How much Pain is Caused by Aging Versus Laziness and Ignorance?

09 Apr 2017 Leave a comment

by Dr. John Persico Jr. in Uncategorized Tags: , , , , , , ,

lazy_workout

Have you ever head the saying “no pain, no gain?”  This is one of the most idiotic pieces of advice ever given.  Pain is a signal that our body wants us to stop something or that it needs help.  I have little doubt that many people have been severely damaged by this so-called piece of wisdom.  However, taken to the other extreme, we see people who are so afraid of hard work and exercise that they have become couch potatoes.  I believe that many Americans have veered so far off the trail of pain that they have gone to the other extreme.  Look around you and what do you see?  Fat people everywhere you look.  We have an epidemic of obesity in America.  Regard the following facts: (From the Center for Disease Control)

  • The prevalence of obesity was 36.5% (crude estimate) among U.S. adults during 2011–2014.
  • The prevalence of obesity among U.S. youth was 17.0% in 2011–2014.
  • From 1999 through 2014, obesity prevalence increased among adults and youth.

The above data pertain to the frequency of obesity in the USA.  Keep in mind that there are many more people who are overweight than there are who are obese.  Obesity is defined as: “Excess amount of body fat with a BMI of over 30.”  Overweight is defined as: “Having more body weight than is considered normal or healthy for one’s age or build.”  If we were to include the amount of people who were both overweight as well as obese, the figures for “fat” people in the USA would skyrocket.

Several years ago, I attended a World Future Conference.  The former founder and CEO of Medtronic was one of the keynote speakers. His talk was on the topic of rising health care costs.  Many people focus on only one or two causes for the escalation of health care costs.  However, Earl Bakken presented a pie chart which showed several reasons for the rise.  These included:

  • Increased cost of technology
  • People living longer
  • Increased percentage of older people in the population
  • Litigation
  • Inflation
  • Lifestyle choices

obesity-is-preventable_52fc767facaae_w1500

Earl noted that all of these issues have had an impact on health costs.  You will notice that the last issue in his list included “lifestyle choices.”  This category includes such problems as diet, smoking, obesity, drugs, alcoholism, lack of exercise and poor health choices.  Contrary to what many people think, this issue was not the major cause of health care cost increases.  Nevertheless, the category is one of the factors linked to the increase in health care costs.

Looking only at obesity as a contributor to health care costs, we note the following facts: (From the Health Care Costs of Obesity)

  • Obesity is one of the biggest drivers of preventable chronic diseases and healthcare costs in the United States. Currently, estimates for these costs range from $147 billion to nearly $210 billion per year. In addition, obesity is associated with job absenteeism, costing approximately $4.3 billion annually and with lower productivity while at work, costing employers $506 per obese worker per year.  As a person’s, BMI increases, so do the number of sick days, medical claims and healthcare costs.
  •  Obese adults spend 42 percent more on direct healthcare costs than adults who are a healthy weight.
  •  Per capita healthcare costs for severely or morbidly obese adults (BMI >40) are 81 percent higher than for healthy weight adults. In 2000, around $11 billion was spent on medical expenditures for morbidly obese U.S. adults.
  •  Moderately obese (BMI between 30 and 35) individuals are more than twice as likely as healthy weight individuals to be prescribed prescription pharmaceuticals to manage medical conditions.
  •  Costs for patients presenting at emergency rooms with chest pains are 41 percent higher for severely obese patients, 28 percent higher for obese patients and 22 percent higher for overweight patients than for healthy- weight patients.

 People who are obese, compared to those with a normal or healthy weight, are at an increased risk for many serious diseases and health conditions, including the following: (From the Center for Disease Control and Prevention)

  • All-causes of death (mortality)
  • High blood pressure (Hypertension)
  • High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (Dyslipidemia)
  • Type 2 diabetes
  • Coronary heart disease
  • Stroke
  • Gallbladder disease
  • Osteoarthritis (a breakdown of cartilage and bone within a joint)
  • Sleep apnea and breathing problems
  • Some cancers (endometrial, breast, colon, kidney, gallbladder, and liver)
  • Low quality of life
  • Mental illness such as clinical depression, anxiety, and other mental disorders
  • Body pain and difficulty with physical functioning

Please notice that the CDC list does not explicitly include hip, knee and back problems.  Of course, many people who are not overweight suffer from these problems, but there is considerable evidence that obesity contributes to these problems.  People who are obese often lack muscle tissue and ligament flexibility which help support their knees, backs and hips.  The less exercise they get, the more the problem is exacerbated.  They may go to doctors and chiropractors to get help but the underlying cause of obesity is seldom treated.  Finally, surgery is performed when exercise, diet and physical therapy could be more effective treatments.  So why do so many people get surgery or pills when there are cheaper and more effective treatments with less side effects?

Let’s go back to what I said in the title of this blog.  Laziness and Ignorance.

too lazy to exercise

Laziness and Ignorance:

Every year, it is a well-known fact at health clubs across the country that right after New Year’s Day, the membership will increase dramatically and the parking lot will fill up with new members. This phenomenon will last about 15 weeks after which the new members will slowly drop off and the parking lot will go back to normal.  Why do you think this happens?  I will give you two reasons:

First:  The assumption that they will get instant results.  Too many people read the magazines at the grocery store promising “Six Weeks to Abs of Steel” or “Lose 40 lbs. in Eight Weeks.”  I would argue that if you can lose 1 lb. in a month, you are doing a great job.  As for the abs of steel, first you will need to lose a large amount of body fat and second, it may take you a year of hard dedicated disciplined ab exercises.  As someone who does regular ab exercises, they hurt.  They are no fun.

20170406_155206There is a difference between pain and hurt.  When I tried to continue my ab exercises after my prostate surgery and then after my hernia surgery, I experienced pain.  I wanted to get back into shape too quickly both times.  I stopped the exercises and worked on other routines that did not cause pain.  Mind you, the ab exercises still hurt and I have been doing them for six years.  I am making a big distinction here between pain and hurt. Perhaps, I should say they “burn.”  Burn is the athletic euphemism for hurt.  Most people don’t like hurt.  However, if you expect that you can get in shape without some discomfort, you are destined for life as a couch potato or in a surgery ward.

Second:  People are ignorant when it comes to exercise.  How many Americans do you think have ever read a book on exercise?  Unless, you are willing to become a student of exercise or trust in an athletic trainer, the knowledge that most people have regarding exercise is insufficient for them to attain the results they seek.  Sadly, most medical practitioners are just as ignorant when it comes to the role of exercise and diet in a healthy lifestyle.

How many exercise books do you think make Amazon’s “best seller” list.  To determine this, I went to Amazon and pulled up their top 100 best sellers.   In the entire list, there was not one book on exercise protocols.  There were two books on dieting at number 41 and number 42 in the top 100 list.  You could find several books on menus and cooking.  It is much easier in the USA to eat, then it is too exercise.

kaelinAmericans are enamored with diets and each new diet best seller promises fantastic results in a short amount of time.  The Amazon number 1 best seller in the health and exercise category was a book titled “Big Fat Lies.”  The author promises you the “truths” that helped her to lose 65 lbs. “without giving up pizza or ice cream.”  The author is Kaelin Tuell Poulin and the book has a very high rating in the customer reviews section.  Ninety-eight percent of the 235 reviewers gave it a 5-star rating.  However, while I often put a great deal of store in ratings, you must be careful about inflated ratings.  The one negative rater had this to say about the book: (typos in the review were not changed)

“Dont be fooled into purchasing a book that was reviewed by 200 hundred women who never read the book (her followees) I have read the book it is subpar at best and not worth the money. My origional review included picture evidence of her asking for reviews but it was removed because it included her identity i suppose. I hope this one stays up so no one else is fooled into buying this. I give this book 1 star only to post. She is a salesperson and she is a great one at that! but if one person reads this and doesnt feed into the hype it was worth the time and effort to type it.”

I would not call the above review a particularly good piece of criticism.  However, the author does alert us to the possibility that the book suffers from a sort of follower worship.  Nevertheless, I would risk the small cost of the book if I were looking for a diet program.  Consider the following review from one of Kaelin’s “ladyBoss” more ardent followers:

“This program has TWO things that every other weight loss program out there is missing.  For ONE Kaelin was heavy once she was 185 pounds herself but with hard work and dedication lost the weight and has kept it off for 5 years.”

This is a great testimonial.  I am not sure if “every other weight program is missing” these two factors, but I am sure that dedication and hard work were necessary for Kaelin to keep the weight off for five years.  One problem with many exercise and diet programs is that the participant is naive and believes that once they lose the weight, their hard work is over.  They may also lack the discipline to continue the work once a certain goal is achieved.  Lack of discipline?  Laziness?  Ignorance? This is a volatile mix.  They seem to go together like salt and pepper.

WWS-Obesity

There is one final factor that we must discuss and that studies have shown have a direct bearing on obesity and poor health.  This is the factor of poverty.  Many studies have shown a direct relationship between income and obesity and between income and exercise.  Poor people get less exercise and generally have poorer nutrition.  There are several explanations for this.  We can posit some possible cause and effect relationships:

  1. Lack of education leads to obesity
  2. Poverty leads to high fat diet and poor nutrition
  3. Lack of education leads to poverty
  4. Poverty leads to low exercise priorities

You might notice that there is a kind of circularity to the above relationships.  Perhaps, if they are circular it does not matter which is cause and which is effect since the result is the same.  The outcomes for poor people are poor nutrition, lack of exercise and obesity.

There are some who dispute the above correlations.  The claim is made that the relationship between poverty and obesity is not linear but varies by age, gender and ethnicity.  It has also been pointed out that rich countries throughout the world have a higher incidence of obesity than poor countries.

“While all segments of the U.S. population are affected by obesity, one of the common myths that exists is that all or virtually all low-income people are far more likely to be obese. In this generalization, two facts commonly are overlooked: (1) the relationship between income and weight can vary by gender, race-ethnicity, or age and (2) disparities by income have been weakening with time, particularly for adults.” — Relationship Between Poverty and Obesity, Food Research and Action Center

However, if we look at obesity from an aggregate point of view and disregard the effects of ethnicity, age and gender, we find the following evidence to show a linkage between poverty and obesity:

“Poverty rates and obesity were reviewed across 3,139 counties in the U.S.  In contrast to international trends, people in America who live in the most poverty-dense counties are those most prone to obesity.  Counties with poverty rates of >35% have obesity rates 145% greater than wealthy counties.” — Poverty and Obesity by James Levine (2011)

Furthermore, even the Food Research and Action Center admits to the problem that obesity poses for America and state on their site that:

“While all segments of the U.S. population can be affected by poor dietary intake and obesity, low-income and food insecure people are especially vulnerable due to the additional risk factors associated with inadequate resources and under-resourced communities.” 

Note the above statement that “poor people” are especially vulnerable.  Let me tell you the following story that illustrates some of my admittedly selective experience with this issue of poverty and obesity.

One day, Karen and I went to Scottsdale Arizona to visit and do some shopping.  We went to several art galleries and jewelry stores.  When it was time for lunch, we found an authentic looking Mexican restaurant and decided to eat outside.  We were right in the heart of Scottsdale and many people kept walking by our table.  It was fun people watching, but something kept nagging at my mind.  I was not sure why, but there was a difference between the average people I was used to seeing and the people I saw in Scottsdale.

Suddenly, I realized what was bothering me.  In the hour or so that we were eating, we did not see one obese or even moderately overweight person walk by.  All the people that passed by us were healthy and athletic looking.  This was my first realization of the connection between wealth and obesity.  I don’t know about the rest of the world but ever since then, I have observed that most overweight people I see in America are either poor or middle class.  In my opinion, rich people have much lower incidences of obesity in this country.

Aging and Pain:

You will notice that I have not attributed pain to aging.  This is not an oversight.  Neither is it denial.  You can have pain when you are young and you can have pain when you are old.  In either case, there is no way you should just accept the pain.  Unfortunately, what medical practitioners often diagnose and treat with young people, they are willing to accept with old people.  Let me give you another personal example.

20170406_155432Two years ago, I started developing a pain in my right shoulder. I was not sure where it came from but after several months of it getting worse, I went to see an orthopedic doctor.  He asked what if anything I might be doing to aggravate the shoulder.  I mentioned that I swim frequently and am aggressive with my laps.  His simple answer was “Well then, stop swimming.”  I decided to follow his advice and for the next year, I stopped swimming.  However, my shoulder pain did not get any better.

A year later, I went to see another orthopedic doctor and he could not find anything wrong with my shoulder.  He did no MRIs or X-ray’s.  I suggested he give me an injection of cortisone, which he did.  I had moderate pain relief for about six weeks and then the pain resumed and continued to get worse.  At this point, I decided to do some of my own research into shoulder pain.  This research was very productive.

I found some very good descriptions of the exact type of pain I was incurring and a few different suggestions on how I could treat the pain without pills or surgery.  The best and most positive ideas I found came from a Doctor John M. Kirsch in Wisconsin.  Dr. Kirsch put his ideas and supporting evidence for his theory of what causes some types of shoulder pain into a small book titled “Shoulder Pain:  The Solution and Prevention.”  I have since been following his treatment regimen with good results.  My shoulder pain has been decreasing and the range of motion in my right shoulder is improving.

I mentioned earlier that I am 70 years old.  I think that there is too often the attitude among people my age and the doctors they see that “pain with aging is inevitable.”  If it is inevitable, then we should just “suck it up” and live with it.  Sometimes, this might be true.  However, the assumption that aging and pain need to go together is a prescription that does not serve any of the elderly very well.  I have talked to many older people and I often find the same set of attitudes either on their part or their doctors.  It is basically “Well, getting old is a bitch and you just have to live with pain.”

No, you do not have to live with pain!   

