The American Dilemma and How We Can Fix It

Posts tagged ‘medicine’

LET’S GET EQUAL

Several friends and acquaintances have made the decision to try to elect the President for yet another four years.  Although none of them has been able to identify a specific item in President Obama’s first four years making him worthy of reassignment as CIC, it happens that all of these folks are women and their reason for voting for him has to do with “women’s issues”.

So I began thinking about this.  Several of them have identified pay inequality in the workplace as something that they feel would be better addressed by the incumbent than by a President Romney.  On this point I agree – not that Obama would do a better job handling it – but that differentiating payment and offering women lower wages for performing the same work is unethical, immoral – and most importantly, just plain stupid.

If you’ve ever worked in an office environment you know that the every office has a “grapevine”.  In fact, the intelligent manager, realizing this, will use the grapevine to transmit information she wants disseminated without the need to write memos or hold staff meetings.  And, of course, one of the items that is always on the grapevine’s agenda is, “How much are you making?”

Paying different amounts to people who perform the same job, whether it is because of gender, age or race, is just plain bad business and will always engender bitterness, jealousy and (in today’s age) lawsuits.  Mitt Romney, as a businessman, knows this and if those who admire (or are envious) of his success really think about it, he would most likely not have pursued that sort of policy in his personal endeavors – or he wouldn’t have gotten where he did.

On the other hand, the President has never held a real job (although arguably being President of the United States is one) – but if so, this is his first.

Another item under the category of “women’s issues” which my friends described is accessibility to various preventative medical tests such as mammograms and cervical examinations.

On this subject, I couldn’t possibly agree more.  Preventive diagnostic tests would greatly reduce the number of female medical conditions which we often do not address until we need to employ radical approaches to treatment.  (The same thing applies to men, by the way).

Once again, as with the case of discriminatory pay, common sense dictates that an enlightened populace would actively campaign for just exactly that sort of early detection.  But then again, common sense would also dictate that we would each of us make an effort to do everything in our power to ensure our personal well-being.  The explosion in cardiovascular disease and diabetes suggests that is simply not the case for the average American.

If we are ever to rein in the burgeoning costs of our “disease maintenance system” we must begin by starting to educate our children on the importance of a good diet and proper exercise so that they do not succumb to the same illnesses in the same quantities as their parents.  The explosion in the obesity levels of young children suggests that we have not seriously, or at least not effectively, addressed this matter, notwithstanding the 2,600 pages of the Affordable Care Act.

I believe, setting aside any of the allegations about Mr. Romney’s personal disdain for the average Joe or Jane, as a businessman he is far more likely to develop cost-effective common sense ways to rein in the skyrocketing cost of healthcare.  And irrespective of the media’s portrayal of him, if for no other reason than that it makes sound business sense, is much more likely than the incumbent to develop positive solutions which not only save costs but save lives.

Then, of course, we have the question of whether women should be allowed to get birth control pills as part of their coverage under medical insurance contracts.  In the interest of equality, I think that if that is the case, then men should equally be allowed to charge the cost of prophylactics to those same insurers.  I mean, fair is fair, after all.

I have never quite understood why our sisters even want to expose themselves to the risks inherent in birth control medicines.  Virtually all of them have side effects and some have been taken off the market for the danger they posed.  Yaz and Yazmin come to mind as recent examples  Wanting to expose yourself voluntarily to that sort of risk is beyond my understanding.  But McDonald’s has tens of thousands of outlets throughout the world, serving some of the most unhealthful food that humankind has yet invented – and they all seem to be doing quite well.  So it’s obvious that people hold different opinions.

While I would advocate that the best birth control available to members of either sex is, “Just Say No,” there are some of us who have found ourselves in a weak moment and offering birth control pills is a far better alternative to having an abortion.

If we do decide to be really equal and allow men the same latitude as our women, then I have a solution (no this is not facetious) about how we could make condoms acceptable even to those who hold a religious belief that this is interfering with God’s plan and the purpose of sexual engagement.  In fact, I think I could make what would be a theologically sound argument supporting my idea.

