"Mission Accomplished" and New York Streets' Shell Games

If you grew up in New York City, or have wandered its streets as a visitor, you have seen people in front of small tables on which there are shells, one of which covers an object (small, like a pea). The object is to get the mark to wager that he can guess which shell covers the pea as the con man moves the shells around, delivers rapid fire patter, and uses distraction and a partner to separate the mark from his money.  The keys to this fraud are rapid movement, distraction, and the appearance of simplicity.  The shell game is a con which separates people from their money because they don't understand what is going on in front of them.

I  wonder whether the well-publicized announcement that our Iraq mission had been accomplished was part of a shell game in which the American people were distracted from the real purpose of their government's executive, advisers and political party while the significant plan was to separate our citizens from $3 billion (and many lives) that the Iraq "mission" has cost, making social and health programs unaffordable and unavailable.  We are now told that we cannot afford schools for kids, health care for seniors, medical care for our poor, or even a clean safe environment because our country has been plunged into near bankruptcy by our social programs.  Was the real plan to be accomplished on the aircraft carrier during the mission accomplished show a carefully staged charade to deplete our financial resources so that the wealthiest country in the world could not afford social justice programs?  Are our pockets now empty - and our ability to provide health care for the poor, sick and elderly wasted - because of  a sophisticated con carried out by a politician who appears to have vanished from the national stage and seems to be forgotten (or hidden?) by his political party?

Kids Drown

One of my former partners, an extraordinarily competent internist, saved a drowned child's life by resuscitating him in the hospital emergency room.  Another doctor, in the same city, lost his adolescent twin sons when they drowned in the backyard family swimming pool.

Kids drown.  And when they do, it means that an opportunity to save their lives through the exercise of  simple adult responsibility, was not taken.  Don't let it happen to you or a member of your family or friends's kids or even a neighborhood child who has obtained access to your pool You are the responsible adult and you must act responsibly.

No children, including adolescents, should be  in a pool without adult supervision.Children do not have adult judgment and they do dumb dangerous childish things: they need adult supervision.

At a party, where adults and children are swimming, the host or hostess should clearly and unequivocally and repeatedly explain that it is each parent's' responsibility to watch his or her own child and be responsible for the safety of that child. It isn't the host's responsibility,  It isn't the responsibility of other parents to watch your child or of you to watch their children swimming.  It isn't  the responsibility of a young adolescent acting as a lifeguard.  If you can't be bothered to watch your own child in the pool, get the child out of the water and to a place where he or she will be safe. And then make sure that he or she stays out of the water, regardless of the taunts of invitations of other kids.

Pay attention. Have a cell phone available, but don't use it to text or chat, or respond to calls,  because you will be distracted and unlikely to be paying attention to your child. Know the address of the house or place where the kids are swimming because in an emergency, that information may save a few precious seconds. Alcohol-containing drinks will probably interfere with your ability to respond to an emergency: save the drinking for another time and place.

Adults should enforce routine safety around swimming pools, stopping potentially dangerous horseplay or behaviors which may result in injury.  Don't apologize to the kids (or their parents) who complain about restrictions on dangerous behavior: explain that you are serious about the safety  rules you are enforcing.

Read the material in the links above because that information may save a child's life, save you from a lifetime of anguish, and save you from financial ruin.

Take the risk of drowning in a family pool seriously. Be a responsible and caring adult.

The Perfect Storm?

As a person who practiced hematology, I learned to ask a few questions early in my career and early in my physician-patient relationships: what kind of work do you do now and what kind of work have you done?  Where do you live now  and where did you live before moving to your current location?  Do you have any occasion to handle toxic materials at work or in your personal life.  Do you live down-wind from a refinery?  When you were in the armed services, did you come into contact with toxic materials, including radiation and chemical warfare or biologic materials? Tell me about your hobbies, and specifically whether you are exposed to wood dust or fine shavings?.  Tell me about your use of alcoholic beverages, drugs and other substances. Tell me about your smoking history.

While all of this may be interesting to my readers, few probably think that it is relevant to them, but environmental toxic exposures play a major role in causing disease.  You may keep your weight under control, be careful about taking saturated fats, never pick up a salt shaker and exercise regularly, but if you are exposed to toxic substances in your environment, in your food and in your home, you may develop leukemia, cancers (bladder, lung, skin, testicles and others), black lung disease, serious infections, emphysema, brain disorders, and a host of other disabling, fatal and expensive-to-treat diseases. And if we allow our children to have those exposures, they are also at risk.

All of which, at a time when the country is working desperately to control its health care costs, makes me wonder why any political party would seek to weaken our environmental laws. Does it make sense to try to roll-back health reform and simultaneously roll back the environmental protections which America - with much effort - has invoked to protect its children, men and women?  Has this become a country in which we cannot trust one another to take reasonable care of our children, workers and vulnerable citizens?  Is the tension between financial interest and the well-being of our citizens always to be resolved in favor of financial interests?