I have been running 4 or 5 times a week for over 40 years now.  During this time, I have had shin sprints, knee pain, hip pain, big toe pain, back pain, Morton’s neuroma, plantar fasciitis, sesamoiditis, corns, calluses and blisters.  Each time the pain came, I have gone through the following sequence of activities:

  1. Awareness of discomfort
  2. Try to ignore it
  3. Discomfort moves into the pain stage
  4. Take over-the-counter meds
  5. Go to see a doctor
  6. Pain improved by prescription pills or shots
  7. Pain returned in a short while
  8. Do research on other remedies
  9. Trial and error with other remedies
  10. Voila, eventually find the right remedy (no surgery and no prescription drugs)
  11. Pain goes away and does not return
  12. Sometimes, continuous exercise such as leg stretches and yoga are necessary to keep conditions from returning or getting worse. g., must do calf stretches 3x per week to stop plantar fasciitis from returning.  

20170406_155233Some people are not so lucky.  However, I hesitate to call all of my good health “Luck.”  There is a saying by Thomas Jefferson that “The harder I work the luckier I get.”  I have worked hard to stay in shape.  I exercise regularly.  I watch what I eat.  I try to avoid excesses.  No doubt, I have had some luck that goes beyond hard work and discipline.  Nevertheless, I believe that hard work and discipline has played a large role in my ability to be healthy and still active at my age.

I wish I had a dollar for everyone that has come up to me and said “I wish I could run but I have bad knees.”   Many people do have bad knees.  But many people do not see a connection between their “bad” knees and their obesity.  Their cycle is more like this:

  1. Overeat
  2. Gain weight
  3. Do no exercise
  4. Get pain someplace
  5. Do less exercise
  6. Get more pain
  7. Go to doctor
  8. Get knee or hip or some other surgery
  9. Continue being overweight and doing little or no exercise
  10. Take pills

4 weeks to a healthier

The only way the above activities relate to aging is that it takes some time to destroy your body through lack of exercise and poor diet.  I guarantee you though, it will happen eventually depending on how much you abuse your body.  It may happen when you are young or it may happen when you are old.  The longer you wait to do something about it, the more difficult it will be to repair the damage you have done.  It seems like my body takes more time to repair itself the older I get.

Finally, you do not have to be rich to have good health.  Money will not bring you good health if you abuse your body, overeat, drink too much, smoke too much and avoid exercise.  You can pay all the doctors in the world and you will still have bad health if you follow the 10 steps listed above.

Time for Questions:

Do you exercise regularly?  Why or why not?  Do you have a program to help keep track of your weight?  Why or why not?  Do you have a weight problem?  What do you do about it?  How effective have your efforts been?  What do you think would help them be more effective?

Life is just beginning.

“My mother was a P.E. teacher, and she was kind of a fanatic about fitness and nutrition growing up, so it was ingrained in me at a young age.  As I get older, I’m finding out it’s not about getting all buffed up and looking good.  It’s more about staying healthy and flexible.” — Josh Duhamel
 

 

 

 

 

 

 

 

 

 

 

 

Is Chiropractic an Art or a Science? 

02 Apr 2017 5 Comments

by Dr. John Persico Jr. in Uncategorized Tags: , , , , , , , ,

When I grew up on the East Coast, I had little or no contact with chiropractors.  Back then, most people I knew and most medical centers did not regard them as real medical practitioners.  Years later, after I came out to the Mid-West, I found a much wider acceptance of chiropractors.  Over the past 40 years of living in Minnesota and Wisconsin, I have known many people who have gone to chiropractors and who firmly believe that they were being helped.  Most of the people I have known were suffering from back problems.  Here is one comment regarding chiropractors from an obviously very satisfied patient:

“I go to a chiropractor irregularly, usually when my neck is bothering me.  He uses heat, ultrasound, and massage therapy to undo the tension in my back and neck, caused by two vertebrae in my back that have been out of alignment since I was 16.  I go away, and am usually good for another 6 months.

I’ve never had a chiropractor offer to cure anything, from gallstones to depression by cracking my back; I’ve never had one suggest I needed to try any homeopathic remedies; I’ve never had one claim my bipolar disorder was all due to a misaligned spine. When I did have gall bladder trouble, my then chiropractor told me to see my primary care doctor post-haste.”

reno-chiropractor-940x627

If chiropractic medicine has any single claim to fame it is in dealing with back and skeletal muscle problems.  Chiropractors are famous for treating such problems with spinal manipulation and “adjustments.”  Often the diagnosis given to the patient will include the claim that the patient has a “pinched” nerve or some type of “subluxation”.  The patient spends an hour or so with the doctor getting an adjustment to treat the problem.  Many patients will then leave feeling much better then when they arrived.  They will also be out between 65 to 200 dollars per visit.  In most states, Chiropractic medicine is recognized and eligible for insurance reimbursement.

“Medicare does cover medically necessary chiropractic services.  According to the CMS,  Medicare Part B now covers 80% of the cost for ‘manipulation of the spine if medically necessary to correct a subluxation.’  There is no cap on the number of medically necessary visits to a chiropractor.”  — Does Medicare Cover Acupuncture or Chiropractic?, Senior 65

OK, so far, we have happy patients, insurance reimbursement in most states and Medicare coverage for chiropractic service, so what is my problem with chiropractors?  What if it is an art, what’s wrong with that?  Well, an art is something that as opposed to a science does not have objective reproducibility.  There is little or no evidence for cause and effect in an artistic relationship.  From an art, we would expect a much wider variation of results then we would get from something that has demonstrated scientific reproducibility.

“Chiropractic theory and practice are not based on the body of knowledge related to health, disease, and health care that has been widely accepted by the scientific community.

 Most chiropractors believe that spinal problems, which they call “subluxations,” cause ill health and that fixing them by “adjusting” the spine will promote and restore health. The extent of this belief varies from chiropractor to chiropractor. Some believe that subluxations are the primary cause of ill health; others consider them an underlying cause.” —- Twenty Things Most Chiropractors Won’t Tell You  by Dr. Preston H. Long

Another way of looking at the difference between and an art and a science lies in the ability to assign risk factors.  With a science, we should be able to assign a probably of risk in terms of outcomes.  With an art, we cannot reliably assign risk factors since they have no bearing in empirical outcomes.  What difference does this make to a potential chiropractic patient?  It should make a great difference since their chances of getting an accurate diagnosis for many potential problems is much less with chiropractic medicine than with traditional medicine.  Here are two comments from people who have gone to chiropractors.  These comments are from the http://www.spine-health.com forum and website.  The subject was: “Does chiropractic treatment help with pinched nerves:”

“Chiropractic “medicine” deals with the musculoskeletal system. However, many chiropractic offices use TENS therapy, which stimulates the nerves. Most of my back problems come from nerve issues and I have personally never found relief from chiropractic, in fact, it made me worse. But this is only my personal experience. My portable TENS unit helps me; I would ask the doctor who is managing your condition if TENS therapy may be right for you. Good luck!”

“In my case, I made the biggest mistake in my life, I was complaining about little pain in my knee but my chiropractor damaged my upper back T5 and T6 which I’m suffering now with a lot of symptoms nerve pain in between my shoulder, legs , arms , headache ….., I’ll never advise anybody to go to the chiropractor , and this is my own  experience.”

Anecdotes and grievances do not prove a case against chiropractic.  However neither do testimonials from satisfied patients prove the efficacy of chiropractic treatment.  It can be argued that the placebo effect will explain much of chiropractic’s reported success.  I have often argued that massage therapy will produce the same results with lower cost.  Some evidence exists to support my contention.

“A study called Patterns and Perceptions of Care for Treatment of Back and Neck Pain appeared in 2003. The studied questioned over 2,000 people on how they dealt with their aches and pains. Massage took home the gold with people preferring it to chiropractic for any kind of back pain or general body pain, but chiropractic led the race in upper-back pain and neck pain. Even with these results, visits to chiropractors were much more common than visits to massage therapists.”  — Chiropractor Vs. Massage

The above study notes that more people go to chiropractors than massage therapists.  You might wonder why?  Especially since seeing a massage therapist will cost you about 1/2 to 1/3 the cost of seeing a chiropractor.  I propose that the reasons for this propensity of people to prefer chiropractors to massage therapists lies in the more successful lobbying and marketing that chiropractors have done.  A second and related reason is that massage therapy will generally not be covered by most insurance plans or Medicare.  The following applies to Medicare coverage for massage reimbursement:

“Original Medicare does not cover massage therapy. Services that are not covered by Medicare are the sole responsibility of the patient.  In some cases, Medicare Part B will cover chiropractic services if they are medically necessary and are meant to correct a subluxation of the spine. In most cases, Original Medicare pays 80% of the cost for this treatment, but the patient is responsible for the other 20% and all other tests and services performed by the chiropractor.” —  Does Medicare Cover Massage Therapy?

Note that in the above description that chiropractic care is covered but massage therapy is not.  The lobby for chiropractors is much more powerful than the lobby for massage therapists.  This latter fact demonstrates that the type of medical care and medical coverage you are eligible for will be determined not by objective scientific facts but by political persuasion and money spent by lobbyists.  How does that make you feel?  But let’s get back to chiropractic treatments and look more specifically at “adjustments”.  This is the bread and butter treatment for chiropractic patients.  Do you need them?  Will they help you?

Chiropractic Adjustments:

chiro with an adjustmentIf homo sapiens have a weak link in their skeletal structure it is the back.  It has been argued that the problem arose when we switched from hanging in trees to walking upright.  Whatever the cause, back problems are easily the most common and perhaps one of the most painful problems faced by Americans today.  I have heard it said that the “opioid epidemic” is really a “pain epidemic” as more people age and have to deal with back problems, knee problems and hip problems.  No one beset by continuous pain can be blamed for wanting to find an escape from that pain.  However, as I noted in the previous blog, this desire to escape pain often leads to bad choices.  Surgery is too often prescribed when other treatment modalities would be more effective with less side effects.  This brings us to the issue of chiropractic adjustments for back pain.  How effective are they?  Here is another comment from Dr. Preston H. Long regarding the effectiveness of spinal manipulation:

“Research studies that look at spinal manipulation are generally done under strict protocols that protect patients from harm. The results reflect what happens when manipulation is done on patients who are appropriately screened—usually by medical teams that exclude people with conditions that would make manipulation dangerous. The results do not reflect what typically happens when patients select chiropractors on their own. The chiropractic marketplace is a mess because most chiropractors ignore research findings and subject their patients to procedures that are unnecessary and/or senseless.” — Chiropractic Abuse: An Insider’s Lament Paperback – 8 Oct 2013, by  PhD. Preston H Long D.C

abuse

I highly recommend you read the book by Dr. Long.  If you are going to go to a chiropractor, you should have a realistic assessment of finding out your chances of getting help and relief.  Too many people leave their medical treatment entirely in the hands of so-called experts.  This is a big mistake.  I will discuss this later in another blog, but you need to be a strong advocate for your health care and not trust any one medical practitioner too much.  How much is too much?

  • It is too much if you are uninformed and have done little or no research into the causes and treatments of your illness.
  • It is too much if you expect that your treatment will take the place of discipline and hard work on your part.
  •  It is too much if you would rather get surgery than lose weight or exercise.
  •  It is too much if you expect that your doctor will advise you to pursue less invasive treatments before surgery or pills.
  •  It is too much if your doctor is overweight, has no exercise program of his/her own or smokes.
  •  It is too much if you have not pursued a second or third opinion.
  •  It is too much if your doctor cannot show you fairly persuasive evidence of a diagnosis and an empirically related treatment modality.

Conclusions:

For the record, I have no vendetta or grudge against chiropractors.  However, it has been my observation that they often treat many problems that they are not competent to treat or that have not had a proper diagnosis.  I have seen too many friends go to a chiropractor and not have a long-term fix to their pain or problem.  Chiropractors may offer a good short term fix to some pain problems but usually no long-term fix.  For the record though, massage, surgery and pills do not usually provide a long-term fix and with surgery, there will usually be consequences that the patient was probably not aware of.

(For more facts on the pro’s and con’s of chiropractic treatment see “Evidence for Chiropractic Treatment“) 

Chiropractors are no better than regular medical doctors when it comes to dealing with the underlying cause of pain.  Sadly, some of the problem for hasty diagnosis must be laid on the patient’s doorstep.  Many pain sufferers want either instant relief or relief that will entail little or no effort on their part.  Doctors too readily give into this desire either because of the financial remuneration that awaits them for treatment or laziness or perhaps simple ignorance.  My skeptical side says that giving a patient an exercise program or diet program is not nearly as lucrative as treating the patient with adjustments or surgery.  Back surgery will generally cost between 50k and 100k.  Spinal adjustments may take place for up to 6 months and final costs may total nearly $5000 dollars (computed as 50 treatments multiplied by an average cost of $65 dollars per treatment.)

On the positive side, there are many chiropractors who offer an alternative to the pills and surgeries so often recommended by mainstream medical doctors.  Perhaps because they have been viewed as less professional by traditional medicine, many chiropractors have considered a variety of non-traditional treatment options.  Many of these treatments are not very scientific or have no proven scientific effectiveness but this does not mean that they may not be effective.  Scientific proof has often taken many years to prove things that traditional folk medicine long knew was true.  However, there is a drawback in delaying some treatments to pursue unscientific remedies.  For instance, when I was diagnosed with prostate cancer, I decided to pursue a “wait and see” or “active surveillance” policy.  I was not ready to accept either the PSA reading or the biopsy or even the MRI results.

During my wait and see time, I opted to try some herbal remedies that were reported to have some success with prostate cancer.  I started taking several of these remedies each day in the hopes that a future biopsy would show a decrease in cancer cells or even the disappearance of my cancer.  No luck.  My next biopsy and a third biopsy all showed increases.  In addition, my Gleason score and PSA scores kept going up.  I now risked the danger that the cancer would spread out of my prostate and migrate to other organs.  It was time for surgery.  Not to pursue surgery at this point would have been foolish and even hopeless.

Thus, there is an ever-present danger that pursuing treatment programs that are a dead end might endanger your life and prevent you from going down more fruitful paths.  There is a reason that many people pursue such options.  It is called “hopefulness.”  I cannot blame anyone for this outlook.  I too was hopeful that I could keep my prostate and continue to pursue a normal life.  Many people go to chiropractors rather than medical doctors in the hope that they will find a cure beyond pills and surgeries.  Some do and some don’t.