All we have to do is make prophylactics that have one or two of the tiniest pinholes in them.  This would allow those really aggressive sperm that happen to be in the right place during intercourse to escape their encasement.  Then, if it were God’s plan that the couple should conceive, they would be able to go out and swim and do their duty.  If we consider a God who can divide the Red Sea, getting some of these little guys out to fulfill their mission should be a matter of little difficulty.

Considering the obviously superior genetic material of a sperm that could overcome the obstacles involved in this challenging environment, we might, as a by-product, even elevate the quality of the offspring so conceived, thus improving the gene pool.  That would be something we could all welcome.

Of course, with this whole issue of birth control, as with the question of abortion, we are dealing with an inherent inequality.  More female children than male are conceived, so we are preventing a disproportionate number of girls from being born than boys.

Again on the issue of equality, statistically there are proportionately more female and minority embryos that are aborted than Caucasian male children.  I am sure that the reasons for this are numerous and beyond the scope of this post.  But it should give a person who is considering the question of “women’s issues” pause, why this should be and how their support of a woman’s “right to choose” impacts the disproportionate number of female embryos that meet an untimely end.

There are countries in which “gendercide” is routine and common.  We think of those countries as primitive and not yet ready to enter the 19th century, let alone the 21st.  Their attitude on the worthlessness of women has not advanced much, if at all, from countries who in ancient history viewed a female child’s birth as an unwelcome event and set the newborn out to be devoured by wild animals.  In those more compassionate societies, the girl would merely be sold into a life of prostitution or servitude.

In view of the historical evidence and what is happening today, I have to believe that Mr. Romney’s business acumen must be in direct conflict with his social views and moral beliefs.  His position on the “right to life” makes bad economic sense – and the President’s “Pro-Choice” posture makes good sense (possibly the only thing about the President’s economic policies which does).

Consider the cost of an abortion versus the cost of raising a child.  There is simply no question that getting rid of an unwanted fetus is far more cost-efficient than bringing a child to term; then having to feed and clothe this infant; getting her ready to enter an already over-crowded and under-productive school system; and since a greater number of our poor than our middle class or wealthy choose the abortion option, having to spend taxpayers’ money to support this child, adding further to the out of control costs of our badly broken welfare programs.

Clearly, abortion is the economically sensible option.  And I cannot but wonder why a heartless, out-of-touch businessman like Mitt Romney doesn’t automatically gravitate to it – unless it’s a matter of conscience.

On the other hand, my friends glowingly endorse a President who advocates a policy which wreaks the most havoc on the unborn of minorities and female babies and consider him to be a man who is in touch with the people.

Perhaps he is.  And perhaps that says something about those who support him – that is, that he directly reflects their own attitudes.

Equality sounds like a good thing.  I’m in favor of it.  Of course, the fact that I’m here writing this and you’re there reading it means that we aren’t two of its victims.

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UNFIT TO SERVE

Every employer makes determinations about people.  Should I hire this person or that one – or hold off hiring anyone and try to redistribute the job’s responsibilities to those already on staff – or should I just do it myself?  These are real questions that real business people face regularly.

The process is, by its nature, essentially discriminatory.  We might require a Master’s degree which discriminates against those who are high school dropouts.  We might believe the job requires at least five years of related work experience – which discriminates against those who are freshly graduated.  This sort of discrimination is allowed by Federal law because it focuses on what are called BFOQ’s (Bona Fide Occupational Qualifications).

On the other hand, discriminating against applicants on the basis of gender, race, religion, national origin, sexual orientation or Vietnam War status is a prohibited practice and a violation of that same law.  That is because we believe these attributes have no bearing on whether a person will be able to perform his or her job duties.

