Saturday, December 12, 2015

Children and Contact Sports

"If a child who plays football is subjected to advanced radiological and neurocognitive studies during the season and several months after the season, there can be evidence of brain damage at the cellular level of brain functioning, even if there were no documented concussions or reported symptoms. If that child continues to play over many seasons, these cellular injuries accumulate to cause irreversible brain damage, which we know now by the name Chronic Traumatic Encephalopathy, or C.T.E., a disease that I first diagnosed in 2002."

Dr. Bennet Omalu, in an opinion piece in a recent issue of the New York Times, arrived at this conclusion concerning the possible damages that may result when children are involved in major contact sports, like football, at young ages.  The conclusion drawn here, however, is purely suppositional.  Children are not subjected to these "radiological and neurocognitive studies" as described and there is no factual knowledge about brain injury in these children. No such study has been done, to the best of my knowledge. That doesn't mean that such injury may not have occurred, but there is no data supporting the claim.  As a rule, young children, with proper protective gear, rarely get injured from mild contact in sport as they are not heavy enough or strong enough to inflict such injury.  Yes, it may come from falling on the ground, but rarely from contact with a rather light, small player.

Nevertheless, there would be nothing wrong with modifying contact sports so that injuries are less likely.  Does football really require tackling at such a young age? Should head shots be eliminated in soccer for young players, etc.?  Not only helmets, but well-regulated restriction of actions that could result in injury, may be very helpful in eliminating, or at least reducing injuries in children engaged in contact sports.  One need not necessarily eliminate the sport, just modify some of the rules to make it safer.

Thursday, November 19, 2015

The Tired, Poor, and Huddled Masses

The outcry to ban Syrian migrants from the United States based on the possibility that one of the terrorists involved in the French attacks may (an I emphasize "may") have had a valid Syrian passport reminds me of the cries during World War II that helped restrict, if not eliminate, the acceptance of Jews attempting to escape the massacres perpetrated by Nazi Germany.  Not only was immigration  severely restricted, in part because similar fears of enemy infiltration, but Italian, German, and Japanese nationals, as well as those American citizens of the aforementioned ethnicities were interned or otherwise restricted.

German citizens were often detained as were American citizens of German descent.  Many were removed from residences in coastal areas.  A total of 11,507 Germans were interned during the war.  110,000 Japanese-Americans were interned.

Italian nationals in the United States during the war were also interned.  Classified as "enemy aliens" they were detained under the Alien and Sedition Act.  A total of 1881 were so detained, and a number of them were also relocated from coastal areas.

I am unaware of any seditious act that was proactively prevented by this relocation and internment policy.

We now have a decision to make.  Will we ban all immigrants from the ravaged countries of the Middle East as a means of protection from ISIS terrorism?  Hypothetically, If we knew that 5 terrorists were planning to enter this country disguised as Syrian refugees, should all refugees be banned?  Even if a terrorist was able to kill some Americans, should we close our borders completely?  As a matter of fact, isn't it possible that a terrorist could enter the United States as an ordinary tourist?  And, furthermore, should we remove Arab muslims from coastal and densely populated areas?

Are we a society that is now ready to close its borders to the "tired, the poor" and the "huddled masses yearning to breathe free."

The world has become a dangerous place.  ISIS must be contained and/or eliminated, and the means by which this can be brought about is unclear.  But to close our doors and enclose ourselves in a tight protective shell that thousands of innocents will be prevented from penetrating, is clearly not a solution.  It is surrender.

Monday, November 9, 2015

Questions a Doctor Should Answer

Doctors should answer a patient's questions.  Doctors should invite questions and ask patients to come prepared with questions.  If a doctor does not know the answer to a question, he should volunteer to get back with the answer.  Doctors should never minimize the importance of a question, no matter how trivial it may seem.   Doctors should understand that a patient may be upset, may not understand what is being related to him, and may need time to compute the information being provided.

Doctors should make certain that patients fully understand what has been told them.  Studies have shown that a patient's comprehension and retention of the issues discussed is unreliable - frequently forgotten and/or misunderstood.  Patients should write down (or perhaps record) what the physician is saying and review these notes with him before departing, insuring comprehensive certainty.   Even better, bring along a relative or friend.  Four ears and two brains are far better than two ears and one   brain - especially if the information is serious and complex.