Time for Questions:

Have you ever been to a chiropractor?  Why or why not?  Did you find them helpful?  Why?  What evidence did your doctor provide to show why he/she gave you the diagnosis you received?  What kind of exercise program do you follow?  Do you think people without an exercise program are higher risks for medical problems and pain?

Life is just beginning.

“The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease.” – Thomas A. Edison

 

 

 

 

 

 

How Effective are Alternatives to Traditional Medical Practice?

26 Mar 2017 2 Comments

by Dr. John Persico Jr. in Uncategorized

curecancers

This is the second of the ten perspectives I am going to discuss about medical care in the United States in the 21st Century.  My caveat this week is that if you truly think witch doctors, fortune tellers, bizarre untested treatments, herbal cures, doctors in foreign countries, prayers and numerous kinds of quack medical treatments can cure your sainted mother’s cancer or your father’s heart condition, then by all means “go for it.”  Much of what passes for medicine in the USA is not based on science but is based on hopes and wishes and dreams.  Far be it for me to destroy your last hope.

On the other hand, if you want to be rationale and logical about it, then evidence based medicine with a feedback loop based upon open scientific investigation and testing is the best way to truly establish cause and effect in medical practice.  Let me tell you an often heard story.

Mary Jane was 31 years old and was diagnosed with terminal brain cancer.  After ongoing chemotherapy and radiation therapy, she continued to decline physically.  There appeared to be no other options for her.  However, her 39-year-old brother Bill had heard of a treatment being used by some people in a village in the Alps which they claimed could cure cancer.  A doctor Kowalski had written a book extolling the virtues of this treatment and Bill had bought the book.  Bill convinced Mary Jane to give it a try.  She stopped her chemo and radiation treatments and started following the treatment regimen.  Within four weeks Mary Jane was looking a lot better and feeling better as well.  After two months on the regimen, she visited her oncologist.  He took some tests and “would you believe it?”  There was no sign of the cancer any more.  This treatment regimen (unknown to modern science) had totally cured Mary Jane. 

Wow, what a story!  Is that fantastic!  Makes you want to kick all those mainstream traditional doctors right in the butt. 

Epilogue:

Three months later, Mary Jane became quite ill.  Further tests showed her cancer had returned or perhaps never left.  Mary Jane died in another six weeks.

Raise your hands please, if you have heard this story or a similar story before.  I am sure most of you have.  Hope springs eternal in the human breast.  I can’t blame anyone for that.  I can blame those who promote untested and unscientific treatments and get poor suffering people to buy into their schemes.  It is one thing to find a new cure that perhaps may be proven to have medicinal value.  That kind of discovery happens all the time.  It is quite another thing to put down traditional medical science as useless.  Furthermore, there are indeed negative consequences of many alternative medical practices.

Dr. Paul A. Offit, a noted medical researcher and pediatrician (Wiki) has proposed four ways in which alternative medicine “becomes quackery”:

  1. By recommending against conventional therapies that are helpful.
  2. By promoting potentially harmful therapies without adequate warning.
  3. By draining patients’ bank accounts.
  4. By promoting magical thinking.

What is a Quack? 

Quacks are often well meaning but “the road to hell is paved with good intentions.”  We have people who believe vaccines are harmful.  We have people who believe poisonous snakes can be handled safely if you only believe in Jesus.  We have people who believe that disease is caused by negative thinking.  We sometimes confuse these people with the old “snake oil” salesman.  The distinction between the quack and the “snake oil” salesman is quite important.

quackery takes your money

The “snake oil” salesman is probably a fraud, a cheat and a con-artist.  The friend who is trying to convince you that you should not go to a regular doctor is probably well intended.  This makes them even more dangerous than the “snake oil” salesman.  You may instinctively distrust the salesman but you trust your friend.  Such unfounded trust can kill you.  Your friend is pedaling an idea which may be dangerous and have no scientific merit.

“But wait,” you say.  “Why does everything have to be approved by the FDA or the AMA or some other authorized group?  What makes them superior to my witchdoctor or acupuncturist?”  The answer to this question if very difficult to explain.  Studies show that less than 30 percent of Americans are scientifically literate.  Trying to explain why science is more trustworthy than hope and intuition is very difficult to people lacking scientific literacy.  It is even more difficult since the search for empirical evidence is a journey and not a destination.  No one can say that science is 100 percent accurate or 100 percent certain.  Furthermore, we can find many anomalies wherein science was at first wrong or where the scientific evidence was premature.  This leads many who are intimated by science to be even more skeptical of its results and processes.

[For an excellent article on understanding scientific medicine and avoiding quacks, read: Tooth Fairy Science and Other Pitfalls: Applying Rigorous Science to Messy Medicine, — by Dr. Harriet Hall]

Homeopathy, Acupuncture and Pseudo Science

Homeopathy, acupuncture as well as creation theory, alchemy, parapsychology and many occult practices are labeled as pseudosciences.  The definition of pseudoscience is:

“Pseudoscience consists of claims, beliefs, or practices presented as being plausible scientifically, but which are not justifiable by the scientific method.   A topic, practice, or body of knowledge can reasonably be considered pseudoscientific when it is presented as consistent with the norms of scientific research, but it demonstrably fails to meet these norms.” — Pseudoscience, Wikipedia

I had intended to start this section off as a critique of homeopathic remedies but I decided to extend it to include the broader issue of pseudoscientific remedies.  I was going to discuss the fact that homeopathy no doubt relies on the well-known phenomenon of the “placebo effect.”  A placebo is a “fake” pill or medical treatment to which no known curative properties can be attached.  Nevertheless, people given such treatments often report “miraculous” cures.  I have even known people to get drunk while drinking colored water that they thought was wine or liquor.

“In many conditions, placebo effect is a big part of the effect of the drug,” said study researcher, Ted Kaptchuk, a professor of medicine at Harvard Medical School.  In the new study, 50 percent of the drug’s effect could be attributed to the placebo effect, he said. — Live Science, 2014

When it comes down to the efficacy of homeopathic pills, the evidence is just as damming.   Homeopathic treatments simple do not work any better than a placebo.

Homeopathic preparations are not effective for treating any condition; large-scale studies have found homeopathy to be no more effective than a placebo, suggesting that any positive effects that follow treatment are only due to the placebo effect and normal recovery from illness. —  Ernst, E. (2002). “A systematic review of systematic reviews of homeopathy”. British Journal of Clinical Pharmacology. 54 (6): 577–82. —- Wikipedia, Homeopathy

A little earlier in this paper, I briefly gave a testament to the scientific method over methods of pseudo-science that we have been discussing.  But, you may well ask, “What is the difference between science and pseudoscience?”   A second question might be “Well, how much faith can I put into the scientific method?”  Let’s take the first question.

What is the difference between science and pseudoscience?

A simple answer to this question is that science is based on objective repetition of results.  It uses evidence based analysis to determine the strength of the relationship between cause and effect variables.  Science must be transparent and the process used to determine cause and effect must be readily available to other scientists.  Numerous examples can be cited wherein faulty scientific research led to erroneous conclusions.  However, unlike pseudoscience, where there are no checks on the process, scientific faults will eventually be discovered and admitted.  This is often to the chagrin of the scientists who were either foolish or biased in their calculations.

In science, you have theories or hypothesis which are open to testing and ultimately being found either true or false.  There is a great range in the power of a hypothesis which renders some more important than others.  For instance, anyone can predict it will snow in Minnesota but the ability to predict exactly when and how much it will snow on any given day would be evidence of a very strong theory.

In pseudoscience, hypothesis and theories are either untestable or often non-existent.  For example, if I gave you a homeopathic pill of aconite (also known as wolf’s bane) as a remedy for your cold and you got better, does this mean the aconite cured you?  Without some type of controlled study, there is no way to know.  Perhaps, you would have gotten better without it anyway.  Many homeopathic practitioners recommend this substance as a means of alleviating cold symptoms.

(Click here for an excellent analysis of some of the many treatments recommended as cold remedies)

There are literally dozens if not hundreds of such substances that you can find recommended by alternative medicine practitioners.  The problem is not that they do not work, since for some people, some of the time, some of these substances might be very effective.  The problem is that often little is known about their effectiveness, their method of working or potential side effects that might be harmful.  Furthermore, as opposed to the scientific method, pseudoscience will make extravagant claims without more than anecdotal evidence that some treatment regimen was indeed effective.

Forbes (2014) published this list of the top five cold remedies to avoid since there is no evidence to support their effectiveness:

  1. Zicamcontains zinc as its active ingredient. There has been some evidence to suggest that taking zinc right at the onset of a cold might shorten its duration a little bit, from 7 days to 6. But as Dr. Terence Davidson from UC San Diego explained, if you look at the more rigorous studies, the effect vanishes. Zinc turns out to have some worrisome side effects, too.
  1. Airborne. You can find this in the cold remedy section many pharmacies but Airborne doesn’t cure anything. It’s a cleverly marketed vitamin supplement with no scientific support for any health benefits.
  1. Coldcalmis a homeopathic preparation sold by Boiron, one of the world’s largest manufacturers of homeopathic remedies (including Oscillococcinum, an almost laughably ineffective flu remedy). It claims on the package to relieve cold symptoms. What’s in it? A dog’s breakfast of homeopathic ingredients, including belladonna, about which NIH says: Belladonna is UNSAFE when taken by mouth. It contains chemicals that can be toxic.
  2. Umckais another homeopathic preparation that claims to “shorten the duration of common cold” and “reduce severity of cold symptoms.” Sounds pretty good—if only it were true. Umcka’s active ingredient is a plant extract called pelargonium sidoides, an African geranium. Interestingly, there have been a few experiments on this extract, some of which showed a small positive effect.
  1. Antibiotics. Even if you cannot buy them, many people take them to treat a cold.  The problem is that antibiotics do not work for colds.

It would be interesting to see how much Americans spend each year on medicinal preparations that have little or no value.  There is so much superstition out there based on anomalies and anecdotes that people put their faith in.  Which brings us to the next question.

How much faith can I put into the scientific method?

The easy answer is that it depends.  What makes a good theory is the question we need to answer before we can know how much faith we should put into science.  Here is one answer as to what makes a good theory:

  1. A good theory should explain the observations or results of an experiment or phenomena.
  2. A good theory should allow for testing. 
  3. A good theory can be tested against an independent objective criteria.
  4. A good theory should be frugal in its nature so others can test it.
  5. A good theory should be predictive.

Thus, if you are looking for the truth and you get a truth, be it from a scientist or from a witchdoctor, you can ask yourself how well the “truth” meets the four criteria above.  Let’s take some hypothetical examples.

  • My good friend Dick says that Fords are better than Chevies? Do any of the above criteria apply to his belief?  I think not.  If so, I cannot see how.  Thus, I would call this a weak theory or more accurately, an opinion.
  • Another friend of mine says it will be very cold next week. This assertion can be validated. Criteria 2, 3, 4 and 5 might all apply.  If he turns out to be right, he would only have to satisfy criteria number 1 to have a very strong theory.  In other words, he would have to provide some logic or rationale for his theory.  Subsequently, we could continue to test his theory and see if he can continue to accurately predict the weather.  The more his predictions come true and can be validated against some external criteria, the stronger his theory is. (We will assume he is not just reporting from the local weather station.)

So, we are now back to the issue of how much faith can be put into the scientific method.  I hope you will see from the above discussion that this will depend on whether the outcomes of the method are indeed subject to some rigorous external validation and criteria.  Without these factors, I would not trust my local scientist any more than my local witch doctor.

Time for Questions:

Why do you think people go to quacks?   Have you ever been to someone you thought might be a quack?  What results did you get?  What can people do when they are not helped by medical practitioners?  What other recourse do they have?

Life is just beginning.

“The claim of alternative practitioners to not treat disease labels but the whole patient…allows alternative practitioners to live in a fool’s paradise of quackery where they believe themselves to be protected from any challenges and demands for evidence.”  — Edzard Ernst

 

 

 

 

 

 

 

 

 

 

 

 

Should We Be Cautious When Seeing Our Family Doctor?

18 Mar 2017 6 Comments

by Dr. John Persico Jr. in Uncategorized Tags: , , , , , , , ,

can you trust your doctor

This is the first of the ten perspectives I am going to discuss about medical care in the United States in the 21st Century.  Before I begin, I have already warned you that if you regard physicians as gods or if you love your MD for saving your life and cannot bear to hear anything wrong about the medical profession, you should probably not read what I am going to say.  One of my friends on Facebook sent me this message or caveat:

“I practiced medicine for 30 years. Be careful about generalizing. I got burned out, I cared. I saw the whole person. I’m not unusual. Medicine is hard. You are always looking over your shoulder. Afraid to be sued. We go into this not for money but to help. Really. Believe it.”

I am quite sure that what she says is true.  True for some.  Not true for others.  Is it the majority?  I don’t know.  But there are a lot for whom the medical system is not working and even more importantly for whom it is dangerous and harmful.  Let’s start with some specifics.

After writing and publishing this blog, a good friend of mine reviewed it.  He had a very different perspective on things than I present.  Together, we are like the Yin and Yang. I see the negative side of things and he sees the positive side of things in the medical profession.  It is my belief that we need to see more of the problems with our medical practices and bring them out so that they are more transparent.  Nevertheless, I realize that there are thousands of medical people who work hard and try to do their best to help their patients.  Thus, I am going to print Fred’s letter to me following my comments.  I hope this will “balance” out my negativity somewhat and create a more balanced view of American medical practice in the 21st century.  (Thank You Fred for taking the time to send us your thoughts.)