These are the rules which regulate privately-owned businesses, from IBM to the little mom and pop diner.  They are also the rules that clog our system with law suits brought on behalf of those who think they have been victims of illegal discrimination – much to the benefit of trial lawyers who specialize in these sort of suits.  Having said that, there is a need to oversee the activities of short-sighted employers who harbor prejudices, whatever the form that it takes.

But when it comes to those who serve in Congress, there are only two requirements, which are that they conform to the eligibility requirements set forth in the Constitution and that they receive a plurality of votes from those who live in their district or state.  Sadly, that may not be enough.

A person of conscience should, as in the case of former Arizona Rep. Gabrielle Giffords, realize that her physical health, as a result of being shot,  was insufficient to allow her to discharge her duties to her constituents.  She resigned her office.  I applaud her for her courage in putting those she represents first and herself second.  That is an attribute of a stateswoman and I hope she experiences a complete recovery.

The House of Representatives has procedures for censuring those who are charged and convicted of ethical violations.  I am not sure if the procedure allows for a convicted congressman’s expulsion – or if that is left to the voters in his district at the next election.

But what happens in the case of a congressman who is physically impaired – as was Congresswoman Giffords, or mentally so.  To the best of my knowledge, there is no procedure other than the way in which that congressman wishes to handle the issue.

The reason I bring up this matter is the physical and mental condition of Illinois’ 2nd Congressional District, Rep. Jesse Jackson, Jr. who has been on a “leave of absence” since May and is currently being treated for depression and bi-polar disorder at the Mayo Clinic.  I am particularly interested in this situation because I lived in the Congressional District from which Rep. Jackson was first elected in 1994.

By way of context, remember Presidential-candidate Sen. George McGovern’s 1972 effort to attain the White House.  Sen. Thomas Eagleton was his original choice for Vice-President but was dropped from the ticket when it was revealed that he suffered from depression.

Let me say that I wish  Rep. Jackson every good wish for a complete and full recovery.  I don’t know enough about these conditions to know if that is a possibility.  I certainly hope it is.

But until that occurs, I would call on him to be a statesman and resign his office in the interest of allowing someone who is, at this time, better physically and mentally able to represent his constituents.

America faces serious challenges – the most serious I remember during my lifetime.  We need everyone in every elected office to be a person who is healthy both physically and especially mentally in order to address these challenges.

No one but those who are running for election truly knows if he meets that standard – or if they are unfit to serve.

ON MEDICAL ETHICS

My physician in Chicago, Dr. Sherman and I had a long-term relationship until his retirement.  He ran a practice in which he knew his patients and never seemed to be overly interested in expanding his business.  His staff consisted of one nurse – a woman who happened to be Mrs. Sherman.

When I called for an appointment, there was no menu to get through to reach the right party.  Either Dr. Sherman or his wife took the call.  I could hear them turning the pages of the appointment book to find a time that was good for both of us.

All his patients had his home telephone number in case of an emergency.  I used it one time in the thirty years I saw him when I had an extremely bad case of the flu.  Dr. Sherman decided that I needed to see him right away – so he made a house call.

Dr. Sherman treated adults and he treated children.  And most of all, he treated his patients with compassion and respect.  After an appointment he always took time to sit down with me to find out how my life was going.  These conversations inevitably concluded with the statement, “I hope I don’t see you until next year for your physical – unless it’s at the symphony.”  I knew he meant that.

Hippocrates would have been proud of Dr. Sherman and other professionals like him.

Are there any Dr. Shermans left today in the practice of medicine?  If so they are well camouflaged.  Today the practice has taken on all the characteristics of our technological age and incorporated some of the worst elements of factory farming as well.

The personal relationship between the physician and patient has been replaced by the more highly efficient bar code where the individual is simply numerically identified as one of the herd, milling about the overcrowded stall.

With the lack of interpersonal relationships between physician and patient, it is easy to see how the following situation might occur.