Questions for the physician might include:
  1) What are the risks/benefits of the prescribed therapy?
  2)  How successful has this therapy been? Are there other forms of therapy to consider?
  3)  How common is my problem?
  4)  If an invasive procedure - what are the chances of complications or death?
  5)  How many procedures (if a procedure is to be done) have you performed?
  6)  How many patients with my problem have you treated?
  7)  What is the followup for my treatment or procedure - how often may it have to be repeated?
There may be others, specifically targeted to the medical issue at hand.  There may also be time constraints and, perhaps, another visit for questions and discussion should be scheduled.

Commendably, many physicians will have proactively covered these questions in their discussions
having anticipated the patient's appropriate concern.  But if not, one should not be afraid to ask.

Remember - as the doctor is interviewing you, you are simultaneously interviewing him.

Friday, October 23, 2015

Trump, Carson, and Joseph N. Welch

"You've done enough. Have you no sense of decency, sir? At long last, have you left no sense of decency?"

These famous words, the words of Joseph N. Welch, the Boston attorney representing the United States Army during the widely-viewed (and infamous) Army-McCarthy hearings in 1954, were directed at Senator Joseph McCarthy of Wisconsin.  McCarthy had just accused a member of Welch's law firm of having been a member of the Communist Party during his youth.

It's time that at least one of the Republican presidential candidates level a similar condemnation of the spiteful, indecent, and ignorant words of Donald Trump and Ben Carson.  Trump certainly has no understanding of "decency" - ridiculing his opponents for their appearance, or for their manner of speech, or because of a tendency to perspire.  But the nadir came when he inferred presidential guilt for 9/11 -  holding President George W. Bush responsible for the event.  Outrageous!!  Yes, he was our president at the time- in office for a total of eight entire months!  And yes, President Roosevelt was in office in 1941 when Pearl Harbor was attacked - and perhaps President Lincoln should be held responsible for the Civil War which began one month into his presidency!

Carson's comparing the United States to Nazi Germany is similarly outrageous.  Peter Wehner, in his New York Times op-ed piece on October 20 characterized Carson's remarks as showing a "staggering ignorance when it comes to the unique malevolence of Hitler's Germany."

"Staggering ignorance." An "imbecilic historical analogy," writes Wehner.

Carson went on to opine as to how Jews in Germany could have survived the Holocaust if only they were permitted to have guns!

"Staggering ignorance."  An "imbecilic historical analogy."

Mr. Trump, Dr. Carson - you've done enough.  Have you no sense of decency, gentlemen.  At long last have you left no sense of decency?

Wednesday, September 30, 2015

What Pope Francis Didn't Say

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

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

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

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

Thursday, September 17, 2015

How To Pronounce "Los Angeles"

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

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

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

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

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


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

Sunday, September 13, 2015

Malpractice - Myth or Reality

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

Some facts:

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

Last fact:

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

Thursday, September 3, 2015

The Kentucky Clerk and Dred Scott

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

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

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

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

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

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

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


Wednesday, August 26, 2015

"Anchor Babies and Tourist Babies"

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

The pertinent part of the amendment read as follows:

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

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

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

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

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


Wednesday, August 12, 2015

Pounds and Ounces in Prevention and Cures

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

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

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

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

It takes dollars of prevention for one cent of cure!

Thursday, August 6, 2015

Discussing Livers and Hearts Over Lunch

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

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

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

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

Wednesday, July 29, 2015

Does One Really Need Both a Mom and a Dad?

Since the Supreme Court ruling on gay marriage, much has been posted about the need for children to  be raised in a two-parent traditional family.  Gay parents?  Single parents?  Such "disadvantaged" children are destined for bad outcomes!

There is absolutely no data to support this.  We all know of many children raised by single parents who have had successful and productive lives - Presidents Clinton and Obama being the prime examples!  As a matter of fact, both George Washington and Thomas Jefferson were raised by their moms; their fathers having died when they were quite young.  Andrew Jackson's father died before the future president was born.  Eleanor Roosevelt's parents died when she was very young and the future First Lady and UN Ambassador was raised by her grandmother.

