were used as human guinea pigs in medical research.  It is an atrocity of such magnitude that, without records or witnesses, it could be regarded as unbelievable propaganda (as it was by many political leaders of the time.)  It is an unequaled barbarity of major proportions - cold, logical, unemotional, efficient, effective and productive.

It is the industry of human extermination.

Time to render Godwin's Law obsolete.  Time for a new law.

The Holocaust is unique

No comparison to other atrocities applies

Holocaust Survivor - Are You Really Special?

Alvin Rosenfeld, in the Jewish Daily Forward (Sep 12) quotes Hans Frank, one of Hitlers top aides and the Nazi commander in Poland, as remembering his "boss" saying:  "I am an innocent lamb compared to revelations by Jews about Jews......these instincts and.....character traits. It is not I who say this, it is the Jews themselves......."

This was used as an introduction to Rosenfeld's comments on a recent NY Times advertisement by  something called the International Jewish Solidarity Network which proclaimed that Holocaust survivors condemn Israel.  "Jewish Survivors and Descendants of Survivors and Victims of Nazi Genocide Condemn the Massacre of Palestinians in Gaza," screamed the headline!

There is no question, and it is only right, that differences between Jews exist  regarding the recent Gaza War.  Jews, whether Holocaust Survivors or not, have the right to opinions.  Rosenfeld goes on to define the signers of the document as  "relative of a survivor" as cousins, friends, distant relatives, grand children and great grandchildren of refugees.  One identified herself as "a great niece of an uncle who shot himself," another as a "third cousin of Anne Frank."

It is generally agreed that the definition of  a Holocaust survivor is: any Jew who lived for any period of time in a country that was ruled by the Nazis or their allies is called a Holocaust survivor or a Nazi victim.  (There is no clear definition of who has status as a "distant relative.")

I am, by that definition, clearly a survivor - I was there from 1937-1939.  Though I was a mere babe, my parents clearly were "adult" survivors whose lives were permanently altered.  My mother never could forget or disregard the great life and rather good social position she had in her beloved community.  My father had been one of the men rounded up on Kristallnacht and sent to Dachau.  Fortunately he survived, was released, and we were able to emigrate.

My mother never called herself a "survivor." She, and my father, never felt that they had special rights to special opinions because of their deplorable and disruptive history.  To them the Holocaust was, and should always remain a personal experience, not exploited, not memorialized with museums, and certainly not to be used as a cudgel by persons who feel "special" because of their victimhood.

They would condemn the rising "Holocaust Industry" which purports to grant survivors, and apparently even the survivors' third cousins and great nieces, special rights to special opinions on special aspects of victimhood.

The Holocaust was unique in Jewish history - in world history.  It cannot be compared to any other form of repression and slaughter.  To even write words that tend to compare this unique event that has no defining adjectives that I believe appropriate, is to do a major disservice to the Jewish People and their history - to then go on and actually compare it to what is termed Palestinian genocide is an atrocity.

There are fewer and fewer real survivors and their distant relatives and friends hardly qualify as experts.  I am certainly no expert.  But these Holocaust bloviators, who feel special because of their suffering, must come to realize that their suffering, especially their suffering, was unique to them and should never be regarded as a special right or privilege.  Holocaust third cousin once removed - express your opinion, but don't feel your distant relationship to victimhood is some sort of privilege.

American Action or Inaction - We Lose

The New York Times ("U.S. Actions in Iraq Fueled Rise of a Rebel," Aug 11) reports that Abu Bakr al-Baghdadi, the self-designated "caliph"of the Islamic world, and the leader of of ISIS, owes his rise to power to U.S. involvement in Iraq.  "Political changes that fueled his fight, or led to his promotion, were born directly from some American action."

The story goes on to enumerate the following "direct" American actions (and inactions):
1.  He allegedly spent five years in an American detention facility.  (The Pentagon maintains, however, that following his arrest in early 2004, he was released that December.)
2.  The American operation that killed Abu Musab al-Zarqawi, leader of Al Qaeda in Iraq, in 2006, led to Baghdadi's chance to take power.
3.  The American ouster of Saddam Hussein (Iraq's brutal dictator) opened the lid that had suppressed extremist Islamist movements in Iraq, allowing Baghdadi "the freedom for his radical views to flourish."
4.  The inaction of the U.S. early in the Syrian revolution my have led to the growth of ISIS, according to Rep. Elliot L. Engel (D-NY).