A 23 year-old  man in Philadelphia was denied a heart transplant.  Although he is a good candidate for the procedure, the reason he was declined was because he is autistic and has other psychiatric issues.  In making the determination to reject his application, reasons that were cited included the possibility of steroidal interference with his general health.  Steroids are necessary in order to maximize the patient’s ability to accept the new organ.

There are, perhaps, better candidates for a heart transplant than this young man.  And there is a shortage of hearts and other organs which are available for that purpose.  But it’s difficult to avoid wondering about the procedures and the people who will make these determinations for all of us should Obamacare survive and go into effect.

Under the Affordable Care Act, seven as yet unnamed bureaucrats will effectively be in charge of our dispensation of medicine.  If that doesn’t frighten you it should.  Simply look at how well bureaucracy has bungled most matters with which it has been entrusted.  It’s been that way since Joseph invented the concept in ancient Egypt.

What is most disturbing to me is that when you have an impersonal bureaucracy viewing the general public as merely components which make up a herd, it is not a difficult step to begin to decide that perhaps that herd should be culled and the weak sacrificed for “the greater good.”

With no personal relationship with the victims it’s not too hard to arrive at that view, if you think of them merely as statistics – a mindset not much different from that held by the mass shooters we hear so much about of late.

If you believe that could never happen in America you are wrong.  It has happened.  It was called the Tuskegee syphilis experiment  (also known as the Public Health Service syphilis study).  If you want more details on how 600 impoverished black sharecroppers went untreated for their disease so that we could analyze its progression, you will find it at this link to the Wikipedia article.

http://en.wikipedia.org/wiki/Tuskegee_syphilis_experiment

It doesn’t take a particularly fertile imagination to question that if this one experiment has made its way to the light of exposure, are there others about which we have never heard?  And if so, how many and who are those who were victimized?

The greater good is a nice phrase.  But the good or ill that any society does must always be measured by the way it treats it’s least important member.

We must always be mindful that if we stand by silently as another group is selected as the sacrificial lambs, we have opened the door to a shift in attitude or policy and we may be the next group of sheep on the way to the slaughter house.  Both ethics and common sense suggest that we should oppose any such policy or program with all our might and strength.

Dr. Sherman passed away several years ago at the age of 87.  I suspect there are few left who are like him – physicians who have a true sense of compassion and a relationship with their patients.  People whose lives embodied the very essence of medical ethics.  Their passing is a great loss for all of us.

GET ON THE BANDWAGON

People go into business for an opportunity to better themselves and their families.  I believe it would be fair to say that no one develops a business plan which is designed to guarantee failure.  But sometimes that happens.

Consider the company that manufactured horse-drawn carriages.  Things are going along nicely, the company offers a quality product at a good price – and then along comes Henry Ford with that darn horseless carriage thing.  All of a sudden a thriving business becomes a thing of the past.

If the business of medicine truly had our welfare at heart, it should be encouraging us to use their services as little as possible.  A well-crafted wellness system would mean that we would rely on their expertise in the case of accidents, congenital conditions, some surgical repair work and very little else.

I realize that this will sound bizarre if you have the mindset that every time you have a sniffle you need to consult the man in the white coat with the stethoscope.  But let me offer an example from one medical discipline which nearly put itself out of business.  It’s called Dentistry.

As a child I remember going to the dentist in order to have a cavity filled.  I still remember the sound as the pulleys turned the drill – that horrible screeching sound followed by the smell of burning calcium as the head made it’s way into my tooth.  Like most people, I viewed a trip to the dentist’s office as an excursion into horror.  We consulted the dentist because we had a problem – much in the same way we go to see the doctor today.

But dentistry evolved.  It turned from being a reactive profession to a proactive one.  It learned that we could easily prevent many of the problems that people of my generation experienced through a regular regimen:  brushing, flossing, regular cleanings and checkups.  Much of the practice today consists of routine maintenance and cosmetic procedures.

