Film review: “The Wolf of Wall Street” (2013)

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Martin Scorsese is the Peter O’Toole of directors. He does great work that never got an Oscar.  Nominated seven times then finally got one for a mediocre film, The Departed-2006. O’Toole was also nominated eight times and never won for a starring role.

Martin is responsible for some incredibly Oscar worthy films, Taxi Driver, Raging Bull, Goodfellas, Gangs of New York, The Aviator, Hugo. But in “The Wolf of Wall Street”, he sinks to an embarrassing De minimis, spending a lot of energy on a very bad re-do of “Wall Street: (1987).

The plot is based on the life of Jordan Belfort, who built a huge financial empire out of duping investors into buying worthless penny stocks. The film interpretation is three agonizing hours of white-collar crime, drug abuse, lust for money, tribal male bonding and open-ended debauchery that would make the Marquis de Sade blush.

Unclear if the moral issues raised in this film fall on the deaf ears of those who continue to emulate Gordon Gekko to this day. Oliver Stone didn’t think he was inventing a role model for a million young would-be finance guys, but that’s exactly what happened. One can only wonder if the real Jordan Belfort grew up in that shadow.

Leonardo de Caprio gives an exuberant performance exploring the consequences of unlimited money as a drug, to the point of exhaustion. Yes, those consequences ultimately end in death or destruction but in the end three hours of naked people emulating the Kama Sutra is a bit much. After the first two hours it becomes repetitive and exhausting.

Cameos:  The real Jordan Belfort introduces Leo as Belfort the motivational speaker in the end scene.

Best scene:  On the yacht when the FBI comes to visit Jordan and a fascinating conversation ensues.  Scorsese at his best.

Worst facet:  Three hours of repetitive debauchery becomes tedious and stale.

I give this two of five 2-million dollar one-night parties.

Not recommended.

A New Year’s Film Reivew Twofer: American Hustle” and “Blue Jasmine”

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American Hustle (2013)

Very interesting Director David O. Russell told the cast of “American Hustle” to fully explore their characters, sparing nothing. So, during the shooting Christian Bale told the Director “You realize that this is going to change the plot greatly down track.” To which the director replied, “Christian, I hate plots. I am all about characters, that’s it.”

So that’s exactly where it went. The plot loosely involves the “Abscam” sting of the late 70s. A quest for local corrupt government officials using a fake Arabian Sheikh to lend classiness to the operation and inadvertently ended snaring major criminals. Against this backdrop, the world-class actors, Christian Bale, Amy Adams, Brad Cooper, Louis C.K, Jennifer Lawrence and Jeremy Renner go to work exploring their characters magnificently.

These actors are as blue chip as it gets in our generation. They are given a free reign to do what they do best by a director who knows how to guide them while maintaining continuity. There is no CGI, no explosions, no aliens, no floating around in space, no metropolitan destruction. Just the best actors of our generation given a masterful chance to show their chops.

The real fireworks come from the women, Amy Adams and Jennifer Lawrence, both of who explode off the screen. Amy Adams explores the would-be fraudsters moll with brilliant precision. In a dramatic change for her, Jennifer Lawrence morphs into a meddling two-dimensional, part harpy, part temptress New Jersey housewife. Jeremy Renner shines as the politician that can’t believe wrongdoing exists if it’s all for the people of his jurisdiction.

Best part:  The plot twist at the end. Un-credited Robert DeNiro.

Not-so best part:  Film is too long and the characterizations tend to be too overwrought.

It’s an excellent film, I give it four of five bottles of toupee’ glue.

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Blue Jasmine (2013)

Woody Allen started out as a neurotic stand up comic, progressed to the star of some really funny comedies and ultimately to a world-class director of some fine films.

I can picture Mr. Allen sitting at a desk somewhere reading the saga of master financial scammer Bernard Madoff and wondering if it would be possible to accurately portray the aftermath of his actions on those close to him. It could not be done without the right actors, but this selection process is Mr. Allen’s stock in trade.  He made it happen and the result is simply spectacular.

Cate Blanchett is perfection languishing in endless luxury as the wife of convincing financial magnate Alec Baldwin. Waited on hand and foot, private jets, surprise diamond trinkets, mansions around the world. An idyllic, limitless existence. Then it all ends as Alec is arrested for massive fraud schemes and it sent to prison where he hangs himself. Cate is hauled through the courts for years where everything she has is appropriated to re-pay those defrauded by her husband.