So are we to blame for the turmoil in Iraq and Syria?  Are we largely responsible for the slaughter that is being inflicted on Kurds and Shiites in Iraq by Baghdadi?  So it's  really all our fault?

We seem to be held responsible for the ills of the world whether by our action or our inaction.  We can't win!

What are Israel's Motives in Gaza?

Why is Israel involved in Gaza?  Why is Israel concerned about border crossings?  Why is Israel engaged in controlling access to Gaza from the sea? Why has Israel constructed walls along its borders with Gaza and the West Bank?  Why is Israel expending financial, political, and human capital on these issues?

Is it because Israel is interested in dominating the Middle East, beginning with the annexation of the West Bank and Gaza (with their 4 million Arabs, resulting in a possible Arab majority within the new state?) Is it because Israel is a war-obsessed anti-Arab country with an overwhelming determination to drive all Arabs "into the sea," and to annihilate the Arab population of Gaza and the West Bank?  Is it because Israel is, at its roots, a violently anti-Muslim country?  Is it because the Judaism, as a religion, demands that other beliefs be eliminated and that Judaism is the only way to the truth and to salvation?  Is it because the Jews want to conquer and enslave the Palestinian world?  Is it that Jews are dedicated to the slaughter and starvation of Arab civilians, especially children?  Is it because Jews are an inherently evil people who  want to "rule the world" - the first step being the "taking over" of Gaza and the West Bank?

Or is it because:

Israel is a recognized country, a member of the United Nations, whose borders have been constantly violated, whose land has been threatened repeatedly from its very beginnings, whose inhabitants (both adults and children) have been slaughtered by suicide bombers entering from Gaza and the West Bank, whose population is under constant threat from missiles launched from Gaza as well as from Lebanon, whose neighbors have charters which include destruction of the State of Israel amongst their articles - Israel has a government whose first and foremost dedication is to the protection of its people from constant threats to its very survival?

What do you think?

Israel, Palestine, Gaza - Some Facts

It probably doesn't make a lot of difference, because many people really don't think it applies to present problems, nor do most people engage in Socratic decision making, nevertheless, I believe the time has come to review a bit of recent Middle East history.  Let's go:

A.  Israel-Palestine

1.  1923 - Palestine, after hundreds of years under Turkish rule, becomes a British mandate - Palestine, at the time, includes what is now all of the West Bank and Gaza.
2.  1947 - The United Nations, under Resolution 181 divides Palestine into two states - one Arab and one Jewish (the term "Palestine" is not used to describe the Arab state).  The Jewish settlement  accepts the terms, the Arabs reject them.  Jordan (then known as Trans-Jordan) annexes the West Bank and it becomes a part of Jordan.
3.  1948 - In May the British mandate officially ends and the British leave Palestine.  On May 14, the Jewish settlement's leader, David Ben-Gurion proclaims the founding of the State Of Israel.  Arab armies attack the new state - eventually losing the war.  An armistice is declared.   A "Green Line" is demarcated, creating an Arab portion including the West Bank (Jordan), Gaza (Egypt), and Golan (Syria).  Jordan resettles its Palestinian refugee population, Syria and Egypt do not.
4.   1949 - Israel is admitted to the United Nations.
5.   1967 - Arab armies mass on Israel's borders starting The Six Day War.  Israel wins and now occupies the West Bank, Gaza, Sinai peninsula and Golan.
6.   1967 - Resolution 242 is passed by the United Nations, resolving that Israel withdraw from "the territories," specifically and intentionally not using the term "all the territories."  Arthur Goldberg, US representative to the UN commented:

“The notable omissions in language used to refer to withdrawal are the words the, all, and the June 5, 1967 lines. I refer to the English text of the resolution. The French and Soviet texts differ from the English in this respect, but the English text was voted on by the Security Council, and thus it is determinative. In other words, there is lacking a declaration requiring Israel to withdraw from the (or all the) territories occupied by it on and after June 5, 1967. Instead, the resolution stipulates withdrawal from occupied territories without defining the extent of withdrawal. And it can be inferred from the incorporation of the words secure and recognized boundaries that the territorial adjustments to be made by the parties in their peace settlements could encompass less than a complete withdrawal of Israeli forces from occupied territories.”