The number of cavities which are treated, thanks to these preventive steps, have declined by nearly 80% since I was a child.   That’s good news for patients – not such good news for dentists.  But they have adapted to the effects of their own good work and most of us are smart enough to see the dentist at least twice a year for our regular checkups and cleanings – and perhaps an occasional tooth whitening.

So if a proactive approach to dental health seems effective, why is it that medicine has not adapted the same strategy?  I can only conclude that there are two reasons for this.  The first is hubris and the second is money.

The fundamental premise of our approach to healthcare is to wait until a problem develops and then attempt to correct it.  It is the exact opposite of what dental science realized was the most effective way to deal with dental disease – avoid it in the first place.

Then we treat the condition with a primary emphasis on doling out drugs, 90% of which do nothing  to address the underlying condition but merely treat the symptoms of the condition – and most of which have side effects that are as hazardous to our health as the disease for which we sought treatment.

I suspect that if you were to ask anyone who is on a “drug therapy regimen” if they would prefer treating their symptoms or getting rid of the disease for which they are taking them, they would universally opt for the latter.  But that is not what modern allopathic medicine provides.

So where does hubris come in?  It begins with that little prescription pad that sits on your doctor’s desk.  Only she can put down the magic words that will enable you to start on a life of servitude to the pharmaceutical industry.  That gives your doctor a great deal of power which most of us lack.

As to the subject of money – there is no question that the root cause of many of our economic woes are generated by our healthcare system.  Medicare and Medicaid are rapidly moving us to the brink of insolvency.  That is not my opinion but rather the consensus of virtually everyone familiar with the subject.

There are many who want to attack the symptoms of the problem by reducing the massive amount of fraud in the system and that is a good first step.  But that is merely a temporary fix applied to a system that is based on an illogical premise.  The concept of waiting for disease to develop and then trying to treat it rather than the proactive approach of avoiding it in the first place simply doesn’t make sense – unless you’re a pharmaceutical company.

What would happen if we turned our emphasis to education and to implementing policies which would encourage people to eat nutritious meals, to engage in a regular program of healthful exercise and to avoid doing things that have been shown to be harmful to our health?

What would happen if our public schools only provided healthful choices in their cafeterias for our children at lunch?

What would happen if each of us took primary responsibility for our health and well-being?

I believe the answer is that over time, we could greatly improve our health and avoid many of the conditions with which we burden the medical system.   We would need fewer doctors and fewer hospitals and fewer pharmaceuticals.  And we would need to worry less about figuring out a way to pay for all of them.

Of course, the key to all of this is our assumption of personal responsibility.  There doesn’t seem to be a lot of that going around in America today.  We all have excuses which are mouthed by our political leaders and the man on the street.

Rather than embark on a long-term program of self-improvement we prefer the quick fix of popping a pill and thinking we will wake up the next morning looking glamorous and muscle-bound.  Check out the infomercials on early morning television if you question the truth of that assertion.

Is there a way to begin on the road to wellness?

As a starting point, what if we got a rebate from our insurance company if we took an annual physical?  What if we received a rate quotation from our insurer based on our personal use of the system – the more use the higher the premium and vice versa?  What if the government subsidized nutritious foods reducing their cost and making them more appealing financially to the consumer – and taxed foods which were highly processed and contain little nutritional value?

(I do hate the thought of governmental involvement but they are already involved.  At least we could redirect the efforts of some in the bureaucracy to something that would have long-term benefits).

There is a specific reason I began this post by talking about the advent of automobiles – because, like cars, our bodies are machines – though far less durable.

If we are negligent in our driving practices, exceed the speed limit, breeze through red lights or fail to maintain our vehicles properly, we are far more likely to be involved in an accident.  We know this is staistically true.

If you have ever had a driver hit your car you know what ensues from that incident.  You have to deal with claims adjustors, drive your car to a body shop, pay a deductible and rent a car.  All of this is a hassle which could so easily be avoided.