Vanessa Redgrave, Natasha Richardson, Jodie Foster, Robert DeNiro, and Judy Garland, among others, are children of a gay parent.  They became rather successful as well, wouldn't you say?

Interestingly, the three mass murderers of the 20th Century were raised by a father and a mother.  They may have had difficult childhoods, but Adolf Hitler, Joseph Stalin, and Mao Tse-tung had both a mother and a father. The 21st Century villain Osama bin Laden also was raised by a mom and dad! I guess you could call them "successful" if you will, but hardly children their  mothers and fathers could be proud of!

Thursday, June 18, 2015

Get Your Embryos Here!!

An article in a recent edition of the New York Times (June 18) concerns the issue of "leftover embryos."  In addition to enumerating the concerns regarding their preservation versus their disposal, the piece goes on to discuss the subject of the commercialization of in vitro fertilization.  Rather mind-boggling,  I thought.

California Conceptions is a company that deals in "embryo creation."  The "clinic" purchases eggs and sperm from donors "whose profiles are likely to have broad appeal - like those who are tall, thin and well educated."  The "clinic" then proceeds to manufacture embryos for sale to would-be parents.  $12,500 buys you three attempts at implantation, with a money-back guarantee if a 12-week pregnancy does not occur.  

It has been termed by some as "the Costco approach to fertility, with quantity discounts to keep costs down."  The article refers to this approach as "one step removed from a mail-order catalog."

It goes on to describe online sites like "Miracle Waiting", where availability of embryos are posted.  Typical posts:  "4 frozen babies, ready for an active fun-loving home."  "Beautiful, intelligent, athletic Caucasian embryos looking for a home."  (Sound rather like ads for pet adoption, don't they?)

Pretty soon these embryos (? humans) may be available on e-Bay or  Or maybe one will actually be able to go to Costco and pick one or two off the shelf!

Just think of all the future siblings there will be out there that have never met.......and most likely never will.  Be careful not to fall in love and marry your "twin"! 

Tuesday, June 9, 2015

Auschwitz - The Reality Show!

"Grim Reality:  Czech TV Makes Game of Nazi Era", an article in the New York Times, (June 8) describes a new TV reality show in the Czech Republic which puts contestants in situations that existed at the time of the Nazi occupation.  Families have to experience and tolerate Nazi terror and threats, and live the lives of Czech families during that period of Czech history.  Actors portray Nazi SS officers who threaten and harrass participants.  The lucky participating families were selected from over 600 who applied.

Hey, we can do better!

How about a reality show based on life and death in Auschwitz - a show placing contestants in death-camp conditions.  We could watch them arrive in crowded boxcars.  We could enjoy the terror and anticipation as they wait to see whether they are consigned to immediate gas-chamber extinction or to  existence in crowded, disease-ridden, overcrowded unheated barracks.  We could thrill as we witness  beatings, and watch with awe as the participants try to survive on thin, cold soup and week-old potato skins.  We could follow them as they labor untold hours in freezing conditions, dressed only in thin  pajamas.  Levels of participation could include varying age groups - from babies to seniors.

Interested producers may be able to engage actual survivors to serve as consultants.  But they'll have to hurry - there aren't many survivors left!

Thursday, June 4, 2015

Caitlyn Jenner and Competitive Sports

So Bruce Jenner is now Caitlyn Jenner.  Though Caitlyn retains testicles and a penis and is chromosomally male, her present gender identification is female.  So could a younger "Caitlyn" enter a woman's decathlon competition?  Dr. Richard Raskin, a nationally ranked tennis player who competed as a male in the 1950s and 1960s transitioned to the female side of the tour (as Renée Richards) in the 70s after undergoing hormonal therapy,  followed by transexual surgical transformation in 1975  - but only after a court order.

Should we continue to agree that all playing fields should be "level?"  Would allowing a chromosomal male, who has decided to declare himself a woman, in order to compete in the female ranks of organized competitive sports, preserve that "level field."  If so, is it wrong to permit a hypothetical amputee who has been fitted with a futuristic prosthesis, that allows a ball to be thrown at speeds over 120 mph, or to drive a golf ball or serve at tennis at superhuman rates of speed, to enter competitive sports?