  1. Number of Needless Surgeries that are Done

There are many people who are enamored with surgery.  There are an equal number of doctors who are enamored with surgery.  When anyone in the first group goes to anyone in the second group, you can bet that surgery will be the answer to all their problems.  Abracadabra!  And like magic, their hip pains, knee pains and back pains will go away.  The patients are joyous, (unless they die on the operating table like my friend did last summer after going in for a hip replacement).  The doctors are joyous since they are thousands of dollars richer and of course the hospitals are also joyous since they too are also thousands of dollars richer.

signs-that-you-should-see-a-doctor-physical-therapyHave you ever heard of a doctor turning anyone down for back surgery, knee surgery or hip surgery by telling them that they are overweight and would be better served by an exercise program or by physical therapy?  If so, I can guarantee they are not typical of most medical practitioners.  How many doctors look at the major cause of back, knee and hip problems and try to deal with that?  Impossible, because doctors do not treat you over a lifetime.  You don’t see a doctor until you have a problem and by then it may be too late.  Surgery is the fastest solution because exercise, dieting and physical therapy take discipline and time.  Doctors do not want to tell you the truth because it is an inconvenient truth but many problems should not be treated by surgery until it is a last resort.  Too often, it is the first resort.

  • Data show that 10% to 20% of some common surgeries are done unnecessarily – USA Today – June 20th, 2013
  • “I think there’s a higher percentage who are not well trained or not competent to determine when surgery is necessary, Santa says. ‘Then you have a big group who are more businessmen than medical professionals — doctors who look at those gray cases and say, ‘Well, I have enough here to justify surgery, so I’m going to do it.” — USA Today

Here per the study reported by USA Today are the six leading surgeries that often performed and just as often not needed:

  • Cardiac Angioplasty, Stents
  • Cardiac Pacemakers

Pacemakers are used to correct heartbeat irregularities, but research shows that more than 22 percent of these implants may be unnecessary.

  • Spinal Fusion Back Surgery

lumbar-spine-surgeryIf you have low back pain and see different specialists you will get different tests: rheumatologists will order blood tests, neurologists will order nerve impulse tests, and surgeons will order MRIs and CT scans. But no matter what tests you get, you’ll probably end up with a spinal fusion because it’s one of the “more lucrative procedures in medicine,” author Shannon Brownlee says – even though the best success rate for spinal fusions is only 25 percent!

  • Hysterectomy
  • Knee and Hip Replacement, and Arthroscopic Knee Surgery

Patients who were informed about joint replacements and alternative treatments had 26 percent fewer hip replacements and 38 percent fewer knee replacements than those who did not. Arthroscopic knee surgery for osteoarthritis is also one of the most unnecessary surgeries performed today, as it works no better than a placebo surgery.

Proof of this is a double-blind placebo-controlled multi-center (including Harvard’s Mass General Hospital) study published in one of the most well-respected medical journals on the planet, the New England Journal of Medicine (NEJM) over 10 years ago.

knee surgeryRecent research has also shown arthroscopic knee surgery works no better than placebo surgery, and when comparing treatments for knee pain, physical therapy was found to be just as effective as surgery, but at significantly reduced cost and risk. And yet another study showed exercise is just as effective as surgery for people with chronic pain in the front part of their knee, known as chronic patellofemoral syndrome (PFPS), which is also frequently treated unnecessarily with arthroscopic surgery.

  • Cesarean Section

According to the World Health Organization, no country is justified in having a cesarean rate greater than 10 percent to 15 percent. The US rate, at nearly 32 percent, is the highest rate ever reported in the US and is higher than in most other developed countries.

The USA Today article went on to talk about many diagnoses that were based on limited medical knowledge and that doctors often lacked the expertise to explore alternative treatment modes.  This is an issue of incompetence and it seems to be a major problem in the medical field with many doctors getting their information from their pharmaceutical representatives.

I have not even touched on the issue of malpractice.  But I will say a few words about this.  No one is perfect.  Everyone makes mistakes.  Medical treatment and diagnosis is a very difficult process.  I will not blame any doctor for an honest error committed with good intentions and not simply out of ignorance or greed.  This is one area where I sympathize with the doctors and hospitals more than I do the lawyers.  Nevertheless, there are some egregious examples of medical practice and a lawsuit might be the only recourse for such cases.

I use the information from the USA Today article, but none of it surprises me.  I have had many friends who have undergone surgery for the situations noted above. I have often tried to counsel them as to other solutions but it is generally a waste of time.  I have had two notable successes though and they have both expressed their gratitude to me for sharing my opinions and thoughts with them and preventing them from getting surgery.

drugs

  1. Pills, Pills and more Pills

If life were fair, many doctors would be in jail right alongside of other drug dealers.  Doctors do not have the violence associated with illegal drugs because they have a license to prescribe drugs.  However, doctors prescribe drugs that are no more needed than heroin or cocaine and at much greater rates than your street drug pusher.

The size of the illicit drug trade (2012 data) in the USA including Marijuana, Heroin, Cocaine and Methamphetamines was estimated to be about 100 billion dollars a year.  —- How Big is the U.S. Market for Illegal Drugs?  We can assume that street dealers and drug pushers are responsible for most of these drugs.  So how much do doctors push?

If we look at the following fact, we can extrapolate from it the total amount of prescription drugs sold each year in the USA.

“In 2013, per capita spending on prescription drugs was $858 compared with an average of $400 for 19 other industrialized nations. In the United States, prescription medications now comprise an estimated 17% of overall personal health care services. —  The High Cost of Prescription Drugs in the United States (2016). 

deaths from over druggingSo if we assume roughly 326,000,000 (USA Population in 2016) people and we multiply that by $858 dollars per capita, the total amount should equal the total amount spent on prescription drugs.  This amount equals = $279,708,000,000.  This is almost three times what is being spent on illegal drugs.  I am not even going to talk about caffeine, alcohol, nicotine, and other “legal” drugs.  Given that doctors love to prescribe pills and many patients love to take them, is there any wonder that we have or are currently experiencing an opioid epidemic in the US.

“Americans are in more pain than any other population around the world. At least, that’s the conclusion that can be drawn from one startling number from recent years: Approximately 80 percent of the global opioid supply is consumed in the United States…. The 300 million pain prescriptions equal a $24 billion market.”  — Americans consume vast majority of the world’s opioids (2016).

I say again that if life were fair, many doctors would be called drug pushers or DP’s rather than MD.’s   They would also be in jail.  Who should be responsible for the opiate epidemic if not doctors.  When and where do they stand their ground.  Even if people are stupid or lazy enough to want surgeries to cure problems of obesity and diet or if they want pain killers to mask the problems from their obesity and lack of exercise, who is the expert here?  Do parents give their children everything they ask for?  You go to an expert on medicine to get help and not to have them take advantage of you for their own benefit or pander to you because they are afraid to tell you the inconvenient truth.  What is this inconvenient truth?  I will talk more about this truth later in this series but to be quite direct and blunt it is this:

“British businesswoman and columnist Katie Hopkins has a controversial view on the obesity epidemic: that the solution is simply to eat less and exercise more — and that fat people have no one to blame for their weight issues but themselves.” — I gained 43 pounds to prove obese people are lazy

I had a friend that I used to ride motorcycles with.  He died in a motorcycle crash a few years back.  He was a great guy.  He always had a smile and something nice to say to someone.  His name was Gary.  He was also obese and exercised little.  He had chicken legs and bad knees.  Well, what would you expect if you weighed 100 lbs. more than you should and you let your leg muscles go to hell.  Of course, he went in to see his doctor with knee pains.  The doctor was more than happy to suggest Gary should lose some weight but in the meantime, he would schedule the surgery for knee replacement.  To my mind, this is criminal, irresponsible and ignorant behavior on the part of his doctor.  Gary got the surgery.  Never lost much weight and died not too long after from other causes.

Doctors pushing pills, pushing surgery.  It is like the Yin-Yang of American medical practice.  Throw into the mix a lot of lazy people who do not exercise or take care of themselves and you have a health care system spending tons of money on acute care when preventive care would be a much more sensible solution.

  1. Me Doctor, Me Busy.  Who are You?

Some of you might remember the skit on Saturday Night Live with Martin Short playing a doctor.  When asked what his badge that said MD meant, he would reply somewhat superciliously “Me Doctor, You Patient.”  When I was working as a consultant to some hospitals, it was not uncommon to hear nurses complain that doctors were like gods whose every word should be obeyed.  They seldom came to team meetings because “their time was too valuable.”

I will stay away from the subject of how much money doctors rake in since they often ascribe their high incomes to the length of time it takes to finish medical school and all of the attendant costs.  This sounds like a reasonable explanation but an alternative theory might mention the strangle hold that the AMA had on medical admissions and the role that restricting the supply of doctors has had on the cost of their services.  The law of supply and demand says that if you have fewer doctors, the cost per care will be higher.  For years, the AMA did all they could to help keep the supply of doctors down.

  • But the entities that will be most injurious to the nation’s health are not so much in the evil-mongers’ group but the first group, including the American Medical Association–a doctors’ cartel that has controlled the medical labor market in the U.S. like its personal fiefdom for a century. — The Evil-Mongering Of The American Medical Association (2012)

So, doctors come to regard themselves as the elite who know more than you do and who must be smarter than you since they make a great deal more money than most of their patients.  Doctors used to do house calls many years ago; back then, a doctor might have known something about your family and you personally.   My wife Karen told me the following story about her family doctor.   It generated the following conversation:

Karen —

“When I was married, and raising four children, my ex-husband Ron and I became good friends with a local White Bear doctor.  He became a family friend as well as our family doctor.  We knew him for over thirty years and he knew me and my family personally and really cared about us.” 

John —

“Okay, so now you have been seeing a doctor in Frederic for about seven years.  How much does she know about you personally or really care about you?”

Karen —

“I think she really cares about me.”

John —

“But how much does she know about you personally.  Your goals.  Your dreams.  What you did this past winter?”

Karen —

“Well, at first, she used to take more time to talk to me but the past few years she has seemed much busier and anxious to keep our meetings short.  I suppose the clinic has a quota for how much time she can spend with a patient.” 

Again, there are numerous anecdotes and articles describing the lack of time doctors have to spend today with patients.   Here is an excerpt from one:

“Joan Eisenstodt didn’t have a stopwatch when she went to see an ear, nose and throat specialist recently, but she is certain the physician was not in the exam room with her for more than three or four minutes.

‘He looked up my nose, said it was inflamed, told me to see the nurse for a prescription and was gone,’ said the 66-year-old Washington, D.C., consultant, who was suffering from an acute sinus infection.

When she started protesting the doctor’s choice of medication, “He just cut me off totally,” she said. “I’ve never been in and out from a visit faster.” — You’re on the clock.  Doctors rush patients out the door (2014)

I can guarantee you that if your doctor only takes a few minutes with you, once or twice per year, there is not much they can know about you personally regardless of how caring and concerned they are.  You might ask “well, why is this important.”   Here is the reason stated very well I think in Wikipedia:

“The quality of the patient–physician relationship is important to both parties. The better the relationship in terms of mutual respect, knowledge, trust, shared values and perspectives about disease and life, and time available, the better will be the amount and quality of information about the patient’s disease transferred in both directions, enhancing accuracy of diagnosis and increasing the patient’s knowledge about the disease. Where such a relationship is poor the physician’s ability to make a full assessment is compromised and the patient is more likely to distrust the diagnosis and proposed treatment, causing decreased compliance to actually follow the medical advice.”  — Wikipedia

Conclusions:

I promised some solutions to each truth that I am telling you.  Here are some that might help you to deal with this first truth.

  1. Get a second opinion for any surgery.
  2. Use the Internet to search for alternative treatment modes. Get advice if you are not Internet savvy. Remember, there are many opinions and not all are right.
  3. Exercise and have a health care plan. Follow it.
  4. Don’t take any pills unless you must. Try to unwean or get off them as soon as possible.
  5. Beware side effects from pills. Every pill has a side effect.  Make sure you are aware of any that might affect you and be cognizant of any changes in your life while taking these pills.
  6. Take a friend with you whenever you go in for an appointment or treatment. Talk to your friends to get their insights and opinions.
  7. Don’t assume your doctor is God and knows what is best for you. Be a skeptic but be realistic.  Modern medicine is better than sorcery but not always much better.
  8. Don’t assume that your doctor is your friend or has your best interests at heart. They might not have enough time to care.

Fred’s letter to me:

I read your blog on medical practice and it was indeed thought provoking.

I’ve had good results with doctors over my lifetime. Not always perfect but usually satisfactory and in some cases, it was excellent.

Medical care is a process and requires the same attention as any process. It seems especially complex today because of how rapidly technology and all the stakeholder’s needs and expectations are changing.

Overall, it’s greatly improved in its capabilities. My main concern for medicine is the same as I’ve had for years in business. My business life became more and more controlled by the bean counters and the lawyers. The same is true of medicine. Blaming doctors is blaming people, which is always a red flag to me as one who has a bad habit of judging others without knowing them. Like the driver for quality improvement, expectations always move to higher and higher expectations. And based on what I’ve heard from friends over my life, expectations are often unrealistic.

A friend recently died. He was an old school, oil field production engineer and didn’t trust any of his doctors. He’d get pissed at one and then begin to “doctor hop”; never telling one what the other had done or prescribed. I questioned him many times, always inquiring why he’d not share his history. His reply: “I ain’t telling them anything.  They make good money and are supposed to tell me what’s wrong.”

I see the process much as we viewed our manufacturing and service processes ..with customers, suppliers, inputs and outputs being carefully considered. A critical output is the result when your illness is diagnosed and this is too often a major problem source. My friend tends to expect this to be an exact outcome but in reality it isn’t. It’s only a statistical prediction that too many older doctors failed to point out to naive, uneducated patients.

In recent years, our doctors point out the statistics and involve us in the decisions for corrective action. My wife’s breast cancer surgery was a good example. Years ago, the doctor would have made the decision for which surgery, mastectomy or lumpectomy. Sandra made the decision armed with various study statistics and discussion with the Doctor. The Internet was a source for me to verify the statistics but that isn’t easy because there are often many studies,

The surgeries are complex and the statistics often work out for the worst. Records on lawsuits and doctor reviews are more readily available today. I recall a bad experience with my dad years ago. Our family doctor became a friend from making many house calls as 3 kids were raised. Dad was a merchant seaman and would provide Porte Rico rum for our good doctor. They were the best of buddies and talked about the old days during visits. Dad visited him yearly but when dad’s tobacco tarred lungs became late stage cancerous it was too late. Doctor “Tom” as an individual practitioner didn’t have the computer technology that red flags today’s doctors. Doctor Tom was as heartbroken as my dad. He and his wife nurse apologized that they’d not x rayed dad 6 months earlier. We probably could have sued but dad would never have agreed to such.