Ultimately she’s turned out on the street with nothing but the clothes on her back. Her only recourse is to move in with her estranged working class sister, who she had previously treated as poor relation. She is then immersed in and must accommodate to a rambunctious, beer swilling, potentially violent minimum-wage culture she previously had no conception of.

Cate Blanchett turns in a suburb, world-class interpretation of the self-delusional socialite fallen on hard times. Sally Hawkins is perfection as her hardscrabble antipode sister. Alec Baldwin exhibits just the right formula of arrogance and smarmy aplomb. Peter Sarsgaard and Bobby Cannavale are excellent. The audience feels for and with the characters.

I think this is Mr. Allen’s masterpiece. He has chosen the right actors and directed them in the right way to show the aftermath of disaster in a passionate but empathetic production worthy of F. Scott Fitzgerald. In Cate Blanchett, Mr. Allen has uncovered a female lead with previously undiscovered depth, texture and pathos.

Blue Jasmine is an elegant, witty and sophisticated film, highly recommended by me.

I give it four and a half of five black frame glasses.

The impending death of inadequate health insurance

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On 21 Dec 2013, at 0:32, From Med-Events

>  Hey Dr. Crippen, isn’t this the equivalent of the Flo insurance you were

> talking about recently? Apparently, it’s not so bad to be able to

> get catastrophic insurance only, as long as it covers Obama’s butt.

Not equivalent as I have had crap insurance polices like “Progressive” and “Safe Auto” explained to me by my State Farm agent. That highly paid huckster from Progressive holds up a “gun” and loudly proclaims the would-be insured can simply name their price to “get insurance for less”.  What she pointedly doesn’t say is that as the gun spits out lower prices, Progressive cuts out anything that might cost them, or pays peanuts for it. So the customer is pretty happy with that deal. They’re “insured” because the popular huckster says so. Once it comes to signing on the dotted line, the “closer” may explain the fine print. Maybe not.

So when “Safe Auto” does it, they “keep you legal for less”. And they do…until you run into the back end of a Porsche with your rusted out 1984 Ford Pickup. If that truck deposits a speck of dust on the back of that Porsche, it’s US$500 for the dealer to flick it off. If the fender is actually dented, it will be somewhere in the range of US$5000 for someone just to look at it. Maybe US$10,000 to actually fix it and probably a complete repaint. So Safe Auto” in keeping you legal for less, will gladly pay up to US$500 for that Porsche injury, and the insured will pick up the rest. The Porsche owner will then sue the insured and set up a court date to garnish his or her wages indefinitely. Sometimes for as much as 25% of wages or more.

Similarly, Garish, loud pitch woman “Flo” is happy to get you in the room looking for “insurance for less” and the “closer” will also explain in not much detail how you’re now “insured”. Then you get unexpectedly get sick or injured and find out you live in the most expensive place in the world, tens of thousands of dollars a day, US$20.00 for a Tylenol tablet to finance those with no “insurance”. Then your spouse reads the plaques on the wall of the attending physician’s, radiologist’s, pathologist’s and emergency department’s wall: “Patients are responsible for all expenses incurred that “insurance rejects”. Junk policies like Progressive pays a small fraction of the invoice or completely ignores some/many expenses or pays a pittance, following which you are financially responsible. The practical difference between being “insured” and “going bare” is academic. If you have a ten-inch hemorrhoid, shrinking it to 5 inches isn’t much help.

Mostly Democrats have been trying to come up with a holistic health care coverage like every other civilized country in the world as far back as LBJ. And of course, Republicans have been trying to trash that idea on a parallel course. Hillary got her head handed to her in 1993. So, come on, give the devil his due. Obama pulled a fairly reasonable plan off, and left to the way it started out, it had a pretty good chance of doing the job.

Obama made at least two very bad tactical mistakes. First mistake was not using the bully pulpit to jam the original plan down congresses throat sideways while instilling the mortal fear of him in all of them, LBJ style. His laid back professorial affect allowed his mortal enemies (the ones he thought would work with him for the good of the country) to dilute the original plan down to it’s present watered down form. Obama had the vision but not the means. And if you read “The True Believer”(Eric Hoffer), it would have been clear that the visionary is never the one to effect the vision. Obama needed henchmen like Rahm, lots of them out there ripping the throats out of his enemy list. The alternative was giving them footholds, which never should have happened. If you’re going to be in charge, then be in charge for better or worse. Let history decide after you’re gone.