The following statements are issued by the Arabs:

"We intend to open a general assault against Israel.  This will be total war.  Our basic aim will be to destroy Israel."  .......Gamal Abdel-Nasser, President of Egypt

"The sole method we shall apply against Israel is total war, which will result in the extermination of Zionist existence."......Egyptian Radio 'Voice of the Arabs

"I, as a military man, believe that the time has come to enter into a battle of annihilation."

...............Hafez al-Assad, Defense Minister of Syria

"The existence of Israel is an error which must be rectified....Our goal is clear - to wipe Israel off the map.".....Abdur Rahman Aref, President of Iraq

7.   1973 - Yom Kippur War following attacks by Egypt and Syria.  Israel wins resulting in 1975 Sinai Agreement between Israel and Egypt.  (Syria refuses to attend the agreement discussions in Geneva)  Israel withdraws from a large portion of the captured Sinai peninsula. 

8.   1978 - The Camp David Accords result in Israel gradually withdrawing from the entire Sinai peninsula.  Egypt recognizes the State of Israel.  Skirmishes with Syria continue and Israel eventually annexes a portion of the Golan.  Israel continues to "occupy" portions of the West Bank, Gaza and the Golan, eventually annexing a portion of Golan (as per Resolution 242), eventually totally withdrawing from Gaza. (see below)

9.   1993 - Oslo Accords divides the West Bank into Areas A, B, C which includes Palestinian control (together with Israeli control) of Area B.  Israel continues settlements in A and C.

10.  2010 - UN grants Palestine "observer status" (similar to the Vatican)

B.  Gaza

1.  1923 - Gaza becomes part of the British Mandate.

2.  1948 - Occupied by Egypt and becomes an "All-Palestinian" government.

3.  1949 - Following the Israel-Egypt armistice it continues as an "All-Palestinian government.

4.  1959 - Egypt occupies Gaza.

5.  1967 - Following the Israeli victory in the 1967 war, Israel occupies Gaza.

6.  1994 - Oslo accords grant Gaza to the Palestine Liberation Organization and Yasir Arafat establishes the headquarters of the PLO in Gaza City.  Israel retains some military forces in Gaza.  Some Israeli settlements are established.  Israel is granted control of airspace and control of sea access to Gaza.

7.  2000 - Palestinian Intafada results in increased Israeli control, including construction of a wall and limited access at Israel-Gaza crossings.

8.  2005 - Israel unilaterally leaves Gaza - both military and civilian.  

9.  2006 - Warring factions established in Gaza between al Fatah and Hamas (declared a terrorist organization by the United States and United Nations) which Hamas wins (at least 600 Palestinians are killed).  Israel closes the borders.

10.  2007 - present - Hamas in Gaza begins arming and firing missiles into Israel.

11.   2014 -  Hamas joins the Palestinian government in the West Bank and increases missile firings into Israel with missiles now reaching points in northern Israel.  Israel institutes military strikes in Gaza.

 Those are the facts.  

Is There Life in "The Death of Klinghoffer"

 “Here was a wanton murder of a helpless human being. Trying to portray both sides and show they’re not monsters, but human beings who did foul, awful things to advance their cause, shows that it was a horrific event. If by producing this those questions are raised again, is that a bad thing? Discussions need to be had.”

The above quote by Rabbi Gary Bretton-Granatoor,  as cited in the recent issue of the Jewish Daily Forward, was his comment on whether the opera "The Death of Klinghoffer" is, in fact, anti-Semitic.  I guess he doesn't believe it is.  The opera has come under major criticism for its supposed anti-Semitic theme and this criticism has resulted in the cancellation of the Metropolitan Opera's world-wide HD transmissions of the live presentation of the work, scheduled for this November.

I have not seen it, nor do I plan to see it (I am not an opera-person) and have no idea whether the theme is anti-Semitic or not.  If the opera portrays all Jews, by virtue of their Jewishness, as a group that should be despised and perhaps even murdered, this is anti-Semitism.  If the opera justifies and praises the killing of Klinghoffer because he was Jewish - that is a clear form of anti-Semitism.   On the other hand, if it portrays the horrors of the Palestinian-Israeli conflict and the monstrous results that it may incur, is this really a form of anti-Semitism?

Anti-Semitic, or not, the right to stage it should not be in question.

