Monday, May 25, 2009

Memorial Day

On report about the land of America:

"Jews, there, are treated just like human beings, instead of dogs. They can work at any business they please; they can sell brand new goods if they want to; they can keep drug-stores; they can practice medicine among Christians; they can even shake hands with Christians if they choose; they can associate with them, just the same as one human being does with another human being; they don't have to stay shut up in one corner of the towns; they can live in any part of a town they like best; it is said they even have the privilege of buying land and houses, and owning them themselves, though I doubt that, myself; they never have had to run races naked through the public streets, against jackasses, to please the people in carnival time; there they never have been driven by the soldiers into a church every Sunday for hundreds of years to hear themselves and their religion especially and particularly cursed; at this very day, in that curious country, a Jew is allowed to vote, hold office, yea, get up on a rostrum in the public street and express his opinion of the government if the government don't suit him! Ah, it is wonderful."

-Twain, Mark. "The Innocents Abroad," 1869.

It bothers me to no end how too often do people nowadays completely take for granted the amazing country we live in. It's so cliche already, but the real freedoms we have here as well as the opportunities which permit us to reach as high as we are able are gifts unprecedented in all of human history. Sure, America is not perfect and there's plenty to criticize in its history and recent events, but the ideals it stands for, as embodied in the Constitution and the Bill of Rights, are among the best and highest ever set in text.

So it's quite proper now to take a moment and acknowledge the great sacrifices (some with the ultimate sacrifice) given by American servicemen to protect us and our way of life. May we soon see the day when no further American soldier need give so much.

Absurd Adventism

I'm not sure why but it seems that people I meet often feel comfortable to share their nutty beliefs with me. It started when I went into see this one patient who from the very beginning upon my entrance into the exam room was eyeing my yarmulkah. This happens from time to time and nothing usually comes of it. Sometimes things do, obviously, but generally the patients don't seem to care much. Anyway, that was the way this interaction seemed to be heading since nothing came of it throughout the standard history and physical that I do for every patient. But as things were wrapping up, he gave me a strange little look and asks, "You Jewish?"

"That I am." I respond, entirely unsuspicious. For some people it's rare for them to have extended interaction with a Jew of any stripe and so they'll often ask me an innocuous question or two.

"Ah," he says, "I thought so."

So I answer dry as a bone, "Oh, what gave it away?"

He laughs, tells me I'm a funny guy - and then the conversation turns weird.

After confirming that I observe the Sabbath on Saturdays he reveals that he's a Seventh Day Adventist and asks me if I'm worried about that. Worried about observing Shabbos? Not really, I answer. He goes on to tell me that I should be because the Pope is planning on enforcing a one-day Sabbath observance and that it'll be on Sunday. Now I'm not exactly an expert on Papal policy, nor do I closely follow Vatican movements, but that didn't sound like something high on the Pope's agenda - and in any event, I didn't care much about the Pope's efforts on that issue. I tell him that the Saturday/Sunday divide has been an issue between Christians and Jews for some time now and I wasn't expecting the Pope to start religious coercion over the Sabbath in modern day.

Not so, he responds, the day is coming soon for when we'll all have to *run to the mountains* to escape this coming religious persecution or otherwise suffer martyrdom! He directs me to read Revelations and the Book of Daniel, where he insists that this whole course of events is clearly written.


That's some wacky stuff. Eschatological beliefs in general tend to approximate different forms of nuttiness, but as the beliefs become more specific and the timeline more acute it becomes only more obvious. I was willing to chalk this one up to one man's weird understanding of religion or Papal conspiracy paranoia since I had some affinity to Seventh-day Adventists, but it turns out that this is basic ideology of the original Adventist Church!

So sayeth Wiki, "The pioneers of the church taught that the Seventh-day Sabbath will be a test, leading to the sealing of God's people during the end times. Ellen G. White interpreted Daniel 7:25, Revelation 13:15, Revelation 7, Ezekiel 20: 12, 20 and Exodus 31:13 this way. Where the subject of persecution appeared in prophecy, it was thought to be about the Sabbath commandment. Some early Adventists were jailed for working on Sunday, in violation of various local "Sunday laws" or blue laws which legislated Sundays as a day of rest. It was expected that a universal Sunday law would soon be enforced, as a sign of the end times."

An interesting aside is that the Adventists were early critics of the Blue Laws, which were designed in the early part of the last century to protect the so-believed Christian heritage of the nation by enforcing certain aspects of Sunday. Some of the Blue Laws still persist today throughout the country, including limitations on liquor stores to not operate on Sunday mornings and the fact that the United States Postal Service does not deliver on Sunday. In this manner, the Adventists have been suspicious of government intrusion into religious life - an orientation that benefited all minority faiths in this country.

See, it's strange how rational-appearing people can have truly way-out-there understandings of the world laying right below the surface. Though, on retrospect, that should not have been so shocking from the Adventists, given that it is a religion founded on the *thrice-failed* predictions of William Miller and Samuel Snow regarding Jesus' immanent return in 1843/1844. As a religion focused on eschatology (hence the "advent" part of Adventist), I wonder whether there is anything to be concerned about over this rapidly expanding religion.

Monday, May 18, 2009

Dammit Jim!

Just saw Star Trek over the weekend. With honor, I present:

Saturday, May 16, 2009

Where's that from?