In most cases, your car can be repaired.  If the damage is too severe your insurer will “total” the car and then you have to deal with finding a replacement.  And herein lies the difference between our car machines and our body machines.  Bodies are one to a customer.

Dentistry has proven that prevention is far more cost-efficient than treatment.  And it’s a lot more comfortable for the patient.

Isn’t it time that the medical establishment and the government got on the bandwagon?

THE LAW OF LARGE NUMBERS

What is it about the number $3 Billion that makes it so popular?

First we had J. P. Morgan Chase and their nasty trading loss in that amount.  Now we have GlaxoSmithKline agreeing to pay a combined $3 Billion in fines to the Federal Government because of their unscrupulous marketing strategies and false claims for their products.  At least Chase merely made a mistake while GSK had an illegal and reprehensible marketing strategy in place to improve their bottom line.

What is particularly disturbing is GSK’s practice of offering physicians expensive gifts for prescribing their products – making claims that they were beneficial in ways for which they were never approved by the FDA.  From the pharmaceutical reps I know, this practice is hardly limited to GSK.  It is a nearly universal  industry-wide strategy.  In other words, your doctor may be more influenced by personal benefit than your health in determining which drug to prescribe for you.

Does that give you a warm and fuzzy feeling about your next appointment with your physician?  It certainly should not.

Even with FDA approved drugs that are thoroughly evaluated we have bad side effects.  If you question that statement flip on your television to virtually any station for a couple of hours and count the number of ads from trial lawyers who will be happy to represent you if you or a loved one suffered as a result of taking drugs which the FDA had approved.

If those drugs which have been “thoroughly tested” have adverse effects, consider the possibility of taking drugs which are untested to treat a particular condition.  (Just as a point of reference, during the time I have been writing this post, two such ads appeared on my television – and I type very quickly).

With healthcare representing an ever larger proportion of our GDP this is hardly a moot point.  The amount of waste and fraud in the system is mind-boggling – and even the Federal Government recognizes this problem.  The settlement with GSK is a small first step at correcting the situation – but far more needs to be done.

What more could be done?  A $3 Billion dollar fine sounds like a lot – but for GSK and many of its competitors this is truly a drop in the bucket.  What should have been done is that the company’s CEO, Sir Andrew Witty should have been forced to resign as part of the settlement with the UK drug giant.

Is this too harsh?  Well, let’s look at something else that happened today.  There is a growing scandal once again emerging from the financial industry.  Although it will be months before we learn the complete story, that is if we ever do, apparently the UK’s third largest bank, Barclays was involved in massaging interest rates to make its bottom line look better during the height of the 2008 worldwide financial crisis.

Even before we know what really happened, Barclay’s CEO, Bob Diamond resigned today.  Perhaps he was guilty of overseeing this strategy and perhaps not.

What is clear is that GSK knew that it was acting in both an illegal and unethical manner – which is why they are pleading guilty to the charges levied against them.  Until those who run corporations pay a personal price for their company’s malfeasance they will continue to implement policies designed to pad their bottom line.

I suspect that in the nine years during which the GSK investigation has been ongoing the company made many times the fine to which they agreed for the specific drugs in question.  And Sir Andrew continues in his position having suffered a little embarrassment and no other personal consequence.

When someone in the financial services industry acts inappropriately it has trickle down consequences for all of us.  They threaten the stability of our financial system and that affects each one of us.

When someone in the pharmaceutical industry acts inappropriately it also has consequences for us in terms of the cost we are all asked to pay for our healthcare system.  And for people who suffered adverse reactions to their products or death the consequences are far more personal and severe.

Trying to put my usual optimistic spin on this, I do see at least one beneficiary from the law of large numbers.  It’s the funeral industry.  Rest in peace.

THE VACUUM CLEANER

If you think that this post is going to be about keeping your home neat and tidy I am sorry to disappoint you.  This is not about the Hoover or the Mighty Mite or Orecks or Eurekas or Dysons.  This is about the most powerful vacuum cleaner ever invented – your car – guaranteed to suck as much money out of your bank account as possible.