His second mistake was not understanding the reality when he assured everyone that they could keep their insurance if they liked it. That applied to me, not much of the rest of the country. I have incredibly good insurance I have no intention of ever dropping for anything. A few years ago my youngest daughter had brain surgery.  I never received a bill for anything but co-pay for office visits. If “Flo” got the bill for that, she’d burst into flames.

Obama thought everyone with health insurance was like me, but in fact there were a TON of “underinsured” out there just quietly languishing, not breaking the surface of visibility until everyone looked a little closer. Obama also correctly built a plan that would assure no one would go broke instantly if they got sick. That isn’t to say they wouldn’t have to pay some out-of-pocket, but it would be affordable. Obama didn’t have any idea that when he forcing them to come up to minimum standards, two things would happen; those paying low rates for junk polices would find out they weren’t “really” covered and they were going to have to pay more for real coverage.

This of course was a perfect opportunity for Fox News to seek out angry talking heads loudly complaining on camera that Obama screwed them out of health insurance by raising the price. Of course, Fox doesn’t mention that they were never actually insured anyway, it was only an illusion.

So, here we are perched on the brink of 2014 and several things are clear. Despite the Republicans making careers of trying, The ACA of 2008 persists and people are signing up.  Those that had/have junk policies are forced to bring them up to the Egyptian Minimum whether they like it or not. Endless blogs complaining about the evils of Obama from lint on his jacket to bad breath are floating around out there bouncing against desensitized ears. In the end, we have the rudiments of some kind of meaningful health care indemnification in place, it isn’t going to be razed and it will grow and evolve into something better.

It is UNACCEPTABLE that we have a huge portion of our population rendered instantly in hopeless debt or financially wiped out if they get sick or injured. NO other civilized country in the world allows that and they all offer some kind of meaningful indemnification for an affordable price. Do the rest of the countries have problems?  Is the care they offer completely free from glitches?  Are there waiting lines for some services? Sure. But everyone gets care and no one goes to the poorhouse if they get sick. We callously ignore a portion of our population and our life expectancy isn’t any better than Portugal’s. UNACCEPTABLE.

So, like it or not, there are some realities in delivering health care and a previously complacent public is finding them out, however harshly. “Insurance” does not and will never cover every dime of every expense. It is in the process of evolving to catastrophic indemnification where the insured participates in risk.  UPMC is evolving there as well, and I feel it in my pocketbook. But I don’t get a bill for US$100,000 for a surgical operation.

Flo will have to get over it and set the magazine in her price gun to reflect the realities, not the dreams. It will be a painful prescription for the public, but they’ll get over it, just like they got over mandatory insurance for motor vehicles and mortgages.

Crippen enters the rarified air of high-end audio

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mcintosh-mcaire-xlI’ve been thinking that I’m behind the curve when it comes to actually listening to music anymore: a victim of the “digital ease” age.  It’s easy to just keep a menagerie of music in my iMacs and play them out of relative cheap desktop speakers.  In my office, I have speakers that stand about 2 inches high and they’re hooked to my desktop computer.  I have a huge supply of music and I just let it run during my day, mostly in the background.

My ears have grown accustomed to music the fidelity of which is about the same as a car radio. But as it turns out, the “real” fidelity of digital music is incredibly bad once you have something to compare it too.

The advent of iTunes has killed “high fidelity” as I remember my dad exploring it in the 50s with tube amplifiers and incredibly big speakers fed through enormous turntables. Highly compressed (for portability) MP3 music files lose a LOT of fidelity in the process. Even the music on garden variety CDs is pretty crummy compared to what it could be. The vast majority of the speakers they’re played through are junk, including and especially ear buds.

Music purchased through iTunes or over Internet radio contains a fraction of the total sound information captured in the studio — as little as 3% of the original. Even CD formats contain as little as 10% of the original information so it can be contained on a 4 3/4-inch disc.

It dawned on me that there must be more to musical life than Pablum in a world otherwise filled with sirloin, so I started sniffing around the erudite world of “audiophiles”.

To begin with, digital music is capable of “high fidelity” in the form of uncompressed audio files such as FLAC, WAV, AIFF, and “Apple Lossless files” but there are two problems.  Space and bandwidth. It takes a LOT of space to contain these files and the equipment required to play them to their maximum extent is expensive.