Is It a Disease or Is It a "Condition"

An article by Dr. Aaron E. Carroll in today's NY Times (The Trouble With Labeling a Health Problem a Disease, June 2) contains important information regarding the over-treatment of "conditions" that are often just variations of a normal physiology, but that have often been termed "diseases," and how the mere labeling of an individual with a "disease" often causes unnecessary life-style consequences.  What follows is the final conclusion, which I believe bears repeating:

"Allowing the medicalization of normal variations in physiology to be transformed into 'treatable conditions' is leading to unintended consequences.  We're spending billions of dollars on treatments that might not, or don't work.  We're making people worry when they don't have to.  And we may be causing actual health problems in the process.  Our job as doctors is to make sick patients healthy not to make healthy patients sick."

Bloomberg, Democracy, and the Woolly Mammoth

In his recent commencement address to Harvard graduates, Michael Bloomberg emphasized how democracies function by empowering the propagation of all ideas, whether liberal or conservative, and followed by chastising universities for their apparent one-sidedness in promoting an  overwhelmingly liberal ideology.  He also emphasized the importance of the acceptance of evidence-based science and cited an interesting example of the lack-thereof using the following little-known fact.

An eight year old girl wrote a letter to her state representative in South Carolina, suggesting that the state adopt the woolly mammoth as the "official state fossil."  (Apparently many states have adopted such "state fossils.")  Though agreed to by both houses of the state legislature, an amendment to declare that this fossil was, in fact, created by God on the sixth day of creation, was seriously considered prior to adoption.  After some debate, the amendment was rejected and the bill subsequently was passed without amendments.

If a democratically elected legislature had, however, decided that evolution is not science, and that the state fossil was created by God on day six of creation,  what is one to do.  As Winston Churchill is said to have said (and I paraphrase, I think) "Democracy is the worst form of government....... except for all the others."

Visa Waivers and Anti-Semitism

In a recent article in The Times of Israel (Apr 25) Abraham Foxman, the outspoken National Director of the Anti-Defamation League, criticized the policy of the United States for continuing to deny Israel admission to a list of countries for which the United States has waived tourist visa requirements.  "The current visa refusal rate for Israelis is at 9.7%.  To be admitted to the visa waiver program, a 3% rate or lower is required.  Data for Israelis aged 21 to 26 shows a rejection rate as high as 32%." (US Dept of State Spokesperson Julia Frifield, as quoted by the Times of Israel, Apr 25)

Foxman accuses the State Department of refusing to add Israel to the waiver list because of American concern for Israeli spying following the Jonathan Pollard affair.  The State Department explained that  reasons for visa refusals are primarily related to an increase in the number of young Israelis entering as "tourists" but then working illegally, and Israel's refusal to treat Palestinian-Americans wishing to enter Israel as it treats other Americans.  Other reasons are said to be the absence of US statutory requirements concerning certain data-sharing agreements and the issuance of e-passports.  (I am not, however, denying that espionage might be included as an additional reason.)

The U.S. State Department lists only 38 countries where tourist visas are not required. The only country in the Western Hemisphere (recently added, by the way) on the list is Chile - even Canada is not included.  No African country is included, and only five Asian countries make the list.

Foxman, however, asserting that these visa issues are primarily related to espionage, concludes that the State Department seems to "draw on false stereotypes that Jews are disloyal citizens and cannot be trusted."  Fear of Israeli spying, says Foxman "taps into prejudice."  In other words, the government of the United States, in its tourist visa-waiver policy, is anti-Semitic - strong words making strong allegations.

Anti-semitism should not be the first thought when evaluating an attitude, or a nation's policies towards Israel.  Even singling out Israel for criticism when there are other countries even more deserving of admonition, should not automatically be construed as anti-Semitism. (After all, even  Israelis themselves often attack their government's policies!) Such statements may be unfair, but are not necessarily anti-Semitic.  I am not contesting that some Israel-directed criticism may be anti-Semitic,  only that one should not attach this label without further scrutiny.  Criticizing a "wrong" is always "right" even if other "wrongs" are not included in that critique. However, refusal to include those other "wrongs" when challenged, indicates true prejudice.

Israel is a state, not a people.  Criticism of a state is limited to its policy and is not a criticism of its people.  Criticizing Vatican policy should not be thought anti-Catholic, criticizing Russian policy should not be considered anti-Russian, criticizing North Korean policy should not be be considered "anti-Korean."