The body of knowledge has expanded too much for any one doctor to master it all, so now we have multiple knowledge based “Specialists” having to deal with the directives from medical organization bean counters and their lawyers.

I consider our medical providers to be leading edge. They seem to focus on continuously improving to meet customer expectations. I’m hoping, but doubt the doctors and staff will be given additional support. They track customer satisfaction inputs so I should be more confident.

I can email any of my doctors and I can access historical results. I especially like being able to take a picture of a physical observation and sent it in.  A couple of years ago, I tore a muscle on the back of my leg and a huge blue area surfaced overnight.  It scared the heck out of me. I emailed a picture and he emailed back telling me what it probably was, how to treat it and to see a doctor if it didn’t heal. My expectations are now at an even higher level which puts more load on the doctor. He not only has to live up to corporate standards on office visits but he must respond to patient emails. Just yesterday I received a corporate email announcing that they have decided to do “Face Time” appointments for $25!

Overall, I have concerns for the profession but I think problems are “process” related. To think otherwise would go against what I’ve believed for a long time.

Fred

Time for Questions:

How satisfied are you with your medical care?  Why or why not?  Have you ever had a loved one die?  How were they treated by the medical profession?  What do you think could be done to improve medical care for you and your family?  What would you like to change in the American medical care system?

Life is just beginning.

“We have really good data that show when you take patients and you really inform them about their choices, patients make more frugal choices. They pick more efficient choices than the health care system does.” — Donald Berwick

 

 

 

 

Startling Facts You Need to Know about Medical Treatment that Might Save your Life!

11 Mar 2017 4 Comments

by Dr. John Persico Jr. in Uncategorized

In the following weeks, I am going to cover some facts about the medical profession and medical treatment that you might not want to hear.  Many of you reading this will object to my opinions and many medical professionals will no doubt take umbrage at my assertions.  Nevertheless, if my truths do not set you free, they might at least keep you healthier.

What are my qualifications for making these claims?  Seventy years or more of dealing with medical professionals.  Personal treatments for broken bones, sprains, cuts, lacerations, infections, pneumonia, measles, whooping cough, bursitis, plantar fasciitis, prostate cancer, hernia, a deviated septum, Morton’s neuroma, knee and hip pains.  I have watched and known many relatives and friends who have died either because of the medical profession or because of the false beliefs that afflict so much of the general population regarding medical treatment.  I have a BS in Health Education and a MS in Psychology.  I also have a wife who has been a nurse for over 50 years and who still works in the medical field.

20170308_084015My disclaimer is that this does not make me an expert.  In fact, I would maintain that expertise in medicine is like the five blind men who were trying to describe an elephant.  Each man had a different perspective on what an elephant looked like.  Individually, no one perspective was a very adequate description of an elephant.  It would take a synthesis of all perspectives and even more to truly describe an elephant.  That is the problem with medicine.  Too often, each professional looks at a problem through the narrow lens of their own discipline. The reality of a medical problem can often only be understood by multiple perspectives because of the interaction of the systems that make up the human body.  This defining perspective of the problem seldom occurs both because of the nature of medical practice and many times because of the egotism of the so-called medical experts we consult.

A few years ago, my wife’s elderly 85-year-old father Ray went into the hospital with a kidney problem.  We knew he had a heart problem, so we were very concerned.  In the hospital, it seems that further complications arose.  He was being treated by several different specialists.  Over the course of the days that he was in, I had the feeling that none of them were talking to each other.

One day both Karen and I went to visit Ray and he seemed very alert and like his old self.  Karen asked him how he felt and he shocked us with the reply that “he was going to die today.”  Since Ray had been somewhat of a hypochondriac, we were wont to dismiss this assertion but we decided to talk to the doctor in charge at the time.  We asked him how Ray was doing.  He replied “Just fine, he will be discharged today.”  Thus, we were both relieved and Karen and I went off to work feeling comfortable that her father was A-OK.

Shortly after noon, I received a call from Karen.  She was crying and wanted me to meet her at the hospital as soon as possible.  She informed me that her father had died sometime after we had left that morning.  I was incredulous.  How could this be?  The lead doctor had said he was going to be discharged this very day.  It was not the first of my many lessons with the medical profession, but it was one of the saddest.  Karen could have been there with her dad, if we had both believed him instead of the MD.  This does not mean that the doctors do not care about you, just that they are too busy to know who you really are or what your problems really are.  They are too busy treating symptoms to give a damn about you as a person.

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In the next few weeks, I am going to cover several perspectives about medicine and medical care.  I will discuss one a week for the next ten weeks.  My perspectives will each be explained in more depth and I will provide some “solutions” for dealing with the problems that arise from these perspectives.  I want to warn you.  If you love your doctor and you truly think that the medical profession are heroes and next to gods, you should not read what I am going to write.  You will not like what I must say.  I am not a “true believer” and this is not a selection to applaud the medical establishment.  There are enough people out there already doing that.

My ten perspectives are:

  1. The AMA and its attendant professionals do not give a damn about you as a person
  2. Homeopathic medicine is a placebo
  3. Chiropractic medicine is an art and not a science
  4. Much pain is caused by laziness and ignorance and not aging
  5. Pharmaceuticals can kill you
  6. Setting exercise goals is a recipe for disaster
  7. Most diet programs ignore basic common sense
  8. Yoga and physical therapy may help but they may make things worse
  9. You need an independent advocate  AND you must be your own advocate
  10. Good health is a journey and not a destination

Time for Questions:

Do you have a favorite doctor?  Why do you like him or her?  How have you been served by the medical profession?  What are the high points?  What are the low points?  What do you think we need to do about the high cost of medical treatment?  Who do you go to first when you need medical help or advice?  Why?

Life is just beginning.

“We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.”  ― Atul Gawande, Complications: A Surgeon’s Notes on an Imperfect Science

 

Unbecoming a Victim: Or how to stop complaining and make a difference

06 Mar 2017 2 Comments

by Dr. John Persico Jr. in Uncategorized Tags: , , , , , , , , , ,

Life’s not fair!  I never get any breaks! Other people have all the luck!  The world is crap and there is nothing anyone can do about it!  It’s not my fault. Why did he/she get the job and not me? (Listen to the Power of Responsibility as you read my blog today)  Do-You-Have-a-Victim-Mentality-at-Work

If you have ever made any of the above comments, rest assured, you are probably normal. It is called feeling like a victim or wallowing in self-pity. From time to time, we all engage in victim-hood. However, if your entire life is dominated by feelings of regret, remorse and envy, you are not just engaging in a bout of self-pity, you are embracing full-on victim-hood. We all feel like victims from time to time. That is normal. But if you are thoroughly convinced that you are a victim, you need help. The world has too many too many real victims, it does not need pseudo victim. This blog is about how to avoid embracing a victim mentality and the key factors necessary to overcome such a mentality.

First, let’s look at two key questions:

  1. What is a victim?

As I am describing it here, I am not talking about victims of torture, oppression, starvation, crime, disease, pestilence or any phenomenon that is beyond the ability of an individual to evade. I am talking about a mindset that occurs when we fail to take responsibility for our actions and the consequences of our actions and behaviors on others. You probably know some people who you would describe as having this mentality. My wife Karen says she defines a victim as “someone whose problems are always someone else’s fault. They also seem to need problems and will create them if they don’t have them.”  hero versus victim

“Your complaints, your drama, your victim mentality, your whining, your blaming, and all of your excuses have NEVER gotten you even a single step closer to your goals or dreams. Let go of your nonsense. Let go of the delusion that you DESERVE better and go EARN it! Today is a new day!”  ― Steve Maraboli

We see many people who cannot find any good in the world since they are so busy feeling sorry for themselves that they cannot see the blessings that they have. I find many right-wing Christians to be prime exemplars of this victim mentality. They are so convinced that the world is evil and will end any day. The “anti-Christ” is coming and then the world will be destroyed and all the evil in it. Such people seem to revel in the idea of an apocalypse which will wipe the entire world out and only spare the “good” people. Of course, these right-wing fundamentalist Christians are the “good” people who will be spared.

  1. Why do people choose a victim mentality?

I believe the answer to this question is that it absolves the “victim” of responsibility. They can blame God, the world, other people, nature, the weather or DNA for their failures. Never having to take responsibility is a panacea for those with a victim mentality. It is easier to do nothing when any effort is predestined to fail.

“Life is not compassionate towards victims. The trick is not to see yourself as one. It’s never too late! I know I’ve felt like the victim in various situations in my life, but, it’s never too late for me to realize that it’s my responsibility to stand on victorious ground and know that whatever it is I’m experiencing or going through, those are just the clouds rolling by while I stand here on the top of this mountain! This mountain called Victory!” ― C. JoyBell C.

Overcoming the Victim Mentality:

The antidote to a victim mentality consists of four vaccines. They are as follows:

  • Moral Courage
  • Moral Reasoning
  • Moral Universalism
  • Moral Responsibility

Anyone of these four vaccines can keep you from becoming a whining victim. Taking all four together, will help you to become independent and strong. You will be a winner instead of a victim. We need to give our children these vaccines at an early age, but it is seldom done. It seems as though we must find them on our own later in life or else we flounder through life succumbing to the victim mentality until we find one or more of them.

Moral Courage:

moral courageTo dream the impossible dream, to fight the unbeatable foe, to go where no one has gone before is courage. To stand up for what you believe, to right the unrightable wrong, to boldly speak out against injustice. This is courage. There is physical courage as is manifested in a war or sports or extreme athletic challenges. Moral courage is of the heart and soul. Bothe moral courage and physical courage result in action. One of my favorite quotes is as follows:

“The test of courage comes when we are in the minority. The test of tolerance comes when we are in the majority.” – Ralph W. Sockman

Moral courage does not exist by just talking about it or complaining about things. Moral courage is an attempt to make a difference by taking some decisive action. You speak out against prejudice, bigotry, hatred, racism, injustice and stupidity. You do more than read the newspaper and bemoan the sad state of the world. The life of the prophet Mohammed provides many examples of moral courage:

“Before claiming Prophethood, the Prophet Muhammad, upon him be peace and blessings, was well off and had a respected place among his community. However, he had to confront all kinds of hardships and persecutions after Prophethood and spent for his cause whatever he had. His enemies slandered him, mocked him, beat him, expelled him from his homeland and waged war on him. He bore all such cruel treatments and hostilities without complaint and asked God Almighty for the forgiveness of even his enemies.” – The Way to Truth 

Moral Reasoning:

devil_angelMoral reasoning occurs when you question right and wrong. Moral reasoning is a cognitive action that takes place when you question standards, conventions, group reasoning, and crowd think. Moral reasoning is the questioning of social and cultural standards. Jesus of Nazereth gave many examples of moral reasoning during his life.

“Woe to you, teachers of the law and Pharisees, you hypocrites! You give a tenth of your spices—mint, dill and cumin. But you have neglected the more important matters of the law—justice, mercy and faithfulness. You should have practiced the latter, without neglecting the former. You blind guides! You strain out a gnat but swallow a camel (Matthew 23:23-24).” 

Jesus is making an important distinction here between convention and morality. We often confuse justice with legality. The inability to understand the difference and its moral relevance is a failure of moral reasoning. Throughout his ministry Jesus gave many examples of moral reasoning.

Moral Universalism:

Hans Kung was a Roman Catholic priest who was stripped of his license to teach theology by the Catholic Church for criticizing the concept of papal infallibility.

“In the early 1990s, Küng initiated a project called Weltethos (Global Ethic), which is an attempt at describing what the world’s religions have in common (rather than what separates them) and at drawing up a minimal code of rules of behavior everyone can accept. His vision of a global ethic was embodied in the document for which he wrote the initial draft:, Towards a Global Ethic: An Initial Declaration.” – Wikipedia

responsibilityKung’s life demonstrates a strong moral believe in the universal principles that underlie all religions. My religion is not better than your religion and all of the worlds’ great religions have a core of morality and ethics which are admirable and worth following. When we find one religion fighting with another religion or one advocate maintaining the superiority of their religion over another, we have a counter example of moral universality.

Moral universalism is an important element in overcoming victimhood. One cannot believe that their religion is superior to another religion without eventually succumbing to the rampant persecution complex that seems typical of so many religious people. I was taught when I grew up that I would go to hell if I ever stepped in a Synagogue or Temple.   Karen was taught that as a good Lutheran she should never date a Catholic. Baptists denigrate other Protestants while Muslims and Christians act as though they were worshipping different Gods. Jesus and Mohammed had a deep respect for all religions because they were wise enough to perceive the universality of religion.

Moral Responsibility:

moral responsibilityThe famous poet John Donne is perhaps best known for one of his lines that goes: “Never send to know for whom the bell tolls, it tolls for thee.”   Donne well understood the idea that we are all interconnected and we all have an incomprehensible interdependency such that anyone’s death affects us all. The same is true with morality. A key tenet of Buddhism is the moral responsibility that everyone on the earth faces for social and political actions.

 “Today we have become so interdependent and so closely connected with each other that without a sense of universal responsibility, irrespective of different ideologies and faiths, our very existence or survival would be difficult” – (Dalai Lama, 1976)

Of the four vaccines that are critical for overcoming a victim mentality, it is my opinion that a sense of moral responsibility is the most important. If I could only receive one vaccine, I would choose to be vaccinated with moral responsibility. A sense of moral responsibility allows us to help others who are in need. Charity, love, compassion and kindness are all nurtured by a sense of moral responsibility. As they say: “what goes around comes around.” When we do “good” for others, we do good for ourselves. By identifying with the pain and injustices that others suffer, we forget our own problems and we understand that we can make a difference in the world. No one who believes in their ability to make a difference in the world can suffer from a victim mentality.