Everybody should have the right to live a life of choice.  But when a male chooses to be a female, or a female chooses the life of a male there are certain truisms that are incontrovertible.  You are a male if you are genetically male and born with male genitalia.  You may choose to live otherwise - but you are who you are.  If you are black you cannot decide to be white - if you are white you cannot declare yourself black.  You are who you are genetically.  Call yourself whatever you wish to call yourself, but for purposes such as classification, birth/population statistics and competitive athletics,  genes matter.

Monday, May 18, 2015

Decisions, Decisions, Decisions

The Republican candidates for President of the United States are being queried a to whether they would have invaded Iraq had they known then what they know today.  Sen. Ted Cruz responded that "Not only would I not have been in favor of it,  President Bush would not have been in favor of it."  Would that we were able to use hindsight in predicting the future.  That is highly improbable, if not impossible.

In fact, predicting today's scenario should Saddam Hussein have remained in power, is mere conjecture.  It is nothing more than fun and games to predict what today's world would look like had 9/11 not happened, or had D-Day (9,000 estimated casualties) failed, or had Henry Wallace, instead of Harry Truman, become president after President Roosevelt died.  (Wallace, Roosevelt's VP, was bumped from the ticket in 1944.)  It is mere speculation to consider the probabilities involved in the "road not taken" - the proverbial "what-ifs."

Decisions bring about results - some anticipated, others not.  These results will lead to new possibilities.  Choices among these new possibilities may lead to another round of possibilities and choices, etc. etc.  Decisions should be made using the best available information from the best available sources.  People can, and will, criticize decisions, but those truly to condemn are only those made improperly.  An error that results from an informed and well-thought out decision is not a mistake - it is an unpredictable error in judgment.

We always assume that a good result was a product of the right decision.  But, in fact, a better outcome may have ensued had another decision been made.

As one brokerage house has cautioned:  "Past performance is not a guarantee of future results!"

Thursday, April 30, 2015

Marriage - Can It Be Legally Limited

Marriage is defined in most (if not all) dictionaries as a "legal union between a man and a woman," with an additional definition in some dictionaries that includes a legal same-sex union in some jurisdictions.

As the Supreme Court argues the constitutionality of same-sex marriage, comments by the Court raised the issue of the definition of marriage.  If marriage is a legal term, then the definition of marriage is a matter of law.  If it is a fundamental right, then the need for legal limits may come into question.   Fundamental rights may have legal limits - free speech does not permit speech designed to incite violence or to instill panic;  the right to bear arms does not include ownership of all forms of weaponry.

Marriage, then, if a fundamental right, may be legally limited.

Can marriage be limited to couples of the same race?
Can marriage be limited to heterosexual couples?
Can marriage be limited to one couple?
Can marriage be limited by age?
Can marriage be limited to couples who are not close relatives?

The interracial couple question is moot - the legal right for interracial couples to marry has been affirmed.

Same sex marriage is presently under review by the Supreme Court.  A significant majority of the people (61% on a recent poll) feel is should be a fundamental as well as a legal right.  Such a right exists in 36 states and the District of Columbia.

Polygamous marriage has not been brought before the Supreme Court.  We know it has historical precedent (both Biblical and otherwise) and continues to be practiced in this country (though illegal in all 50 states) among certain Mormon cults.  Polygamy is legal in 50 countries.

States have defined a lower marital age limit for a man and a woman - an age which may vary from state to state.  South Carolina permits a girl of 14 to marry if she has the consent of both parents.  New York, however, requires not only parental, but judicial approval at that age.  Is the legal marriage of a South Carolina couple, where the bride is 14 years old, legal in New York without judicial consent?

Marriage is denied to first cousins in 30 states.  Six states prohibit marriages between first cousins once removed.  Some states, not all,  that prohibit marriage will recognize cousin marriages performed in other states.  I could find nothing about marriages of siblings.  I don't believe marriage between siblings or parent-child is legal in any state - but, nevertheless, such weddings have taken place.  Incestuous (non-marital) relationships are legal in New Jersey.