Israel is the "Jewish State," but it is not the Jewish Nation and it is not the Jewish People.  All Jews - in Israel and elsewhere - comprise its peoplehood and its nationhood.  Unsubstantiated and stereotypical criticism of Jews, prejudicial restrictions or untoward treatment of Jews, or just plain prejudicial hatred of Jews - that's anti-Semitism.

Who's a Boy and Who's a Girl, or None of the Above

A Brazilian cave insect has done a most unusual sex-role reversal, a new study finds: Females have penises, and males have vaginas.  All four known species of the genus Neotrogla in Brazil have this anatomy, which has not been seen in any other animal, said Rodrigo Ferreira, a cave biologist at the Federal University of Lavras in Brazil and an author of the study, in the journal Current Biology.

This fascinating phenomenon was reported in the Science Section of the Apr 22 issue of the New York Times.  Please note the phrase "Females have penises and males have vaginas."  It's this phrase that piqued my interest.  So if a human male develops a vagina (naturally or artificially) is he still a male?  The same question, of course, holds for the female.

The New York Times referred to those insects with new vaginas as males and to those with new penises as females.  So what makes an insect (or a human) male or female?  Scientifically speaking, determination of sex has been dependent on chromosomal analysis. Yet we are now permitting people to choose to be whatever gender (sex) they wish to be with total disregard to external appearances or chromosomal analysis.  It is now apparently difficult, if not impossible, to determine human gender by outward appearance, whether clothed or unclothed.

Let's assume you encounter a hypothetical person who is found dead or totally unresponsive.  How should you sexually identify him/her?  What sex should be assigned?  If the person has a penis should this hypothetical person be termed a male?  If that person has breasts and a vagina should that person be designated female?  Should such individuals be subjected to chromosomal analysis?

Society now allows a citizen to assign whatever sex he/she wishes to him/herself, and that's OK with me. But this cannot alter an individual's biologic and genetic determination.  So - here's my idea for  gender identity disclosure, should anyone be interested:

Examples:

A.  Carl Steeg (Gender identification)
      1.  Gender preference - male
      2.  External sexual characteristics - male
      3.  Chromosomal designation - XY(male)

B.  Person Unknown (Gender identification)
      1.  Gender preference - unknown
      2.  External sexual characteristics - male/female
      3.  Chromosomal designation XX (female)

And so on.

Controversies Regarding Pre-K Programs

Pre-K programs (or Head-Start programs) are the headlines todays - they are important subjects for discussion. Most significant is the question as to whether the outcome of these programs justifies their significant expense.

Pre-K (Heard Start ) programs designed to improve the education and future success of participants remain controversial in outcome studies.  Though a number of studies have shown true gains in   reading, math, etc over a number of years, a recent study by the Department of Health and Human Services (Dec 2012) found overblown expectations. The study showed gains with Head Start in experiencing success in kindergarten, but no advantages over the non-Head Start students by the third grade.

It's remarkable that answers to the success, or lack thereof, of these programs are still in question after having been in effect in one form or other since the days of President Lyndon Johnson - some 50 years ago!  Admittedly there can be a number of explanations for differences in studies, primarily in the methodology, e.g. the number of children involved in each study, how rigorous the methodology, and the statistical tools used to evaluate the data.  I admit to being unaware of the various techniques employed in all the studies, but do know that the Department of Health and Human Services evaluated some 5,000 children across 23 states, and that this study involved a random assignment of children to a Head Start group or a control group.  Such "random assignments" are the only way to evaluate such data when comparing two groups.  The groups should be identical in every other way.

If we allow parents to decide whether or not to enroll their students in a pre-K (Head Start) program, one cannot compare the pre-K group whose parents selected the program with an otherwise similar group of children whose parents chose not to enroll them.  These groups are selectively different - biased groups, not random groups.  No conclusive data can result from such a comparison.

New York's mayor Bill DeBlasio has promised to institute "universal pre-K", whatever that denotes.  Does that imply universal availability or universal compulsion?  If the former, one can rightly assume that there will be parents who do not enroll their children in such a program.  Given a significant number of non-participants,  the true success of a pre-K program may remain unanswered.

Hate Speech

Much has been written about Dieudonne M'bala M'bala, the French performer who has been accused of promoting anti-Semitism as well as Holocaust denial, both of which are in violation of French anti-hate laws.  The French government has forced cancellation of some of his performances.  As reported in the NY Times (Mar 11), these actions have actually "fueled support" for him.