Time for Questions:

Are you a victim or a hero? How often do you feel hopeless? What do you do about your feelings of hopelessness? How do you overcome feeling like a victim? Do you think people have a choice of how they feel? Why or why not?

Life is just beginning.

“Most things, even the greatest moments on earth, have their beginnings in something small. An earthquake that shatters a city might begin with a tremor, a tremble, a breath. Music begins with a vibration.”  -― Lauren Oliver

 

 

 

 

 

 

 

 

 

The Inadequacy Paradigm

14 Feb 2017 4 Comments

by Dr. John Persico Jr. in Uncategorized Tags: , , , , , , , , , ,

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Have you ever felt that you were not pretty enough, smart enough, coordinated enough, talented enough, handsome enough, strong enough or fast enough?  If so, you were suffering from the “inadequacy paradigm.”  A paradigm is a model or template for thought or behavior.  Feeling inadequate is one of the major paradigms of American society.  The marketplace wants you to feel inadequate because then they can sell you products and services that will make you feel “ADEQUATE.”

hqdefaultThere are beauty products, breast enhancements, hair implants, plastic surgery, expensive cars, perfume, jewelry, large homes, designer clothes, college degrees and many other products or services designed to help you feel less inadequate and more adequate.  We all want to feel adequate which means we must somehow learn to escape or jettison our inadequacy paradigms.  The marketplace strategy involves spending huge amounts of money on a regular basis to escape the “inadequacy paradigm.”  This strategy is often a failure as money and products cannot provide for real happiness or address some of the cultural biases, prejudices, racism and bigotry that contribute to the “inadequacy paradigm.”

“A fascist is one whose lust for money or power is combined with such an intensity of intolerance toward those of other races, parties, classes, religions, cultures, regions or nations as to make him ruthless in his use of deceit or violence to attain his ends.” — Henry A. Wallace

When I was growing up in New York City during the fifties, many of the popular singers were Italian.  There was Fabian, Frankie Avalon, Connie Francis, Dion, Dean Martin and many others.  Most of the famous male singers had traditional Italian good looks being tall dark and handsome.  My father (6’ 4” tall) fit this model but my mother was Irish.  I (much to my chagrin) took after my mother.  I was short (5’ 8”) light skinned, brown thin hair with very nondescript looks.  No woman ever looked at me twice in high school.  I did inherit a good brain and cannot attest which side it came from.  Nevertheless, brainy nerdy intellectual guys had no more demand among the attractive high school girls in the fifties and sixties than they do now.  Beauty would seem to always trump brains in our society.

Now there are many different aspects or subdivisions of the “inadequacy paradigm.”  There is a division for Blacks, Latinos, women, disabled, intellectuals, old people and of course poor people.  If you belong to any one or more of these categories there are special rules that will be directed to you to help you feel even more inadequate than average. (Racism and Xenophobia create their own paradigms of inadequacy which go well beyond Madison Avenue but are supplemented by Madison Avenue to a large degree).  As a White male growing up in an Italian neighborhood, my complaints will not doubt seem trivial to individuals in these other “inadequacy categories.”  Let’s look at each group and see if we can perhaps walk a mile in their shoes.  What would it be like if you were in one of these other categories.  Now, one caveat must be shared.  If you are White and rich, you will probably be able to escape the most noticeable effects of the “inadequacy paradigm.”  For rich White folks, money provides a means to ameliorate the more consequential effects of inadequacy.  Money can’t buy you love but it can buy you many other things to make you feel better.

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African Americans:

What is it like growing up Black in America in the 21st Century?  Has years of Affirmative Action, Civil Rights and even a Black President mitigated the effects of the “inadequacy paradigm” for our African American citizens?

I decided to approach a Black man who was walking down my street.  I started to walk towards him and I yelled out “Hey, I need to talk to you.”  He immediately threw up his hands, laid on the ground and starting shouting “Hands up, don’t shoot.”  I hollered out “I am not a cop.”  He got to his feet and said “Sorry, just an instinctive reaction.  How can I help you?”  “Well, I said, I just wanted to ask you what it was like being “Black in America today?”

Brian Lipscomb, IT Professional and Web Programmer/Website Designer

“Once I got off a trolley in downtown Philadelphia and accidentally bumped into an older White woman.  She immediately said “Here! Take my purse! Just don’t hurt me!” I was shocked. I couldn’t believe that she thought I was going to rob her.  When walking down the street, if a White woman is walking in my direction, they often cross the street or clutch their purse more tightly as I approach.  I guess I’m numb to it now, because I expect it.  I think that’s the sad part. There is nothing post-racial about our society.  Racism and prejudice have just become more subtle, more nuanced.”

Latinos:

Many Latino people in the USA have been residents since before the Pilgrims arrived.  With the annexation of Mexican Territory after the Mexican American War and the subsequent Gadsden purchase, many former Mexican citizens elected to become American Citizens.  The border between Mexico and the US was porous for many years with much travel back and forth.

Many Mexican Americans have families and friends still living in Mexico.  There has always been a White bias towards Mexican Americans and others from south of the border but recently this bias seems to have escalated.  Part of the reason for this lies in the drug wars but much of it is rooted in a xenophobia directed to Latinos who do not have traditional Northern European customs.   Latinos have become an increasingly larger segment of the population in many Southwestern cities.

But what is it like being a Latino?  We know that with the election of Donald Trump and his talk of building a border wall and deporting “Latino Rapists” that he has fanned the fears of xenophobia common among many Southwestern Whites.  There is no doubt that numerous Latino people residing in the Southwest and other parts of the USA are now uncertain about their future as US citizens.

Brittany Escalera, College Student

“Being born in the United States, I am automatically a citizen.  I am an American.  But according to society, I’m “too” Mexican to be American.  My complexion is too dark to be American.  My dark hair and dark eyes are too Mexican to be American. I’m Mexican, therefore, I can’t be American…. Yet it’s not always just the language barrier that is a struggle, there are constantly stereotypes and racial slurs being put on us everyday.  Being from the south, I had to work extra hard at breaking this.  No not all Mexican’s are illegal.  Sorry Trump, we are not all the criminals, drug dealers and rapists that you claim us to be.”

Women:

Of course, I cannot speak for being a Woman in America.  But I do not have to be female to see that Women must also suffer from the “inadequacy paradigm.”

“As Sheryl Sandberg and Adam Grant pointed out in a recent New York Times op-ed, when male executives speak up, they receive 10% higher competence ratings; when female executives do the same, their ratings from their peers are 14% lower.  Similarly, when male employees offer ideas, they receive higher performance evaluations; when women offer the same ideas, managers’ perceptions of their performance remain unchanged.”  — What’s holding women back?

If the bias in the workplace is not bad enough to insult many women, the bias they face in the home is even worse.  The rates of domestic abuse and rape in American society are shameful.  But perhaps the worse indicator of the “inferiority paradigm” for women lies in the number of women who think they deserve such treatment.

“The cultural acceptance of spousal abuse can be so pervasive that in some countries, large majorities of women say it’s acceptable.  In Rwanda, 96 percent of women say the practice can be justified, according to the World Values Survey.  About two-thirds of women in India and South Africa feel the same way.  The attitude is also held by large shares of women in countries across the religious and cultural spectra — China, Egypt, Iraq, Nigeria, Peru, the Philippines and Uzbekistan, to cite a few. 

Even in countries where the vast majority of women don’t approve of spousal abuse, the share that do find it potentially acceptable isn’t exactly tiny.  It’s about 1 in 10 in the U.S. and about 1 in 5 in Germany.”  — Alarming Number Of Women Think Spousal Abuse Is Sometimes OK — NURITH AIZENMAN

Many women are now worried in the USA due to the election of a President who openly bragged about his right to grab a women’s “pussy” because he was rich and privileged.  Many of his supporters were men and women who belong to fundamentalist religions that believe women have no place in politics or in the business world and that their only role is to bear children for men.  Thus, after years of battling to achieve equality with men, women now face the prospect of losing many of the hard-earned rights that they fought for and won.

Disabled:

One of my best friends committed suicide about a year ago.  He was a Cerebral Palsy victim who had dedicated his life to helping fight for more rights for disabled people.  He walked crablike and had to use walking sticks to keep his balance.  His head was always cocked at an odd angle due to his disability.  He was two years younger than I was and died at the age of 67.  Brian took his own life because he could fast see a time approaching when he would no longer be able to live on his own.  Brian was a fiercely independent man who struggled to obtain dignity in a society that does not always respect people who are disabled.

I first saw Brian when he would come into the town bakery to buy donuts or for lunch.  I was usually sitting with a bunch of locals who knew Brian and several had gone to school with Brian.  I was uncomfortable with the way they seemed to greet Brian and their response towards him.  It became disagreeable enough to me that I stopped my morning coffee sessions with this group.  Instead, I found a group of people at the library who met for coffee each day.  Brian was among the group at the library and we became good friends.

Brian told me many stories of how he was treated as though he was mentally disabled rather than physically disabled.  On several occasions that we went out together, it was clear that people wanted to avoid dealing with Brian.  For Brian, it must have felt like being a leper.  I am sure that much of the bias towards Brian was not intentionally hateful.  Nevertheless, it still was difficult for Brian to deal with.  Brian wanted to be treated as a normal person and not someone with a disability.  His strong desire to be normal ultimately led to his ending his life.

The following chart shows the changes in employment for disabled people in the USA since 1991.  Notice the “progress” is backwards.

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Intellectuals:

99632_origIf you have not read Hofstadter’s “Anti-Intellectualism in America Life” I heartily recommend it. I have often joked that the worst discrimination in America seems to be saved for people who think.  Many companies trumpet their desire for “out of the box” thinkers.  This is usually nothing more than a well parroted display of self-deception.  What Human Resources and the company are really looking for is “people who fit in.”  People who are iconoclasts, people who are critical thinkers, people who rock the boat “need not apply here.”

Intellectuals include nerds, free thinkers, geeks and anyone who works with ideas as opposed to building things or throwing things.  Academics are often lumped in with this category since most people assume an academic to be a brilliant thinker.  This is very often a misplaced assumption.  People in the arts including music and theater are often very intellectual but they somehow manage to escape the opprobrium reserved for pure thinkers.

If you think I am exaggerating on the bias that is reserved for intellectuals, you should turn on any right wing talk show like Rush Limbaugh or Sean Hannity and listen to them for a while. It won’t be long before they are attacking commie pinko faggot intellectuals for all the problems in America.

“There is a great superficiality in today’s evangelical world.  Many Bible-believing Christians share the contemporary case for self-gratification, emotionalism, and anti-intellectualism. Many people who believe in the Bible have never read it.” — Gene Edward Veith Jr.

I must mention one of the dumbest stupid-ass TV shows I have ever seen.  It is the epitome of anti-intellectualism in America today.  It is called the “Big Bang Theory.”  It is supposedly about genius and of course the geniuses in this show have Ph.D.’s but absolutely no common sense or interpersonal skills. They are also geeky with no athletic skills and about zero muscle mass on their puny frames.  This show portrays how much of America views intellectuals.

“Our big mistake in modern intellectualism is first and foremost its lack of nuance.  We have made science synonymous with atheism – a presupposed conception and yet, another means to non-sequiturs – and therefore, to a number of enthusiasts determined to go the further, anti-theism.  Hereby let us observe that science has long served best and should be, if none other, the one discipline, if at all possible, free of potential ideology, religious or anti-religious, and/or biased presupposition in order to maintain the authenticity and the reliability of its nature.” —–  Criss Jami

Elderly:

Every so often, my wife and I like to go to a Pow Wow.  I remember one of the first we went to and they had a free dinner for all attendees.  As we stood in line waiting our turn to get up to the food table, a young man came up and said “Oh Elders go to the front of the line.”  I said “I am not a Native American.”  He said “It did not matter” and escorted my wife and I to the front of the line with the other Elders.  Other Pow Wows that I have attended have had a special line for Elders.  I was pretty much blown away by this deference.  It was totally unexpected but greatly appreciated.

Many venues and shops have discounts for seniors or “Senior Days” where food is cheaper or there are discounts for those over fifty-five or sixty.  I am not impressed by these as you and I know it has nothing to do with “respect” for the elderly.  It has more to do with getting more of our money.  Respect for the elderly seems to be dwindling the older I get.

Both my wife and I have noticed that increasingly when we go to a clinic anymore with a health problem such as a sore hip or sore shoulder, we often get responses like “Oh, it is just part of getting old, you will just have to live with it.”  Instead of investigating to see if some our problem might be amenable to treatment, we are simply told to more of less “suck it up.”

“There is also a lack of recognition of the positive contributions that elderly people make to society.  The amount of unpaid childcare provided runs into the tens of billions.  Without this form of labor, fewer parents could work and gain fulfillment in their jobs.  Indeed, as some local authorities have recognized the 60 plus generation offer a huge reservoir of untapped energy for the voluntary sector.”  — Why do we treat elderly people so badly? — By Paul Donovan

Poor:

The “poor” otherwise known as lazy, drug addicts, stupid, trailer trash, welfare bums, welfare cheats, handout recipients, bag people, curb people and homeless.  The poor in America are thought by many to be poor by choice and not by chance.  This makes it much easier to denigrate them and to blame them for their poverty.  When someone picks their lifestyle, it is much harder to be sympathetic for the choices they have made.

In 1978, I had finished my Master’s Degree in Counseling and I took a position as a Manpower Counselor II with the State of Wisconsin in the Department of Industry Labor and Human Relations or DILHR as it was known then.  My job entailed working with the WIN or Work Incentive Program to help families who were receiving welfare (AFDC or Aid to Families with Dependent Children) find gainful employment so they could get off Welfare.  I also worked with the Indochinese Refugee Assistance Program (IHRAP) and the Labor Education and Advancement Program (LEAP) to help mainly Southeast Asian refugees in the IHRAP program and women and minorities in the LEAP program find jobs.  I worked with several other job training programs as well.  The bottom line of all my programs and effort was to help people find employment by which they would become self-sufficient.