Who can and can't get married will continue to be a question.  Will we require a special classification for the legal marriages of the transgender and transexual community? The whole concept of gender identity has become an issue. Should consenting adults be permitted to enter into a legal polygamous marriage?  If not, why not?  If marriages between closely related individuals are presently limited for reasons of potential deleterious effects in offspring, should such marriages be allowed if direct offspring are impossible, such as the sterility of one of the members in a heterosexual relationship, or if the relatives are of the same sex?

If the definition of a legal marriage is to change, should it be changed broadly, or should each step await its turn in court?  If the Court is leaning towards incremental, rather than broad changes in how marriage is defined, these other issues may require future consideration.

Wednesday, April 15, 2015

Discrimination In the Providing of Services

There is a difference between discriminating against a group of people because of who they are or what they believe, and refusing physically to provide a service at a ritual that one personally cannot support on reasonable religious, moral, and ethical grounds (emphasis on "reasonable").

Although one may not approve of gays or neo-Nazis, one may not discriminate against their civil rights - one may not deny them a product or a service because of a lifestyle that one cannot morally support (one certainly cannot ask a person about his beliefs before serving him, or selling to him), but one should not be legally obligated to take part in a ritual he finds morally offensive.

I have separated services into two categories - "elective" and "mandatory."  "Mandatory" services such as providing medical care, providing legal civil services,  or providing funeral services can be denied to no one.  On the other hand "elective" services -  those that often accompany rituals - are often desired, but are never required.  One does not need photographers, florists, musicians, or food to get married, or to be buried.  Owners of a business must provide the materials or products requested by a couple for its satanic nuptial ritual, but should not be required to actually provide on-site services at the ritual if it is contrary to their moral or ethical (or religious) beliefs.

Thursday, March 5, 2015

A Dangerous Precedent in Alabama

Amendment VIII
Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.

So reads the Eighth Amendment to the United States Constitution.  Please note that the Founders did not define the meaning, nor give examples, of the adjectives "cruel and unusual."  Interpretation of the Constitution (and these terms) rests with state and federal judges, and for a legal system to function, there is a tier of judicial opinion that must be followed.  When it comes to interpretation of a federal law (The Constitution), it would seem that federal courts override state courts.

Alabama has decided that this is not the case.  The Supreme Court of Alabama has ruled that the decision of a US Federal District Court finding Alabama's ban of same-sex marriage unconstitutional was, in itself, unconstitutional, since the ruling defied Alabama's constitutional right to regulate its own marriage laws.  Alabama's marriage law, then, trumps a federal courts's interpretation of the constitutionality of that law.  At this point in time, the rulings of the Alabama Supreme Court stands, and probate judges are not issuing marriage licenses to same-sex couples.

Most felonies, including homicide, come under state regulation.  Methods of punishment fall under a state court's jurisdiction as per the laws enacted by the state legislature.  

Using the same argument, Alabama could rule that a hypothetical state law that includes punishment of a felony by water-boarding, sleep deprivation, weekly periods of starvation, or death by beheading, is also not subject to review by a federal district court, since said federal court has no judicial standing in Alabama's determination as to what constitutes "cruel and unusual" punishment under the Eighth Amendment. After all laws providing for punitive measures are left to the states.

The federal government is responsible to insure that Alabama comes into compliance with the rulings   of federal courts

Denying same-sex couples the right to marry may not be unusual, but it can certainly be regarded as cruel! 

Tuesday, March 3, 2015

Saudia Arabia Honors an Islamist

King Salman of Saudi Arabia, one of our staunch "allies" has just awarded Dr. Zakir Naik, a prominent televangelist from India, one of his country's highest awards - the King Faisal International Prize for services to Islam.

I thought one should be made aware of whom Saudi Arabia decides to honor.

Here are some quotes and ideas attributed to Dr. Naik:  (NY Times, March 3)

Re Osama bin Laden:  "If he is terrorizing America the terrorist, the biggest terrorist, I am with him.  Every Muslim should be a terrorist."

Re the Jews:  "The Jews are a minority less than 5 percent in America but they are controlling the economy, they are controlling America."

Re 9/11:  " is a blatant open secret that this attack on the twin towers was done by George Bush himself."

Re 9/11:  "....the amount of ample evidence, a fool will know this is an inside job."

Re other religions:  Apostates who propagate other religions should be killed.

Re the United Sates:  "Is the US really bothered about human rights? No!"