Aging 60s rocker Neil Young has led the charge to affordable players for uncompressed music files for the past several years. Young filed six trademarks with U.S. Patent and Trademark Office in 2012, all of which would offer a higher quality audio alternative to mp3 files, but none have reached the marketplace yet. He’s starting to release albums on Blu-Ray for better sound quality and his high-resolution player is said to be in the works for 2014.

http://www.rollingstone.com/music/news/neil-young-plans-pono-launch-for-2014-20130904

Then comes the re-emergence of “audiophile” 33-1/3 vinyl discs. Yes, vinyl is definitely coming back, and in extremely high-resolution format, said to be as close to studio quality as it’s possible to get.

They’re going all the way back to the 50s and finding the original master tapes, then putting them on vinyl in an amazingly lossless high tech process no one dreamed of back in the day. What you hear is as if you were standing in the control booth watching Linda Ronstadt in 1976. They now cost about US$30.00 each. The “sound” is said to be amazing and spectacular (I have not heard one yet).

http://www.mofi.com/product_p/mfsl1-319.htm

As the discussion proceeds, we’re now talking about the rarified air of hardware for the discriminating listener.  With a little research, three things become apparent. There is no limit to the ability of hardware to reproduce sound fidelity, there is no limit to the amount of money that can be spent to do so but there is a limit to what my aging ears are capable of discerning.  A perusal of the available hardware is fascinating (especially the cost).  You can easily pay US$10,000 for a set of speakers.  Many of the hard core literally build their houses around US$350,000 audiophile hardware.

There is simply no discernable point of diminishing returns. The more you pay, the more rarified audio acuity you can get. But at some point, the line on the graph heading up into infinity exceeds sanity, especially since I only listen to 60s and 70s classic rock. Not exactly the same fidelity required might be the entire New York Philharmonic playing Beethoven at 100 decibels.

Interestingly, all my research eventually led to the same place it did for my dad in 1956 when my mother was loudly predicting the end of the world at the hands of the Prince of Darkness, Elvis. McIntosh Audio. (Note different spelling- not to be confused with Macintosh Computers). In the end, when you’re seeking high end, all paths lead to McIntosh and once that obsession becomes manifest, an emptying of your wallet.

http://www.mcintoshlabs.com/us/systems/pages/systemdetails.aspx?SystemId=SoHoIIMusicSystem&Systemcatid=Music

Back in the day, the high-end amplifiers were all vacuum tube driven. They were big and heavy and required equally big pre-amplifiers to drive them into enormous stereo speaker cabinets.  My father ate peanut butter sandwiches for months to afford what was then a rudimentary McIntosh setup. Tell the truth I can’t remember what it sounded like but I remember him reposing for hours in a darkened room enjoying it.

So I decided to dip my toe in these waters with a relatively entry-level McIntosh combo unit that will play uncompressed digital files (for me, FLAC “Free Lossless Audio Codec” files) on my iPad and iPhone. Each of these files are not completely uncompressed but somewhere in the range of “better” to “much better” than straight up MP3. Not even close to vinyl but cheaper.

http://www.mcintoshlabs.com/us/Products/pages/categorylanding.aspx?CatId=NewProducts

The unit allows wireless loading with FLAC files from either an IPhone or iPad.

http://www.youtube.com/watch?v=_SMma_CQJ3I

It sounds absolutely amazing. So this will give me a taste of audiophile. Someday if I save my pennies and dimes (US$100 bills) I might look into building a full McIntosh system with a high-end phono player for the emerging mastery of vinyl.

It’ll be in my Scaife office around Christmas week. Drop by and I’ll give you a quick lesson in the difference between MP3 and FLAC.

 

 

 

 

 

 

Requiem: Dr. Gene E. Michaels

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Michaels_Gene_20110612Michaels GE, Crippen DW: Post-scanning viability of specimens on support studs used in scanning electron microscopy. Bulletin of the Georgia Academy of Science, vol. 29, no. 4, September, 1971 http://www.gaacademy.org/
 
The first “scholarly” paper I ever participated in. We showed that fungal specimens frozen in liquid nitrogen for scanning electron microscopic freeze etching were still quite infectious when warmed (the liquid nitrogen didn’t kill the spores). Microsporium canid and microsporium gypsum as I recall. This was not known before our paper which was well received in the academic community. I was a total nobody.
 
Dr. Gene Michaels was a new Assistant Professor in the Department of Microbiology at Georgia and was the fungus guy. New PhD. He and I bonded when I came back to college from Vietnam and he agreed to be my de-facto pre-med advisor when the real one refused to see me (because of my overall 1.9 grade point average). He believed in me and never ceased to encourage me. He had my infinite respect. He retired and had snow white hair and long white beard and was a continuing ambassador for the University of Georgia till his death.
 
