"House"

Dr. Gregory House is a fictional character in a television program named "House". Dr. House is a cranky, caustic, rude, conniving, constantly in pain, drug abusing, brilliant physician. His specialty is diagnosing difficult cases that present themselves in a New Jersey teaching hospital. He does this by using his genius mind to play off other brilliant Doctors on his team, as they attempt to cure mystifying diseases and conditions that seem unsolvable. The typical storyline involves a patient who suffers a collapse of some kind and ends up in House's unit. House rarely sees the client in person, but uses his extraordinary mind and the hands-on talents of his team to eliminate possible conditions and maladies one patient at a time. Usually, they come upon a diagnosis and immediately begin a course of treatment that seems right until new and puzzling symptoms pop up to throw the whole diagnosis off. At that point the team reassembles and they order a series of intricate and exotic tests, ranging from tissue and fluid sampling to major surgical biopsies or procedures. In the end House usually has some brilliant, intuitive idea that leads him to the correct diagnosis and a cure that seemed impossible. Once again House finds a miracle cure to solve the problem while being a pesky, near sociopath, prankster with a roguish charm.

To call this "fictional" is an understatement. Last week my wife and I accompanied my mother-in-law, Ellie, to a medical appointment at a teaching facility in Oregon. She was there for the fourth time in several months with a medical scenario not unlike something that might appear on an episode of "House". I won't go into her personal medical issues, but I can say that she has been experiencing a series of troubling and debilitating symptoms for some time that, up until now, have gone undiagnosed. Her condition and the symptoms have proven to be a mystery thus far, and she continues to develop new symptoms regularly. Sound familiar? It could be an episode of House.

This is the point at which the fictional hospital where House does his magic takes a serious departure from the reality of our health care system. My mother-in-law didn't start at a teaching and research facility. She started with her home-town Family Practitioner. He spent several months diligently attempting to decipher the symptoms and treat her- but to no avail. One of his tests suggested a serious brain malady-but it could not be diagnosed definitively, locally. Being a good doctor he knew he needed to send her to a more specialized diagnostic facility. He gave her a couple of out-of-town options and she chose a facility in Oregon that's part of the University of Oregon medical complex. For her, and my father-in-law, this requires long car trips and stays in motels to complete the process. These trips are costly and are a hardship themselves, because they are elderly and they each have mobility problems.

Once my mother-in-law finally heard back from the facility after the initial referral, she had to wait several very anxious weeks for her first appointment. The wait was difficult because her local doctor's suspicion was for a very grave, life threatening condition that normally would be treated immediately. Upon her eventual arrival she was attended to by a Resident who was only willing to discuss the symptoms and have her back in a few weeks for the actual testing. Her oldest daughter (my sister-in-law) was along for that trip and pressed them to do the testing during this visit to eliminate the need for additional travel. Blood tests, MRI, vision tests, and the like resulted in more waiting, unanswered phone messages and E-mails.

It has now been two months since Ellie has been traveling to her appointments in Oregon. Fortunately, they have determined she doesn't have the condition that was originally considered. Unfortunately, the doctors have not been able to diagnose her yet and her condition continues to worsen significantly. Even though Ellie and the family are still waiting for the diagnosis, and it seems like this whole process is taking too long a time to get resolved, this article isn't about being upset with her care. It's about the difference between expectations and reality in the complex world of health care. It's about the frustrations patients feel with the slow grind of science and health care access.

At fictitious Princeton-Plainsboro hospital where House practices he and his team see patients immediately. House can order a test and it happens instantly. House doesn't need to have his patients take an appointment weeks from now because "that's the next available time". House never has to get an insurance company to approve a test or a treatment, and he is NEVER told to look for a less expensive drug. In House's world a patient needing a brain scan will be in the tube before House can pop another pill. In the real world it takes time to get appointments. It takes weeks or months to get results, and it takes patience to deal with communication issues in an overburdened system of care. All the while patients suffer the endless days of worrying about their future and suffering from untreated symptoms. Perhaps the fictionalized, TV version of  medical care has us a bit spoiled. But running into it in real life is another matter, entirely. I don't fault the folks at the facility in Oregon trying to help my mother-in-law. They are all fine practitioners, I'm sure. I know we have the most advanced medical care available anywhere in the world.