If you’re as mechanically-challenged as I you too will find yourself at the mercy of your local “car repair shop” or garage.  I can add gas to the beast and I now know where the windshield solvent goes (it seldom runs out here in Las Vegas) and I do know how to run it through a car wash.  I even can put air in the tires.  And that’s about it.  For the rest I rely on the “car doctors” to do their thing.  Of course, I should share with you my view on doctors – something which I used to incorporate into my seminars.

THE FOUR KINDS OF DOCTORS

1.  The Internist – Knows Everything and Does Nothing.

2.  The Surgeon – Knows Nothing and Does Everything.

3. The Psychiatrist – Knows Nothing and Does Nothing.

4. The Pathologist – Knows Everything and Does Everything – Too Late.

I have had the misfortune of having various cars treated by each of these kinds of car doctors.

1.  The Internist – You bring your car in because there’s one of those little annoying lights that just went on in your dashboard.  Despite the fact that you’re looking at the Owner’s Manual you can’t seem to figure out which of the little diagrams pertains to your particular service light.  So, thinking that your car is likely to explode you take it in to have the problem corrected.

The internist mechanic sticks his head in the door, sees the offending light and begins poking around under the hood.  After twenty minutes at this he explains that the reason your light is on is that you have a fuse that’s blown.  There’s nothing really wrong with the car at all.  (Sigh of relief).  Unfortunately, he doesn’t happen to have a fuse in stock with the required amperage.  You leave in search of a place where you can buy the correct fuse and install it.

2.  The  Surgeon – You bring your car in because there’s a subtle but strange noise that occurs intermittently while you drive.  You really can’t identify the noise much more specifically than that.

Your surgeon mechanic listens attentively to your description of the problem.  He hooks you up to one of those fantastic automatic diagnostic machines which will surely identify the cause of this noise.  After a few minutes of being on this EEG for cars machine, a magic code appears.  This will tell him what is causing the noise.  So he looks the code up in his book but doesn’t think that this is actually the reason for the problem (so why does he have this machine?) and says that based on his years of experience he is sure he can get rid of your noise.

As you listen to him he raises your car up on the hydraulic rack.  You go back to the waiting room.  After an hour you go to the service bay and find that the car surgeon has called in a few assistants.  You also notice that your car’s engine, catalytic converter and muffler are lying on the ground.  You call to reserve a rental car for the three days it will take them to reassemble most of the parts that they have removed from your vehicle.

3. The Psychiatrist – You bring your car in because you’ve noticed that your car isn’t accelerating as well as it used to.  You’re wondering if there’s something clogging the fuel line or perhaps it needs a tune-up. 

The psychiatrist car mechanic requests a little additional information.  He asks, how long has your car been unhappy?  Have any great life changes occurred in your garage – perhaps the addition of a newer model?  Did this happen all at once or have you noticed that your car has been suffering a slow encroachment of this malaise?

You leave thinking that you will try using premium gas to see if that fixes the problem.

4.  The Pathologist –  Your car has stopped while you were driving.  Nothing you can do will get it started so you call the car repair service and they dispatch a tow truck to bring you and your vehicle into the shop.

The pathologist mechanic looks at your vehicle, verifies that it will not start and hands you a business card for a used car dealer, pronouncing your vehicle to be officially dead.  It’s time to get out there and get a newer model – and do your part to help support the economy.

I don’t know why but every time I go in to have something done to my vehicle, the phrase “like lambs to the slaughter” runs through my head.  If I ever got filthy rich I know how I would handle this problem.  I would wait until the ashtray was filled (since I don’t smoke I would have to take up the habit) and that would be my clue to trade my cigarette-clogged vehicle in for a new one.  The way I figure it – the cost would be about the same as trying to get the old one fixed.

JUST A LITTLE SHORT

I had a friend who was 5′ 6” and weighed about 300 pounds. He died at the age of 52 as a result of the diabetes for which he took insulin for twenty years and the strain he placed on his cardiovascular system. His name was John.