If anyone who has borrowed a sum of money from Jews dies before the debt has been repaid, his heir shall pay no interest on the debt for so long as he remains under age, irrespective of whom he holds his lands. If such a debt falls into the hands of the Crown, it will take nothing except the principal sum specified in the bond.

If a man dies owing money to Jews, his wife may have her dower and pay nothing towards the debt from it. If he leaves children that are under age, their needs may also be provided for on a scale appropriate to the size of his holding of lands. The debt is to be paid out of the residue, reserving the service due to his feudal lords.

Debts owed to persons other than Jews are to be dealt with similarly.

Nice. Guess the source.

Thursday, May 14, 2009

Who Said it?

Alexander of Aphrodisius said that there are three causes which prevent men from discovering the exact truth: first, arrogance and vainglory; secondly, the subtlety, depth, and difficulty of any subject which is being examined; thirdly, ignorance and want of capacity to comprehend what might be comprehended. These causes are enumerated by Alexander.

At the present time there is a fourth cause not mentioned by him, because it did not then prevail, namely, habit and training. We naturally like what we have been accustomed to, and are attracted towards it. This may be observed amongst villagers; though they rarely enjoy the benefit of a douche or bath, and have few enjoyments, and pass a life of privation, they dislike town life and do not desire its pleasures, preferring the inferior things to which they are accustomed, to the better things to which they are strangers; it would give them no satisfaction to live in palaces, to be clothed in silk, and to indulge in baths, ointments, and perfumes.

The same is the case with those opinions of man to which he has been accustomed from his youth; he likes them, defends them, and shuns the opposite views. This is likewise one of the causes which prevent men from finding truth, and which make them cling to their habitual opinions.

Quote from whom? (No cheating!)

Monday, May 11, 2009

The Physicians’ Perspective: Medical Practice in 2008

"Through responses provided by approximately 12,000 physicians nationwide that included more than 800,000 data points – as well as through written comments by more than 4,000 physicians – the survey offers a unique and valuable insight into the practices and mindsets of today’s doctors."

Some key findings:

Only 6% described the professional morale of their colleagues as “positive”
78% said medicine is either “no longer rewarding” or “less rewarding”
60% said they would not recommend medicine as a career to young people

Only 17% rated the financial position of their practices as “healthy and profitable”
82% said their practices would be “unsustainable” if proposed cuts to Medicare reimbursement are made
65% said Medicaid reimbursement is less than their cost of providing care
36% said Medicare reimbursement is less than their cost of providing care
33% have closed their practices to Medicaid patients
12% have closed their practices to Medicare patients

49% of physicians indicated they will take one or more steps in the next one to three years that will reduce or eliminate patient access to their practices:
11% said they plan to retire
13% said they will pursue a job in a non-patient care setting
20% said they will cut back on patients seen
10% said they will work part time
7.5% said they will work locum tenens
7% said they will switch to concierge practices

So folks, for those of you who're steaming forward trying to establish a Medicare-type plan for everyone in the country - where do you expect to find doctors who will be willing to accept them? More and more doctors are finding that public health "insurance" programs reimburse them less than they're laying out, thereby making such practices frankly unsustainable. In response, more and more practices are simply not accepting such insurance programs.

Consider: these programs which are designed to help the poor gain access to care are actually making it more difficult.

How can the state respond?

Oh, we get fun stories like this from Illinois where the attorney general sued clinics who were simply trying to stay in business. They refused to accept more Medicaid patients because they just could not afford to continue operating at the reimbursement rates they were receiving. Yes, apparently the state thinks it has the right not only to dictate prices but also the right to force doctors to accept them. Isn't it nice to see doctors becoming government serfs? Does anyone think actions like these will encourage people to enter the healthcare arena, much less primary care?

My solutions: return free market medicine to primary care. Don't pretend that government reimbursement is full compensation for the doctor's time and effort. Care given to those who cannot pay should be understood as charity care and should be able to be deducted come tax day.

Sunday, May 10, 2009


Academic medicine is supposed to be different. It is supposed to exist for the purpose of applying scientific principles to medicine and thereby making new discoveries to use to treat disease, testing them in clinical trials to find out if they are effective, and then applying them systematically. Uncritically introducing therapies that are by their very nature unscientific, therapies like homeopathy, reiki, reflexology, and “energy medicine” taints the entire scientific enterprise at these institutions. Worse, offering such therapies outside the context of a clinical trial in academic medical centers gives the patina of scientific credibility to therapies that have not earned it, promoting the impression that science supports their efficacy....Medicine has finally, after over a hundred years, evolved to the point where it can actually become truly science- and evidence-based. From my perspective, the growing uncritical acceptance of CAM in academic medicine is a major threat to the continuation of that evolution. There should be no such thing as “alternative” medicine, anyway. There is medicine that is effective, as determined by science and clinical trials, and there is medicine that is not or is as yet unproven. We should not be “integrating” the latter with the former, and especially not in academia.

-Dr. David Gorsky; "The infiltration of complementary and alternative medicine (CAM) and 'integrative medicine' into academia."

Excellent article. Do read:

Saturday, May 09, 2009

Overheard in Conversation

"I think vampires are real. How do you know vampires don't exist? It says in the Torah that witches are real, so why not vampires?"


Can't argue with that...