No surprise.  Attempts at suppression of speech actually may tend to promote it!  Censorship at any level tends to promote the "offensive" item, whether it be a speech, a film, or whatever.  Yes, we can try to restrict the sale or viewing or private access to "offensive" materials to certain age groups, but total elimination is unworkable.

However, hate speech (or any form of speech) with an intention to promote violence is (and should be) illegal!

Anti-Semitism (and other forms of extreme hatred and prejudice) has been extant throughout all of Western history - and can take hold in countries where there are few, if any, Jews!  But trying to eliminate such hate speech with anti-hate speech laws has been unsuccessful, merely driving such speech underground or into cyberspace.

Fight fire with fire.  Fight hate speech with anti-hate speech!

Medical Coding and Medical Billing - New Codes!

I thought you might be interested in some additions in the ICD -10, the newly updated (the last one, ICD-9, was published some 30 years ago) tenth version of the International Classification of Diseases which is published by the World Health Organization.  It is the standard for coding diagnoses and procedures that physicians must use when filing for reimbursement from Medicare and other insurance companies.  The current coding system, according to an article in the recent issue of The Weekly Standard, will increase the number of accepted diagnoses from 17,000 to 155,000!!

Medical coding has become a specialty of its own.  Medical facilities and physicians offices employ individuals who have become certified in this "specialty."  The recent edition of the new ICD-10 regulations was discussed at a meeting of the American Academy of Professional Coders.  Yes, this specialty now has its own special "Academy."

Here, believe it or not, are some of the new ICD-10 Codes:

Code T63112A - Toxic effect of venom of gila monster
Code V9412XA - Bather struck by non powered watercraft
Code X060XXA - Exposure to ignition of plastic jewelry
Code T63612A - Toxic effect of intact with Portugese Man-o-War
Code S30867A - Insect bite (non-venomous) of anus
Code W5612XA - Struck by sea lion
Code T71222A - Asphyxiation due to being trapped in a car trunk
Code R461 - Bizarre personal appearance
Code V9542XA - Forced landing of spacecraft injuring occupant
Code V9733XA - Sucked into jet engine
Code V80731A - Occupant of animal-drawn vehicle injured in collision with streetcar

Estimated cost of implementing new code for a small medial practice is $83,290, and for a very large practice - $2.7 million!

Addressing Both Sides of the Israeli - Palestinian Issue

Today's NY Times (Feb 27) includes a story describing the rescinding of an invitation to Professor Rashid Khalidi to address the student Ramaz Political Society, a group of Ramaz high school students.  The head of the Jewish modern orthodox school, Paul Shaviv, felt that "any dialogue between the professor and students would be imbalanced."  "'It would be a bit like inviting the head of our high school tennis team to play an exhibition match with Andre Agassi.'"  He apparently considered Ramaz high school students not astute enough to enter into dialogue with this renowned and respected pro-Palestinian speaker.

This follows efforts of other Jewish organizations dedicated to Zionism to inhibit or interfere with local chapters of such groups engaging speakers that propose a different view of the Middle East problem, especially speakers, most often Jewish, who support the BDS (Boycott, Divestment, Sanction).  Such actions are and will continue to be counter-productive.

Attempts to suppress the views of opposing factions in a debate can only reflect poorly on those involved in the censorship.  In fact, pro-Israel organizations should encourage invitations to dissenters to address them.  There should be no fear of hearing the words and opinions of those on the other side - they should be welcomed and openly debated.

The Logic About Abortion - Whether Pro-Choice or Pro-Life

Wendy Davis,  "liberal" candidate for governor of Texas, who gained fame as a state legislator for her filibuster of state abortion restrictions, has modified her stand, saying she is opposed to late term (after 20 weeks) abortion except in cases of rape or incest, or when the mother's life is at risk.   Apparently, according to Ms. Davis, there is a point where a fetus has a "right to life."

Let's take a look at this issue once again.

A fetus (here defined as any product of conception) either has "a right to life" or it does not.

If it does not have a "right to life,"  abortion may be performed at any point prior to birth.

If a fetus has a "right to life," then this right either begins at conception or some time thereafter.

If it begins at conception - end of discussion.  Abortion for the sake of abortion would be immoral - rape, incest, or other crimes can have no bearing on this decision.  Once a fetus has attained "the right to life," the subsequent denial of that right cannot be modified because of the means of fetal generation.