I spoke to him a few years ago but sadly, he passed away in 2011. http://www.obitsforlife.com/obituary/354271/Michaels-Dr-Gene.php
 
Rest in peace, Gene. A life lived well. On 29 Nov 2013, at 23:07, Gabriel Castillo wrote
 
The paper is not entirely lost

Film Review: “The Hunger Games: Catching Fire” (2013)

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One of the most incomprehensibly bad films I’ve ever seen, the dense culmination of many pernicious factors.

The plot was incomprehensible and excruciatingly boring. Any character development the book had has been left out. The corrupt society tale and the pyrotechnic manipulations thereof made no sense even by a stretch of the imagination. Obtuse and impossible-to-follow action. Train wrecks of improbable circumstances, scenes that in real life would reliably kill off most life on earth, much less the impossibly durable actors.

Jennifer Lawrence showed two expressions- boredom and cold-blooded mayhem, within seconds of each other, and to no particular consequence other than to appear to have constipation throughout the movie. Actors pop in and pop out for no explainable reason. Donald Sutherland looks bored.  Philip Seymour Hoffman should be ashamed of himself for appearing in this turkey. He probably demanded a ton of money to assuage his embarrassment.

This film is about as interesting as a forced two and a half hour walking tour of your living room. A desultory quest for the summit of Mt. Bad, dragged up the aisle toward the Film Hall of Shame like fat eunuchs, to reside the company of stinkers like “Heaven’s Gate”, “Battlefield Earth”, “Howard the Duck”, “Gigli” “Mars Attacks” and of course “Glitter”, each with their own foul excuse.

I give this turkey 1 of 5 blank Katniss expressions. Yes ONE, with heavy eyeliner.

Latest revelations on the Affordable Care Act of 2008

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Dr. Crippen, I am reading your blog post about the ACA right now, I have one month to decide, as I am now 26, to purchase private insurance though (current employers insurance).  The deductibles are insanely high, as well as the premiums…or wait for the January ACA kick in?

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What we have now is a situation where the cost of health care is escalating out of control with no end in sight, fueled by providers (yes doctors) that can create demand for their services and then supply it. As this process progresses, the affordability of health care insurance decreases commensurately. So insurers must cut more services to remain viable and employers must pass on the cost to you. Many employers will eventually stop providing health care services for employees. There is simply no way *private* insurance can be maintained. It will crash. Not a matter of if, but of when.

The issue of “junk” health care plans that were promised would remain viable after the onset of the ACA don’t directly apply to you. The law says that “junk” policies that allow you to pay a very small premium and fail to cover needed and necessary medical conditions is just what it is. You’re either insured or you’re not.

The law says policies must cover all potential illnesses but there can be varying amounts of co-pays and deductibles to keep the price down. In he ACA, if your illness lands in an area that is not covered at all in a junk policy, that area is at least covered to some degree, even as a catastrophic. This is a better deal than a junk policy.

So here’s my current opinion:

1. You do NOT want to go bare for any length of time. Yes, you’re young and healthy and you don’t think much about getting sick or injured, but an unexpected hospitalization, especially if it involves surgery or ICU care is so mind-alteringly expensive you have no conception of it. You would never be able to pay it off in three lifetimes, and you can be sure the hospital would be there to dun you for it for the entirety of those lifetimes.

2.  Expect to pay out of pocket for most of your health issues now and in the future. It’s just the reality. The issue of being *completely* indemnified for health care is vanishing. No insurance will be willing to pay for *all* of it, or even most of it. You will pay more every year and get less.

Ultimately, insurance will only cover what amounts to “catastrophic coverage”.  You will pay out of pocket for everything except disasters for which you are hospitalized.  Those out of pocket expenses will then seek out incredibly expensive deductions and co-pays.

3.  Given that the above is true, then it becomes a matter of *shopping around* to get the best deal possible for what you have to put into it. I assume your options are either your current (medical center based plan) or the ACA.

a) Your current medical center based insurance plan is extremely large. The good thing about insuring with a large employer is that they are “too big to fail”. They will always be offering health insurance no matter what the economy does. So it’s unlikely they’ll arbitrarily drop you when they run out of money, but they can and will make you pay more every year. You’ll break before they will.

b) As much of a political football the ACA is, it’s still here and its still recruiting patients.  Attempts to kill it at every social and political level have failed, including a presidential candidate that promised to kill it if elected and an attempt to shut down the government. Now the question comes up, will Republicans and other Philistines be able to kill it (after you’ve paid) in the future?  I say probably not. Enough people have signed up to make it impossible to negate their service, and more are signing up every day.