Even though we have the best medical technology and the most highly trained medical professionals available on the planet, our system doesn't produce the best medical outcomes. Our health care system is the most expensive in the world (by percentage cost vs. total GDP, and actual dollars spent) and our results rank pretty far down the list compared to other countries. The answer has to be access, and a lack of emphasis on prevention along with holistic health. Any system driven by private enterprise will always seek to protect the capital that it generates. As we are entering a new era, and the basic debate over the kind of country we will be goes on, we must answer the difficult questions about universal access to health care.

Most of us have (or will) come face-to-face with these issues, as our family is now. Most of us feel lucky just to get through our critical medical issues, then we move on without too much thought about fundamental change that must happen. Until we can all have the kind of care House can deliver at Princeton-Plainsboro there will continue to be problems in a system of care that is corrupted by the system of commerce that infects our health care industry. Should our health care system really be subject to the ups and downs of a private eneterprise model built to generate capital? I have to imagine what kind of timeliness would be applied to a very wealthy person who might find themselves in Ellie's situation. Would they wait weeks for test results? Would they spend six months suffering, searching for answers? I doubt the Trumps or Buffets of the world would be told to wait three or four weeks for an appointment with a Resident. And yet this is the system we have because we still cannot bring ourselves to adopt a universal health care system. The myths we hold about private enterprise are sacred- even when the health and wealth of the nation are at stake.

We know better when it comes to a decision of conscience. For instance, we don't tell our veterans to seek medical care through the marketplace (even at government expense). When we decide that medical care is an absolute priority (like the VA-or active-duty military health care) government provides it- and does so at greatly reduced cost. Government has no overpaid CEOs who get big bonuses for NOT providing care while collecting your premiums- Government has no share-holders to pay-off. Some things we do because it is the right thing to do and it promotes the common good of the country and its people. I look forward to the day when we can come to our senses on this issue and all the Ellie's of the world will have the same access to care and timley service that the Donald's and the Warren's have. That seems a great deal more humane to me.  I think even Dr. House would agree.

Thanks for looking in.

I Am Jane's Ovaries

When I was a kid the Reader's Digest was everywhere. We got it at home and you could find it in just about any waiting room. It was a quaint little monthly that provided condensed versions of all manner of magazine articles, short stories, or books- all wholesome and American. It was perfect if you had a few minutes to kill and needed a quick read. It was the perfect bathroom publication long before the days of People Magazine. They used to run a series called "I am Joe's_______" It would feature a human organ speaking in the first person, telling us all about themselves. I am Joe's heart-I am Joe's lung- I am Joe's liver, etc. So, this is my (slightly altered) homage to the Reader's Digest series.

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Hello, I am Jane's Ovaries. I am part of Jane's reproductive system and I reside in her abdomen. There are actually two of us and we are placed on either side of Jane's uterus. Technically I am a gland, and my existence is considered a primary sex characteristic. That is, under normal circumstances, I have to be present in order to classify Jane as a female. My counterpart in Joe are Joe's testicles. Well, back to me. I have two main functions in Jane's body. Because I'm a gland I secrete hormones. The hormones I produce are Estrogen and Progesterone. These two hormones are very important because they cause Jane to have secondary sex characteristics (the one's that make her look like a woman) as well as regulate her menstrual, reproductive cycles. The other main function I perform is to produce the human ovum. Another word for that is a human egg. We do that about once a month, during the childbearing years. The ovum is expelled out of me and finds it way to the Fallopian tubes nearby. If the timing is right, the ovum can be fertilized by Joe's sperm. Then the fertilized ovum travels down and attaches to the wall of the uterus and a pregnancy happens. Normally this ends with the birth of a baby. Well, that's me in a nutshell. Oh, that reminds me- I'm about the size of a walnut.