If a "right to life" begins at some point after conception, then abortion for the sake of abortion is immoral at that time and thereafter - rape, incest or other crimes can have no moral effect on this decision.  Once a fetus has attained the "right to life," the subsequent denial of that right cannot be modified because of the means of fetal generation.

When the right to life is said to occur at some point after fertilization, that point needs to be defined.  It is generally considered to be the age of "viability"-  the age at which the fetus is considered able to sustain life ex-utero (outside the uterus.)  However, not all fetuses may attain viability at the same in-utero age.  Just as ex-utero "normal" infants don't all mature at the same rate - so it would be for in-utero fetuses.

Viability ex-utero is not defined by the ability of a "born" infant to survive without the assistance of technology.  The need for technological assistance to sustain life is, in fact, the rule rather than the exception in children born prematurely.  It must be acknowledged that the fetal age of ex-utero viability may decrease with advancement in this technology.  With time, future technology may progress to the point where ex-utero viability may extend very close to, or actually to, the onset of fertilization!

Some interesting further considerations:

If you believe that rape or incest justify abortion, consider the rare cases of "superfecundation."  Superfecundation is the fertilization of two or more ova from the same cycle by sperm from separate acts of sexual intercourse.  If one ovum was fertilized because of rape or incest, and the other through "mutual non-incestuous consent," which fetus should be aborted - one, both?  Should there be DNA testing to make that determination?

Is a fetus truly a "part of the mother's body" to which she has full control?  A fetus is genetically distinct from its mother and from its father.  If a mother is to have full control of her body, including control over a genetically distinct entity within, then she could logically abort a fetus at any age.  There could be no moral distinction between abortion at 6 weeks and abortion at 34 weeks.  One cannot lose this "right to my body" as that part of the "body" develops over time.

If a woman accepts the implant of a fetus from another couple which, therefore, is not genetically related to her at all, does this fetus become part of her body as well?  Does she have the moral right to make decisions regarding this fetus who entered her body from without rather than from within?  Or does the "right to my body" not apply in such cases.

If the life of a mother is potentially compromised by an ongoing pregnancy and one must make the "Solomonic" choice as to which of the two shall survive - this decision should be in the hands of the concerned individuals who are legally and ethically involved.  Decisions may be based on moral and/or religious beliefs or tenets.  Such judgments are always extraordinarily difficult - and non-involved parties should not have the right to impose them on the concerned parties.

Conclusion:

If you are "pro-choice" you must be pro-choice in all situations.  It does not follow that exceptions apply except where the Solomonic decision is required.

If you are "pro-life" you must be pro-life in all situations.  It does not follow that exceptions apply except where the Solomonic decision is required.

The False Constancy of Inherited Guilt - Israel, Germany and Victimhood

“Silence in the face of false propaganda legitimizes actions against Israelis. I will not accept false moralizing against the people of Israel, in Israel’s Knesset. Certainly not in German.”

“His support for Palestinians who incite for the destruction of Israel, from the Knesset podium, 70 years after the Holocaust, is a chutzpah without parallel.” 

The Times of Israel (a web-based English-language Israeli newspaper) included these quotes in its article describing the reaction of right wing members of the Israeli Knesset (Parliament) and their subsequent walking out on the President of the European Union, Martin Shulz, during his  address to the Knesset (apparently in his native German).

These words are far more than mere criticism of Mr. Schulz's remarks.  They continue the process of using Jewish victimhood during the Third Reich as a modifier, if not justifier, of Israel's existence today.  This is not right.  Recently many speeches have been made and books written, including Yascha Mounk's current thoughtful and disturbing "Stranger in My Own Country," discussing the German-Jewish issues that continue to besiege this unique relationship - the never-ending accusations of evident "inherited guilt" now beginning to beleaguer a fourth generation of the Germans born after World War II.

Constant accusations of guilt towards grandchildren and great-grandchildren of perpetrators is having more negative than positive effect - as would be expected.  The time of repeated reference to Holocaust and victimhood during political debates should be over.  Right wing (or any other) parties wishing to inveigh against a European or German point of view towards Israel should do so without such allusion.

Israel - Then and Now

Rhonda and I have just returned from a 10-day trip to Israel - a trip designed for "first-timers."  Now though Rhonda was a first-timer, I was actually a "third-timer," having visited Israel in 1966 and 1980.  When I visited as a "first-timer" I was in my late 20's and Israel was 18.   How did my sense of the country change over this 48-year span.