So, what the ACA seems to do is let you shop for a policy you can afford, and that’s a good thing for you, exactly what you need to do. Before, shopping around was time and labor intensive. Now because of the Internet, you have a unique opportunity to meticulously shop around and see what’s out there.

My humble personal opinion is also that the ACA is here to stay and will start to thrive once the word spreads and the website is 100% up to the task. I do not believe it is possible to kill it now.

The reality is simply that you will draw a metaphorical line graph. One line will describe the minimum and maximum you have to spend on a health care insurance policy and the other line will describe the cost and availability of such indemnification. Where those lines cross is the point where you will purchase a policy. It’s about as simple as that.

Bottom line:

* Don’t even dream of going bare.

* Expect to pay more for less

* Budget some mad money for unexpected out of pocket costs

* Get the most policy you can afford and hope for the best

Some personal observations on the events of Nov 22, 1963

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It was the year 1959 AD. My dad was the only general surgeon in a town of about 10,000 souls located in northwestern Wisconsin studiously picked for his hunting and fishing passions.

He was a very conservative Republican as most if not all doctors were at that era. The “up by your bootstraps” age selected for them. The best government was no government, and in the escalating post war, post-Eisenhower age of prosperity, that seemed attractive.

Credit cards were virtually unknown. Gas was 29.9 cents a gallon, a mortgage on a nice house was a hundred bucks a month, a nice car cost US$2000 and virtually all health care was affordable out of pocket. There was no Medicare or Medicaid.

But the Eisenhower era was closing and a new era of cold war paranoia was emerging with the Presidential election of 1960. The world was becoming a dangerous. I was a sophomore in high school and my only interest was girls and cars, pretty much in that order. My interest in politics was yet to emerge so I was pretty much a disinterested observer.

The two candidates that emerged for 1960 were polar opposites, Richard M. Nixon, a crusading anti-communist from California and Kennedy, a relatively new senator from Massachusetts.

In the first ever TV debates in living black and white, he looked sneaky, dark and foreboding as opposed to the other guy, Kennedy, who brightened up the screen with an articulate vernacular. Even to my naïve eye, Nixon looked positively sinister.

Seemed like a pretty easy choice to me, but there was a problem. Kennedy happened to be a Catholic, a big problem in 1959 American culture. Catholics were very much discriminated against in mainstream America, thought by many to be as much a cult as “Christian Scientists” or “Scientology”.

Catholic. That’s all my bible thumping conservative Baptist mother needed to hear. So I could hear from my bedroom the fervent pleas that Richard Nixon would save us from being ruled by the Pope. But it wasn’t to be. Kennedy was elected by the thinnest of margins and my dad had to pull my mothers head out of the oven.

But in the end, Kennedy went on to become possibly the more revered President in American history, maybe rivaled by Bill Clinton. Interesting that they shared the same vices, but with different media access saturation.

But no matter. Kennedy was perhaps the most intelligent, articulate, funny President our country ever had. If he had shortcomings, all downplayed them. He and his family formed a veritable dynasty that was almost immediately equated with the Camelot legends of King Arthur. It is impossible to overestimate the love this man accumulated by the American public, (never my mother).

It was an idyllic scene unsullied by the eventual cultural revolution of the late 60s and the war in Vietnam. A relatively brief period of quietude and prosperity that was destined to collapse under it’s own weight, but it was extraordinary while it lasted. My only worries were girls and cars.

Cut to November, 1963. I had flunked out of the University of Wisconsin the first time (long story) and had eased into a job as an “orderly” at the local hospital where my dad practiced general surgery as I plotted my next move. The then Director of Nursing was the venerable and formidable Miss Myrtle Worth who watched me closely. After she died the hospital was re-named after “Myrtle Worth Memorial Hospital”. But that’s another story.

Sometime in the early afternoon of 22 November I was perambulating down the hall of one of the hospital floors on my way to some chore, probably carrying a bedpan, when one of the TV sets in the rooms I was passing by suddenly proclaimed a “We interrupt this program”.

This was a little unusual as these kinds of interruptions rarely justified breaking into regular programming. So I stopped and backed up in time to see Chet Huntley (NBC News) solemnly announce that President Kennedy had been shot in Dallas and no details were available.

Everything in the entire hospital instantly stopped cold. Every nurse, every administrator, every doctor all stopped what they were doing and congregated around the nearest available TV. Shortly thereafter came the famous spectacle of American’s most trusted TV commentator, Walter Cronkite, sadly proclaim with tears in his eyes that the President was dead.