Even though I'm the size of a walnut, the last few weeks I've felt more like a football. A political football that is! I don't operate alone in here, you know. I'm part of a reproductive "system". The team includes me, the Fallopian tubes, the Uterus, Vagina and the rest of Jane's body, including her Brain. But lately we've all been getting treated like we're second class nobodies. I've noticed that a lot of middle-aged (or older) white men have been trying to control me and tell the rest of my whole team what to do. Just look around and you will see a bunch of men arguing about how and when I need to function. These guys are getting a lot of press and face-time on TV because a few of them want to be the President. Others are causing quite a stir because they run that big Catholic church. I think they're using me and the rest of Jane as fodder for their little political games. Well, let me tell you boys something- I don't want to be part of your self-serving political debate. As far as I'm concerned you men have had way too much to say about me for too long as it is.

I may just be an ovary, but I know a little about history. What Jane's eyes read and her brain understands, I get too. A very long time ago men figured out that if they can control me, and all I do in human reproduction, they can control all of Jane and keep her subservient to them. Traditionally men enjoy that kind of power over women, so they make rules that won't allow women to control their own reproductive life. Men have skillfully used government and religion to keep women in their place. But Jane has been doing some other research and we've found out that when women have more control over their reproductive choices, they enjoy more social, educational, and economic equality with men. There are a few places in the world where that actually happens, and women in those places are always better off. You can look it up.

The latest skirmish over me happened when the government insisted that all employer-based health insurance policies in the future needed to include coverage for birth control (contraception). Turns out a whole bunch of employers are also Catholic institutions. And the MEN who run the Catholic church don't permit birth control. (let's not kid ourselves- the rhythm method is not birth control) So they are arguing that they shouldn't have to provide that coverage. Now politicians and Bishops are all up in arms over this big conflict. Hey, remember me down here! I'm not a politician or a Pope- I'm an ovary and a very important part of a woman. So, listen up about what's important to me. It's important to me that I stay healthy. I'm a sensitive human organ. I can get diseased or injured, and when that happens I need health care. I'm connected to the rest of Jane and we've decided it's not healthy for us (emotionally, socially, or economically) to be constantly producing children. It's probably not good for the planet either. Ever hear of over-population? We love kids and we're the only ones who can have them, so how about showing us a little respect. How about letting us have some choice in the matter, and make sure we can get the reproductive health care we need, including preventative contraception. When are you testicle owners going to get it?- these political squabbles aren't about church vs. state, its about women's health! Even when the Catholic church was offered a way not to pay for the coverage, they said that wasn't good enough. I knew all along- it's really about controlling me. I noticed that nobody is getting all up in men's faces about vasectomies- also a form of "banned" contraception in the eyes of the church.  

You know, with all the economic troubles in the country I thought you might leave me alone this year. But no! There's more talk about me lately than ever. This Rick Santorum, the latest big-deal, flash-in-the-pan, staunchly Catholic,  Presidential candidate even wants to allow each State the right to outlaw birth control all together. He just thinks birth control is wrong. I thought we settled this in the 60's. I've got news for you Rick- 98 % of all sexually active Catholic women have defied the Pope, the Bishops, and you, and used birth control- including the pill, sterilization and IUDs. (Guttmacher study 2011) Hey Rick, try being Jane for a while and it might change your perspective. We ovaries always joke that if men had us instead of women it would be a whole different world. 

Being part of Jane, I have to say this has been a rough year to be a women. Not only do men use us to score political points, there have been some real threats to us. Just before we got in to this nonsense over contraception, The Susan G. Komen people tried to cut off funding to Planned Parenthood for breast cancer screening. Thanks to a lot of folks who care more about Jane (and the low income women Jane knows) than these anti-choice types-  that got reversed. I don't know anymore. Jane and the other women live in a country that is supposed to be so "advanced", but it seems women still don't have much power here. We know this because all the big players in this debate are men. Just last week a congressional hearing was held to discuss contraception and religion, with no women allowed to testify! When you combine that with the fact we still haven't recognized health care as a basic Human Right- I'm a little worried. If America were like every other advanced country, we would have universal health care (including contraception) and Jane and I (and all our sisters) could rest a little easier. We just wouldn't have these silly, and very dangerous arguments.