Now there are two interesting points I want to make gleaned from my two years working in these programs with mostly poor and under-privileged people.

  1. None of the programs really went far enough in their benefits or stipends or financial assistance to really help as much as was needed by my clients.

I am not going to say that many benefits were not helpful.  We could offer financial incentives to employers, daycare benefits, transportation help and even some educational benefits.  These were in addition to the monthly welfare checks that many families were receiving.  Nevertheless, the key to getting off welfare was to provide enough education to help the client to break out of the cycle of poverty.  Only education would help those who wanted to climb the proverbial “ladder of opportunity.”  Unfortunately, the ladders that were being provided never seemed to have enough rungs in them.  Whether through stupidity, frugality or simply underestimating what was needed, many people could not get enough help to break out of poverty.

  1. Ninety Percent of my clients wanted to get off Welfare.

There is a pernicious and vicious myth that most people on Welfare like it and want to stay on it.  Nothing, could be further from the truth.  I worked with hundreds of Welfare clients and the clear majority (90 percent or better) wanted to find a good job and become self-sufficient.

Yes, I encountered some Welfare cheats and some Welfare dependent people who had little or no incentive to gain employment and lose their Welfare checks.  However, these were a small minority of the clients that I saw in my two years working with the WIN program.   Even these individuals often had severe handicaps either physically or mentally which would have made holding gainful employment near impossible.  The average person does not realize how many barriers and hardships face some of the poor in this country.

“Saving our planet, lifting people out of poverty, advancing economic growth… these are one and the same fight. We must connect the dots between climate change, water scarcity, energy shortages, global health, food security and women’s empowerment. Solutions to one problem must be solutions for all. — Ban Ki-moon

Conclusions:

inadequacy-cropWe have a pervasive problem that I labeled the “Inadequacy Paradigm.”  Much of it is caused by racism, xenophobia, prejudice, stereotypes and bigotry.  The majority of it is systemic and will need major changes in policies and institutions in this country to eliminate.  However, it is felt on a very personal level.  Feelings of inadequacy may be conveyed by others and cultural mores but they are received by an individual who assimilates these feelings into their psyche.  Thus, inadequacy becomes a personal problem and not simply a social problem.  Inadequacy is not “out there” it is right inside.  The vast numbers of suicides in our society are testament to the inadequacy that many of our fellow citizens feel.   This includes Whites as well as minorities.

  • Suicide is the tenth leading cause of death in the USA
  • 44,000 people die every year by suicide (2015)
  • White males accounted for 7 of 10 suicides in 2015.

What can we do to overcome these problems?  Clearly education and social support systems must be developed and deployed.  If we see the problem of inadequacy as something that is “not my problem” nothing will be done.  We have people who refuse to spend one dime of their taxes to help others because of selfishness and greed.  We have many who want to label America as a Christian nation, but they do not practice Christianity.

Any church that does not practice tolerance for the oppressed, charity for the poor and compassion for the needy, regardless of what religion they belong to, should not call themselves a Christian church.  They should call themselves a HATE church.  Hate leads to prejudice and bigotry and these are the primary factors in the Inadequacy Paradigm.  Destroy prejudice and bigotry and we will create a society with many more well-adjusted people.

Time for Questions:

What makes you feel inadequate?  Why?  What do you do about it?  How do you think you could help others who feel inadequate?

Life is just beginning.

“I have had to experience so much stupidity, so many vices, so much error, so much nausea, disillusionment and sorrow, just in order to become a child again and begin anew.  I had to experience despair, I had to sink to the greatest mental depths, to thoughts of suicide, in order to experience grace.”  — Hermann Hesse

 

 

The Man or the Office?  Which Do We Respect?

06 Feb 2017 8 Comments

by Dr. John Persico Jr. in Uncategorized Tags: , , , , ,

trump

Hardly a day goes by that I don’t wonder whether I should call him Chump, Asshole or Mr. President.  There are many decrying the use of my pejorative adjectives to describe our new president.  They say “Even if you do not respect the man, you must respect the office.”  This rule (I know not where it began) seems to have taken the form of “common knowledge” as though there was some ancient prescription that admonished us to always respect an elected or appointed official.

Ironically, the man in office now gave no respect to his predecessor.  Beginning with the birther conspiracy before Obama even took office and continuing right up until his election, the man now in office took every opportunity to denigrate and insult President Barack Obama.  Nevertheless, I am not using this as an argument to insult our new President.  It fails the test of morality in that we all know “two wrongs do not make a right.”

My dilemma stems from my difficulty with understanding whether we should assign respect to an office regardless of the character of the individual that might be in it.  Perhaps history could shed some light on this issue for us.  What does history tell us about this question?  Is it really a universal law that we must respect the office even if we do not respect the man?  Have people in the past always respected the office even when they disliked the office holder?  Should we respect the office or the office holder?

Let us go back to the time of Israel under the Roman occupation when Herod was king.  What did they say about Herod?

“On an appointed day, Herod put on his royal robes, took his seat upon the throne, and delivered an oration to them.  And the people were shouting, “The voice of a god, and not of a man!”  Immediately an angel of the Lord struck him down, because he did not give God the glory, and he was eaten by worms and breathed his last. …” — Acts 12:19-24 

king-georgeMarching forward in time to the period of the Revolutionary war when George the III was ruler of the American Colonies, what did they think of King George?  Here is what is written in the Declaration of Independence:

“A Prince, whose character is thus marked by every act which may define a Tyrant, is unfit to be the ruler of a free people.”

Our second President John Adams was called a “hideous hermaphroditical character which has neither the force and firmness of a man, nor the gentleness and sensibility of a woman.” By James Callender, a supporter of Thomas Jefferson.

The insults were returned by Adams supporters who called Jefferson a “a mean-spirited, low-lived fellow, the son of a half-breed Indian squaw, sired by a Virginia mulatto father.”

President Abraham Lincoln who is today revered by many as either the greatest or second greatest president in American history received even more scorn than Jefferson or Adams from his contemporaries:

funny_lincoln_400

“George Templeton Strong, a prominent New York lawyer and diarist, wrote that Lincoln was “a barbarian, Scythian, yahoo, or gorilla.”  Henry Ward Beecher, the Connecticut-born preacher and abolitionist, often ridiculed Lincoln in his newspaper, The Independent (New York), rebuking him for his lack of refinement and calling him “an unshapely man.”  Other Northern newspapers openly called for his assassination long before John Wilkes Booth pulled the trigger. He was called a coward, “an idiot,” and “the original gorilla” by none other than the commanding general of his armies, George McClellan.” —- Knowledge Nuts

I could cite pages of examples such as the above.  History is full of examples of insults levied against Presidents, Kings and many other office holders.  I listed only a few to show that insults against an office are nothing new.  However, does this make it right or are these insults simply a lack of character?  What are our obligations to an “office?”   This question might be posed in one of two ways:

  1. We should respect an office even if the office holder is not worthy of our respect.

Yes!  We should respect an office because it represents an agreed upon authority.  If offices had no authority, institutions would break down and there would be no rule of order.   Democracy is based on the acceptance of authority emanating from the will of the masses.  No one person is above the masses in a democracy.

No!  An office has no intrinsic entitlement to respect.  The respect for an office comes from the office holder and not the other way around.  To simply respect a title because it is a title is both illogical and dangerous.  One can think of the harm that was caused by the respect that the Fuhrer had in Germany because he was the leader even when many disagreed with his policies and his behavior.

quote-the-president-of-the-united-states-whoever-it-is-deserves-a-certain-level-of-reverence-chris-matthews-117-93-79

  1. We should only respect an office when the office holder is worthy of respect.

Yes!  People can only remain free and independent absent of an authority that comes solely from titles, ranks and names.  If we obey or show respect for an office that is in violation of ethics or morality, we give away our free will.  Massacres, murders and other atrocities often arise from a group mentality or an unwarranted willingness to acquiesce to authority.  An office is not entitled to respect unless the office holder imbues the office with respect.

No!  People must show respect to the institution or office regardless of who the office holder is.  We must recognize that in the case of Trump, millions of Americans chose him over Hillary.  To disrespect Trump is to disrespect the millions of citizens in this country who following the laws of the land duly elected him to the office of POTUS.

do-not-respec

Well, there you have it.  I think I have laid out the “two sides of the coin.”   Now it is time for you to weigh in with your opinions.  Do not sit this one out.  Put your opinions in the comments section and let me hear from you.

Time for Questions:

What do you think? How would you answer these questions?

Life is just beginning.

“In a few days, I will lay down my official responsibilities in this office, to take up once more the only title in our democracy superior to that of President: the title of Citizen.” — Farewell Address, President Jimmy Carter.

For another opinion on this issue, see the article by Jonathan Chait.

Must We Respect the Office of the Presidency?

 

 

 

 

 

Moth Superpowers

31 Jan 2017 Leave a comment

by Dr. John Persico Jr. in Uncategorized

Wonderful piece of writing. I hope all will read this and take the time to share it with your friends or relatives.  By Gringa of the Barrio.

Let’s Play “Whack a Mole” with the World

15 Jan 2017 1 Comment

by Dr. John Persico Jr. in Uncategorized Tags: , , , , , , , , , ,

whack-a-mole-cartoon

The saying is often noted but just as often ignored that “Those who forget the past are condemned to repeat it.”  — Santayana.   To this profound advice, I would argue that my following observation is equally true and that it has resulted in an equal number of policy disasters and misadventures.  To wit:  “Those who do not recognize the patterns around them are doomed to failure.”   I came by this observation in the middle of a night while pondering the intricacies of playing the “Whack a Mole” game

There is a game that children play and it is called “Whack a mole.”  Have you ever played this game?  If not, view the game at “Whack a Mole”.  Basically, it involves a series of plastic moles that keep randomly popping out of different holes.  You get points for each mole that you whack before it drops back into its hole.  No sooner do you “Whack” one mole then another one pops up again.  [If you would actually like to play the game, you can play a free fast paced version of the game at “Whack a Mole.”]  They call it Smack and Bash at this site.

As I thought about this game, I began to see how it applied to numerous efforts that we undertake to bring about change.  Understanding the game, I could see how futile many of these efforts are and clearly why they are doomed.  Let me give you four examples that will show you how pervasive the “Whack a Mole” game is in politics and US policy:

  1. Eliminate the Mafia
  2. Win the war on drugs
  3. Defeat terrorism in the Mideast
  4. Stop the arms race

 1.  Eliminate the Mafia:

The Mafia may have begun in the United States in the second half of the 19th Century.  The US law establishment has been waging a war to eliminate the Mafia for well over 100 years.  During that time they have killed or arrested the following Mafia leaders:

large_movie_mobsters

It should be noted that this list includes only the leadership in just one crime family.  There are at least a dozen or more Mafia crime families in the USA.  Each one has a history of crime bosses since the early 1900s.

treeCrime bosses get eliminated or changed in a number of ways. Some die.  Some are murdered.  Some are arrested.  Few if any ever simply retire.  This last fact is good for our law enforcement agencies, since it helps keep them occupied with finding and catching Mafia leaders.

So for over 100 years now, the FBI, the Justice Department and every police department in the USA have been playing the “Whack a Mole” game with the Mafia.  They no sooner whack one Mafia leader down and another pops up in his place.  What fun!  At the taxpayers’ expense of course.

  1. Win the war on drugs:

Drugs starting becoming a major problem in the USA with the competition between cigarettes, alcohol and other substances designed to give someone a feeling of either being up, down or out of it.  We know that in 1920 the US passed the Eighteenth Amendment to the Constitution making the manufacture, transportation and sale of alcohol illegal.  Few who have studied any history can forget the fiasco that Prohibition entailed.  Alcohol continued to flow while crime, murder and mayhem associated with alcohol increased dramatically.   Did we learn anything from this?  Following is a short list of the major drug laws and “banned” drugs in the USA.  (By the way, alcohol and nicotine and caffeine are all drugs and at one time or another have all been banned someplace in the world)

1906 The Pure Food and Drug Act was passed, forming the Food and Drug Administration and giving it power to regulate foods and drugs, and requiring labeling of contents on foods and drugs. The most important effect on the drug problem was the demise of the patent medicine industry. Drug addiction began a dramatic drop.
1914 The Harrison Tax Act was passed, effectively outlawing the opiates and cocaine.
1915 Utah passed the first state anti-marijuana law. Mormons who had gone to Mexico in 1910 returned smoking marijuana. It was outlawed at a result of the Utah legislature enacting all Mormon religion prohibitions as criminal laws.
1922  Narcotic Drug Import and Export Act – Intended to eliminate use of narcotics except for legitimate medicinal use.
1924  Heroin Act -Makes it illegal to manufacture heroin.
1937  Marijuana Tax Act

1938    Food, Drug and Cosmetic Act

1942    Opium Poppy Control Act

1951    Durham-Humphrey Amendment

Established more specific guidelines for prescription drugs: habit forming, safety, and evaluation of new drugs

1951    Boggs Amendment to the Harrison Narcotic Act

1956    Narcotics Control Act

Intends to impose even more severe penalties for narcotics violations

1965    Drug Abuse Control Amendments (DACA)

Strict controls over amphetamines, barbiturates, LSD, etc.

1966    Narcotic Addict Rehabilitation Act (NARA)

1968    DACA Amendments

Provides that sentence may be suspended and record expunged if no further violations within 1 year

1970    Comprehensive Drug Abuse and Control Act

Replaces and updates all previous laws concerning narcotics and other dangerous drugs. Empasis on law enforcement.