There are no words even in my formidable vocabulary to express to you the emotional and cultural disaster that followed. This was absolutely unprecedented on every level. Camelot by its nature was impenetrable. No one ever thought in their wildest dreams that Camelot was vulnerable. To have it come crashing down was a cultural train wreck of immeasurable consequences. Like an out of control LSD trip, there was n way to process it.

What was to follow was unbroken ground, chronicled minute to minute by the unblinking eye of network TV in living black and white. Everything in the country stopped dead in its tracks, and I mean EVERYTHING. Every radio station carried only continuous funeral dirge music. There was no traffic anywhere. All businesses were closed including gas stations.

Everyone in the country sat ensconced before a TV set watching the funereal progression, the caisson, the riderless horse with boots reversed in the stirrups, the lying-in-state under the Rotunda, the unimaginable grief and horror of his wife preserved on.

It was like a nuclear winter until after the funeral when things slowly came back to at least baseline, but never actually back to normal. Even my mother was in tears. We then went on to the further culture shock of Bobby Kennedy and Martin Luther King, further illustrating the danger society never dreamed of on November 21, 1963.

 

 

Some thoughts on mandatory influenza prophylaxis

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This month marks a year since I got a demyelinating spinal cord disorder a week after getting the same flu shot I had received every year for at least 20 years. This one happened to be the one that liked me spinal cord better than the virus. It is very slowly improving but definitely still there.

Both of my lower legs are on fire 24 hours a day. Just like both legs immersed in a bath of hot water. Both hands are the same. It appears to be completely sensory in nature but now maybe not. My personal gym trainer noticed that all my muscle groups are consistently tight, then nagged me for months to have a massage therapist check it out. So I finally relented and had one bend my bones for an hour, She said every muscle group was tighter than a turkey’s ass, especially the muscles of my feet and lower legs and that was unusual. So there may be some long-term motor stuff as well.

Neurologist says it might go as long as two years but if it goes longer; I’m probably stuck with it. I’ve learned to live with it and it rarely interferes with my daily life.

I DO believe in immunizations, especially as it pertains to children. I fervently believe Jenny McCarthy, who made a career as a dumb blond really is one as it pertains to children’s immunization and she has all the credibility of Sarah Palin.

And that said, I hope the efficacy of flu immunizations are at least better than chance for adults. If so,then complications such as mine for a few are collateral damage that must be accepted to gain the benefit of many. But there are some problems as it pertains to mandatory injections for all health care workers.

First, I would like to see more convincing evidence that the flu shot actually works. People get the shot every year and are relived that they didn’t get the flu. I have elephant repellant in my back yard and I’ve never seen an elephant back there. Does that mean the repellant works? What if they do get the flu after accepting the shot? Is it the old Christian paradox, if you have good luck, its God’s working in your life. If you have bad luck, it’s still good, you just don’t understand the big picture of God’s will. If I am to accept the bad luck component for me, I’d like a little more evidence that the flu shot has a better than chance potential for mass benefit.

Second is the consent issue. I can assure you after going through this that there is NO informed consent involving potential complications of the flu shot. Anyone who asks is told that the occasional complication may occur but it’s minuscule compared to the benefit for all so don’t worry abut it. If asked specifically about the potential for Guillian-Barre, they are told this possibility is shown in the literature to be about the same as chance. BTW, this year I had a woman with Guillian-Barre that developed a week after her flu shot in my ICU. That’s two cases in this hospital this year.

So, everyone lining up for the shots are overwhelmed by good news and any potential for bad news buried. Fine. But we are a society that runs on informed consent, so much so that it frequently gets ridiculous. So should everyone in line be told that there have been two potentially serious complications of the flu shot this year in this hospital (that we know of).

But that implies they have the option to decline the shot, an option that is rapidly disappearing. The crushing wave of optimism for an injection containing various iterations of virus has now reached the point where the issue of informed consent is crushed with it. The prevailing opinion that darts thrown at a list of a thousand potential damaging viruses will hit the right ones has obliterated the issue of options.

In New York, a law is being considered, and will probably pass, that will create incentive for getting the flu shot by punitive measures. If anyone opts out, they must wear a “surgical mask” everywhere in the hospital. Now the wave of optimism for flu shots turns into a gun to the head.