I am Jane's Ovaries, and that's my story. I want to be cared for. You just need to care about, and respect, the women in your life- and I'll be OK too.

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Thanks for looking in.

That's Obscene!

On occasion some small item will catch my eye and get me thinking about an issue. Often times it's not a new issue or even a new take on an old issue. Surely this one isn't. It's just the kind of random thinking that invades my brain from time to time. It happens to all of us. This week the item is obscenity, and  I began thinking about it after seeing the coverage of the Super Bowl commercials that aired during the big game last week. Of course, lots of commentators weigh in on all aspects of this modern iconic cultural event. We talk about the half-time show, pre-game festivities and analysis, the game itself, and the millions spent on TV commercials. The article that caught my eye was one where a parents' group (The Parent's Television Council-PTC) was voicing all kinds of objections to some of the commercials that aired during the game.

The PTC was not happy with the commercials that were sexually suggestive, depicting scantily dressed performers (both male and female), and the "racy" nature of some ads. I make no argument with their observations. Indeed some of the ads were racy, sexually suggestive, and depicted near naked people. The PTC was concerned because they believe the Super Bowl is, or should be, a "family" television event- and therefore should not be sullied by nasty commercials children can see. I'm not sure when the Super Bowl became a "family" event. It is usually an over-hyped game following a week-long orgy sponsored by the NFL owners and other obscenely rich people. It takes place in big cities that attract a huge influx of prostitution and sex trafficking- routinely ignored by the local police at the urging of the local Chambers of Commerce. The game features ads that encourage us to eat too much, drink too much and behave badly with fast cars, casual sex, goofball characters, and the latest electronic gadgets. (All due respect to the Clint Eastwood ad)  The day nationally is one of the highest incident days for drunkenness, domestic violence, and elicit gambling. "Family event"? Super Bowl Sunday is responsible for more debauchery than all the Roman Emperors put together.

Given what this day usually involves, I would think some of these groups might be more helpful if they concerned themselves with the real obscenities of this spectacle, rather than the ones in 30 second commercials. Nonetheless, The PTC and others are free to comment on what bugs them. As for me, I have always felt that our culture identifies obscenity incorrectly. So, in a broader sense, it might be good for us to re-think the nature of what we call obscene or objectionable.

Americans tend to focus on materials that are sexual in nature as being obscene. Formal definitions of the word vary. Some definitions concentrate on materials that are "offensive" and are sexual in nature. A broader definition I found suits me better. It defines an Obscenity as something that is "disgusting and morally offensive". Naturally any definition on something so subjective is open to many interpretations. Unfortunately our Puritan heritage has forced us to dwell on the sexual aspects of obscenity, while we ignore other evils that represent far greater offences- by being disgusting and morally offensive.

The picture below is offered as food for thought only. I don't have the answers, or any concrete definition of obscenity. But as I was thinking about this topic I was immediately reminded of this haunting photograph. Being the age I am, some of my earliest impressions of obscene or objectionable sights came from memories of the Viet Nam era images I was exposed to in adolescence. Images like this have stayed in my mind since those days. When I think of obscene materials, I don't think of the body-painting in the Go-Daddy ads or the overtly sexual inferences in the Fiat car commercial, or David Beckam's naked torso- I think of this image. The obscenity isn't derived from the child's obvious full frontal nudity- it is derived from the horror and violence of this image. This 1972 photo won a Pulitzer Prize. It is famously known as "Napalm Girl", and it depicts terrified, traumatized and badly hurt children running from their village after it was destroyed by American napalm bombs. The girl, Kim Phuc was so severely burned by the napalm attack she nearly died. She survived, but spent her life recovering from the physical and emotional pain of this obscenity.