A Common Denominator: Questions For Obama's Administration

As a hematologist, I had many patients with severe, life-threatening blood malignancies, such as acute myeloid leukemia. I also consulted on patients with less advanced blood and bone marrow disorders of the type which predicted "there is a high likelihood that this person's bone marrow has been severely injured and will eventually develop leukemic changes".  There was a startlingly common denominator: even with extensive and repeated history-taking, most of the patients could not provide a history of toxic exposure which might have damaged their bone marrow.  Sometimes their occupations shed light on a petrochemical cause: commercial painters, workers (often undocumented immigrants working for construction contractors) who crawled under houses to spray for insects, farmers who worked land that had been contaminated by the dumping of insecticides years earlier), shoe-makers,  and artists using oil-based patients and solvents. But even homemakers with no commercial exposure to high levels of petrochemical based products came to my examining room with the story that they had "sprayed"  in a closed area (their homes' crawl-spaces) to rid their homes of destructive or annoying insect pests. Sometimes children who lived in residential communities not far from what we later learned was toxic industrial contamination of local water supplies presented with fatal acute leukemias. In each and every case, the person affected lacked information which would have aided him, her or parents to accept or avoid a life-threatening toxic exposure.

As I listen to the story of BP and the oceanic flood of raw oil contaminating the ocean, shore and coastal environment, I find it disturbing that there is no reliable information coming from the federal government about the level of highly toxic oil-based environmental contaminants to which adults and children are being exposed every day on the streets, at work,  in their homes and in their schools.  Why is this information not being obtained and distributed to the media for public knowledge?  How are people in the areas affected to know whether they and their families are being exposed to a high risk of bone marrow damage from raw oil and its airborne fumes?

This is serious business.  The Obama administration needs to treat its citizens as sensible adults and not dummies. The Obama administration should give the people facts about the very real and serious exposure to toxic materials spewing  from BP's disastrous oil well and let the people decide what is in their - and their families' - best interests. Should there be evacuation of entire shoreline communities? Should hospitals be gearing-up for an eventual flood of patients with petroleum-based bone marrow toxic effects, such as acute myeloid leukemia? Or is BP's calamity truly benign?

Have our public health authorities been gagged or do they just not know? And is finding out and disseminating information about toxic exposure a high priority or have the massive political contributions of the petroleum industry set the priorities to favor industry concerns over citizens' welfare?

Same Old --- Same Old

I have been listening and looking for substantive improvements in our health care system coming from Washington, but none have been forthcoming. Lots of talk from President Obama about cutting the costs of health care (health care is approaching 20% of the GDP because our economy stinks - it's the old specious "denominator" problem). Lots of speculation in the New York Times and elsewhere about how insurers, those "guardians of all improvement in the health care system," will be protected from competition by the government, other insurers, and providers. Meanwhile, the focus on profits for insurers and cutting the cost of services for the public makes me wonder who will be the victims.

Will it be children, who have no voting rights and therefore only very limited political power whom we have proportionately decapitalized? Will it be the elderly, who do vote, but with a cost-benefit analysis approach don't add much to the GDP and make it hard for economists to justify spending a lot of money for each year of life which is added (or to relieve pain and suffering which is difficult to value). Will it be the unemployed and uninsured who will simply be a drain on the Treasury, and from one party's political perspective, may not be worthy enough to justify health care expenditures for them. Will it be the working middle class, who seem no longer important enough politically to justify their getting the "middle class tax break" that Obama promised pre-election? Will it be armed forces personnel, who, once political furor over Iraq simmers down, will nurse their injuries in understaffed and underfunded back wards of VA and inaccessible facilities? Will it be the undocumented immigrants who now fill our emergency departments? Will it be the prisoners in our federal/state/local prisons and jails?

Folks, competent health care will be available to the same people who now get what they want: individuals who are wealthy, who are well-connected politically, make substantial contributions (directly or through PACS or otherwise) to politically powerful people/organizations and their connections and employ lobbyists who have access to the politically powerful and their rule makers. (Google the search terms "political donation insurer".) And, like AIG and the financial sector, they will take care of each other. And the children, elderly, working middle class, injured and uninjured veterans, immigrants and prisoners - "sorry - but we have to cut costs."

And if you (or a member of your family) are really sick and need expensive testing, treatment, care, pharmaceuticals, and technology, where do you think you or your family member will be prioritized in cutting health care costs?

How Do You Picture Health Care?

Our usual perception, when asked to visualize health care, is a television image of an emergency room, a physician, a sympathetic nurse, and perhaps a paramedic. In reality, our images symbolize a failure of health care and its end-stages. We should be visualizing poor quality unsanitary food, poor quality housing, cultural conflicts, gang warfare, excessive (and often underage)alcohol use, poor quality water, poor quality and insufficient quantity of preventive health services, poor environmental conditions, the prenatal visit not done within the first trimester, the mammogram not done in the vulnerable woman, the testicle not palpated in the adolescent male who has a cancer mass which could be found and successfully treated, the school nurse whose services have been lost because of insufficient funding for our children.

Health care is a lot more than physicians, nurses, hospitals and ambulances. The determinants of health are often those issues which are arrogantly dismissed by politicians and planners because their political contributors don't want them to pay attention to those complex issues, and it is easier to provide political benefit to wealthy voters and their corporate allies than to the poor, nonvoters and our kids.

After all, how many minutes of political advertising, or seats at a campaign dinner, can the poor and children buy?