This is straight up coercion with an empty gesture. There is NO evidence in any world literature that suggests ANY efficacy for surgical masks preventing spread of virus or anything else. When the ‘bird flu” came along a few years ago, I attended a mandatory lecture and fitting of a “real” effective mask we would be wearing. It was bulky, heavy and incredibly uncomfortable. The audience was told in no uncertain terms that surgical masks were worthless and no one would be wearing one.

So the mandatory wearing of a surgical mask to prevent spread of virus is not to prevent spread of virus. It’s to provide an incentive to avoid having to wear a mask everywhere. We’ve now entered theater of the bizarre.

I continue to be conflicted. On one end, I do believe in immunizations and I support them, even accepting the occasional complication. On the other end, I’m not so sure about FORCING health care workers to line up and get with the program in the face of weak evidence and known life threatening complications, however rare.

Patients, prospective or otherwise, are said to have a right to determine medical treatment on the basis of informed consent. Every other hospitalized patient can, and frequently does refuse treatment even when informed the benefit greatly exceeds the marginal risk. And they do so with total impunity. Are we now suspending that societal maxim for the flu shots because our optimism exceeds theirs?

So, I will be watching all this unfold from the sofa of fraternity rejects of “Animal House”.

The ACA of 2008 as whipping boy

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On 2 Nov 2013, at 8:29, Lisa XXXXX wrote:

> We actually have a really good policy with United HeatlhCare, which is
> getting cancelled – we have had the insurance for almost 15 years now. Also,
> the insurance at my work will (because of Obamacare – it says so on the
> paperwork they sent) no longer cover my spouse if he can get coverage through
> his own employer (which he can). Also, because of Obamacare, the premiums
> are going up under my company’s insurance (yes, it says that on the
> paperwork, too).

Insurance companies that are strapped because of ever increasing medical care prices (with no end in sight) are more than happy to blame their impending bankruptcy on anything other than they can’t make the same profit the had been making. If Obamacare had not come along, it would have been something else.

The fact is they have been increasing their cost to employers every year, and various thresholds are eventually met where employers can’t afford it anymore and still make their own profit margins. Obama is the best diversion that ever happened to them. It gives them an excuse.

In fact, what I *think* I see is that Obamacare really is just a signpost along the way to full single payer government health care in the USA for several convincing reasons:

1. The price of health care shows no signs of any *real* decrease in price over time. It continues to climb yearly and the occasional smidge dip lower than usual means nothing. It’s like celebrating because the price of gasoline went down five cents from four dollars a gallon to three ninety five. The long term is that it’s going up and will continue to do so as long as we run a “customer satisfaction maxim”.

2. The private sector of health care insurance will eventually find that it can no longer make a profit. Most will tank for the simple reason that they cannot risk-manage. If they MUST accept every applicant and they can’t charge the sicker ones more or dump them like auto insurers do, think about how long that situation can last.

3. When the day comes that the private health insurance sector gives up the ghost, and that day will come, there is only ONE sector that can accommodate taking care of the entire citizenry, warts and all, without going broke from feeding the endless desires of the endlessly sick. The government because it can simply tax it away, or hide it with the already big national debt.

4. Everyone now is fixated with the seeming evils of the ACA of 2008, which stripped to it’s essence is not really a bad plan. Especially not if you compare it to what’s coming. If the forces of *real* evil, the same guys that literally want to take the food out of the mouthes of the disadvantaged are successful in killing the ACA, then in one step we go right back to the private sector that refuses to insure or underinsure at least 30% possibly 40% of the American public.

5. A third of the American public at risk for financial collapse if one of the family unit gets unexpectedly sick is a VERY VERY big problem for the country. Every nickel it WILL take to keep them literally alive will come out of the tax base. So pay me now or pay me later as the band plays on.

6. Those standing in front of CNN camera holding big “No Government Medicine” signs are clueless. Guess what? Fully 50% of the American population, possibly more are already covered by some form of government medicine, including I might add, the same Republican senators and congressmen that want to destroy it.

7. A big majority of the rest of the world manages to indemnify their ENTIRE population with (their) government sponsored health care and last time I looked, they’re still managing. these governments have in the past learned the lesson we’re about to learn, that open-ended demand for health care services cannot be sustained. It must be rationed in some form, hopefully intelligently designed.

So, Lisa, I very strongly suspect the change, when it comes, and it will, possibly in my lifetime, will be that you’ll be complaining you have to wait a month for a non-emergent MRI and also a month for non-emergent surgery. But what you won’t complain about is if you get unexpectedly sick because your former employee insurance has dumped you, you’re liable for financial ruin forever.