As our kids were growing up we tried to go beyond those old Puritan, sexually repressive notions of  obscenity. Our sensibilities about obscenity leaned more in the direction of horrific violence and senseless human destruction. Seeing the outline of a breast is nothing compared to the indecency of violence. In a world of violent school-yard bullying, graphically violent video games, warlike national rhetoric and behavior, and random shootings I think our children would be better off being repelled by violence than being shocked by sexuality- and we as parents have the power to teach those lessons. No offense to the self-appointed PTC- but there are far worse things to protect and shield our kids from than Madonna's cleavage.

My apologies for this display of obscenity, but
Thanks for looking in.

p.s. If you would like to learn more about Kim Phuc's life and struggles it is easy to research on the Internet. However, be warned, there is also videotape of her fleeing the village that is (even more) graphic in nature, showing far more details of her injuries and burns. Nonetheless, her story is inspiring.

President Barack H. O'Blama

After watching months of really curious and often times pathetic campaign rhetoric coming from the field of Republican hopefuls, I've concluded that they are campaigning against President Barack H. O'Blama (pronounced: O-Blame-a). According to the stump speeches and the silliness I've seen in the 729 Republican debates this O'Blama fellow is quite a bad President. In fact, he is the worst President in the history of the country-maybe the history of any country. Here are some examples.

Generally speaking he is a "failed" President. He is a socialist. He is the most radical, liberal President in our history. He has raised taxes. He hates capitalism. He doesn't understand business. He wants us to have European socialism. He hates America. He is soft on immigration and doesn't protect the borders. He apologizes to other countries for America. He is a Muslim. He is Kenyan. He has destroyed jobs- on purpose. He sides with terrorists. He is an "appeaser" who likes our enemies. He is a "divider".  He is trying to start a class war. He won't protect Israel. He is "threatening". He wants to take every one's guns. He is aloof and unengaged. He is a micro manager who meddles in industries. He nationalized health care. He's put more people on food stamps- in fact he wants you on food stamps instead of working. He's gutting the military. He has too many regulations......................Wow! You name it, and that S.O.B. did it. What a horrible President.

I concluded they have to be talking about President O'Blama because they couldn't possibly be talking about the real President. The real President is Barack H. Obama. Same initials- different guy! Let me give you the facts about the real President, compared to this fictional O'Blama fellow. Please understand, I have some issues of my own with the real President, but they are nothing compared to the over-the-top shenanigans of this made-up President the Republicans are campaigning against.