1972    Drug Abuse Office and Treatment Act

1973    Methadone Control Act

1973    Heroin Trafficking Act

1973    Drug Enforcement Administration (DEA)

Remodels Bureau of Narcotics and Dangerous Drugs into DEA

1978    Alcohol and Drug Abuse Education Amendments

Sets up education programs within Department of Education

1984    Drug Offenders Act

Sets up special programs for offenders and organizes treatment

1986    Analogue (Designer Drug) Act

Makes use of substances with similar effects and structure to existing illicit drug illegal

1988    Anti-Drug Abuse Act

Establishes oversight office: National Drug Control Policy

So here we see the efforts of over 100 years of drug policy to stop people from using, enjoying and abusing drugs in the USA.  What has been the result?

“America is at war.  We have been fighting drug abuse for almost a century.  Four Presidents have personally waged war on drugs.  Unfortunately, it is a war that we are losing.  Drug abusers continue to fill our courts, hospitals, and prisons.  The drug trade causes violent crime that ravages our neighborhoods.  Children of drug abusers are neglected, abused, and even abandoned.  The only beneficiaries of this war are organized crime members and drug dealers.” — Stanford University. 

2fc723fa35b08b711797709df3d9235b

For an excellent article on the costs of the drug war in the US, please see:  (“The Hidden Costs of America’s War on Drugs” by Joseph D. McNamara, The Hoover Institution, Stanford University)

As it should be clear, the US Government, the FDA, the FBI and most mainstream churches in America have been playing the “Whack a Mole” game with drugs since the Puritans first landed at Plymouth Rock.   First they “Whack” one drug down.  Then another one pops up.  Then they eliminate one drug lord and then another one pops up.  They defeat one drug cartel and then another one takes its place.  Our drug enforcement agencies are so busy playing “Whack a Mole” that they don’t have any time to deal with the reasons behind the influence and attraction of drugs.  Instead they just keep on “Whacking Moles.”

  1. Defeat terrorism in the Mideast:

The beginning of terrorism in the Mideast can be traced back to the Assassins sect that began in the eleventh century.  Wikipedia notes the following:

“Assassins (Persian|حشاشين}} Hashashin) is a name used to refer to the medieval Nizari Ismailis.  Often described as a secret order led by a mysterious “Old Man of the Mountain”, the Nizari Ismailis were an Islamic sect that formed in the late 11th century from a split within Ismailism – itself a branch of Shia Islam.”

wac-a-terrorist

Modern terrorism is actually a form of asynchronous and asymmetric warfare.  One side being more powerful than the other side (asymmetric) forces the other side to avoid one to one confrontations or pitched battles in favor of random unpredictable strikes (asynchronous).   Terrorism is a means of striking back at a more powerful enemy and avoiding what might be an assured defeat by not confronting your opponent in a pitched battle.  History is full of episodes where fighters and even entire armies engaged in such warfare.  In the US, the Indian Wars often followed such methods of warfare.  The battle against Geronimo being a prime example.

Terrorism in the Mideast since George H.W. Bush and through the Obama administration seems to be following the pattern that I have called “Whack a Mole.”  Using drone attacks, surgical strikes, clean bombing, decapitation strikes, discriminant deterrence, hunter killer teams, kill boxes, and counterinsurgency attacks, the US military attempts to “neutralize” the power of the “terrorists” who have their own panoply of attack methods.

If you look at what has happened over the past twenty years in the Mideast in terms of the War on Terrorism, you can clearly see the “Whack a Mole” game at work.  We eliminate one of their leaders, they destroy some of our soldiers with bombs, IEDs or suicide attacks.  We then strike back at their leaders and then it is their turn again to kill us.  We “Whack” them and then they “Whack” back.

whack-a-moleEach time we kill one of their leaders, another one pops up to take their place.  Each enemy group we defeat seems to be immediately replaced by another enemy group.  Our Army, Navy Air Force, Marines, armament industries and politicians never seem to get tired of playing the “Whack a Mole” game.  Keep in mind, that while the game might be great fun for these groups, there is a cost to the game.   To date the financial and human costs are:

Financial Cost of the War on Terror : 

“A recent Brown University study, for example, pinned the cost of the wars in Iraq, Afghanistan, Pakistan and Syria at about $3.6 trillion from 2001 to 2016, using the $1.6 trillion operations costs as a baseline but also accounting for counterterrorism costs.

Adding in money appropriated for war spending and on homeland security in 2017, the total reaches $4.79 trillion. This figure also includes future obligations for veterans medical and disability costs ($1 trillion through 2053) as well as interest on borrowing for wars.” — Politifact, Linda Qiu, October 27th, 2016.

Human Costs of the War on Terror:

Afghanistan and Pakistan:  173,000 dead and 183,000 seriously wounded.  (2001 to 2016)

Iraq:  1.9 million killed (1991 to 2003) and 1 million killed (2003 to 2015)

For the figures I used above as well as for other estimates and detailed breakdowns of casualty figures, see the following sources.  The above figures are low compared to some estimates.  None of these figures include the deaths in Libya, Syria, Israel, Turkey, USA or Palestine which should also be considered as deaths from the War on Terrorism.

  1. Stop the arms race:

The final example of a “Whack a Mole” game that we are caught in deals with our oft stated goal to stop creating more dangerous and more expensive weapons of war.  We call this the “arms race” and we have played it with Great Britain, France, Russia and now China.  I will briefly explain how the game works.  You will readily see that it is a version of the “Whack a Mole” game.

arms-race

Step 1, we conceive of a weapon that nobody else has or has even dreamt of having.  It must be dangerous, expensive, frightening and have the potential to kill millions or at least thousands.  Step 2, we spend billions of dollars on R&D to develop the weapon.  Step 3, we then spend billions of dollars to produce the weapon.  Step 4, we then sell the weapon to any military agency in our own country that will buy it.  Step 5, after a sufficient period of time has elapsed (but before the weapon is obsolete), we sell it to other friendly countries that will buy it.  We must start with the highest bidder.  Step 6, after we have sold it to all our allies or potential allies, we wait until they have sold it to any potential enemies.  This might take a year or so.  Finally, after our enemies have now acquired the same weapon potential (even if in a slightly modified form) we then loudly proclaim that:

“Our nation’s security and ability to defend itself is being undermined by the weapons that our enemies have.  We must build new and better weapon systems.  We must increase defense spending.  We risk falling behind in the ability to defend ourselves.”

Then we start the process all over again from Step 1.  

It is the “Whack the Mole” game, albeit a modified version of the game.  We build the weapons to whack our enemies and then they buy the weapons or build similar weapons to whack us back.  Then we build weapons to counter their weapons and then they build or buy weapons to counter our weapons.  We have been engaged in this game since 1776 with every single weapon system that has ever been devised.   Think of the Atom bomb.  How long did it take Russia to develop a similar bomb?  Think of the Hydrogen bomb.  How long did it take the Russians and others to develop a Hydrogen bomb?

Here is a list of rifles that have been used in the USA since the War of 1776.  The following list does not include carbines.  For a full list of weapon systems and their history see:  List of individual weapons of the U.S. Armed Forces – Wikipedia

  • M16A3 (5.56×45mm NATO) (USN SEALs and USN Seabees)
  • M16A2 (5.56×45mm NATO) (USAF, USCG, and US Army)
  • M27 IAR (Infantry Automatic Rifle) (5.56×45mm NATO) (USMC)
  • Mk 16 Mod 0 (5.56×45mm NATO) (USSOCOM)
  • Mk 17 Mod 0 (7.62×51mm NATO) (USSOCOM)
  • M14 SMUD (Stand-off Munition Disruption rifle) (7.62×51mm NATO) (USAF)
  • M39 Enhanced Marksman Rifle (7.62 NATO) (USMC)
  • XM8 (Lightweight Assault Rifle system) (never issued) (5.56×45mm NATO)
  • XM29 (Kinetic Energy and Airburst Launcher System; 5.56×45mm NATO and 20 mm airburst munition (XM1018)(early)/25 mm airburst munition) (experiment canceled)
  • Advanced Combat Rifle entries (concluded 1991)
  • Future Rifle Program entries (canceled)
  • Special Purpose Individual Weapon (SPIW) entries (concluded/canceled)
  • FN FAL (battle rifle, trialled as T48 against the T44 and T47 to replace the M1: lost to the former)
  • Olin/Winchester Salvo Rifle (battle rifle, 5.56mm duplex)
  • M14E1 (Selective Fire Rifle, 7.62×51mm NATO) (never standardized)
  • M16A1 (5.56×45mm NATO)
  • AR-15/Colt Model 601/602 (5.56×45mm NATO rifle) (USAF and SOF use only)
  • XM22/E1 Rifle (Selective Fire Rifle, 5.56×45mm NATO)
  • Mk 4 Mod 0 (Suppressed Rifle, 5.56×45mm NATO)
  • M1 Garand Variants (E1-E6 and E9-E14) (Semi-Automatic Rifle, .30-’06)
  • Mk 2 Mod 0/1/2 (Semi-Automatic Rifle, 7.62×51mm NATO)
  • M1 Garand (Semi-automatic rifle, .30-06)
  • M1941 Johnson rifle (Semi-Automatic Rifle, .30-’06)
  • Model 45A
  • M1946 rifle (never used in active duty)
  • M1947 Johnson auto carbine (Semi-Automatic Rifle, .30-’06)
  • Gyrojet rifle (13 mm) (never issued)
  • Pedersen Rifle (.276) (competed unsuccessfully with M1 Garand to become primary service rifle)
  • Pedersen Device (attachment for Springfield M1903, .30 conversion)
  • M1918 BAR (.30-06)
  • M1903/A1/A3 (Bolt-action rifle; .30-03, .30-06)
  • M1917 Enfield (Bolt-action rifle)
  • Model 1907/15 Berthier rifle (Bolt-action rifle)[14]
  • M1916 Mosin–Nagant (Bolt-action rifle)[15]
  • M1895 Navy (Navy Lee, 6 mm Navy)
  • M1892/M1896/M1898 Rifle (a/k/a Krag Bolt Action Rifle; .30-40 Krag)
  • M1885 Remington-Lee (Bolt-action rifle; .45-70 Gov)
  • M1882 Short Rifle (.45-70 Gov.)
  • M1882 Remington-Lee (Bolt-action rifle; .45-70 Gov.)
  • M1879 Remington-Lee (Bolt-action rifle; .45-70 Gov.)
  • Remington-Keene rifle (Bolt-action rifle; .45-70 Gov.)[16]
  • M1875 Officers’ Rifle (.45-70 Gov.)
  • M1873/M1879/M1880/M1884/M1888/M1889 Springfield (a/k/a Trapdoor Springfield;.45-70 Gov..: .45-55-405 & .45-70-500)
  • M1872 Springfield (a/k/a Rolling Block Springfield; .50-70 Gov.)
  • M1865/M1866/M1868/M1869/M1870 Springfield (a/k/a Trapdoor Springfield; .50-70 Government)
  • Sharps carbine/rifle (Breech-loader; .42-60-410) (.52 caliber issued to Berdan’s 1st and 2nd US Sharpshooters in the US Civil War)
  • Henry rifle (Lever-action; .44-26-200)
  • Spencer rifle (Lever-action; 56-56 (.52-45-350))
  • M1863 Springfield
  • M1861 Springfield (.58)
  • Colt revolving rifle (Colt Model 1855; 6/5-shot revolver rifle;.44/.56)
  • Greene rifle (Bolt-action breech-loader)
  • P53 Enfield (.577 (.58))
  • P51 Enfield Musketoon (“Artillery Carbine”; 24″ barrel, .69)
  • Model 1854 Lorenz rifle (Rifle-musket, .54, .58)
  • M1859 Sharps (‘New model 1859’, breech loader; .52, .56)
  • M1855 Rifle-Musket
  • M1855 Rifle (Percussion muzzle-loader; 58-60-500)
  • M1847 Musketoon (Springfield, .69)
  • M1842 Musket (Percussion musket, .69)
  • M1841 Rifle “Mississippi Rifle” (percussion muzzle-loader;.54, .58)
  • M1840 Musket (flintlock musket;.69)(later percussion)
  • M1835 Springfield (flintlock musket; .67 cal)
  • M1819 Hall rifle (Harper’s Ferry;Breech-loader)
  • Model 1822 Musket (Flintlock Musket) .69 (later percussion)
  • Model 1816 Musket (Flintlock musket; .69) (Later Percussion)
  • Model 1817 Rifle (‘Common rifle’;Derringer, Johnson, North and Starr; Flintlock rifle, .54) (later percussion)
  • Model 1814 Common Rifle (Deringer, Johnson; Flintlock rifle; later percussion; .54)
  • Springfield Model 1812 Musket (Flintlock musket; .69)
  • Model 1808 Contract Musket (Flintlock musket; .69)
  • Harper’s Ferry Model 1803 Rifle (Flintlock rifle; .54)
  • Model 1795 Musket (Flintlock musket; .69)
  • 1792 contract rifle (Flintlock rifle; .49)
  • Charleville musket (Flintlock musket; .69)
  • Brown Bess (Musket; .75)
  • Kentucky Rifle (Flintlock rifle)
  • Ferguson rifle (Flintlock breech-loader; .69)

not-safe-yet

Do we call this progress?  Do you call this progress? 

Conclusions:

I started this blog off with the comment that if we fail to connect the dots and see the patterns in our lives, we are doomed to keep repeating them and failure will never be far away.  It is almost but not quite the same as forgetting the past.  There is indeed a similarity between my comment and Santayana’s famous quote.  However, I see it as a pattern that I have described as “Whack a Mole.”  How long will we go on whacking moles, killing people, spending money that could go to education, health care or eliminating poverty?

Time for Questions:

Do you think that we should be playing “Whack the Mole?”  How do we stop playing this game?  Do you think it is human nature to keep fighting and killing others?  Should we really be trying to ban every substance that people want to take?

Life is just beginning.

Falken:  Did you ever play tic-tac-toe?

Jennifer:  Yeah, of course.

Falken:  But you don’t anymore.

Jennifer:  No.

Falken:  Why?

Jennifer:  Because it’s a boring game. It’s always a tie.

Falken:  Exactly. There’s no way to win. The game itself is pointless! But back at the war room, they believe you can win a nuclear war. That there can be “acceptable losses.”

may_june_2014_cover_of_foreign_policy_magazine

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