Re Islamic State:   He was against its actions if the media had reported them correctly, although he had no way of knowing.

The words and thoughts of Saudi Arabia's honoree.

It might also be of interest to readers that Saudi Arabia is the only country in the world (please correct me if I'm wrong) that is named for its founding royal family (Al Saud).  This is said to express the view that the country is, in fact, the personal possession of the family for whom it is named.

Friday, February 27, 2015

Circumcision and Herpes Infection in New York

Flash!! The City of New York has just instituted a new regulation that permits the performance of female circumcision (more-often referred to as female genital mutilation.)  If, however, the procedure results in major genital deformity, pain, and/or permanent painful uro-genital complications, the person responsible for the procedure will be permanently banned from future performance of the procedure.

Of course, female genital mutilation is a banned procedure in New York, as well as in the entire United States, and the above paragraph is total fantasy, but, believe it or not, would parallel what New York City has now decided is the correct way to cope with the issue of transmission of the potentially fatal Herpes virus to orthodox Jewish male newborns undergoing ritual circumcision, including the horror of MBP (metzitzah b'peh) - the oral sucking of penile blood by a Herpes-infected mohel (ritual performer of the circumcision).

The City has decided to permit MBP to go forward unchecked.  If the infant develops Herpes, the infected mohel will be banned from performing future procedures.  The city, then, has decided not to proactively attempt to prevent the infection of newborns, but to allow the infection to take place and  to punish the perpetrator retroactively.

Among radical orthodox Jewish sects, the rabbis have come to play the major role in the health and welfare of the community's infant children.  They are convinced that their religious beliefs outweigh medical risks and will not even permit the screening for the virus among the MBP performers.  It is disquieting to see them play such a negative role in the politics of New York City - and it brings to mind the negative role they exert on the politics of Israel.

These communities vote as blocs and have major political clout in New York City, similar to the  clout they exert in the State of Israel.  The mayor of New York, Bill DeBlasio, has chosen to ignore what is clearly in the best medical interest of these infants and to proceed with what is in the best political interest of DeBlasio and the rabbis.

Netanyahu Addresses Congress - Really??

Benjamin Netanyahu, Prime Minister of Israel, will be addressing Congress next week in order to "enlighten" it on Iranian nuclear development, and the potential effect on its sharing of future developed nuclear weaponry with Hamas and Hezbollah - terrorist organizations dedicated to the elimination of the State of Israel.  Can there be anyone in Congress who is not aware of these potential threats?  Will Netanyahu really be presenting anything new?  Does he really believe that such an address will alter the foreign policy of the United States, which is primarily initiated and 
executed by the President?

He could easily have addressed his views on Iran to the American Israel Political Action Committee (Aipac) or some other such organization.   He could easily have addressed his views on Iran to the Knesset (Israeli Parliament) and had it telecast world-wide for all Americans to watch.  Instead, in a manner disrespectful to our President, arranged the unprecedented act of addressing the legislature of the United States without the courtesy of proper notification and discussion with the executive.

Diplomacy requires certain behavior, and like it or not, there are reasons for such behavior if human beings are to relate well to one another.  When one dispenses with diplomacy and cordiality, one is either ignorant of proper behavior or unconcerned with the feelings of others.

His speech will change nothing.  Though the safety and well-being of the State of Israel are always considered in the formation of U.S. foreign policy - they will never, and should never, be the sole determinate of such policy

So, fully aware that his address to the Congress of the United States will have no significant effect whatsoever on American policy towards Iran, why does Netanyahu risk the enmity of its most important ally by such a divisive and clearly undiplomatic (even unfriendly and discourteous) approach?  Politics - Israeli and American!!

Not nice, Bibi!

Tuesday, February 17, 2015

Obama, The Crusades and Islamic Fundamentalism

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

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

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

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

Monday, February 16, 2015

Gay Rights and God - This World and the Next

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

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

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

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

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

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

Tuesday, February 3, 2015

Miracles in Medicine - Not Everyday Events

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

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

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

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

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

"Parents Own Their Children!" Do They?

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

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

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

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

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

Monday, January 12, 2015

Peace - The Occasional State Between Conflicts

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

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

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

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

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

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

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

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

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

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