John, obviously aware of his obesity, used to joke with us that, “I’m the right weight. I’m just a little short.” We used to laugh at this – until the day we attended his funeral.

The admonition that we should do, “All things in moderation” has been around for 2500 years since it was uttered by Aristotle. John failed to heed that advice – and paid for it with a shortened life.

Let me re-iterate something that I said early on in this blog. I have always had to be careful about what and how much I ate. I inherited this from mom’s side of the family. It used to amaze me how dad could eat two pieces of apple strudel and lose weight. I would go into the kitchen while it was in the oven and merely sniffing the aroma I could put on a pound. So I understand how people who struggle with weight issues view themselves and the world.

But I took charge and took responsibility for myself – believing that I was the best person capable of taking care of me. (In the absence of anyone else – it was a fairly simple choice).

Over the years that I knew John, it would be fair to say that he not only stressed his own body but he put an equal stress on the healthcare system. It is no exaggeration when I tell you that he averaged twenty to thirty appointments with his various physicians a year. (I have no doubt they gave him advice to lose weight which he either ignored or at which he was unsuccessful). Personally, I think any of us who weren’t medically trained could have offered the same good advice.

By contrast, in the 10 years I knew him I had 12 appointments with my doctor. All but two were for an annual physical – and the others were as a result of slipping on the ice and fracturing my right elbow. I am not one of those who has to see the doctor because I have a small sniffle – and I reject the idea that we have to get an annual shot to immunize ourselves against all the diseases the world is waiting to dump on us.

I have neighbors who are as religious about getting an annual flu shot as they are at attending Sunday services at their church. And almost without exception, they wind up getting flu-like symptoms for a few days. Several have still gotten full-blown cases of the disease against which they were supposedly immunized. By contrast, unprotected as I have been, I have never gotten the flu as an adult. Call me lucky – but I think otherwise.

There’s an adage that people in information technology know intimately, “Garbage in, garbage out.” If our diets are poor – we will experience their effects – perhaps not today or tomorrow but eventually. If our diets are good we will experience their beneficial effects for our lifetime. It seems to me that isn’t so much a matter of medical awareness as it is a matter of common sense.

But is this simply a matter of personal choice – or is there something more profound at stake here? I believe that it is the latter.

Whether Obamacare is ultimately held to be unconstitutional or is repealed by a future Congress is at this point a moot question. Presently it is the law of the land – and it has implications for all of us. In fact, because of its provisions it has implications for more of us than ever before in the nation’s history.

Study after study have shown that when people have health insurance, there is a greater utilization of the services available to them than for those who do not have that coverage. That is something which a reasonable person would expect to happen. If something is available to us at little or no cost we are likely to take advantage of it.

The corollary to this is that we will be putting an even greater strain on a system that is already overburdened. The inevitable conclusion is that the quality of medical care can only decline for those who need it. (If I have to wait an extra week to get my annual checkup that’s no big deal to me. But for those who have a legitimate medical issue and have to wait an extra week to see a physician– it might be significant).

Having said earlier in this post that I view the matter of my health as my primary responsibility (and by extension your health is yours), I view what I do, the foods that I consume, the lifestyle I follow as my business. However, my actions not only affect me but they can have a positive influence on society. Since I am less likely to need the services of the healthcare industry, my space is free for someone else.

If you understand the concept of personal responsibility (and more importantly are willing to implement it in your own life) then the next time you pull into the drive- through perhaps you will think twice before you automatically decide to “Super-size” that order of fries and might consider a juice or water alternative to that extra large soda you normally order.

If you adopt that strategy – it could be the first step toward a life-changing pattern of healthier behavior. You might help unclog the system by reducing the number of times a year you show up in your doctor’s office.

If we fail to take personal responsibility when it comes to our own health – inevitably we will all come up, “Just a little short.”

 

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