Charge: Radical/Liberal. Not even close here. President Obama is moderate, no where close to a socialist. I'd bet most who repeat this rant couldn't give a correct definition of a socialist. He is so moderate that he  often infuriates his own party who have urged him to move much further to the left. If you honestly look at his policies, you will see a consistently centrist agenda. The Republicans have just moved so far to the right, they don't recognize the center anymore.
Charge: He raised taxes. Total falsehood. Obama has not raised taxes. It just didn't happen! In fact his leadership provided tax reductions for 98% of the people in the country. The only tax hike he is proposing is to slightly increase taxes on millionaires and billionaires. 72% of all Americans want the same thing. Americans and American corporations are paying the lowest tax rates in generations.
Charge: Hates Capitalism/Hates Business. The real President did criticize some businesses (mostly the Banking sector) for unethical and predatory practices- the same practices that caused the financial crash of 2008. And he criticized those who outsourced of millions of jobs overseas, while hiding their profits. Oh, he did say they should pay their fair share. Doesn't sound Un-American to me. Look at the stock market- nearly doubled since he took office. Look at corporate wealth- profits at all time highs. Nearly all forward looking trends in business are up. If he hates business, please do it some more.
Charge: Sides with Terrorists/Failed Foreign Policy/Won't Protect Israel/ Apologized for America. You can lump all this nonsense together under the banner of Foreign Policy. Foreign policy, in my opinion, has been his strong suit. The speech in Cairo was not an apology. He told the world that America would support freedom and democracy in a different way. He specifically told the Middle-Eastern people that we would stand behind them- not occupy their countries. What happened? The Arab Spring happened. In the last year, three Arab dictators have fallen (Tunisia-Egypt-Libya) and a fourth is near (Syria). He successfully engaged other countries in common support, so the U.S. doesn't have be the world's sole policeman, or even the lead policeman. On Israel, his policies are exactly the same as previous Presidents including the last three Republican Administrations run by the two Bush gentlemen. Further, the real President has eliminated more terrorist leaders (through smart use of military assets) in three years than President Bush did during his eight years in office. The real President is winning the war on "terror"- and he is doing it without deploying hundreds of thousands of troops, and spending hundreds of billions of dollars, in the process. You have to admit that invading Middle-Eastern countries hasn't worked out too well.
Charge: Food Stamp President. The Obama administration has not changed one word in Food Stamp eligibility. We have a high number of recipients because the Recession that began in 2007 put so many more people in poverty. Gingrich pontificates about replacing Food Stamps with paychecks and believes it is an "inner city" (read: minority) issue. The facts are that over 70% of recipients are white and nearly 70% of FS recipients are working. The problem is an economic system that favored the top 1% while more working class folks become poorer. Obama did not do this- the previous administration and the whole myth of "trickle down economics" ushered us into this mess. The real President has pretty clear about wanting more jobs and how to create them, but the Congress has stopped almost every initiative.
Charge: He's wants to take every one's guns. There has not been word one from President Obama on this issue and certainly no legislation or programs remotely associated with this mythical complaint. It's all part of creating a false image that can be used to scare people.
Charge: He meddles in private business- or alternately, is uninvolved. I admit he was responsible for "meddling" in the automobile industry. His "meddling" saved it and got General Motors back to being the largest auto maker in the world, again. Romney's idea was to let the whole industry go bankrupt. ( Incidentally, Romney has the same idea for the Home Foreclosure crisis)You might also lump the the Affordable Health Care Bill in this category. "Obama Care" as they call it, is anything but a government take-over. It relies almost entirely on private insurance companies to provide coverage. A boon to them. There's a mandate for sure- just like every state has a mandate for auto insurance. The merits are debatable, but it's hardly a government take-over.
Charge: He is destroying jobs. Each of the opposition candidates have said in one way or another that we have lost jobs because of Obama. The simple fact is that our economy has added jobs the last 23 months straight-amounting to over 3.4 million jobs. The employment picture would be much better if the public sector hadn't lost so many jobs in the last 18 months. Public sector jobs are: teachers; police; firefighters; and other public employees. This happened mostly at the state and local level in states controlled by Republican Governors and Legislatures. Even so, 8 million jobs were lost under President Bush- so this is a favorable comparison. The opposition complains that government regulation under O'Blama is the reason for slow growth, but Obama has instituted fewer regulations than Bush did his first 3 years in office.
Charge: Soft on Immigration. President Obama has stationed more guards on the southern border and deported more illegal aliens than President Bush ever did.
Charge: He's a Muslim/ He's a Kenyan. I heard a woman say this to Rick Santorum (on TV) last week and Santorum didn't even flinch or correct the woman. This is an outgrowth of a deep-seated level of racism, in my view. For obvious reasons (skin color) some people just have to cast O'Blama as un-American- the other. It is a disgusting part of our political rhetoric and just has to stop. There is no debate here. The facts are clear. He is an American and he is Christian. End of story!

I believe there are enough areas of legitimate disagreement, in fact some deep philosophical disagreements, for the candidates to debate without making up a fictional President to go after. The problem is that we have become so accustomed to vitriol and falsehoods that we accept them as factual, with outlandish statements washing over us without question.The other obvious problem for the opposition is that when you really examine the facts, Obama's record isn't so bad. Let's insist these guys who want to be President treat our collective intellect with a bit more respect. Opinions can vary, but facts are facts. Let's insist they stop running against O'Blama and deal with President Obama and the real issues. This election is too important to conduct it on Fantasy Island- and we are too smart to let them.

Thanks for looking in.