I still remember the words of our guide Max, in 1966, as he addressed our group on entering Tel Aviv after having landed at Lod Airport.  He pointed out to us (a group of US Military officers) that the people cleaning the streets were Jewish, even the criminals were Jewish and, yes, the prostitutes were also Jewish!  There was no West Bank. There was no East Jerusalem to visit. There was no Western Wall to approach  There were armed Jordanian soldiers readily visible in towers overlooking us as we walked the streets of Israeli Jerusalem.  Most of the Israelis we met were European by birth.  So many questioned why we were still part of the Diaspora and refused to emigrate to the State of Israel.  Israelis would accost us in the streets to lecture us, with a classically Israeli uninvited insistence, that the place for Jews was Israel - all Jews should feel an obligation to emigrate.   I felt disrespected as a Jewish-American.  I was made to feel less Jewish, made to feel that Israelis did not consider me a committed Jew unless I committed to an intention to emigrate.  I was clearly uncomfortable.

Fast forward to 2014.  I'm in my mid-70's and Israel is 66.  It's a different place - not only physically, but also in its sociologic and self-sustaining evolution.  I'm also a different "place" - not only physically but also in my sociologic and self-sustaining evolution.   Israeli "street cleaners" do not appear to be Jewish (I must admit, I did not knowingly meet any prostitutes, so can't be sure about their backgrounds) and  there are noticeably now people of color!  The cities seem much more cosmopolitan.

That sense of being a derided, uncommitted Diaspora Jew was no longer.  No one encouraged emigration.  No one even suggested it.  Diaspora Jews were Diaspora Jews and Israelis were Israelis!  We have a common history, but not necessarily a common commitment.  That's good.  A feeling of Israeli "dependency" no longer existed.  The word "miracle" is often used in describing this extraordinary, vibrant country.  "Miracle" is a word that I find hard to accept in describing anything, but somehow the word may apply here.  I venture to say that if there is such a thing as a "miracle," Israel may be the unique paradigm.

Israel - Mature, Modern, Madcap, Majestic, and - simply aMazing!

A Fetal Life in a Dead Mother

A woman who is legally dead, is being kept on "life support" in a Texas hospital against the wishes of her husband and parents.  She is being maintained on "life support" solely to sustain the viability of her 21-week old fetus.  Physicians have refused to honor the wishes of the family, arguing that Texas law prevents them from withholding "life-sustaining treatment" from a pregnant patient.  The family contends, however, that since the mother has been declared "brain-dead" she can no longer be considered a pregnant patient, since a "patient," by definition, is someone who is alive.  Physicians intend to continue the present regimen until the fetus has reached the age when a caesarian section can be performed.

This fetus is now approaching extra-uterine viability - a fact which makes this case difficult to morally adjudicate.  However, if the fetus were as little as 4 weeks of gestational age, or if the fetus were as much as 30 weeks gestational age, how one would feel about this tragic set of events might be quite different.

If the fetus is to be the sole consideration here, then perhaps a caesarian section should not even be considered, there being no question that a fetus has a far better chance of survival in-utero than ex-utero.  Assuming no complicating medical factors, would it be ethical to continue to maintain this "natural" form of fetal nurturing rather than proceeding with a C-section?  Would it be ethical at 4 weeks gestation?  Would it be ethical at 30 weeks gestation?

Whose Medical Record Is It Anyway!

A recent article in the prestigious New England Journal of Medicine discusses the usefulness of giving patients full access to their medical records, including the physicians "notes," which had previously remained inaccessible.

A medical record includes laboratory results, radiology results and pathology results - all of which I concur should be made available to a patient - after all, they are his lab results, his radiology results, and his pathology results.  However,  it had always been my feeling that what I entered into a medical record (my "notes") was only for my eyes and for other eyes to which I wished to show them.  And when I translated these notes into a formal letter, most commonly to a referring colleague, the letter was a private communication between my colleague and me.

Medical record "notes" often contained personal reflections on the patient, possibly his family, his attitude, and maybe even some quirky anecdotes to help recall a a previous encounter.  I never regarded my "notes" like those that would be part of a personnel record or subject to the Freedom of Information Act.

But I guess those are bygone days.  Now, were I to enter information into a patient's record - it would be limited to "the facts." Any "color" would have to be withheld from the written record and restricted to some non-written form of communication (if deemed necessary).

Progress - onward and upward.